Heroin Maintenance: The Issues

Abstract

This article aims to assess the influence of the need to inject and drug withdrawal on drug injectors' perceptions of human immunodeficiency virus (HIV) risk behavior inside and outside prison. Complementary qualitative research methods were used with 24 drug injectors in England. It was found that when sterile injecting equipment was unavailable the need to inject and drug withdrawal were important factors on the reported readiness to share injecting equipment. This finding was broadly consistent both outside and inside prison. However, different patterns of responses between these two environments were influenced by the social context in which HIV risk was considered. These perceptions of HIV risk are situationally specific, but the influence of the need for a drug injection and drug withdrawal on HIV risk behavior transcends social settings. Thus, HIV risk reduction strategies should be consistent outside and inside prison.     

“Friendships Are a Big Part of It”: Social Relationships,Social Distance,and HIV Risks

Social distance, or how close or distant individuals consider others, is an important influence on drug injectors' HIV risk behavior. Qualitative in-depth interviews with a vignette were employed with a sample of drug injectors in England to explore the influence of social distance on HIV risk behavior. Analysis of these data distinguish between close and distant relationships in sexual behavior in the community and in drug-injecting behavior inside prison. These findings help to expose the constituents of social distance in relation to drug injectors' perceptions of HIV risk, which are discussed throughout this paper.     

"When you're using gear you put HIV to the back of your mind and forget about it": constructs of risk

This article presents findings from a qualitative study concerning drug injectors' constructs of human immunodeficiency virus (HIV) risk behavior. Analysis of data obtained from in-depth interviews (some with a vignette) of drug injectors found that when individuals needed an injection of drugs and were experiencing drug withdrawal they were more likely to take drug injecting risks. This was often discussed within an overall preoccupation with drug use. The substantive focus of the analysis goes on to explore drug injectors' desire to think about the consequences of HIV risk behavior at a later point in time. These exploratory findings highlight how further research needs to be undertaken in order to improve understanding of the temporal issues concerning drug injecting HIV risk behavior.     

Socio-demographic factors,health risks and harms associated with early initiation of injection among people who inject drugs in Tallinn,Estonia: Evidence from cross-sectional surveys

AimTo explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia.MethodsIDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation.ResultsA total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (n = 156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity.ConclusionsOur results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs.     

Drug use and the risk of HIV infection amongst injection drug users participating in an HIV vaccine trial in Bangkok, 1999–2003

BackgroundHIV spread rapidly amongst injecting drug users (IDUs) in Bangkok in the late 1980s. In recent years, changes in the drugs injected by IDUs have been observed. We examined data from an HIV vaccine trial conducted amongst IDUs in Bangkok during 1999–2003 to describe drug injection practices, drugs injected, and determine if drug use choices altered the risk of incident HIV infection.MethodsThe AIDSVAX B/E HIV vaccine trial was a randomized, double-blind, placebo-controlled trial. At enrolment and every 6 months thereafter, HIV status and risk behaviour were assessed. A proportional hazards model was used to evaluate demographic characteristics, incarceration, drug injection practices, sexual activity, and drugs injected during follow-up as independent predictors of HIV infection.ResultsThe proportion of participants injecting drugs, sharing needles, and injecting daily declined from baseline to month 36. Amongst participants who injected, the proportion injecting heroin declined (98.6–91.9%), whilst the proportions injecting methamphetamine (16.2–19.6%) and midazolam (9.9–31.9%) increased. HIV incidence was highest amongst participants injecting methamphetamine, 7.1 (95% CI, 5.4–9.2) per 100 person years. Injecting heroin and injecting methamphetamine were independently associated with incident HIV infection.ConclusionsAmongst AIDSVAX B/E vaccine trial participants who injected drugs during follow-up, the proportion injecting heroin declined whilst the proportion injecting methamphetamine, midazolam, or combinations of these drugs increased. Controlling for heroin use and other risk factors, participants injecting methamphetamine were more likely to become HIV-infected than participants not injecting methamphetamine. Additional HIV prevention tools are urgently needed including tools that address methamphetamine use.     

Quantitative and Qualitative Methods to Assess Behavioral Change Among Injection Drug Users

SUMMARY

The risk injecting drug users (IDUs) have for contracting the human immunodeficiency virus (HIV) led to governmental requests for interventions to prevent its spread. At the same time there was an urgent need to evaluate the effectiveness of these proposed interventions. We believe that both quantitative and qualitative research methods should be employed in this effort. In this paper we discuss the differences between the two approaches, how they can complement one another, and present findings derived from their joint application to a particular risk behavior, needle sharing. Despite behavioral changes in a number of high risk activities, significant reductions in borrowing syringes were not reported by participants in structured interviews. Evidence obtained through participant observation and open-ended interviews indicated Colorado's paraphernalia law may have played a major role in encouraging this behavior.     

