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Index A Abortion clinics, seroprevalence surveys in, 7-8, 57, 59 Acquired immune deficiency syndrome (AIDS) case-control studies of, 129 cause, 1 disease model of, 129 erroneous beliefs about, 263, 264 IV drug use and, 1018, 180240, 407-408 latency period, 3, 4, 5, 31-32, 62, 64-65, 68, 76, 451 in male homosexual population, 11 multidisciplinary research teams/ centers for, 25 number of sexual partners and, 129 probability of HIV infection progressing to, 42 n.l4, 228 prostitutes and, 142-145 severity of epidemic, 213 sexual behavior and, 9-16, 73-169, 405-407 sharing of data on, 15, 168 similarities to past epidemics, 26, 28 sources of information on, 269 stereotyping of, 130 stigma and, 393-399 surveillance definition of, 32 n.2, 45 n.l7, 234 Adolescents and teenagers age at first sexual experience, 95, 98, 148, 412, 414-415 condom use by, 288, 488-499 569 drug prevention programs for, 267, 295 in drug treatment programs, 191 education programs for, 302-307 homosexual experiences of, 118 implications of sexual behavior for HIV transmission, 12 initiation of sexual intercourse, 12 IV drug use by, 191-192, 197 misconceptions about HIV transmission, 264 number of sexual partners, 12 peer pressures, 278 precautions taken by, 12 premarital sexual behaviors, 95 research needs on, 15 risk perception, 273 sexual conduct of, 12, 118, 197, 261 sexual development of, 500, 511-518 trends in heterosexual behavior of, 80101 Africa cofactors in HIV transmission in, 287 multiple-partner relationships in, 164 prostitution in, 137 sexual and ritualistic practices relevant to spread of HIV, 163 AIDS cases accuracy of incidence and prevalence estimates, 33 geographic variation in, 103, 109, 235 and HIV prevalence, 3, 38, 42-45 in IV drug users, 16, 187 number of, 2, 4, 16, 37, 187, 197, 447048

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570 ~ INDEX reporting of, 32-33; see also Reporting of AIDS/HIV infection statistics on, 4-5 value as indicator of magnitude of epidemic, 4, 31 AIDS-related complex, 45 n.17 Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), 10, 165, 438 Amphetamines, 187, 196, 219, 231, 431, 436, 439-440 Amsterdam, syringe exchange program-, 203-204, 208, 302 Anal intercourse condom use in, 131, 134, 136, 287 cultural standards for, 161 frequency of, 113, 129 practices, 129, 131-134, 155-156, 280, 286 prevalence of, 11 by prostitutes, 137 risk of HIV infection from, 11, 133-134 unprotected, 11, 128, 131-133, 280; 280287 with women, 113, 137 Anonymity in antibody testing, 21 in probability surveys of serostatus, 7-8, 48-49, 57, 58 n.30, 464-467 Anthropological research on human sexual behavior, 157-164 on IV drug use, 215 Antibodies to HIV, in newborns, 7 n.7 Antibody tests for HIV anonymity in, 21, 27 and behavior modification, 21 uncertainties in prevalence data, 46-47 Atlanta, HIV seroprevalence in, 40, 143 AZT (zidovodine), 280 B Baltimore ex-addict outreach program in, 204 HIV seroprevalence in, 40, 235 Bathhouses, 129, 135, 150, 272 Bayview Hunter's Point Foundation, 295 Behavioral research, see Social science and behavioral research Behavior change/modification altruism and, 279 antibody testing and, 21, 279-282 assessing, 285-287 assistance and-support for, 20 barriers to, 198-199, 213-214, 274, 286, 288-290, 297-300 choices offered for, 20, 274, 277 community role in 291-297 costs to personal relationships, 281 evaluation of effectiveness of, 78, 259, 316-350 existing beliefs and values and, 20 fear in health messages and, 266-268 in homosexual male population, 11-12, 132, 133, 134-135, 136, 261, 286-287 innovative and controversial approaches to, 300-302 by intravenous drug users, 198, 202-214, 240, 261, 298-299 length of program and stability of, 284 motivation for, 20, 260, 261, 276-282 normative beliefs and, 293 potential for, 261, 297 by prostitutes, 299-300 relapse prevention, 283-284, 285 risk perception and, 108-109, 204, 265, 271-273 role models and, 269 self-efficacy and, 277-279, 283, 285 in sexual behavior, 11-12, 132, 133, 134-135, 136, 209-211 skills training for, 20, 212, 268, 278, 283, 285 smoking prevention programs as an example of, 278, 285 and social learning theory, 26~270, 283 social supports for, 261-262, 265-266, 285, 29~307 STD statistics as surrogate measure of, 16 sustaining, 213, 283-285 Bias in surveys and self-reported data correlation, 438, 442 in educational levels of survey respondents, 36, 104 n.l6 in Kinsey sample, 123 nonresponse, 6 n.6, 8, 48 - 50, 58, 217 recall, 96 n.l2, 153, 218 reporting, 149 research to characterize, 46 sample selection, 6 n.6, 35-36, 46, 52, 54, 56, 58, 118, 234

