Wechsberg W M, Dennis M L, Stevens S J
Research Triangle Institute, Research Triangle Park, North Carolina 27709, USA.
Am J Drug Alcohol Abuse. 1998 May;24(2):239-57. doi: 10.3109/00952999809001711.
The study described here presents an innovative approach to analyzing intervention outcomes among women substance abusers participating in a national HIV prevention research study funded by the National Institute on Drug Abuse. We used cluster analysis to divide the women in our sample (N=557) into four distinct subgroups predominantly characterized by differences in drug use, injecting risk, sexual behaviors, and drug and sexual risk combined. The four subgroups resulting from this process were primary crack-using women, primary needle-using women, high-frequency needle-using women, and women with multiple drug and sex risk behaviors. Our analysis focuses on changes in self-reported risk behaviors from baseline to 6-month follow-up. In general, the results clearly indicate that the women are heterogeneous; that is, the subgroups exhibit varying patterns of drug use, injecting risk, sexual behavior, and HIV seropositivity. Significant outcomes were found in many areas, indicating positive changes in risk behaviors. The two smaller subgroups of women--high-frequency needle users and those in the multiple-risk behavior subgroup--reported the highest rate of high-risk behaviors and seropositivity but also showed the greatest change at follow-up. A particularly important finding resulting from our analytical approach is that well over half the women in our sample were primary crack users (n=313). This finding is even more significant in light of the fact that the Cooperative Agreement specifically tried to include 70% or more participants who were injectors. Although the rate of HIV seropositivity is not as high for this crack-using subgroup as for the two smaller needle-using subgroups, a greater number of "women who are HIV positive" are in this primary crack-using subgroup than in all the other subgroups. Most of the crack-using women reported that they were not currently injecting drugs and never shared needles, but 10% were seropositive for HIV, suggesting that their risk comes primarily from sexual behaviors. Behaviors in this larger subgroup of women did not change as dramatically as those of women in the smaller subgroups; however, the women did show improvement in areas related to indirect risk (e.g., alcohol and crack use) and in several areas where change is most needed (e.g., trading sex for drugs and using condoms). The results demonstrate a promising alternative approach to analyzing substance abuse and HIV risk behaviors, and they suggest the need for further research on alternative interventions for women with different patterns of risk behaviors.
本文所述的研究提出了一种创新方法，用于分析参与由美国国立药物滥用研究所资助的一项全国性艾滋病预防研究的女性药物滥用者的干预结果。我们使用聚类分析将样本中的女性（N = 557）分为四个不同的亚组，主要特征是在药物使用、注射风险、性行为以及药物和性风险综合方面存在差异。这一过程产生的四个亚组分别是主要吸食快克的女性、主要使用针头的女性、高频使用针头的女性以及具有多种药物和性风险行为的女性。我们的分析重点关注自我报告的风险行为从基线到6个月随访的变化。总体而言，结果清楚地表明这些女性具有异质性；也就是说，各亚组在药物使用、注射风险、性行为和艾滋病毒血清阳性方面呈现出不同的模式。在许多领域都发现了显著结果，表明风险行为有积极变化。女性中的两个较小亚组——高频使用针头者和处于多种风险行为亚组的人——报告的高风险行为和血清阳性率最高，但在随访时变化也最大。我们的分析方法得出的一个特别重要的发现是，样本中超过一半的女性是主要吸食快克的使用者（n = 313）。鉴于合作协议特别试图纳入70%或更多的注射者参与者，这一发现就更加重要了。尽管这个吸食快克的亚组的艾滋病毒血清阳性率不如两个较小的使用针头的亚组高，但这个主要吸食快克的亚组中“艾滋病毒呈阳性的女性”数量比所有其他亚组都多。大多数吸食快克的女性报告说她们目前不注射毒品且从不共用针头，但10%的人艾滋病毒血清呈阳性，这表明她们的风险主要来自性行为。这个较大亚组的女性行为变化不如较小亚组的女性那么显著；然而，这些女性在与间接风险相关的领域（如酒精和快克使用）以及几个最需要改变的领域（如以性换毒品和使用避孕套）确实有所改善。结果证明了一种分析药物滥用和艾滋病毒风险行为的有前景的替代方法，并且表明需要对具有不同风险行为模式的女性的替代干预措施进行进一步研究。
