History of Traumatic Abuse and HIV Risk Behaviorsin Severely Mentally Ill Substance Abusing Adults

Epidemiological studies in the United States estimate HIV seroprevalence rates ranging between 4% and 23% for serious mentally ill adults (SMIA; i.e., schizophrenia, bipolar disorder, and other chronic disorders with psychotic features), with substantially greater estimates for risky sexual behaviors. Among the most consistent factors linked to HIV risk in non-SMIA populations is a history of emotional, physical, or sexual abuse. The current study examined the intersection of abuse history and HIV sexual risk behavior in SMIAs with a group of men (n = 64) and women (n = 115) recruited from eight geographically diverse and representative clinical sites around Florida. A cross-sectional interview revealed a high prevalence of alcohol and other drugs problems, as well as a history of emotional, physical, or sexual abuse in 75% of the participants, with 68% of these reporting multiple types of abuse. Compared to nonabused counterparts, those with a history of abuse reported significantly greater: (a) lifetime and current psychiatric symptoms, (b) recent unprotected sexual intercourse, and (c) crack cocaine, heroin, and marijuana use. No gender differences were detected in the associations of abuse history and sexual risk behaviors. These results underscore the need for HIV prevention efforts targeted to SMIAs and the critical importance of addressing abuse history in interventions with this underserved population.     

INCREASING PRODUCTIVITY OF GOVERNMENT'S RELIANCE UPON OUTSIDE ORGANIZATIONS TO PROVIDE ANALYSIS AND MANAGEMENT SERVICES

The federal government spends vast sums of money for management and analysis services. The authors contend that the selection process to determine the winners of the awards of contracts to perform these services too often disregards cost competitiveness as a factor in the award. The relative importance of technical proficiency and cost are examined and a model is proposed whereby a high level of technical expertise can be obtained at a more reasonable cost.     

Members of the Society for the Reform of Criminal Law, 1992–1993

Members of the Society for the Reform of Criminal Law, 1992–1993     

Reflections Tornatzky writes first commentary for journal

Editorial Advisory Board