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INDEX ~ 571 in seroprevalence surveys, 35, 38, 45, 52 Bisexuality lack of data on, 10 perceptions of, 163 social-psychological aspects of, 156, 504 Bisexual men heterosexual rate of partnering, 152-153 HIV incidence and prevalence rates among, 38 sampling for surveys, 15~153, 156 see also Homosexual men Blood donation as an avenue for testing, 280 lack of risk associated with, 264 Blood donors HIV seroprevalence among, 35, 36, 37, 40, 41, 45 & n.16, 46 sampling bias, 35-36 Boston education/outreach program for prostitutes, 145 trends in same-gender sexual behavior in, 131, 132 C California AIDS incidence in, 43 Drug Abuse Data System, 440 IV drug use in, 229, 439-441 Parents VVho Care program, 295 Prostitutes Education Project, 295 Casual contact, lack of risk from, 264 Celibacy among heterosexuals, 105, 106-108 among homosexuals, 136 Centers for Disease Control (CDC) AIDS data collection responsibilities, 24 data disclosure practices, 49 educational activities, 265 estimates of IV drug users, 228-229 evaluation of interventions, 23, 24 HIV seroprevalence surveys, 08, 50-62, 142 personnel burdens and needs at, 23-24 quality assurance programs for laboratories, 47 report on HIV incidence and prevalence, 34, 37, 38, 45, 226 sex research by, 10, 145, 165 time lag in reporting cases to, 32-33 Chancroid, 287 Chicago estimates of IV drug users in, 439, 444 same-gender sexuality studies in, 120-121, 132, 134, 135 Children, see Infants and children Client-Oriented Data Acquisition Process (CODAP), 195 n.3, 216, 220, 232, 439 Cocaine crack smoking, 144, 196, 281 frequency of use, 196 n.4, 223, 230, 231 injection of, 187, 196, 216, 223 number of users, 229, 431, 436, 439-440 research needs on, 219 and sexual behavior, 193-197 treatment for dependency, 214 use by prostitutes, 144 Cofactors in AIDS prior to discovery of HIV, 129 sexually transmitted diseases, 13, 129, 137 Cohabitation/coupled relationships case gathering on, 110 duration, 111 heterosexual, 109-110 homosexual, 109-110 monogamous, 12 sexual behavior outside of, 12, 111-112 sexual frequency in, 111 sexual relationships between, 13 turnover rates in, 13 Colorado HIV seroprevalence in, 40, 143 prostitute outreach program in, 145 Community support and behavior modification, 291-293 in seroprevalence surveys, 8, 150 intervention programs, 293-297 Condom use by adolescents, 288, 488-499 for am intercourse, 132-133, 287 by heterosexuals, 273 by homosexuals, 131-133, 287, 288 impediments to, 168, 199, 288-290, 292 canons IV drug users, 198, 210, 279 for oral sex, 132-133

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572 ~ INDEX promotion of, 13, 20, 270-271, 275 by prostitutes, 141, 144-145, 146, 211, 300 rates of, 76, 273 research needs on, 13-14, 167-168 risk perception and, 108-109 & n.20, 278 for STD prevention, 260267, 275, 289 surveys of, 103, 21~211 Condoms advertising on network television, 20, 26, 271, 376-378, 408 availability of, 13, 169 distribution of, 270-271 effectiveness against HIV infection 488-499 failure rates, 13, 133, 167-168, 289-290 misleading information on, 289-290 packaging for women, 270 n.3 purnh~ce frequencies, 103, 108 Confidentiality of antibody testing and serostatus, 27, 282 of data collected in seroprevalence surveys, 8-9, 4809, 57, 58, 69 data release and reporting standards, 49, 58 in Kinsey studies, 81 safeguards for assuring, 8-9, 27, 49, 69-70, 223 Counseling with HIV testing, 21, 53 to reduce risky behavior, 78 n.2, 188, 209 Couples, see Cohabitation/coupled relationships Courtship patterns of adolescents and young adults, 88, 91 prostitution and, 138 role of sexuality in, 91, 138 D Deaths from AIDS, 2, 4 from HIV-related illnesses, 32 & n.2 Detroit, HIV seroprevalence rates by high-risk group in, 40 Discrimination against gay men and lesbians, 27, 114-115, 127 fear of, and survey responses, 126 HIV testing and, 280 legal protection against, 9, 27, 69, 264 against research on same-gender sexuality, 127 sexual conduct as a basis for, 27, 114-115, 127, 161 District of Col~l~nhia, see Washington, D.C. Divorce, 13 Drug abuse education and prevention programs community participation in, 295 role of fear in, 267 Drug Abuse Warning Network (DAWN), 219, 232, 440 Drug treatment programs adolescents in, 191 availability of, 17, 211, 284, 291 client types, 220 and condom use, 279 detoxification, 203, 220, 231, 235, 284, 435 demand for, 302 effectiveness of, 17, 187, 284 entry-reentry patterns, 232 ethnic aIld racial minorities in, 215 facilitation of entry into, 200209 free vouchers for, 203 HIV seroprevalence surveys in clinics. 