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In his 'Composition in White, Red, and Yellow,' Dutch artist Piet Mondrian illustrated geometric abstraction. He accomplished this effect via two primary-colored units embedded in a grid of vertical and [...]

Fernand Leger (French, 1881-1955) Mechanical Elements, 1920 Oil on canvas 36 1/8 x 23 1/2 in (91.8 x 59.7 cm) Metropolitan Museum of Art Jacques and Natasha Gelman Collection, 1998 [...]

Objectives. We examined relationships between herpes simplex virus type 2 (HSV-2), a biomarker for sexual risk, and HCV, a biomarker for injecting risk, with HIV among injecting drug users (IDUs) who began injecting after large-scale expansion of syringe exchange programs in New York City. Methods. We recruited 337 heroin and cocaine users who began injecting in 1995 or later from persons entering drug detoxification. We administered a structured interview covering drug use and HIV risk behavior and collected serum samples for HIV, HCV, and HSV-2 testing. Results. HIV prevalence was 8%, HSV-2 39%, and HCV 55%. We found a significant association between HSV-2 and HIV (odds ratio [OR]=7.9; 95% confidence interval [CI]=2.9, 21.4) and no association between HCV and HIV (OR=1.14; 95% CI=0.5, 2.6). Black IDUs had the highest prevalence of HSV-2 (76%) and HIV (24%) but the lowest prevalence of HCV (34%). Conclusions. Most HIV infections among these IDUs occurred through sexual transmission. The relative importance of injecting versus sexual transmission of HIV may be critical for understanding racial/ethnic disparities in HIV infection. [ABSTRACT FROM AUTHOR]

The article reports on the major findings of the United States Centers for Disease Control and Prevention's HIV and AIDS Prevention Research Synthesis Project, which aimed to review HIV and AIDS intervention research. The results include methodologies, logic of meta-analyses, populations studied, theories of AIDS-related behavior change, studies of sexual behavior among drug users, men who have sex with men and youth and adult heterosexual behavior.

The article presents information on a research-to-practice framework for HIV prevention. One reason for the difficult transition from HIV prevention research to practice is that researchers and providers may have different views about when new interventions are ready for use. Organizations tend to develop practices that evolve into standard operating procedures and eventually are formalized in job descriptions and departmental structures. A lack of routine opportunities for information exchange among researchers and providers probably contributes to these perceptions and ongoing differences in the face of a common interest, HIV prevention. Research steps typically proceed in a sequence-from conducting an assessment of research needs, to developing the study, obtaining support for the research, and carrying out the study, to reporting or publishing the results. In HIV prevention, the U.S. Centers for Disease Control supports research to develop and evaluate new prevention interventions, a national community planning infrastructure in which health departments partner with community members to establish local priorities and plan strategies to reduce HIV transmission, and a system for providing training and technical assistance to state and community-based grantees.

This article discusses the effectiveness of an HIV risk reduction counseling intervention for out-of-treatment drug users. Behavioral risk reduction continues to be the primary means for containing the spread of the HIV epidemic among out-of-treatment drug users. Results of several studies have indicated that out-of-treatment drug users are capable of adopting safer behaviors and have been more successful in reducing their HIV drug risk behaviors than their sexual risk behaviors. A variety of cognitive and behavioral strategies have been used in designing HIV risk reduction interventions with out-of-treatment drug users. These strategies include the provision of information on HIV infection and transmission, counseling on reducing risk behaviors and adopting safer behaviors, and training in skills that are necessary in the adoption of safer behaviors. The Cooperative Agreement Multi-Site Projects were built on the knowledge and experience gained from implementing and evaluating the Multi-Site National AIDS Demonstration Research Projects. Both projects were designed to implement and compare the effectiveness of various standard and enhanced counseling interventions conducted with different subgroups of out-of-treatment drug users.

During the last three decades, both the injection of illicit psychoactive drugs and HIV infection among injecting drug users (IDUs) have spread throughout industrialized and developing countries. Extremely rapid transmission of HIV has occurred in IDU populations with incidence rates of 10 to 50/100 person-years. In sharp contrast, there are many examples of very effective HIV risk reduction for IDUs, both in preventing initial epidemics and in bringing existing epidemics under control. IDUs are capable of learning basic information about HIV/AIDS and modifying their behavior to protect both themselves and their peers. Effective HIV prevention for IDUs requires programs that treat IDUs with dignity and respect, provide accurate information and the means for behavior change-access to sterile injection equipment, condoms, and drug abuse treatment. Programs that provide these services need to be implemented on a public health scale for IDU populations at risk for HIV infection.

Although sampling is a crucial component of research methodology, it has received little attention in intervention research with populations at risk for HIV infection. We review the challenges involved in sampling these populations for evaluating behavioral and social interventions. We assess the four strategies used for street and network sampling that have been reported in the HIV-intervention research literature and used because traditional probability sampling was not possible. The sampling strategies are: 1) targeted, 2) stratified, (3) time-space, and (4) respondent-driven. Although each has strengths and limitations in terms of its ability to produce valid results that enhance generalizability, the choice of a particular strategy depends on the goal of the study, characteristics of the target population, and the availability of resources and time for collecting and analyzing sampling-related data. Continued efforts are needed to improve the sampling strategies used in evaluation studies of HIV risk-reduction interventions.

In 1996, the Centers for Disease Control and Prevention (CDC), in collaboration with many partners, initiated the HIV/AIDS Prevention Research Synthesis (PRS) project to accumulate HIV prevention research studies and analyze their effectiveness in reducing sexual and drug-related risk behaviors for HIV transmission. The PRS team developed standardized guidelines and procedures for the systematic reviews, conducted systematic searches for pertinent studies, characterized the selected studies, analyzed effectiveness data, and established a cumulative database. As of June 1998, the database contained more than 5000 reports: 4068 were reports that met the PRS scope criteria for inclusion and 586 of those reports contained outcome data from an intervention study. Of the 586 reports that included outcome data, 276 have been reviewed: 223 (81%) included measures of PRS-specified behavioral or biologic HIV-related outcomes, and 124 of the 223 (56%) used PRS-defined rigorous study designs. The PRS database is a valuable resource for accessing and integrating the literature on HIV prevention research. CDC is committed to 1) updating the database; 2) producing systematic reviews, including meta-analyses, related to key research questions; and 3) disseminating findings to encourage and facilitate the use of science-based research in preventing HIV infection.