While the spread of HIV and AIDS has slowed among a number of groups, the incidence of both continue to rise among intravenous drug users in the United States. Female IDUs and female partners of IDUs are particularly vulnerable to HIV. More than 70% of the female AIDS cases in 1991 were directly linked to intravenous drug use and women now constitute the fastest growing subgroup of IDUs with HIV and AIDS. The continued spread of HIV among IDUs has magnified the need to establish and evaluate treatment modalities which diminish risk among this population. Methadone maintenance remains one of the most efficacious treatment modalities for slowing the spread of HIV and AIDS among IDUs. Methadone maintenance has been found to decrease drug use, needle sharing, high risk sexual activity, and slow the onset of AIDS symptomatology among seropositive IDUs. However, problems recruiting opiate addicts into treatment and in retaining clients enrolled in treatment have diminished the potential impact of methadone maintenance in slowing the spread of AIDS. Two potential barriers to recruiting opiate injectors into methadone programs and to retaining IDUs in treatment are the rising cost of methadone maintenance and gender-specific life experiences such as a sexual and domestic assault. The first major aid of the proposed continuation of """"""""I.V. Drug Use, Methadone Maintenance and AIDS"""""""" is to examine the impact of public defunding and the cost of methadone maintenance on IDUs in and out of treatment. The second major aim of the proposed continuation is to explore the reasons for increased HIV risk among female IDUs relative to their male counterparts and to examine gender-specific barriers to methadone maintenance. Employing a primarily quantitative methodology, five waves of data collection from 233 IDUs in and out of treatment initiated during the current project will be completed and used to test a number of key hypotheses concerning: the relationship between the cost of methadone and recruitment and retention; the relationship between gender and HIV risk; and the relationship between gender and recruitment into and attrition from methadone maintenance. Multiple and logistic regression techniques will be used to test within time hypotheses and two-way repeated measures analysis of co-variance procedures will be employed to test over-time models. Qualitative data will also be used to glean a fuller understanding of the relationship between the cost of methadone; maintenance and recruitment and attrition and to examine the nature of the gender-HIV risk and gender-treatment status relationships.
