Over the past decade, intravenous drug users (IDUs) have surprised policy makers and researchers by exhibiting large-scale HIV risk reduction, despite the fact that the majority of drug injectors axe unwilling or unable to enter formal drug treatment. Needle exchange programs offer direct contact with drug users who have initiated HIV risk reduction. The maintenance of risk reduction among out-of-treatment IDUs has never been studied. In the present study we suggest that the presence of depression among needle exchangers who have gone at least six months without sharing injection equipment places them at risk for a return to unsafe drug injection behaviors. Using a randomized, controlled design, enrolling 265 needle exchange clients in Providence, Rhode Island, this study provides the opportunity to treat the patient's depressive symptoms and thereby further sustain HIV risk reduction. The Primary Aim of the present application is: To test if treatment for depression using antidepressant medication will maintain safe injection behaviors among needle exchange clients compared to a treatment-as-usual condition. The Secondary Aim is: To determine if antidepressant medication treatment will reduce depressive symptom scores compared to the treatment-as-usual condition. The Tertiary Aims are: 1) To determine if reduction in depressive symptoms is associated with maintenance of safe injection behaviors, and 2) To describe specific patient characteristics associated with maintenance of safe injection behaviors. Given that many injection drug users (IDUs) continue to inject drugs over decades, maintaining HIV risk reduction is a critical public health problem. Our results will have policy implications for needle exchange programs where many IDUs have initiated HIV risk reduction.
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| Lagu, Tara; Anderson, Bradley J; Stein, Michael (2006) Overdoses among friends: drug users are willing to administer naloxone to others. J Subst Abuse Treat 30:129-33 |
| Stein, Michael D; Anderson, Bradley J; Lassor, Joanna et al. (2006) Receipt of disability payments by substance users: mental and physical health correlates. Am J Addict 15:160-5 |
| Rosengard, Cynthia; Anderson, Bradley J; Stein, Michael D (2006) Correlates of condom use and reasons for condom non-use among drug users. Am J Drug Alcohol Abuse 32:637-44 |
| Hayaki, Jumi; Stein, Michael D; Lassor, Joanna A et al. (2005) Adversity among drug users: relationship to impulsivity. Drug Alcohol Depend 78:65-71 |
| Stein, Michael D; Anderson, Bradley J; Solomon, David A et al. (2005) Reductions in HIV risk behaviors among depressed drug injectors. Am J Drug Alcohol Abuse 31:417-32 |
| Stein, Michael D; Solomon, David A; Anderson, Bradley J et al. (2005) Persistence of antidepressant treatment effects in a pharmacotherapy plus psychotherapy trial for active injection drug users. Am J Addict 14:346-57 |
| Stein, Michael D; Solomon, David A; Herman, Debra S et al. (2004) Pharmacotherapy plus psychotherapy for treatment of depression in active injection drug users. Arch Gen Psychiatry 61:152-9 |
| Stein, Michael D; Herman, Debra S; Solomon, David A et al. (2004) Adherence to treatment of depression in active injection drug users: the minerva study. J Subst Abuse Treat 26:87-93 |
| Stein, Michael D; Solomon, David A; Herman, Debra S et al. (2003) Depression severity and drug injection HIV risk behaviors. Am J Psychiatry 160:1659-62 |