6, 38, 53-54 methadone maintenance, 196, 198, 202, 204, 208, 220, 231, 235, 287, 435 out-patient drug-free, 231 recruitment for, 203, 224 recruitment of samples from, 187, 202, 215, 220, 224, 235, 279, 281, 287, 434-435 residential drug-free, 220, 231, 235, 435 resource allocation for, 188 and risk of HIV infection, 38 safer injection programs and, 208-209 and street counseling, 209 E Edinburgh, Scotland, HIV seroprevalence in, 236 Education, see Public education about AIDS/HIV; Sex education

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INDEX l 573 Educational levels and AIDS/HIV educational messages, 263 and frequency of sexual intercourse, 89 and HIV infection, 146 and premarital sexual conduct, 90 and sexual partners, 146 of survey participants, 36, 104 Ellis, Havelock, 157 Emergency room patients estimates of IV drug users as, 228 HIV seroprevalence surreys of, 45 Endocarditis, 32 n.2 Enzyme-linked immunosorbent assays, 55 Epidemics definition relative to HIV/AIDS, 2-3, 26 dimensions of, 4, 18 doubling time, 77-78 dynamics, data needs on, 78-79 effects on poor and minorities, 380390 first wave, 78 historical lessons of, 388-399 patterns in, 2 reproductive rate of, 74, 76-77 second-wave, 77-78 self-susta~ng, 236 social response to, 372-375 traditional monitoring of, 67-68 Epidemiological surveys adequacy of current statistics, 31 and AIDS latency period, 5, 62, 64 anonymity in, 7-9, 48-49, 57, 58 n.30, 464-467 barriers to, 8 biases in, 6 n.6, 8, 35, 36, 38, 45, 48-49, 52 blinded, 49-50, 53-54, 56, 60 CDC family of HIV seroprevalence surveys, 6-8, 50-62; see also National Seroprevalence Survey coding for minorities/ethnic groups, 55 n.29 community involvement in, 8 confidentiality in, 8-9, 4809, 57, 58 convenience samples, limitations of, 454-456 costs of, 460-461 coverage, adequacy of, 462-463 cross-sectional, 52-53 data management plans, 58, 66 data sources for, 452-453 definition of AIDS for, 32 n.2, 45 n.17, 64, 234 demographic information in, 61 design considerations, 6, 11, 45, 54, 55-57, 64, 69, 130, 457-468; see also Samples/sampling for surveys development of systems for, 4-5, 31-32, 51, 6~67 generalization of data from, 7 & n.7, 22, 34, 51, 57, 59 ideal, for measuring HIV seroprevalence, 47-50, 67-68, 452-453, 459-460 indicators of HIV infection for, 55 infonned consent for, 8 interpretation of statistics, 60 methods for estimating prevalence, 5, 36-37, 47-50, 56, 62~6 Multicenter AIDS Cohort Studies, 11, 45, 130 nonresponse rates, 57-58 objectives of, 50-51, 52, 69 probability sampling, 6, 7, 46, 48, 52, 59 quality assurance in testing for, 50 resource needs for, 33, 66 responsibility for, 461 sample size and efficiency of, 457-459 sample survey method, 66 by self-reports, 11 sensitivity of programs, 8 sbarin& of data from, 9 site selection for, 6, 48, 52, 53 n.23, 54-56, 61 testing of survey design, 8, 48, 51 n.22, 58, 462 traditional methods for, 67~8 usefulness of data from, 07 see also Surveys Estimation of IV drug use accuracy of, 431-432 aggregation of state estimates, 228-230, 435, 438-443 AIDS mortality data for, 228 back-extrapolation methods, 227, 436 437 barriers to, 225 critique of CDC estimates, 22~227, 420446 data sources for, 232, 436, 430441

