AIDS and Behavior

, Volume 16, Issue 6, pp 1472–1481 | Cite as

Correlates of Staying Safe Behaviors Among Long-Term Injection Drug Users: Psychometric Evaluation of the Staying Safe Questionnaire

  • Peter Vazan
  • Pedro Mateu-Gelabert
  • Charles M. Cleland
  • Milagros Sandoval
  • Samuel R. Friedman
Original Paper


We report on psychometric properties of a new questionnaire to study long-term strategies, practices and tactics that may help injection drug users (IDUs) avoid infection with HIV and hepatitis C. Sixty-two long-term IDUs were interviewed in New York City in 2009. Five scales based on a total of 47 items were formed covering the following domains: stigma avoidance, withdrawal prevention, homeless safety, embedding safety within a network of users, and access to resources/social support. All scales (α ≥ .79) except one (α = .61) were highly internally consistent. Seven single-item measures related to drug use reduction and injection practices were also analyzed. All variables were classified as either belonging to a group of symbiotic processes that are not directly focused upon disease prevention but nonetheless lead to risk reduction indirectly or as variables describing prevention tactics in risky situations. Symbiotic processes can be conceived of as unintentional facilitators of safe behaviors. Associations among variables offer suggestions for potential interventions. These Staying Safe variables can be used as predictors of risk behaviors and/or biological outcomes.


Staying safe Symbiotic goals Prevention tactics Injection drug users HIV Hepatitis C 


Informamos sobre las propiedades psicométricas de un nuevo cuestionario para estudiar estrategias a largo plazo, prácticas y tácticas que pueden ayudar a usuarios de drogas inyectables (UDI) a evitar la infección de VIH y hepatitis C. Se entrevistaron sesenta y dos UDI en Nueva York en 2009. Se desarrollaron cinco escalas basadas en un total de 47 elementos cubriendo las siguientes áreas: evitar el estigma; prevención del síndrome de abstinencia; protección de infección cuando sin hogar; incorporación de protección dentro de redes de usuarios y acceso a recursos/apoyo social. Las escalas presentaron coherencia interna (rango alfa de Cronbach: .61 a .86). Todas las escalas (α ≥ .79) excepto una (α = .61) presentaron alta coherencia interna. Siete medidas de variable única relacionadas con la reducción del consumo de drogas y las prácticas de inyección también se analizaron. Todas las variables fueron clasificadas como pertenecientes a procesos simbióticos que no están directamente enfocados en la prevención de infecciones pero, sin embargo, conducen a la reducción del riesgo indirectamente, o como variables que describen tácticas de prevención en situaciones de riesgo. Procesos simbióticos pueden ser concebidos como facilitadores involuntarios de comportamientos seguros. Las asociaciones entre las variables ofrecen sugerencias para posibles intervenciones. Estas variables para “permanecer protegido” (Staying Safe) puede ser utilizadas como predictores de conductas de riesgo y/o resultados biológicos.

Palabras clave

“permanecer protegido” objetivos simbióticos tácticas de prevención usuarios de drogas inyectables VIH hepatitis C 


  1. 1.
    Friedman SR, Mateu-Gelabert P, Sandoval M, Hagan H, Des Jarlais DC. Positive deviance control—case life history: a method to develop grounded hypotheses about successful long-term avoidance of infection. BMC Public Health. 2008;8:94–103.PubMedCrossRefGoogle Scholar
  2. 2.
    Friedman SR, Sandoval M, Mateu-Gelabert P, Meylakhs P, Des Jarlais DC. Symbiotic goals and the prevention of blood-borne viruses among injection drug users. Subst Use Misuse. 2011;46(2–3):307–15.PubMedCrossRefGoogle Scholar
  3. 3.
    Mateu-Gelabert P, Treloar C, Agullo V, Sandoval M, Valderrama JC, Maher L, et al. How can hepatitis C be prevented in the long-term? Int J Drug Policy. 2007;18:338–40.PubMedCrossRefGoogle Scholar
  4. 4.
    Mateu-Gelabert P, Sandoval M, Meylakhs P, Wendel T, Friedman SR. Strategies to avoid opiate withdrawal: implications for HCV and HIV risks. Int J Drug Policy. 2010;21(3):179–85.PubMedCrossRefGoogle Scholar
  5. 5.
    Mateu-Gelabert P, Maslow C, Flom PL, Sandoval M, Bolyard M, Friedman SR. Keeping it together: stigma, response, and perception of risk in relationships between drug injectors and crack smokers, and other community residents. AIDS Care. 2005;17:802–13.PubMedCrossRefGoogle Scholar
  6. 6.
    Bourgois P. The moral economies of homeless heroin addicts: confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments. Subst Use Misuse. 1998;33:2323–51.PubMedCrossRefGoogle Scholar
  7. 7.
    Friedman SR, Maslow C, Bolyard M, Sandoval M, Mateu-Gelabert P, Neaigus A. Urging others to be healthy: “intravention” by injection drug users as a community prevention goal. AIDS Educ Prev. 2004;16(3):250–63.PubMedCrossRefGoogle Scholar
  8. 8.
    Mateu-Gelabert P, Bolyard M, Maslow C, Sandoval M, Flom PL, Friedman SR. For the common good: measuring residents’ efforts to protect their community from drug- and sex-related harm. J Soc Asp HIV/AIDS. 2008;5(3):144–57.CrossRefGoogle Scholar
  9. 9.
    Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.CrossRefGoogle Scholar
  10. 10.
    Kopalle PK, Lehmann DR. Alpha inflation? The impact of eliminating scale items on Cronbach’s alpha. Organ Behav Hum Decis Process. 1997;70:189–97.CrossRefGoogle Scholar
  11. 11.
    Koning AJ, Franses PH. (2003). Confidence intervals for Cronbach’s coefficient alpha values. ERIM Report Series Reference No. ERS-2003-041-MKT. Available at Erasmus University, Rotterdam
  12. 12.
    R Development Core Team (2011). R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. ISBN 3-900051-07-0.
  13. 13.
    Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B. 1995;57:289–300.Google Scholar
  14. 14.
    Clark LA, Watson D. Constructing validity: basic issues in objective scale development. Psychol Assess. 1995;7:309–19.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Peter Vazan
    • 1
  • Pedro Mateu-Gelabert
    • 1
  • Charles M. Cleland
    • 2
  • Milagros Sandoval
    • 1
  • Samuel R. Friedman
    • 1
  1. 1.National Development and Research Institutes, Inc.New YorkUSA
  2. 2.NYU College of NursingNew YorkUSA

Personalised recommendations