Differences Found Between Women Injectors In and Out of Treatment: Implications for Interventions

SUMMARY

Women substance abusers, particularly those who are injecting drug users, are at high risk for HIV infection. It has been demonstrated that injecting drug users found out of drug treatment settings show different patterns of drug use and HIV risk than those who enter treatment. Previous studies, however, have not indicated the extent to which women injectors in and out of treatment exhibit these same differences. This study examines data from two studies sponsored by the National Institute on Drug Abuse to determine similarities and differences between women encountered by outreach efforts in four cities and those entering methadone treatment programs in the same cities.

The results indicate significant differences in race, drugs used (both injecting and non-injecting), injecting risk behavior, and treatment history. However, the two groups of women shared similar histories of first injecting use and sexual risk. Women who entered methadone treatment reported higher frequencies of injecting drug use and HIV risk behaviors, both direct (sharing needles) and indirect (sharing cookers, cotton, and water); yet they were also more likely to clean needles and to use new needles than the women encountered through outreach. The outreach women were more likely to be African American, to inject less than daily, and to use alcohol, crack, and non-injecting cocaine daily.

The results suggest that women injectors entering treatment and those encountered in outreach are very different in their injecting intensity and HIV risk behaviors. However, both groups are still at risk for HIV infection, particularly as a result of multiple sexual partners and little reported condom use. The need to identify the risk, reinforce risk reduction maintenance, and further develop HIV prevention strategies that successfully address both the needs of these women and the differences that exist between them will be essential to stopping the spread of HIV.     

Drug use and risk behaviour profile,and the prevalence of HIV,hepatitis C and hepatitis B among people with methamphetamine use in Iran

BackgroundStimulants substances use, particularly methamphetamine use, is increasing globally, including in Iran. This study assessed the drug use and risk behaviour profile, and prevalence of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) among a large population using methamphetamine as their primary drug in Iran.MethodsThis cross-sectional study was conducted in eight provinces of Iran. Individuals using methamphetamine for ≥3 months during the past three years, with no life-time history of injecting opioid drugs were enrolled. Drug use and risk behaviour data were collected through interviews. Blood samples were tested for HIV antibodies (HIV Ab), HCV antibodies (HCV Ab), and HBV surface antigen (HBs Ag).ResultAmong 567 participated, 84% were men and mean age was 36 years. Smoking with pipe was the most common method of methamphetamine use (53%), while 13% had a history of injecting methamphetamine, among whom 30% shared needles or syringes. Among those having sex during intoxication phase (n = 270), 48% never used condom. The prevalence of HIV Ab, HCV Ab and HBs Ag was 6.7% (95%CI: 4.7–9.1), 19.4% (95%CI: 16.2–22.9) and 1.4% (95%CI: 0.6–2.7), respectively. Age ≥ 30 years (adjusted OR [aOR]: 2.10, 95%CI: 1.18–3.76), lower education (high school vs. tertiary education, aOR: 13.95, 95%CI: 1.90–102.60), and injecting methamphetamine (aOR: 1.92, 95%CI 1.10–3.35) were significantly associated with HCV exposure. No factor was found associated with HIV infection. Among those reporting no potential injecting or sexual risk factors, 19.8% and 6.8% have HCV Ab positive and HIV Ab positive, respectively.ConclusionHigh prevalence of injecting and sexual risk behaviours, HIV infection and HCV exposure were found among individuals using methamphetamine as their primary drug, demonstrating them as an emerging population at risk of HIV and HCV in Iran. Targeted screening and harm reduction programs for this population are required.     

An Analysis of Differential Factors Affecting Risk Behaviors Among Out-of-Treatment Drug Users in Four Cities

SUMMARY

Although its explanatory value remains questionable, “race/ethnicity” is often offered as an explanation of enhanced risk behavior or enhanced risk of acquiring HIV. The literature is often unclear about the underlying causes of racial differences in seroincidence. By examining the role of intervening factors in the association between race and HIV risk, it was thought that the role attributed to race could be clarified. This document describes the process by which the differential factors affecting HIV risk in a population of out-of-treatment drug users were analyzed. Condom use, number of partners, number of times injecting in the previous 30 days, number of times injecting with a used needle, and number of times injecting with a used needle without cleaning were examined. Besides race, the other factors considered are demographics (gender, age, mobility, job status, education, domestic status) and sexually transmitted disease history.

