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Background: data on vaccine immunogenicity against SARS-CoV-2 are needed for the 40 million people globally living with HIV who might have less functional immunity and more associated comorbidities than the general population. We aimed to explore safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine in people with HIV. Methods: in this single-arm open-label vaccination substudy within the protocol of the larger phase 2/3 trial COV002, adults aged 18–55 years with HIV were enrolled at two HIV clinics in London, UK. Eligible participants were required to be on antiretroviral therapy (ART), with undetectable plasma HIV viral loads (0·05 for all analyses). Interpretation: in this study of people with HIV, ChAdOx1 nCoV-19 was safe and immunogenic, supporting vaccination for those well controlled on ART. Funding: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.

Duration of protection from SARS-CoV-2 infection in people with HIV (PWH) following vaccination is unclear. In a sub-study of the phase 2/3 the COV002 trial (NCT04400838), 54 HIV positive male participants on antiretroviral therapy (undetectable viral loads, CD4+ T cells >350 cells/ul) received two doses of ChAdOx1 nCoV-19 (AZD1222) 4-6 weeks apart and were followed for 6 months. Responses to vaccination were determined by serology (IgG ELISA and MesoScale Discovery (MSD)), neutralisation, ACE-2 inhibition, gamma interferon ELISpot, activation-induced marker (AIM) assay and T cell proliferation. We show that 6 months after vaccination the majority of measurable immune responses were greater than pre-vaccination baseline, but with evidence of a decline in both humoral and cell mediated immunity. There was, however, no significant difference compared to a cohort of HIV-uninfected individuals vaccinated with the same regimen. Responses to the variants of concern were detectable, although were lower than wild type. Pre-existing cross-reactive T cell responses to SARS-CoV-2 spike were associated with greater post-vaccine immunity and correlated with prior exposure to beta coronaviruses. These data support the on-going policy to vaccinate PWH against SARS-CoV-2, and underpin the need for long-term monitoring of responses after vaccination.

Background: The ChAdOx1 nCoV-19 (AZD1222) vaccine is immunogenic and protects against COVID-19. However, data on vaccine immunogenicity are needed for the 40 million people living with HIV (PWH), who may have less functional immunity and more associated co-morbidities than the general population. Methods: Between the 5th and 24th November 2020, 54 adults with HIV, aged 18-55 years, were enrolled into a single arm open label vaccination study within the protocol of the larger phase 2/3 COV002 trial. A prime-boost regimen of ChAdOx1 nCoV-19, with two doses (5 × 1010 vp) was given 4-6 weeks apart. All participants were on antiretroviral therapy (ART) with undetectable plasma HIV viral loads and CD4+ T cell counts >350 cells/µl at enrolment. Data were captured on adverse events. Humoral responses were measured by anti-spike IgG ELISA and antibody-mediated live virus neutralisation. Cell-mediated immune responses were measured by ex-vivo interferon-γ enzyme-linked immunospot assay (ELISpot) and T cell proliferation. All outcomes were compared with a HIV uninfected group from the main COV002 study. Findings: 54 participants with HIV (median age 42.5 years (IQR 37.2-49.8)) received two doses of ChAdOx1 nCoV-19. Median CD4+ T cell count at enrolment was 694 cells/µl (IQR 562-864). Results are reported for 56 days of follow-up. Local and systemic reactions occurring during the first 7 days after prime vaccination included pain at the injection site (49%), fatigue (47%), headache (47%), malaise (34%), chills (23%), and muscle or (36%) joint pain (9%), the frequencies of which were similar to the HIV-negative participants. There were no serious adverse events. Anti-spike IgG responses by ELISA peaked at Day 42 (median 1440 ELISA units, IQR 704-2728) and were sustained out to Day 56. There was no correlation with CD4+ T cell count or age and the magnitude of the anti-spike IgG response at Day 56 (P>0.05 for both). ELISpot and T cell proliferative responses peaked between Day 14 and 28 after prime and were sustained through to Day 56. When compared to participants without HIV there was no statistical difference in magnitude or persistence of SARS-CoV-2 spike-specific humoral or cellular responses (P>0.05 for all analyses). Interpretation: In this study of PWH, vaccination with ChAdOx1 nCoV-19 was well tolerated and there was no difference in humoral and cell-mediated immune responses compared to an adult cohort without HIV who received the same vaccination regime. Trial Registration: Trial Registration number is NCT04400838. Funding: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midlands NIHR Clinical Research Network, and AstraZeneca. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Declaration of Interest: Oxford University has entered into a partnership with AstraZeneca for further development of ChAdOx1 nCoV-19 (AZD1222). AstraZeneca reviewed the data from the study and the final manuscript before 474 submission, but the authors retained editorial control. SCG is cofounder of Vaccitech (a collaborator in the early development of this vaccine candidate) and named as an inventor on a patent covering use of ChAdOx1-vectored vaccines (PCT/GB2012/000467) and a patent application covering this SARS-CoV-2 vaccine. TL is named as an inventor on a patent application covering this SARS-CoV-2 vaccine and was consultant to Vaccitech. PMF is a consultant to Vaccitech. AJP is Chair of the UK Department of Health and Social Care’s JCVI, but does not participate in policy advice on coronavirus vaccines, and is a member of the WHO Strategic Advisory Group of Experts (SAGE). AVSH is a cofounder of and consultant to Vaccitech and is named as an inventor on a patent covering design and use of ChAdOx1-vectored vaccines (PCT/GB2012/000467). Ethical Approval: Written informed consent was obtained from all participants, and the trial was done in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. This study was approved in the UK by the Medicines and Healthcare products Regulatory Agency (reference 21584/0424/001-0001) and the South Central Berkshire Research Ethics Committee (reference 20/SC/0145). Vaccine use was authorised by Genetically Modified Organisms Safety Committees at each participating site.