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574 ~ INDEX definition of an IV drug user for, 226-227, 431-435 direct estimates, 227-228, 231-232, 436 dual-systems (capture recapture) estimates, 227-228, 231-233, 437-438, 442 HIV seroprevalence data for, 228 indirect estimates, 227, 229, 436 informed guesstimates, 227, 229, 436, 442-443 Lange's approach, 443044 national estimates, 443 Newmeyer's ratio estimate, 444-445 regression models, 227, 440 synthetic estimation models, 233 survey use for, 227 Ethical issues in evaluation of intervention strategies, 342-343 in observation and reporting of illicit behaviors, 222 see also Confidentiality Ethnographic studies applications, 218-219 of awareness/knowledge of AIDS/HIV infection, 202 of crack use and prostitution, 197 of gay communities, 119 of IV drug users, 144, 192, 199, 202, 217-218 of prostitution, 140, 144 of social factors relevant to spread of HIV, 163 Evaluation of intervention strategies attrition and noncompliance in experiments, 344-345 barriers to, 286, 483-484 collateral program effects in, 481-482 community demonstration projects, 265, 295 condom effectiveness example, 488-499 constraints on, 326 cost-effectiveness analysis, 471-499 defining and measuring outcomes, 205, 322-324, 474-477 dimensions of, 317-326 education programs, 164, 265, 266 ethical issues in, 342-343 implementation of, 347-350 inference strategies and, 22, 324-326 information base for, 212, 340, 478079 measurement and observation in, 322-324, 345-347 need for, 18, 19, 188, 331, 337 net program costs, estimating, 482083 nontreatment controls in, 21 personnel requirements for, 23, 24 planned variation in programs and, 213, 307-308 premarital screening example, 484088 resources for, 22-23, 164 responsibility for, 21, 316 role of, 21-23 sample heterogeneity, 481 valuing program consequences, 483-484 see also Randomized field experiments F Fear in health promotion messages, 19, 266-268 Florida, AIDS incidence in, 43 G Gay communities changes within, 127 educational interventions, 264-265, 270 ethnographic studies of, 119, 163 reform movements/political activism, 119, 126, 163 relationship to larger society, 505 research focus in, 127-128 as sampling sites, 155 social and sexual diversity in, 120 supporting role of, 291 Gender identity, 502-502; see also Sexual development Gonorrhea, 28, 150, 167, 275, 287 Gregg, Aim, 85-86 H Hartford, HIV seroprevalence in, 235, 238-239 Health care plamiing data needs for, 188

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INDEX l 575 prevalence data on HIV infection and, 5-6, 34, 67, 78 Hemophiliacs, 38, 39, 432 Hepatitis B. 151, 188, 189, 232 Heroin, see Intravenous (IV) drug use Heroin Lifestyle Study, 215-216 Heroin Problem Index, 232 Heterosexual transmission AIDS cases from, 197 efficiency of, 197 among ethnic/minority grouper 3 female-to-male, 39 HIV incidence and prevalence, 38-40 by IV drug users, 197 male-to-female, 39 probabilities in, 76 by prostitutes, 137 Heterosexuals adolescent/young adult sexual behaviors, 88-101 adult sexual behaviors, 102-113 celibacy among, 105, 106-108 condom use by, 109 couples study data, 110-111 HIV incidence among, 38 HIV seroprevalence among, 38, 40 nonmonogamous, lack of data on, 74 number of sexual partners, 91, 104, 106-107 reproductive rate of HIV infection in, 77 risk of HIV transmission among, 113 risk perception among, 108-109, 130, 297-298 social cleavage of homosexuals and, 503-504 social norms of sexual behavior, 100 High-risk groups data collection methodologies for, 167, 168 opinion leaders' role in prevention, 20 research needs on, 74, 166, 167 see also Bisexual men; Homosexual men; Intravenous (IV) drug users; Prostitutes/prostitution HIV infection AIDS case data as a proxy measure of, 42-45 denial of susceptibility to, 19 helper T-cell counts as markers of, 129 indicators of, for survey purposes, 55 natural history of, 76 probability of progression to AIDS, 42 n.l4, 76 n.1 reproductive rate for, 76-77 sexual exposures and, 146 sharing of data on, 15 time course of infectiousness, 76 and tuberculosis, 57 HIV infection, spread of barriers to tracking, 3 behavioral factors in, 1, 74; see also - Sexual behavior; Injection behavior controlling, 4, 5, 1~23, 73; see also Belisvior change/modification; Intervention strategies for HIV/AIDS data needs on, 75-79 geographic correlations in, 42-45 IV drug use and, 16-18 modeling of, 74, 477-481 monitoring, (18, 31-70, 405, 447-469; see also Epidemiological surveys occurrence of AIDS and, 3 prevention of, see Public education about AIDS/HIV risk factors for, 11 sexual behavior and, 74 statistics on, 5-9 time course of, 42, 44-45 Homophobia, 162 n.37 Homosexual men age of initiation of sexual activity, 148 awareness of and knowledge about AIDS, 272, 296 behavior modification among, 11-12, 132, 133, 134-135, 136, 261, 279, 280, 286, 290, 296 celibacy among, 136 closeted, 152, 162, 504 cohort studies of, 11, 45, 130 condom use by, 132-133 cultural labeling of, 117 definition of, 82 n.5, 450 discrimination against, 27, 114-115, 127 drug use by, 130, 283 Educational intervention for, 264-265 exclusively, 62-63, 118, 123, 152, 450 HIV incidence rates among, 37, 38, 132 HIV seroprevalence among, 38, 62, 63 n.34