Data for the study were derived from the Risk Behavior Assessment (RBA), the Risk Behavior Follow-up Assessment (RBFA), and the TCU Self-Rated Form. Data were collected from four Cooperative Agreement sites: Houston, New Orleans, San Juan, Puerto Rico, and Tucson. The data for several risk behaviors and for HIV serostatus were analyzed using a three-stage sequential logit regression model. Socio-demographic variables were analyzed first, followed by clinical variables. A standard software package (SPSS+) was employed.     

Correlates of injecting in an HIV incidence hotspot among substance users in Tijuana,Mexico

BackgroundSubstance use and HIV are growing problems in the Mexico–U.S. border city of Tijuana, a sex tourism destination situated on a northbound drug trafficking route. In a previous longitudinal study of injection drug users (IDUs), we found that >90% of incident HIV cases occurred within an ‘HIV incidence hotspot,’ consisting of 2.5-blocks. This study examines behavioral, social, and environmental correlates associated with injecting in this HIV hotspot.MethodsFrom 4/06 to 6/07, IDUs aged ≥18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and interviewer-administered surveys eliciting information on demographics, drug use, sexual behaviors, and socio-environmental influences. Participants were defined as injecting in the hotspot if they most frequently injected within a 3 standard deviational ellipse of the cohort's incident HIV cases. Logistic regression was used to identify individual and structural factors associated with the HIV ‘hotspot’.ResultsOf 1031 IDUs, the median age was 36 years; 85% were male; HIV prevalence was 4%. As bivariate analysis indicated different correlates for males and females, models were stratified by sex. Factors independently associated with injecting in the HIV hotspot for male IDUs included homelessness (AOR 1.72; 95%CI 1.14–2.6), greater intra-urban mobility (AOR 3.26; 95%CI 1.67–6.38), deportation (AOR 1.58; 95%CI 1.18–2.12), active syphilis (AOR 3.03; 95%CI 1.63–5.62), needle sharing (AOR 0.57; 95%CI 0.42–0.78), various police interactions, perceived HIV infection risk (AOR 1.52; 95%CI 1.13–2.03), and health insurance status (AOR 0.53; 95%CI 0.33–0.87). For female IDUs, significant factors included sex work (AOR 8.2; 95%CI 2.2–30.59), lifetime syphilis exposure (AOR 2.73; 95%CI 1.08–6.93), injecting inside (AOR 5.26; 95%CI 1.54–17.92), arrests for sterile syringe possession (AOR 4.87; 95%I 1.56–15.15), prior HIV testing (AOR 2.45; 95%CI 1.04–5.81), and health insurance status (AOR 0.12; 95%CI 0.03–0.59).ConclusionWhile drug and sex risks were common among IDUs overall, policing practices, STIs, mobility, and lack of healthcare access were correlated with injecting in this HIV transmission hotspot. Although participants in the hotspot were more aware of HIV risks and less likely to report needle sharing, interventions addressing STIs and structural vulnerabilities may be needed to effectively address HIV risk.     

Development and validation of a novel scale for measuring interpersonal factors underlying injection drug using behaviours among injecting partnerships

BackgroundPeople who inject drugs with sexual partners or close friends have high rates of syringe/ancillary equipment sharing and HIV and hepatitis C virus (HCV) infection. Although evidence suggests that interpersonal factors underlie these higher risk profiles, there is no quantitative measure of how interpersonal factors operate within injecting relationships. We aimed to develop and validate a quantitative scale to assess levels of injecting drug-related interpersonal factors associated with risky injecting behaviours within injecting partnerships.MethodsWe conducted qualitative interviews with 45 people who inject drugs (PWID) who reported having injecting partners to inform item development, and tested these items in a quantitative study of 140 PWID from San Francisco, USA, to assess internal reliability (Cronbach’s alpha) and validity (convergent, and discriminant validity).ResultsWith results from the qualitative interview data, we developed the Interpersonal Dynamics in Injecting Partnerships (IDIP) scale with 54 final items for 5 subscales of injecting-related interpersonal factors. Exploratory factor analysis revealed 5 factors (“trust”, “power”, “risk perception”, “intimacy”, and “cooperation”) with eigenvalues of 14.32, 6.18, 3.55, 2.46, and 2.14, explaining 57% of the variance, and indicating good internal reliability (alpha: 0.92–0.68). Strong convergent validity was observed in bivariate logistic regression models where higher levels of trust, intimacy, and cooperation within partnerships were positively associated with partners sharing needles and injecting equipment, whereas higher levels of power and risk perception were negatively associated with partners sharing needles and injecting equipment.ConclusionsThese findings offer strong evidence that the IDIP scale provides a psychometrically sound measure of injecting drug-related interpersonal dynamics. This measurement tool has the potential to facilitate additional investigations into the individual and collective impact of trust, intimacy, power, cooperation, and risk perception on injection drug using behaviours and engagement in HIV and HCV testing and treatment among PWID in a variety of settings.     