We describe a new species of Cornufer, subgenus Batrachylodes, from high-elevation forests of New Britain Island in the Bismarck Archipelago of Eastern Melanesia. The new species, Cornufer exedrus sp. nov., is a biogeographically disjunct member of the Batrachylodes clade, representing the first record of the subgenus from outside of the Solomon Archipelago. The new species is a small terrestrial form from dense, closed-canopy forests above 1500 meters elevation in the Nakanai Mountains of eastern New Britain. It differs from its closest relatives, the other members of the subgenus Batrachylodes, on the basis of its minute body size, degree of digital disc expansion, reduced subdigital tuberculation, color pattern, and other traits related to its small size. We also provide a description of the new species’ simple advertisement call. The diversity of ceratobatrachid frogs of the Bismarck Archipelago is most likely still underestimated despite several recent surveys. Our understanding of evolutionary trends and species boundaries in the subgenus Batrachylodes currently is hampered by lack of genetic samples and call recordings corresponding to voucher specimens of the endemic species of Bougainville Island.

Results are presented of enrolling HIV+ active-injection drug users (IDUs) into a peer-driven intervention (PDI) to improve their adherence to medical care. Using respondent-driven sampling (RDS), which evolved out of the PDI model, the authors recruited and tested 1,097 IDUs, of whom 145 were confirmed to be HIV+. Despite promises of confidentiality, increased social supports, and direct cash rewards for participating, only 78 (54%) of the HIV+ IDUs enrolled in the subsequent adherence study. Correlates of participation as well as interviews with respondents who declined participating are presented. The seemingly negative findings have important implications for future adherence studies. RDS provided a powerful mechanism for recruiting HIV+ IDUs. But selection biases were revealed to favor sicker yet more socially connected respondents, which resulted in more conservative outcomes with regard to social supports and positive health-seeking behaviors. The analysis may help streamline future efforts using the PDI, which harnesses IDUs’ abilities to help one another, by underscoring some of the mechanism’s limitations.

