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Biomedical subjects

S Strathdee

Publications and source records attributed to S Strathdee.

8 recordsLinked to original sources
PubMed1999

Use of incentives to increase compliance for TB screening in a population of intravenous drug users. Vancouver Injection Drug Use Study Group.

SETTING: Intravenous drug users (IDUs) represent a high risk group for dual human immunodeficiency virus (HIV) and tuberculosis (TB) infection. Screening with TB skin testing has therefore been suggested in this group. Subjects' compliance for returning to have TB skin test results read is a major problem. In the setting of a needle exchange program we evaluated the role of financial incentives to increase compliance. METHODS: We evaluated the role of giving a small financial incentive of Can $5 to subjects if they returned to have their purified protein derivative (PPD) skin test read. IDUs who had previously been skin-tested were compared with IDUs drawn from a similar population who, prospectively, were offered a financial incentive. RESULTS: During the initial period 558 subjects were evaluated and no incentive was offered. During the second phase of the study 549 IDUs were assessed but were also offered Can $5 if they returned to have their skin test read. Use of incentives increased compliance from 43% to 78% (P = 0.001). During the same period three active cases of TB were also diagnosed. CONCLUSIONS: We suggest that use of financial incentives can increase the return of IDUs to have their skin tests read. Further studies are required to assess the efficacy of follow-up interventions, especially the use of isoniazid chemoprophylaxis.

Adult↗
PubMed1997

Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994.

Trends in sexual behavior associated with incident infection with human immunodeficiency virus (HIV) type 1 are described and a case-control study was conducted to examine risk factors for HIV seroconversion in homosexual men who became infected with HIV between 1982 and 1994 from four geographic sites: Amsterdam, the Netherlands; San Francisco, California; Vancouver, Canada; and Sydney, Australia. Changes in sexual behaviors were evaluated from cohort visits in the preseroconversion, seroconversion, and postseroconversion intervals and were further examined over three time periods: 1982-1984, 1985-1987, and 1988-1994. In a case-control study, sexual behaviors, substance use, and presence of sexually transmitted disease were compared between 345 HIV-positive cases and 345 seronegative controls matched by visit date and site. Receptive anal intercourse was the sexual behavior most highly associated with seroconversion. The odds ratio (OR) per receptive anal intercourse partner increase was 1.05 (95% confidence interval (CI) 1.02-1.09). To more carefully examine risk associated with receptive oral intercourse, analyses were done in a subgroup of men who reported no or one receptive anal intercourse partner. The risk (OR) associated with receptive oral intercourse partner increase was 1.05 (95% CI 1.0-1.11). In multivariate conditional logistic regression analyses, presence of sexually transmitted disease (OR = 3.39, 95% CI 1.95-5.91) and amphetamine use (OR = 2.55, 95% CI 1.26-5.15) were independently associated with seroconversion. Although the prevalence of major risk factors has decreased over time, the associations of these behaviors and HIV infection persist, suggesting that these risk behaviors remain important avenues for public health interventions.

Adult↗
PubMed1995

A comparison of the determinants of safe injecting and condom use among injecting drug users.

A sample of 582 injecting drug users were interviewed as part of an evaluation of an AIDS prevention programme for drug users. This paper examines the biographic and predispositional determinants of five HIV preventive behaviours--equipment sharing (not receiving and not giving) and and condom use (with regular partners, casual partners and sex clients). A two-stage sequential approach was adopted for a logistic regression analysis. Initially, to model each of the five preventive behaviours, biographical and drug use variables were entered. In a second set of models, behavioural predisposition factors were included. Age, drug use and prison experience correlate with variables in both models, although not consistently in the same direction. While a predisposition to reject sharing correlates with safer rejecting and condom use, the predisposition to safer sex only correlates with condom use. Needle exchange programmes that only target the individual would seem to be inadequate. To enhance targeted interventions changes in public and agency policy that create a social environment conductive to behaviour change are required.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The Met repressor-operator complex: DNA recognition by beta-strands.

