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  • Title: Outcomes of an AIDS prevention program for methadone patients.
    Author: Magura S, Siddiqi Q, Shapiro J, Grossman JI, Lipton DS, Marion IJ, Weisenfeld L, Amann KR, Koger J.
    Journal: Int J Addict; 1991 Jun; 26(6):629-55. PubMed ID: 1757169.
    Abstract:
    Methadone maintenance patients are at risk of contracting or transmitting HIV through intravenous drug use and/or unsafe sexual practices. An outcome evaluation of a voluntary AIDS prevention program for methadone patients in three clinics (two experimental, one control) is reported. The prevention program included three components: didactic AIDS education, HIV antibody counseling/testing, and facilitated peer support groups. Participation in AIDS education was associated with increased knowledge of AIDS risks and with improved attitudes toward condoms. Peer group participation was associated with improved attitudes toward the use of condoms and with increased use of condoms. Learning of HIV seronegativity was related to increased self-efficacy and decreased intravenous drug use risk behaviors. Rates of participation in the prevention program were disappointing, but the program seemed beneficial for those patients who did become involved. 289 patients in 3 methadone maintenance clinics in New York City volunteered to participate, with incentives, in an evaluation of AIDS prevention education. The purpose was to assess the cumulative impact of interventions on patients' AIDS related knowledge, attitudes, and drug using and sexual behaviors compared with those not receiving interventions. 2 clinics received interventions consisting of an AIDS education seminar in clinics 1 and 2, HIV antibody testing only in clinic 1 to those attending the seminar, and facilitated peer support groups. A table is provided which summarizes evaluation results to date for 3 types of AIDS prevention interventions with IV drug users: direct education, HIV counseling, and facilitated peer groups. The methods section describes methods, an AIDS education description, HIV antibody testing, peer support groups, and sources of data (pre- and postseminar questionnaire), subjects' characteristics, independent and dependent variables, and statistical methods (multivariate analysis and multiple ordinary least squares regression analyses). The results indicated that AIDS education was associated with increases in knowledge of AIDS risks and in acceptability of condoms in the initial analysis. Participation in support groups was associated with increases in acceptability of condoms and condom use. Learning of a negative HIV test was associated with an increased sense of self-efficacy and decreased IV drug use risk. Positive test subjects were associated with increased condom use, although caution is urged in generalizing because the sample was small at 6 subjects. These subjects expressed anxiety about the HIV results. A caveat is that self-selection effects are included, but separate analyses were conducted excluding subjects who declined posteducation intervention. The results were identical. Nonwhites reported increased condom use in the analysis after the group sessions. Behavioral changes were not observed as a result of the AIDS education component, which supports prior findings. Support for the Health Belief Model of Becker and Maiman is evidenced in the relationship between seronegative HIV testing and increased condom use and self-efficacy, and decreased drug use risk behavior. The social learning from peer groups improved participants' attitudes and increased condom use. A limitation is the short follow-up time of 2 months after the last intervention. Support is given to add specialized AIDS prevention services to drug abuse treatment programs.
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