Hazardous alcohol consumption among young adult IDU and its association with high risk behaviors

BackgroundHeavy alcohol consumption has been associated with risk-taking behaviors in intravenous drug users (IDU). However, limited information exists on the relationship between alcohol use and injecting and sexual risk in young adult IDU (<30 years) who are at risk for hepatitis C virus (HCV) and HIV infection.MethodsWe conducted a cross-sectional study of young adult IDU in San Francisco (2006–2012) who had not previously tested positive for HCV. Participants completed a structured interview and HCV testing. We examined whether hazardous drinking (Alcohol Use Disorders Test-Consumption [AUDIT-C] 3–9 for women and 4–9 for men) and probable dependent drinking (AUDIT-C 10–12) levels were associated with injecting and sexual risk behaviors and HCV status, indicated by adjusted odds ratios (AOR) in separate models controlling for potential confounders.ResultsOf the 326 participants, 139 (42.6%) were hazardous drinkers and 82 (25.2%) were probable dependent drinkers; thus over two-thirds evidenced problem drinking. Being a hazardous drinker was significantly associated with injecting drug residue from another's drug preparation equipment (AOR 1.93). Probable dependent drinking was significantly associated with sharing non-sterile drug preparation equipment (AOR 2.59), and inversely, with daily/near daily injecting (AOR 0.42). Both heavy drinking levels were associated with having ≥2 sexual partners (AOR 2.43 and 2.14). Drinking category was not associated with HCV test results.ConclusionThe young adult IDU reported consuming alcohol at very high levels, which was associated with some unsafe sexual and injecting behaviors. Our study demonstrates the urgent need to intervene to reduce alcohol consumption in this population.     

Drug Use Patterns of Substance Abusing Women: Gender and Ethnic Differences in an AIDS Prevention Program

SUMMARY

The social context of drug use defines women's experiences of addiction and their patterns of use. Gender relations and roles, ethnic identity, poverty, and local circumstances, including drug-related epidemics such as the human immunodeficiency virus (HIV) and sexually transmitted diseases (STDs), constitute powerful social forces that create a unique set of risky conditions for women drug users. This paper presents findings from a community-based AIDS prevention research project for 1,022 out-of-treatment drug users recruited through street outreach and targeted sampling. Data from a baseline risk behavior assessment and in-depth interviews on contexts of women's drug use show different patterns of use when comparing women to men, and among women comparing African Americans, Puerto Ricans, and Whites. Related differences in prevalence of HIV, STDs, and other consequences of drug use and addiction also are presented. Implications of these findings are discussed in terms of the development of drug treatment and harm reduction programs that are appropriate for women of different ethnic backgrounds.     

Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya

IntroductionGender dynamics and interpersonal relations within intimate partnerships are known to determine health behaviors, including substance use, within couples. In addition, influence from intimate partners may occur in the context of wider social ecological determinants of health behavior. The aim of this study was to document the role of intimate partners in influencing injecting drug use among women in Kenya, where injecting drug use is on the rise.MethodsWe performed secondary data analysis of an existing dataset from a 2015 qualitative study involving 45 women who inject drugs and 5 key stakeholders in coastal Kenya. Primary data had been collected via a combination of in-depth interviews and focus group discussions exploring sexual, reproductive, drug use, and other social contexts of women who inject drugs. The process by which intimate partners influenced women's initiation of drug use, transition to injecting practices, and maintenance of injecting drug use were identified using thematic analysis.ResultsBoyfriends and intimate either facilitated or restrained women's drug-injecting. On the one hand, young women's entry into drug use was prompted by relationship problems, or a need to acquiesce with their drug-using boyfriends. Once women started injecting, intimate partners facilitated ongoing drug-injecting by financing the acquisition of drugs, peddling drugs to their women, or sharing their drugs with their women. The social capital that peddlers held insulated women from police arrests, and encouraged women to seek and sustain intimate relations with well-connected peddlers. Men's influences over women were driven by an underlying patriarchal drug acquisition and economic power. On the other hand, boyfriends and intimate partners who were non-injectors or non-drug users sought to moderate women's injecting drug use by encouraging them to inject less, to smoke or snort instead of injecting, or to enroll into rehabilitation. These moderating influences were most prominent when couples were pregnant. Despite men being a source of practical and emotional support, women were frequently unable limit or alter their injecting drug use, due to its addictive nature. Men's disagreement with women's ongoing injecting strained relationships, and occasionally led to separation.ConclusionsSome boyfriends facilitated women's injecting drug use, while others moderated it, supporting assertions that intimate relationships can both be a site of injecting risks or protection. At the micro-level, these findings highlight an opportunity for couple-based interventions, leveraging on non-drug injecting males as a resource to support women adopt safer injecting practices. At a macro level, incorporating livelihood interventions into harm reduction programs is required in order to mitigate economic-based influence of male intimate partners on women's injecting drug use. At both levels, gender transformative approaches are essential. To gain a comprehensive understanding of women's injecting drug use, future studies drug use should explore women's contexts beyond micro influences and consider their wider macro-structural determinants.     