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576 ~ INDEX HIV transmission modes among, 128, 131, 147 legal difficulties of, 114-llS & n.22 married, 152, 424 minorities/ethnic groups, 155 monogamous relationships, 135-136 national study of 109, 121 number of sexual partners, 11, 111, 130, 134-136, 424 patterns of coupling and directional relationships, 120, 127 perceptions of risk by, 133-134 population estimates, 10, 62~3, 64, 74, 114, 117-118, 450 primary relationships, 111, 133, 136, 181 psychiatric morbidity associated with HIV testing of, 281 recruitment for studies/surveys, 46, 130, 150-153, 272 reproductive rate of HIV infection in, 77 research focus on, 127-128 research needs on, 15 risk of HIV infection among, 131 risk perception by, 133-134, 272 self-efficacy in, 279 sexual behavior of, 11, 111, 129, 130, 132-136, 148, 155, 280, 283 social cleavage of heterosexuals and, 503-504 STD rates among, 272 stereotyping of, 115, 130 stigmatization and victimization of, 27, 114-115, 291, 395-397, 504-505 surveys/studies of, 45, 46, 151-152 see also Gay communities; Homosexual men; Lesbians; Same-gender sex Hospital patients bias in samples drawn from, 35 HIV incidence among, 38 HIV seroprevalence surveys of, 6, 35, 38, 39, 41, 42, 48, 55-56 site selection criteria for surveys of, 48, 55 see also Emergency room patients Human immunodeficiency virus (HIV) discovery of, 128, 130 infectiousness of, 39, 497 - 499 see also HIV infection I Illinois, estimates of IV drug users in, 439 Immune system, infectiousness and deterioration of, 39, 7077 Incidence of AIDS, 4-7, 41, 43 Incidence of HIV infection CDC report on, 34 data collection on, 4 definition, 2 n.4, 33 estimation of, 33-34 among homosexual men, 37, 38, 132 uses of data on, 37, 64, 65 Infants and children birth order, 60 HIV incidence among newborns, 38 maternal antibodies in newborns, 7 n.7, 39 n.11 probability of progressing from HIV infection to AIDS, 43 n.14 seroprevalence surveys of newborns, 6, 7, 38, 39, 52, 57, 5~62 see also Mate~nal-infant transmission; Pediatric AIDS Injection behavior changes in, 202-209, 281 ethnic differences in, 237 frequency of injections, 63, 190, 195-193, 203-204, 208, 223, 431 polydrug use, 196-197 Elf-reports of, 220 sharing drugs without sharing equipment, 195 sharing of equipment, 14, 16, 76, 187, 189-195, 208, 213, 218, 223, 226, 237, 279 skin popping, 193, 431 social aspects of, 190-193, 218 during withdrawal, 192-193, 195, 213 Tnn.cbru~, HIV seroprevalence in, 214 Instituto Familiar de la Raza, outreach activities, 295 Intergovernmental Personnel Appointments, 24 International Conference on AIDS (Fourth), 142, 210 Intervention strategies for HIV/AIDS barriers to implementation of, 23, 109, 274, 275-276 bleach distribution programs, 203-205, 209, 213

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INDEX community role in, 20-21, 264-265, 270, 274, 275-276, 293-297 cost-effectiveness analysis, 471-499; see also Evaluation of intervention strategies data needs for development of, 5 design of, 221, 260, 275, 300, 319-320 effort expended on, 260 escalation of, see Evaluation of intervention strategies implementation of, 18, 321-322 ' information needs for, 19 for IV drug users, 1017, 18, 202-214, 260 length of program, 284 measures of effectiveness of, 5, 205, 322-324 methodological issues, 260 monitoring of, 18 multidisciplinary research on, 25 need for improvement in, 260, 331 objectives of, 319, 34~342 opinion leaders' role in adoption of, 274 outreach activities, 18 n.11, 203, 204, 295 planned variations in, 260, 274, 307-308 poverty and, 26 Project Aware, 145 protocol, 319 psychological and social factors in design of, 109, 274 safer sex programs, 132, 154, 209, 210, 264-265, 270, 279, 286-287, 295 social barriers to, 26-27, 274, 372-399 sterile needle programs, 17, 188, 203-205, 300-302 targeting of, 34, 46, 132, 165, 188, 300, 337-340 treatment of STDs as, 13 uncertainty about, 331-332 see also Behavior change/modification Intravenous (IV) drug use addiction and, 191, 192-193, 195, 198, 200, 226, 299, 431 AIDS and, 16-18, 186-240, 407008 amphetamines, 187, 194, 196, 219, 231, 431, 436, 