a b s t r a c t Background: A peer-driven intervention (PDI) for injecting drug users (IDUs) was implemented in five Ukrainian city-sites to test-pilot its effectiveness in rejuvenating harm reduction (HR) projects that had become moribund. A PDI relies on drug users in a unique way to educate their peers in the community and recruit them for HIV prevention services. The goal of the PDI was to recruit in six month 500 IDUs who had never been respondents before to each of the five HR projects, especially stimulant- and women-injectors, and IDUs < 25 years of age. Method: We standardized the PDI's structure and operations across all five sites. All five PDIs were started in May 2007 using a carefully selected handful of "seed" IDU-recruiters who were trained to educate three peers who had never received HR services. We also accessed the database of all five projects and analysed the new respondents they recruited six-months prior to the start-up of the PDIs with the new recruits generated by the PDIs. Results: Whilst the HR projects in the five city-sites recruited 72 new respondents on average during the six months prior to the PDIs' start-up, the PDIs recruited 455 new respondents on average in each city during their six months of operation, indicating that the PDI was 6.3 times more powerful as a recruitment mechanism. Compared to traditional outreach the PDIs resulted in significant increases in the recruitment of women- and young-injectors, and IDUs who injected a more diverse variety of drugs. Conclusion: The PDI can have a rejuvenating effect when added to HR projects that had become stagnate over time, resulting in an increase in the number and diversity of new IDU-respondents. © 2012 Elsevier B.V. All rights reserved.

The HIV epidemic in China and Vietnam is on the increase among injection drug users (IDUs). We report on the results of a pilot outreach study in northern Vietnam and southern China to test the feasibility of a peer-driven intervention (PDI) to prevent HIV among IDUs. In the PDI, recruitment relies on a “chain-referral” model in which IDUs carry-out the core outreach activities that salaried outreach-workers/peer-educators traditionally provide. A 6-month follow-up was built into the study design to measure possible changes in IDUs' risk behaviors. The impact results of the pilot study are reported bearing on several different measures, such as changes in IDUs' rates of lending or borrowing used syringes, willingness to enter into drug treatment, baseline and follow-up recruitment success, and effectiveness of serving as peer-educators in the community. The evidence suggests the PDI is highly feasible and deserving of greater research in both China and Vietnam.

History is repeating itself: revolution is the new evolution. The author looks at two products that enable users to adopt a truly revolutionary approach to IT depolyment in the attempt to gain competitive edge: Isilon Systems' IQ series of network attached storage clusters and Trapeze Networks' Mobility System Wireless LAN product range.

This article examines health care utilization among injection drug users. Based on previous health care models, we identify various attitudes and personal characteristics that have been found to affect health care utilization in the general population, and we examine their effect with this at-risk group. They include trust in physicians, self-esteem, self-efficacy, social isolation, and depression. We examined survey data collected from 374 injection drug users in New Haven, Connecticut. Our findings indicated that trust in physicians significantly increased health care utilization, and depression decreased it. We also found that HIV+ respondents as well as those with health insurance utilized health care more often. These findings broaden the generalizability of existing health care utilization models, and they inform efforts to increase health care among vulnerable populations such as injection drug users.

We report impact results on the first operating year of an HIV prevention field experiment for injection drug users (IDUs) in two cities in western Russia, comparing a Standard "peer-driven intervention" (PDI) in Bragino to a Simplified-PDI in Rybinsk. The PDI relies on IDUs to educate one another in the community about HIV prevention, and recruit peers for enhanced prevention services and education. In the Standard-PDI, IDU-recruiters are offered nominal monetary rewards for both recruiting peers and educating them in a body of prevention information. In the Simplified-PDI, IDU-recruiters are similarly asked to educate and recruit their peers, but the reward for recruiting is woven into their education efforts. This modification streamlined the model's operations and made it 50% less expensive to operate in respondent fees. The overarching research question is whether the modification in the PDI's reward structure affects the model's recruitment power and educational effectiveness. First year results indicate that both PDIs achieved high baseline recruitment rates, although the Standard-PDI out-performed the Simplified-PDI by approximately 35% (493 recruits versus 365 recruits, respectively). However, the IDU-recruiters in the Simplified-PDI did a significantly better job educating their recruits at both baseline (an average knowledge test score of 5.19 versus 4.07 on an 8-point scale) and at follow-up 6 months later (an average knowledge test score of 7.21 versus 5.56 on an 8-point scale). Both PDIs demonstrated about equal and significant efficacy in reducing respondents' injection frequency, the sharing of syringes and other equipment, and rates of unprotected sex. Two additional refinements in the PDI model were also documented: an enhanced follow-up mechanism more than doubled the PDI's retention strength (to approximately 75%), and clear demonstration that IDUs are capable of educating their recruits in two different bodies of prevention information, depending on whether the recruits are new or follow-up participants.