Blowing Some Lines: Intracultural Variation Among Miami Cocaine Users

Abstract

The practice of injecting shared drugs, in which drug users prepare, divide and inject portions of a drug solution, is a means of transmitting HIV, HCV, and other blood-borne pathogens. This study examined the process of injecting shared drugs among drug users in San Juan, Puerto Rico, through detailed observations of 25 episodes of the injection of shared drugs, and by informal interviewing of episode participants. The ways in which price and packaging of drugs, access to drug preparation materials, and social and economic relations between drug-sharing “partners” influence the process of injecting shared drugs are explored. Because differential power relations, and in turn, injection drug users' exposure to HIV and HCV, are apparent in some drug-sharing partnerships, a key objective of this study was to extend our understanding of contributions or “investments” made by different drug-sharing partners, the benefits and costs that different partners experience, and the extent to which IDUs assume different partner roles. The findings of this small, in-depth qualitative study provide insight into drug users' motivations for injecting shared drugs, and suggest reasons why certain standardized, countrywide HIV/HCV intervention efforts have not been entirely successful in preventing the devastating illnesses that disproportionately affect injection drug users.     

Safer injecting education for HIV prevention within a medically supervised safer injecting facility

Background:Requiring help injecting has recently been independently associated with syringe sharing and HIV incidence among injection drug users (IDUs) in Vancouver. We examined IDUs who were receiving safer injecting education within a supervised injecting facility (SIF) in Vancouver.Methods:The Scientific Evaluation of Supervised Injecting (SEOSI) cohort is based on a representative sample of SIF users. We examined the prevalence and correlates of receiving safer injecting education within the SIF using univariate and logistic regression analyses.Results:Between May 31, 2003 and Oct 22, 2004, 874 individuals of the SEOSI cohort have completed the baseline questionnaire, among whom 293 (33.5%) received safer injecting education. In multivariate analyses, requiring help with an injection in the last 6 months (OR = 2.20 [95% CI: 1.62–2.98]) and sex-trade involvement in the last 6 months (OR = 1.54 [1.09–2.16]) were independently associated with receiving safer injecting education within the SIF.Conclusions:Since requiring help injecting has previously been associated with HIV incidence, it is encouraging that this risk factor was associated with receiving safer injecting education within the SIF. Nevertheless, prospective evaluation is necessary to examine if receiving safer injecting education is associated with reduced HIV risk behaviour and blood-borne disease incidence.     

Decreased injecting is associated with increased alcohol consumption among injecting drug users in northern Vietnam

BackgroundReducing injecting frequency may reduce the risk of HIV infection and improve health outcomes among injection drug users (IDUs). However, the reduction of one risk behavior may be associated with an increase in other risk behaviors, including the use of other risk-associated substances. Our objective was to determine if an association exists between a reduction in injecting and level of alcohol use among IDU.MethodsWe conducted a longitudinal analysis of data collected for a randomized controlled trial examining the efficacy of a peer education intervention in reducing HIV risk among IDU and their network members in Thai Nguyen, Vietnam. Our analysis included active male injectors (n = 629) who were study participants and attended both baseline and 3-month visits. Frequency of alcohol consumption was assessed as the number of alcoholic drinks in the past 30 days. Change in risk and outcome behaviors was calculated as the difference in frequencies of behaviors between baseline and 3-month follow-up visits. The outcome of interest was concurrent decreased drug injection and increased alcohol consumption.ResultsThe mean difference between baseline and 3-month follow-up of alcohol consumption and injection frequency in the past 30 days was 19.03 drinks (93.68 SD) and 20.22 injections (35.66 SD), respectively. Participants who reported reduced injection frequency were almost three times as likely to report increased alcohol consumption (OR 2.8; 95% CI, 2.0, 4.0). The proportion that both decreased injecting and increased alcohol by any amount in the past 30 days was 35.6%. In multivariate analysis higher education was significantly associated with an increase in alcohol and decrease in injecting of any amount.ConclusionMale IDU may be at risk for increasing alcohol consumption when they reduce injection frequency. Interventions with male IDU that encourage reduction of injection may need to review specific strategies to limit alcohol consumption.     