439-440 cessation, 200 INDEX ~ 577 cocaine, 144, 187, 196, 214, 216, 219, 223, 229, 230, 231, 431, 436, 439 440 consumption patterns, 191, 230-231, 233 contamination sources, 193-195; see also Needles, injection equipment, and other Nonsterile implements data on, 17-18, 234 n.l7 dynamics of, 20~201 family problems and, 191 geographic patterns of, 230 heroin, 63, 144, 187, 190, 196, 198, 199-200, 208, 215-216, 219, 221, 223, 228-233, 431-432, 436 initiation into, 190-191 market forces in, 191 marijuana use and, 187 mechanics of, 193-195 madding of, 231-234 phases of, 226 peer influence and, 191-192, 292-293 pleasure and discomfort in, 191 polydrug, 187, 190197, 217, 229, 230, 231 prevalence of, 219, 225-234 prevention of, 17; see also Drug treatment progrmn~s psychological denial of, 223 research methodologies for, 214-225 role in spread of HIV infection, 16-18, 190200, 431; see also Heterosexual transmission; Maternalinfant tran~nission safer injection programs and, 17, 197 n.5, 203-204, 208, 213 scope of the problem, 225-240 self-reporting of, 221-223, 224, 299 in shooting galleries, 18 n.ll, 135, 192-193, 212, 216 social forces in, 191, 200 sources of information on, 219, 230 sterile needle program and, 20~204, 301-302 traditional research on, 215-217 see also Injection behavior Intravenous (IV) drug users adolescents, 191-192 AIDS cases among, 16, 187 awareness of and knowledge about AIDS, 261

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578 ~ INDEX barriers to data collection on, 233-234 behavior rh~r~ges by, 189, 198, 202-209, 240, 261, 279, 281, 284-285, 287, 292-293, 298-299 behaviors that transmit HIV, 186-187, 189-202, 217-223; see also Injection behavior; Sexual behavior bleach distribution programs, 203-205 childbearing among, 187; see also Maternalinfant transmission; Women condom use by, 198, 210 cooperation as research subjects, 217 data needs on, 187, 188, 189, 200-202, 223-225, 234 definition of, 226-228, 431-435 ax-addicts as outreach workers, 203, 209, 212, 216 HIV incidence among, 38 HIV seroprevalence among, 18, 38, 40, 41, 42 & n.13, 62, 63 n.34, 187, 189, 214, 234-240 friendship networks and intimate relationships, 192, 210, 213 hepatitis transmission among, 188 infections (non-HIV) in, 188-190 intervention strategies for, 16-17, 200, 202-209, 260; see also Drug treatment programs non-AIDS deaths, 32 n.2, 228 n.l3, 234 population characteristics, 189, 198, 221, 232, 235-236, 240, 434-435 population size estimates, 5, 63, 225-226, 227-230; see also Estimation of IV drug use prostitutes, 14, 40, 137, 142, 144, 200 recruitment for studies, 187, 202, 215, 220, 224, 235, 237 reduction of risk among, 202-214 relapse among, 200, 212, 214, 231 reproductive rate of HIV infection in, 77 research needs on, 15, 200-202, 216-217, 232, 407-408 risk of HIV infection among, 14, 17, 144, 186, 217-218, 431 self-help interventions for, 164 sexual behavior of, 18, 76, 166, 187, 192, 197-201, 209-211, 283 sexual partners of, 15, 16, 137, 145, 164, 186, 192, 198-199, 218, 279 sources of information on AIDS, 269 sterile needle programs, 17, 203-205, 301-302 stigmatization of, 27, 211, 237, 298-299 street, 220, 221 surveillance of HIV seroprevalence, 52-54 surveys on behaviors of, 196, 198, 217-222, 230 n.l5; see also Ethnographic studies turnover rates, 230-231, 234 understanding of risk-associated behaviors of, 200-202 J Job Corps program participants and HIV seroprevalence, 35 K Kaposi's sarcoma, 32 n.2, 129 Kinsey studies application to HIV prevalence studies, 10, 74, 8~87 approach, 79, 95 comparability of data from, 95 defects of, 9, 63, 85, 91, 123 definition of sexual contact, 95, 96, 117-118, 413 on female sexual behavior, 79, 100, 117, 419-421 on heterosexual behavior in adolescents and young adults, 88-91, 9095, 100 impact and importance of, 9, 79, 85, 118-119 interviews, 80-82 on male sexual behavior, 10, 74, 79, 115-118, 138, 146, 422 prostitution data, 138, 146 quality of data from, 63, 74, 80~4 of same-gender sexual behavior, 114-118, 122-128 sampling, 82-84, 91 sexual theory in, 79, 85-86, 90-91, 115-116 strengths of, 80 utility of data, 84-85, 450 L Las Vegas, HIV seroprevalence in, 143