Law enforcement activity has had multiple influences on injection drug users' (IDUs') participation in a cross-border HIV prevention project in southern China and northern Vietnam. The project has successfully achieved and maintained the official support of police and other government agencies and effectively implemented its interventions. However, analysis of process data, site visit observations, and interviews with project staff, peer educators, IDUs, and police officers reveal the ongoing effects of actual and perceived threats from law enforcement, as well as community stigmatisation, on IDUs' project participation. These effects are discernible in variations in the monthly numbers of needles/syringes provided, cross-border differences in IDUs' preferred ways to receive new needles/syringes and retain used needles/syringes for exchange, and geographic patterns of IDUs' receiving and redeeming pharmacy vouchers. HIV prevention programmes must not only maintain the support of police and other officials but also convince IDUs that it is both beneficial and safe for them to participate in the interventions. Programmes must also be implemented with flexibility, adapting to the potentially changeable preferences, perceptions, and needs of IDUs.

HIV, hepatitis B & C, drug overdose, and other drug-related health problems still pose significant health risks to injection drug users (IDUs) and their sexual partners, indicating the need for further development of innovative public health interventions. A relatively new intervention implemented in many municipalities throughout the world is the “safer injection site” (SIS). An SIS is a legal facility that allows people to prepare and inject pre-obtained drugs in a hygienic, anxiety-free atmosphere under the supervision of health personnel. This paper examines the responses of a sample of IDUs in New York City to whether they would use an SIS should one be implemented in mid-town Manhattan. The SIS would be part of a comprehensive harm reduction project that already offers needle-exchange, street outreach, testing and counseling, support groups, referral services including drug treatment, and on-site primary medical and dental services. The results of our study indicate that a large majority of the IDUs sampled would utilize an SIS should one be implemented, and that those most likely to use it are IDUs at the highest risk for contracting or spreading blood-borne diseases such as HIV and hepatitis, and for experiencing a drug overdose.

The continuing threat posed by HIV, HCV, drug overdose, and other injection-related health problems in both the United States and Canada indicates the need for further development of innovative interventions for drug injectors, for reducing disease and mortality rates, and for enrolling injectors into drug treatment and other health care programs. Governmentally sanctioned “safer injection facilities” (SIFs) are a service that many countries around the world have added to the array of public health programs they offer injectors. In addition to needle exchange programs, street-outreach and other services, SIFs are clearly additions to much larger comprehensive public health initiatives that municipalities pursue in many countries. A survey of the existing research literature, plus the authors' ethnographic observations of 18 SIFs operating in western Europe and one SIF that was recently opened in Sydney, Australia, suggest that SIFs target several problems that needle exchange, street-outreach, and other conventional services fall short in addressing: (1) reducing rates of drug injection and related-risks in public spaces; (2) placing injectors in more direct and timely contact with medical care, drug treatment, counseling, and other social services; (3) reducing the volume of injectors' discarded litter in, and expropriation of, public spaces. In light of the evidence, the time has come for more municipalities within North America to begin considering the place of SIFs in public policy and health initiatives, and to provide support for controlled field trials and demonstration projects of SIFs operating in injection drug-using communities.

Researchers generally use nonprobability methods such as chain-referral sampling to study populations for which no sampling frame exists. Respondent-driven sampling is a new form of chain-referral sampling that was designed to reduce several sources of bias associated with this method, including those from the choice of initial participants, volunteerism, and masking. This study expands this method by introducing “steering incentives,” supplemental rewards for referral of members of a specific group, injection drug users (IDUs) aged 18–25. The results are based on an interrupted time series analysis in which 196 IDUs from Meriden, CT, were interviewed before introduction of the steering incentives, and another 190 were interviewed afterwards. The steering incentives increased the percentage of younger IDUs sampled by 70%. We compared recruitment patterns with institutional data and self-reported personal networks to determine representativeness and whether volunteerism or masking were present. The results indicated that steering incentives helped to increase recruitment of younger IDUs, that the sample was representative, and that both volunteerism and masking were modest.