Prevalence of IGRA-positivity and risk factors for tuberculosis among injecting drug users in Estonia and Latvia

BackgroundIllegal drug use and HIV are independent risk factors for tuberculosis (TB) among injecting drug users (IDU). Estonia and Latvia have experienced high rates of TB as well as IDU and HIV outbreaks. There is a lack of knowledge about TB among IDUs in these countries. The purpose of the current study was to estimate the prevalence and risk factors of Mycobacterium tuberculosis (MTB) infection among IDUs in Estonia and Latvia.MethodsParticipants for this cross-sectional study were recruited from syringe exchange programmes using respondent-driven sampling. For assessing infection with MTB interferon-gamma release assay (IGRA) was used.ResultsThe study included 375 participants from Estonia and 313 from Latvia. The prevalence of IGRA-positivity among IDUs was 7.7% in Estonia and 25.6% in Latvia. HIV-prevalence was 62% in Estonia and 23% in Latvia. In both countries, IGRA-positivity rates did not differ between HIV-positive and HIV-negative participants. IGRA-positivity was independently associated with a prior diagnosis of TB in Estonia and with imprisonment (ever within a lifetime) and preceding contact with a TB patient in Latvia.ConclusionOur findings indicate there is an urgent need for a more vigorous approach in providing IDUs with TB screening services.     

Binge drinking,stimulant use and HIV risk in a sample of illicit drug using heterosexual Black men

BackgroundRelatively little research has examined the effects of binge drinking and HIV risk in heterosexual Black men. Even less research has explored this relationship in illicit drug using heterosexual Black men who are at an elevated risk of contracting and transmitting HIV through various vectors, including risky sexual behavior, in the Black community.PurposeThe purpose of the current study is to examine the associations between binge drinking, drug use and HIV status in a community-based sample of 127 self-identified heterosexual Black men.ResultsOverall, 17% reported binge drinking in the past month. Both stimulant use (AOR 7.29; 95%; CIs, 2.07, 25.70), and binge drinking (AOR = 5.28; 95% CIs, 1.34, 20.91) were associated with HIV status.ConclusionThese findings will inform prevention interventions to reduce the HIV risk among Black heterosexual men.     

Spatial accessibility of drug treatment facilities and the effects on locus of control,drug use,and service use among heroin-injecting Mexican American men

BackgroundThis study explores the spatial accessibility of outpatient drug treatment facilities and the potential relationship with drug use-related outcomes among Mexican American heroin users.MethodsSecondary data on 219 current and former heroin-injecting Mexican American men aged 45 and older were drawn from a research study in Houston, Texas. We used geographic information systems (GIS) to derive two spatial accessibility measures: distance from one's place of residence to the closest drug treatment facility (in minutes); and the number of facilities within a 10-minute driving distance from one's place of residence. Exploratory logistic regression analyses examined the association between the spatial accessibility of drug treatment facilities and several drug use-related outcomes: internal locus of control (LOC); perceived chances and worries of injecting in the next six months; treatment utilization; and location of last heroin purchase.ResultsParticipants with greater spatial access to treatment programs were more likely to report a higher chance of injecting in the near future. However, while current heroin users were more worried about injecting in the next six months, greater spatial access to treatment programs seemed to have a buffering effect. Finally, those who lived closer to a treatment programs were more likely to have last purchased heroin inside the neighborhood versus outside the neighborhood. Spatial accessibility was not associated with internal LOC or treatment utilization.ConclusionThe findings showed that the presence of outpatient treatment facilities—particularly services in Spanish—may influence perceived risk of future heroin use and purchasing behaviors among Mexican American men. Implications for future spatially-informed drug use research and the planning of culturally and linguistically responsive drug treatment programs are discussed.