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INDEX Legal issues legal status of homosexual behaviors, 395-397 penalties for disclosure of seroprevalence data, 9 protection against discrimination, 9 Lesbians coupled relationships, 111 cultural labeling of, 117 lack of research on, 156-157 national study of, 109, 121 patterns of coupling and affectional relationships, 120, 127 primary relationships, 11, 133, 136 research focus on, 127-128 sexual behavior, 111 see also Homosexual men Los Angeles AIDS cases in, 103, 109 education/outreach program for prostitutes, 145 estimates of IV drug users in, 439-441 HIV seroprevalence in, 40, 143, 235, 238-239 sexual behavior of white and Afro-American women in, 111-113 M Marijuana, 187 Marital status and frequency of sexual contact, 122 and number of sexual partners, 105-107, 560-565 and same-gender sexuality, 122-123, 124-125, 152 Marriage first, age at, 12-13 sexual behavior outside of, 12, 111 see also Cohabitation/coupled relationships Maryland, HIV seroprevalence in, 44 Massachusetts adolescent drug use in, 192 seroprevalence in women of reproductive age, 39 Mass media basis for seroprevalence reports, 36 evaluation of efforts of, 20 role in public education about HIV/AIDS, 19-20, 202, 26& 271, 274 . stigmatization, role in avoiding, 27 Masturbation, 86, 94, 116 Maternal-infant transmission among ethnic/minority groups, 3 intervention strategies for, 18 IV drug use and, 186, 190200 risk of, 7 n.7, 39 n.11, 59 n.31 Menarche, and age at onset of sexual activity, 148 Miami AIDS cases in, 103, 109 HIV seroprevalence rates by high-risk group in, 40, 142-143 Milan, Italy, HIV seroprevalence in, 236 Military applicants AIDS incidence in, 45 n.16 age of, 39 n.10 educational levels of, 36 generalization of HIV test results from, 35, 45 HIV seroprevalence among, 35, 36, 39, 40, 41, 42, 43-45 standardization of testing for, 47 women, 39 Minorities/ethnic groups AIDS cases in, 235 coding for, in surveys, 55 n.29 collaboration with, in research, 25 disproportionate effects of epidemics on, 298, 388-390 in drug treatment programs, 215 health care workers, 25 IV drug use by, 3, 230 overrepresentation in surveys of Job Corps entrants and drug criers, 35, 215 prevalence of HIV infection among, 42, 237, 298 prostitution among, 137, 144, 156 research needs on, 15 same-gender sex, perceptions about, 155-156, 162, 291 see also Racial and ethnic minorities Mississippi, HIV seroprevalence in, 45 Models/modeling of HIV/AIDS adolescent risk of HIV infection, 480492 components model, 62-64 cost-effectiveness, for AIDS prevention, 47~474 dynamic, 479 480 epidemiological model, 62, 64 66, 78, 448-452

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580 ~ INDEX forecasting, calibration of, 34 HIV prevalence, 46 n.l8, 62-66, 78, 440452 IV drug-using population, 227, 231-234 multiplicative model, 449 451 predictive powers of, 233 program effects on HIV transmission, 477-491 proportional model, 448-449 of sexual behavior, 85 of spread of HIV infection, 74, 78 temporal distribution model, 451-452 testing of, 233 Monitoring, see Epidemiological surveys Monogamy, 135-136, 261 Mothers antibodies of, in newborns, 7 n.7 HIV incidence among, 38 ~eroprevalence among, 6, 7, 38 Multicenter AIDS Cohort Studies, 11, 45, 130-131 N National Association of State Alcohol and Drug Abuse Directors, Inc. (NASADAD), 229, 436, 438 National Center for Health Statistics (NCHS), 7 - , 24, 48 National Institute on Allergy and Infectious Diseases (NIAID), 130 National Institute of Child Health and H,lman Development (NICHHD), 102, 103 National Institute on Drug Abuse (NIDA) estimates of IV drug users, 229 National Household Survey on Drug Abuse, 227, 232 National Research Council, Committee for Research in Problems of Sex, 73 National Seroprevalence Survey in drug treatment clinics, 6, 38, 53-54 of childbearing women, 7-8, 39, 59 of newborns, 6, 7, 38, 39, 52, 57, 58-62 sample bias in, 6 n.6, 8 of sentinel hospital patients, 6, 35, 38, 39, 41, 42, 48, 55-56 in STD clinics, 6, 38, 46 in tuberculosis clinics, 6, 57 National Survey of Family Growth, 60, 95, 97, 416-417 Needles, injection equipment, and other unsterile implements contamination sources, 193 - 195 cookers, 194 cotton, 194 decontamination of, 193-195, 203, 205, 213, 264, 287 legal controls on, 190, 192, 193 needles, 194 rinse water, 194-195 sales of drug injection equipment, 203, 299 social context of needle sharing, 190193, 218 sterilized, availability for IV drug users, 190, 204 syringe exchange program, 204-205 syringes, 193-194, 203 see also Injection behavior Nevada, prostitution