VALIDITY OF INTRAVENOUS DRUG-ABUSERS SELF-REPORTED CHANGES IN HIV HIGH-RISK DRUG-USE BEHAVIORS

The HIV-1 high-risk drug use behavior of intravenous drug abusers was assessed both retrospectively (for 6 months) and prospectively (for 6 months) via structured interview and urinalysis testing. Subjects were 281 intravenous drug abusers, 146 enrolled in outpatient methadone tr eatment (Treatment group) and 135 not in treatment (Community group). The Treatment group reported fewer drug injections and less needle sha ring and had fewer positive urinalyses for opiates and cocaine than di d the Community group. Reported drug injection and needle sharing decl ined over time, and an increasing proportion of subjects reported abst inence from these behaviors. In contrast to the behavioral reports of subjects, positive urinalyses indicating opiate and/or cocaine use did not decline over time. Almost half(45.8%) of the reported increase in injection abstinence from intake to month six was disconfirmed by uri nalysis. In contrast to this large discrepancy regarding reported beha vior change, there was good agreement between reported injection absti nence and urinalysis results at single points in time. These data indi cate that the validity of the reported HIV-1 risk behavior change of d rug abusers may be less than that of reported risk behavior occurrence . The data raise important questions about the validity of reported re ductions in high-risk drug use behaviors, and indicate the importance of using biological indicators of HIV-1 risk behavior (such as urinaly sis) whenever possible.