A dilemma arises for researchers who sample hidden populations, such as injection drug users (IDUs), and use financial incentives to recruit respondents. To prevent respondent duplication (a subject participates in a study multiple times by using different identities) and respondent impersonation (a subject assumes the identity of other respondents), researchers must confirm their subjects' identities. Documentation, however, introduces sampling bias against those who lack such identification, or who wish to remain anonymous. Definitive forms of identification like photography and fingerprints introduce a bias against the more distrustful members of the population, and scanner-based biometrics can be expensive. Most research projects therefore rely on staff to recognize former respondents, but staff turnover and a large number of respondents compromise accuracy. We describe and assess quantitatively the accuracy of a method for subject identification based on a statistical principle, the interchangeability of indicators, in which multiple weak indicators combine to form a stronger aggregate measure. The analysis shows that observable indicators of identity (scars, birthmarks, tattoos, eye color, ethnicity, and gender) and five biometric measures (height, forearm lengths, and wrist widths) provide the basis for a reliable and easily administered method for subject identification.

The research literature is replete with discussions of ethnography as a methodology involving deception, especially in the conduct of participant observation. When such research involves forging trusting relationships with active drug users-who develop many skills in deception during their ‘careers in dope’-deception may be used as much by, subjects in dealing with researchers as it is used by researchers in dealing with subjects. The element of deception increases further in ethnographic studies of AIDS prevention efforts for injection drug users (IDUs). Here ethnographers work to forge trusting relationships with outreach workers, who have been hired by prevention projects to forge trusting relationships with IDUs in the community to help protect themselves from HIV. In this paper, I discuss some deceptions basic to participant observation in virtually all social settings, with examples taken from my research of outreach workers and their dealings with IDUs in working to combat HIV. I then discuss some ...

We report on the first two years of operation of the Yaroslavl, Russia harm reduction project for injection drug users (IDUs). From October 1996 to September 1998, the project was one of 13 projects in central and eastern Europe that comprised the International Harm Reduction Development Program, funded by the Open Society Institute in New York City and the city and province of Yaroslavl. The project is modeled after and received technical support from the Eastern Connecticut Health Outreach project of the University of Connecticut, which was funded by the National Institute on Drug Abuse. The Yaroslavl project consists of two interrelated programs: a peer-driven outreach intervention that offers active drug users modest rewards for educating their peers in the community and recruiting them to a storefront for further education, interviews, free HIV, STD, and hepatitis B and C test counseling; and a needle exchange where IDUs can return used syringes for new ones and also receive other harm reduction materials such as condoms. We report on the development and implementation of the project and on in-depth interviews with 484 IDUs recruited to the project, 161 first follow-up interviews, 86-second follow-up interviews, and 35 third follow-up interviews. These interviews are based on clients' drug use and sexual risk behaviors, knowledge of HIV and other drug-related harms, and the Yaroslavl drug scene. We conclude with a discussion of the operational and political obstacles that the Yaroslavl project faces as those factors bear on the future of harm reduction programs in Russia.

Objective The Windham, Connecticut, needle exchange closed in May 1997 after becoming embroiled in a public controversy in which it was blamed for the city's drug problem, discarded syringes, and even the economic decline of the city itself. The authors interviewed injection drug users and conducted a community survey of discarded drug paraphernalia to explore the effects of the needle exchange's closure. Methods After the needle exchange was closed in March 1997, the authors re-recruited former participants in an AIDS prevention research project, the majority of whom were clients of the needle exchange. The authors analyzed responses from these respondents' pre-closure interviews and from III post-closure initial interviews and 78 post-closure follow-up interviews as well as data on discarded syringes and "dope bags". Results Following the closure of the needle exchange, significant increases were found in the percentage of respondents who reported an unreliable source as their primary source of syringes, in respondents' reports of the frequency of reusing syringes, and in the percentage of respondents who reported sharing of syringes. Surveys of outdoor drug-use areas found that the closure of the needle exchange did not reduce the volume of discarded syringes and other drug-injection debris. Conclusions The problems in Windham that led to the closure of the exchange still remain, and the city's drug injectors are engaging in higher levels of HIV risk behavior.