in, 139 Newark AIDS cases in, 103, 109 IV drug users in, 444 New Guinea, sexual practices in, 160-161 New Jersey outreach and education program for ~~ - prostitutes, 145 seroprevalence surveys, 52 n.23 National Institute for Mental Health (NIMH) multidisciplinary AIDS research centers, 25 same-gender sexuality studies, 120-121 National Institutes of Health (NIH) sex research by, 10, 165 National Opinion Researth Center (NORC), 94, 102, 103, 126 AIDS incidence in, 43, 103, 109 ex-addict outreach programs, 203, 209 HIV seroprevalence in, 38, 44, 45 n.16, 143 New Mexico, rates of unprotected anal intercourse in, 11, 132 New York City AIDS cases in, 103, 109, 129, 202 behavior modification in, 202, 287 birth rates for addicted women, 199-200

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INDEX ~ 581 Greenwich Village, 152 HIV seroprevalence rates in, 38, 40, 44, 46, 146, 214, 235, 236, 238-239, 434 IV drug users in, 196, 197, 229, 232, 235, 261, 287, 434, 441-444 Narcotics Registry, 232, 441 non-AIDs deaths among IV drug users in, 32 n.2, 234 outreach programs in, 209 prostitution and IV drug use in, 137 sales of infection equipment in, 203 same-gender sexual behavior in 131-135 tracking HIV infection in, 129 New York State AIDS incidence in, 43 estimates of IV drug users in, 441043 rates of unprotected anal intercourse in, 11, 132 Nitrites, inhaled, and sexually transmitted disease, 129 o Office of the Assistant Secretary for Health, 21 Opportunistic infections and reporting of AIDS, 32 n.2 Oral-^nal sex, 134 Oral-genital sex condom use for, 132-134 cultural standards for, 86, 161 frequency of, 131 practices, 131, 134, 161 by prostitutes, 141, 146 risk of AIDS from, 133 p Pacific Mental Health Services. Operation Concern, 295 Pediatric AIDS geographic distribution of, 16 and IV drug use, 16, 186 latency period for, 64 n.36 in minorities, 42 Phoenix, education/outreach program for prostitutes, 145 Pneumocystis carsnfi pneumonia, 32 n.2 Presidential Cornrnission on the Human Tlnmumodeficiency Virus Epidemic, recommendations of, 47, 69, 70, 268 Prevalence of AIDS correlation with HIV seroprevalence, 42 data collection on, 4 gender and, 41 race/ethnicity and, 42 Prevalence of HIV infection age and, 41, 146 AIDS cases and, 38, 42-45, 62, 64, 235 barriers to obtaining data on, 8 CDC report on, 34 data collection on, 4, 5-6, 8 definition, 2 n.4, 33 educational level and, 146 and enumeration of high-risk groups, 10 estimates of, 5, 35, 38-45, 54, 63, 65, 74, 234-240, 447, 440452 false positives in testing and, 50 gender and, 41 generalization of data on, 7, 35, 36, 45 geographic variation in, 38, 39, 40, 42-45, 189, 235-239 and health care planning, 5-6 heterogeneity of, accounting for in models, 495-497 incidence of HIV infection and, 62, 64, 65 infectiousness and, 497099 interpretation of data on, 45, 60 methods for estimating, 5, 36-37, 47-50, 56, 62-66 modeling of, 46 n.18, 440452 monitor trends in, 36-37 multiplicative model of, 440451 need for data on, 453 outreach study of, 46 probability of progression to AIDS and, 62, 64 proportional model of, 448 449 race and, 41 ranking of high-risk groups by, 3045; see also specific groups reliability of data on, 5, 6-7 sensitivity analysis of condom efficacy and, 492-494 sources of data on, 34-35, 235, 452-453

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582 ~ INDEX temporal distribution model, 451-452 uncertainties about, 45-47 uses of data on, 34~6, 6070 variation in, 37 - 38 Prevention strategies, see Intervention strategies for HIV/AIDS Project Aware, 145 Proj actions/prediction ~ of AIDS cases, basis for, 59 of AIDS deaths, 2-3 data needs for, 75 impediments to, 74, 103-104. Prostitutes/prostitution and AIDS, 142-145 behavior change by, 211, 290300 CDC studies of, 145 condom use by, 141, 144-145, 146, 211, 300 control of, 136, 130139 crack use by, 144 customers of, 89-90, 97, 137, 138, 140-141, 145-147, 166 data on, 10, 138-140 economic and psychological burdens of, 141-142 ethnic/minority, 40, 140, 144, 156 exits and reentries, 139 female, 14, 40, 46, 136-147, 164, 299-300 HIV incidence among, 38 HIV infection through sexual behavior, 14 HIV seroprevalence among, 38, 40, 46, 142 intervention programs for, 164, 295 arid IV drug use, 14, 40, 137, 142, 144, 166, 199, 236 male, 14, 156, 164, 504 mobility of, 236 motivation for using, 146-147 organization for, 145