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Alaska Justice Statistical Analysis Center |
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Andrea M. Fenaughty, Holly A. Massay, and Dennis G. Fisher
As part of an extensive study
of drug users, AIDS, and HIV, the virus that causes AIDS, researchers
at the University of Alaska Anchorage have assembled data measuring
the risk perceptions of individuals in Anchorage who are at some
actual risk for contracting HIV. These data may have some implications
for correctional systems. Inmates appear to be at increased actual
risk of HIV infection because of the nature of prison life. During
confinement inmates have less access to clean needles or condoms
than the general population, yet research indicates that within
prisons, despite efforts at control, illicit drug use and sexual
activity continue. Other research indicates that HIV seroprevalence
rates among incoming inmates in U.S. correctional facilities
are high compared to rates for the general public (Table 1).
Early HIV prevention efforts revealed
that information alone was not enough to effect the changes in
behavior necessary to slow the spread of the disease. Beyond
a certain level, increasing what a person knows about AIDS does
not seem to affect behavior. This finding led researchers to
look for other factors related to behavior change.
One promising variable is risk
perception. Several theories of health behavior suggest that
it is an individual's perception of risk rather than the actual
risk involved that determines behavior. Hence it is important
to assess the risk perception of those at greatest actual risk.
The UAA study sought to determine
factors related to the perceived risk of AIDS among a sample
of drug users from the Municipality of Anchorage. Information
obtained from 1002 users participating in the study between October
1991 and April 1994 was examined. All participants were eighteen
or older, showed evidence of recent drug use (through positive
urinalysis or needle marks) and had not been in treatment during
the preceding thirty days. Males were 69 per cent of the sample;
females, 31 per cent. Forty-one per cent were Caucasian (non-Hispanic);
36 per cent were Black (non-Hispanic); 17 per cent, Alaska Native
or American Indian; and 6 per cent, Hispanic, Asian, Pacific
Islander or unknown. Seventy per cent of the sample had been
arrested at least once.
Participants were classified according
to actual AIDS risk associated with drug use. Those who had injected
a drug any time during the previous month (IDUs) were classified
as high risk -- 30 per cent; all others (non-IDUs) were classified
as low risk for drug behavior. (The 70 per cent who were non-injectors
were primarily crack smokers.)
Participants were also classified
according to sexual behavior. Higher actual risk from sexual
behavior was associated with more partners, more IDU partners
and less condom use.
To determine their level of risk
perception, participants were asked what they believed their
chance of contracting AIDS was. Almost three-quarters of the
subjects reported either "no chance" or "some
chance" of contracting the disease -- and were classified
as having low risk perception. Those reporting their risk as
"half" chance or "high" chance were classified
as having high risk perception. (The overall low perception of
risk among study participants may be due to the relatively low
HIV seroprevalence in Anchorage.)
The actual risk variables were
then analyzed in conjunction with the risk perception variables,
both individually and in combination. The results show that higher
risk perception was associated with higher actual risk, when
the variables were analyzed singly; that is, those who were IDUs,
those who had more sex partners, or those who had more IDU sex
partners, were more likely to see themselves at higher risk.
In addition, those individuals who had been arrested more than
once perceived themselves at higher risk for HIV infection. (This
perception may be related to the fact that arrest often results
in incarceration, and perception of risk may grow during incarceration.
Also, those engaging in the riskiest behavior may be more likely
to be arrested.)
When actual risk variables were
analyzed in combination, IDUs, individuals with multiple sex
partners, and people with more than one arrest were more likely
to perceive themselves at high risk of HIV infection.
These results of the analysis suggest
that, overall, while perceived risk of HIV infection is low,
the level of perception is related to actual risk from both drug
use and sexual behavior among this sample of drug users in Anchorage.
This may be encouraging from a prevention standpoint if, as theorists
suggest, those who perceive themselves at risk are most likely
to change their behavior.
However, one result from the analysis
was more worrisome. IDUs, considered as a group solely on this
variable, did not exhibit an increased perception of risk in
association with an increase in the number of sexual partners,
although they did recognize the increased danger associated with
their drug usage patterns. Perhaps compared to the elevated risk
IDUs perceive from their injection drug use, the added danger
from having multiple sex partners appears negligible. Hence,
prevention programs targeting IDUs might emphasize the risk associated
with unsafe sexual behavior without minimizing that incurred
from injecting drugs.
The significance of these findings
depends upon the nature of the relationship between perception
of risk and behavior change. Research examining this link and
refining the picture of those at most risk can contribute to
further development of AIDS prevention programs aimed at drug-users
or other groups, including those within the correctional system.
Andrea M. Fenaughty is a post-doctoral fellow with the University of Alaska Anchorage. Holly A. Massay is a graduate student in clinical psychology. Dennis G. Fisher is an associate professor in the Department of Psychology at University of Alaska Anchorage.
The Anchorage study cited in
the accompanying article is part of a national five-year community-based
AIDS research project. Researchers on the project, which is being
funded by the National Institute on Drug Abuse, are assembling
data on drug users and AIDS at over twenty-five sites throughout
the country. In addition to the risk perception data discussed
in the Forum article, researchers are looking at many other variables
which may be involved in the transmission of the disease, including
sexual practices, reading level, and demographic variables.
Interviews with subjects form the
main source of data. Participants join the study on a volunteer
basis, receiving a nominal sum in compensation for participation
at each stage. Currently, the participant group continues to
expand, with data being collected on each subject for as long
as possible for the duration of the study. Through the use of
standardized questionnaires the same types of information are
being collected at all study sites. Researchers at individual
sites may also collect data suggested by the particulars of that
locale. Drug Abuse Field Stations have been established within
study communities to provide interview, clinic and education
facilities easily accessible to participants.
The project includes a preventive
intervention component which involves education, counseling and
distribution of free AIDS prevention supplies, such as condoms.
Because HIV seroprevalence rates
within the Anchorage study group, and in the Alaska population
as a whole, are low in comparison to those at other study sites
-- such as those in New York or San Francisco -- the Anchorage
study can be a source of significant information on the results
of the preventive intervention effort. (Currently, only twenty-three
of over twelve hundred respondents in the Anchorage group are
HIV positive -- a prevalence rate of under 2%.)
In addition, the participation
of a higher number of American Indians and Alaska Natives than
at other sites is facilitating the acquisition of important data
about this population.
Dr. Dennis Fisher of the Psychology
Department at UAA heads the Anchorage study.