Whereas many infectious diseases are spread through casual contact and contagion, HIV transmission results from risk behaviors that involve close and often intimate contact. As a result, the transmission of HIV is structured by the social relationships within which these contacts are embedded. Hence, social network analysis is especially suitable for understanding the AIDS epidemic. This paper reports the results of a field experiment that compares a network-based HIV prevention intervention, termed a “Peer-Driven Intervention” (PDI), with the standard form of street-based outreach intervention. The results suggest that the network intervention outperforms the standard approach with respect to number of people accessed, reductions in self-reported levels of HIV risk behavior and cost. Finally, the analysis focuses on the network structure of drug injectors and discusses the implications of these structures for understanding both the spread of HIV through social networks and the design of HIV-prev...

Despite the wealth of scientific findings showing that needle-exchange programs reduce unsafe injection practices, and that these practices are the direct or indirect cause of one third of new HIV infections in the United States, the future of needle-exchange in this country remains uncertain. The federal government continues to ban the use of federal funds to support needle-exchange programs. In many cities with large numbers of HIV-positive drug injectors, local and state officials continue to oppose the implementation of exchange services. Needle-exchange staff members also continue to risk arrest, prosecution and imprisonment. Whereas previous studies have focused on the effectiveness of needle-exchange programs, we offer an analysis of a unique event, the closure of a well-established needle-exchange. The study consists of two parts. The first analyses examines the claimsmaking that succeeded in defining the needle-exchange as a public health hazard and a social problem, causing it to be closed after several years of operation. In the second part, based on initial and follow-up interviews with needle-exchange clients, surveys of public drug-using sites, and ethnographic interviews, we present an impact analysis of the exchange's closure. The analysis provides a case study showing how a community's demonstrably effective HIV prevention efforts can be quickly eroded by the termination of a key harm-reduction service.

Serious methodological and ethical flaws are detailed in an ethnographic study of a respondent-driven sampling (RDS) project for drug users in Chicago. The study is also disconnected from the larger social context within which the project operated, and from the existing literature on human-subject problems the author claims he "discovered" about RDS - problems common to traditional outreach projects that researchers have known about and managed successfully for years. Due to an admitted bias in the author's sampling, and an eagerness to accept respondents' claims uncritically, the author's results are not generalizeable to RDS projects operating in other cities, in Chicago itself, or even to the specific project studied.

Rational choice theory is a controversial basis for institutional design. Dire warnings have been issued about its potential effects. This paper examines in detail a single example of rational-choice-based institutional design in light of these warnings. The conclusions are that these warnings are ill-founded because they are based on an inaccurate or incomplete understanding of rational choice analysis, that rational choice can serve as a basis for effective and humane institutional design, and that rational choice has features that make it suitable for policy analysis.

AIDS prevention efforts for injection drug users (IDUs) since 1988 in over 60 inner-city areas within the United States have been based on a “provider-client” model called “street-based outreach.” We document the research showing that these traditional outreach projects operate under conditions that cause hierarchy and supervision to break down easily. The result is an array of organizational problems that push outreach projects toward inertia, and invite high levels of mal- and nonperformance by outreach workers (OWs) as rational adaptations to their work conditions. Nevertheless, research has also documented that IDUs responded very impressively to the outreach services they received. Based on IDUs' responsiveness, we outline the operational features of a “Peer-Driven Intervention” (PDI) that relies on an active collaboration with IDUs in place of a “provider-client” model. Based on a comparative study in eastern Connecticut, we present preliminary impact data comparing the effectiveness of a PDI with a traditional outreach intervention in terms of recruitment power, educational effectiveness of IDUs in the community, and comparative intervention costs.