The crystal structure of the E. coli met repressor in complex with a synthetic 19-base pair oligonucleotide reveals two dimeric repressor molecules bound to adjacent sites on the DNA. The oligonucleotide contains two adjacent repeats of an 8-mer known as a met-box, which represents the consensus of the met operator sites. Each met repressor dimer is centered on a met box and interacts with the adjacent dimer through antiparallel alpha-helices, which explained the observed cooperative nature of the binding. DNA binding takes place through the insertion of a beta-ribbon into the major groove of B-form DNA, representing a novel DNA binding motif. Sequence specificity arises from direct interactions between side chains of the beta-strands and the edges of the bases in the major groove. The local DNA conformation confers additional specificity through interactions between protein and the phosphate backbone. The repressor is activated through binding of S-adenosyl methionine (SAM), the corepressor, to the face opposite to that used for DNA binding. The lack of significant conformational change upon SAM binding, together with electrostatic calculations, suggests that DNA binding enhancement occurs through long-range electrostatic interactions.

Bacterial Proteins↗
PubMed1994

Indirect costs of HIV/AIDS mortality in Canada.

OBJECTIVE: To estimate and compare the societal impact of HIV infection and AIDS with other selected causes of male mortality in terms of the indirect costs of future production lost. DESIGN: Descriptive, population-based economic evaluation study. PATIENTS: All men aged 25-64 years for whom HIV/AIDS or another selected disease was listed as the underlying cause of death in Canada from 1987 to 1991, as reported to Statistics Canada. SETTING: Canada. MAIN OUTCOME MEASURES: Present value of future earnings lost for men using a human capital approach based on potential years of life lost in men aged 25-64 years. RESULTS: Assuming a 2% annual growth in earnings and a 3% annual real discount rate, the present value of the total loss of future production for all men aged 25-64 years who died in Canada during 1987-1991 was estimated to be 39.74 billion 1990 US$. Deaths due to HIV/AIDS accounted for 5.3% of this total loss or 2.11 billion in 1990 US$. Future production loss due to HIV/AIDS more than doubled during the period from 1987 to 1991, from 0.27 to 0.60 billion 1990 US$. The loss in future earnings attributable to HIV/AIDS was exceeded only by that of ischaemic heart disease (15.2%), suicide (9.4%), motor vehicle accidents (6.6%), and lung cancer (6.6%). In total, these five causes of death accounted for 43.1% of the total indirect cost of production lost for men aged 25-64 years during the 5-year period. CONCLUSION: Our findings demonstrated HIV/AIDS mortality is already having a dramatic impact on future wealth production in Canada. If the past trend continues, the production lost in 1994 should exceed 0.86 billion 1990 US$ and will account for more than 10% of the total annual loss for men aged 25-64 years.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Prevalence of human immunodeficiency virus and associated risk behaviour in injection drug users in Toronto.

During 1989-90, interviews were conducted with 582 current injection drug users in the City of Toronto, 535 of whom also provided blood and/or saliva for anonymous unlinked HIV antibody testing. The rate of seropositivity identified was 4.3% (95% CI 3-6). The subjects were predominantly male, with a mean age of 28.3. The commonest drug of choice was cocaine (70%). Forty-six percent of the subjects reported using someone else's needle in the preceding six months, 60% of these indicating that they always cleaned it first. Eighty-one percent of those interviewed had been in jail at some time since they began injecting; 25% of these had injected while in custody, and of these 61% had shared injection equipment. Eighty-two percent of the men and 85.4% of the women reported opposite sex partners in the previous six months. Only about 20% of men reported consistent condom use, while 22% of females reported condom use at least 75% of the time.

Adolescent↗
PubMedDate not supplied

HIV-positive women living in the metropolitan Toronto area: their experiences and perceptions related to HIV testing. The HIV Women's Study Group.

Forty HIV-positive women from diverse socioeconomic backgrounds were interviewed. Most (90%) did not perceive themselves to be at risk of HIV infection prior to knowing their HIV-positive status. The majority (61%) were tested because they developed symptoms, or because someone with whom they were intimate, or their child, tested positive for HIV or became ill. The majority (93%) of the women interviewed indicated that they did not receive both pre- and post-test counselling. The findings from this study suggest that encouraging individuals to be tested if they have engaged in "at risk" activities will not be appropriate for individuals who have no perception of risk, and other strategies to encourage appropriate testing may be needed. This research also suggests that continued emphasis needs to be placed on the counselling process, and that consideration may need to be given to multiple counselling sessions to ensure individuals clearly understand the information provided.

AIDS Serodiagnosis↗