Drawing on original field research and agency theory, we examine the operations and internal workings of community-based outreach projects to combat AIDS among out-of-treatment injection drug users (IDUs). We show that even though these projects suffered from a host of organizational problems, the response from ID Us was positive and vigorous. Based on these findings and recent developments in the theoretic understanding of collective action, we describe new approaches to AIDS prevention that build on traditional outreach prevention efforts but rely more heavily on an active collaboration between IDUs and service providers. These approaches fulfill the call by many AIDS researchers for the development of future prevention projects that capitalize on the unexpected responsiveness IDUs exhibited to traditional outreach efforts. Finally, we consider other public health areas in which such interventions might be effectively applied.

In 1985, the National Institute on Drug Abuse (NIDA) funded an ethnographic research project in San Francisco to study the needle sharing behavior of injection drug users (IDUs). The goal of the re...

Following decades of corporate strategy promoting common household bleach as essential for peoples' health and happiness, a use for bleach was finally discovered in 1986 that actually achieved life-saving proportions for a certain population: injection drug users in preventing the spread of AIDS. Since then, substantial promotional efforts have surfaced – corporate, governmental, and community-based – to downplay or obstruct the public definition of bleach as a major AIDS prevention weapon. An analysis is offered of four competing social constructions of bleach that have emerged since 1986: bleach as a public health breakthrough; bleach as a liability; bleach as an endorsement for drug abuse; and bleach as a social policy copout.

An ethnographic analysis is offered which examines four methodological problem areas that community health outreach workers manage in attempting to stop the spread of AIDS. Outreach workers' client populations include drug injectors and their sexual partners, prostitutes, and homeless/runaway youths. The analysis notes that outreach workers confront several problems of work that are strikingly similar to some of the central methodological problems of conducting ethnography. These are (a) establishing a very unusual but credible identity in communities whose members harbor substantial distrust; (b) discovering a community from members' points of view; (c) forming relationships, but controlling one's level of involvement and impact; and (d) cultivating viable roles in the field.

Active drug users with HIV infection suffer from both low utilization of, and adherence to, primary care. Combining drug treatment and primary care on-site reduces these problems significantly because it creates a social support structure; treatment program staffs can monitor patients' adherence and provide ongoing encouragement. But in the United States, only a very small minority of HIV + drug users receive this demonstrably effective form of care. We report the results from a feasibility study of an alternative support structure, termed a "peer-driven intervention", that serves as a functional equivalent to drug treatment for increasing drug users' adherence to HIV therapeutics. The six-month study included 14 adult active drug users receiving medical care for HIV disease in New Haven, Connecticut. As a health advocate, each subject was assigned and asked to meet with another subject once a week at the project's storefront to provide peer support and counseling. As a peer, each subject was assigned and asked to meet with another health advocate once a week to receive support in keeping up his or her medical care. No two subjects played both roles for one another. Advocates earned nominal monetary rewards for eliciting positive responses from their peers in keeping clinical appointments, responding to physicians' referrals, picking up prescriptions on time and attending weekly meetings with the advocate. The results of the study suggest that an alternative social support structure to drug treatment is feasible for increasing active drug users' adherence to medical care. Innovative mechanisms that harness drug users' peer pressure to promote positive behavioral changes deserve greater study.

Since the relatively recent advent of evaluation research, researchers have overwhelmingly advocated the use of experimental designs over other methodological approaches. However, implementing such designs produces an interaction effect which greatly alters the nature of programs being evaluated. As an alternative to experimental designs, an interactionist approach to evaluation research is introduced and developed, both conceptually and procedurally. The advantages of a phenomenological skepticism, which is epistemologically integral to an interactionist approach, over an experimentalist's naive or common sense skepticism, is discussed. Stages and methodological problems of carrying out an interactionist approach are explicated. It is argued that the implementation of an interactionist approach would be “nonreactive” with either the structure or functioning of a program under analysis. And it would simultaneously bring into relief much of the anxiety and distrust between researchers and those being evaluated that characteristically accompanies the application of experimental designs.

Intrinsic and extrinsic factors contributing to job satisfaction of pharmacy technicians in two community hospitals were studied. A pharmacy student employed part-time as a pharmacy technician by one of the hospitals observed fellow technicians in a wide range of job activities for 22 months. In a second hospital, the same student conducted similar observations during one summer while posing as a social researcher. Both hospitals had technician training programs providing classroom instruction and on-the-job training. Data were gathered primarily from informal conversations with technicians and pharmacists and by recording activities through notetaking. Formal training programs, praise from pharmacists, opportunities to train other technicians, diversity of job activities, and autonomy in coordinating work with time demands were identified as factors contributing to job satisfaction of technicians. Negative aspects of the job that employers attempted to circumvent or clarify were the unchallenging nature of the work and the limited opportunities for advancement. Technicians' and pharmacists' attitudes toward job enrichment for technicians are discussed, and suggestions for improving technicians' intrinsic and extrinsic job satisfaction are provided. A reliable cadre of pharmacy technicians is necessary for further expansion of clinical pharmacy services under current hospital budgetary restraints. In addition to modifying job activities to promote technicians' intrinsic job satisfaction, pharmacy managers can improve extrinsic satisfaction by providing adequate salaries, job security, and flexible work schedules.

This historical analysis focuses on the arrival of acute poisoning as a fully institutionalized social problem. Early medical concerns about childhood poisonings, voiced particularly by pediatricians, made dramatic news in the early 1950s. Further promotion of the problem occurred as hundreds of hospitals hurriedly established poison control centers and telephone hotlines. I examine reasons why hospitals rushed into poison control as well as why, despite a high incidence of poisonings and over two million hotline calls annually, hospitals are now abandoning poison control. A highly consolidated, governmentally supported network of poison centers is currently emerging — an anomaly in this age of corporate transformation of the larger health care system.

The controversial question of how much disease is caused by medical intervention goes to the heart of a social movement within the profession of pharmacy. The fate of “clinical pharmacy” is tied to the ability of pharmacists to detect and correct errors in prescribed medications, a potential source of iatrogenic disease. The dilemma for pharmacists is that documentation of their clinical activities could increase the liability exposure of medical organizations and impugn the reputations of physicians as competent prescribers of drugs. A participant observation study reveals how problems of drug therapy and the work of clinical pharmacists are negotiated within hospital settings.

An empirical study of the dynamics of clinical clerkships in professional education is offered, with particular attention to ancillary professions. For students to eventually establish innovative practices within professional organizations, they need skills in the technical aspects of their fields, as well as in role-making and interprofessional negotiation. In examining a clinical clerkship in pharmacy, it was found that faculty overwhelmingly focus on technical matters, and assume that technical competence alone is enough to attain role expansion. The experiences of students, simulating participation in a complex organization as members of clinical teams, give good reason to question this and other assumptions constituting the structure of clerkships. Several recommendations issue from the analysis for strengthening the objectives of professional training.

The distribution of the recombination fraction between two distal, autosomal loci, plexus and orange, was investigated in reciprocal crosses between the marker stock and each of two wild-type strains, Harwich and Ottawa. The dysgenic cross between Harwich males and marker females exhibited high sterility, low fecundity, and a non-normal distribution of the recombination fraction. Neither the distribution of the reciprocal Harwich cross nor those of the two Ottawa crosses deviated from normal. In general, the results support the view that the recombination fraction is a variable.

Increasing concern has been expressed over the way sponsorship of research by various governmental agencies and private foundations has influenced the “objectivity” of scientific investigations. Actual manifestations of the social control of research can be studied through an analysis of the role of the “gatekeeper.” Gatekeeping influences the research endeavor in a number of ways: by limiting conditions of entry, by defining the problem area of study, by limiting access to data and respondents, by restricting the scope of analysis, and by retaining prerogatives with respect to publication. Strategies are not well developed for managing pressures of gatekeeping. Furthermore, the location of researchers within university settings mitigates against confrontation with gatekeepers, particularly if the research effort is directed toward elites or powerful institutions. Where institutions such as universities agree with gatekeepers that proposed sensitive and critical research would be “inappropriate,” researchers must create autonomous positions from which to conduct their research.