Gender differences in injection risk behaviors at the first injection episode

OBJECTIVES: To examine gender differences in drug injection equipment sharing at injecting initiation. METHODS: Young injecting drug users (IDUs) in New York City February 1999-2003 were surveyed about injection risk behaviors and circumstances at initiation. Analyses were gender-stratified and excluded participants who initiated alone. Multiple logistic regression estimated adjusted odds ratios. RESULTS: Participants (n=249) were 66% male and 82% White. Mean initiation age was 19.2; mean years since initiating was 3.0. Women were significantly more likely to cite social network influence as a reason for initiating, to have male and sex partner initiators, and to share injecting equipment than men. Among women, sharing any injection equipment was associated with initiation by a sex partner and having > or =2 people present. Among men, being injected by someone else predicted sharing any injection equipment, while using a legally obtained syringe was protective. CONCLUSIONS: Social persuasion stemming from sexual and/or social relationships with IDUs may increase women's risk of sharing injection equipment at initiation, and consequently, their early parenteral risk of acquiring blood-borne infections. Interventions should focus on likely initiates, especially women in injecting-discordant sex partnerships, and IDUs (potential initiators).     

HIV prevalence and risk behaviors among new initiates into injection drug use over the age of 40 years old

Injection drug users (IDUs) who have recently initiated an injecting career have high risk behaviors for HIV infection. The average age of an IDUs first injection is typically reported as 19-20 years, and some literature has reported 'maturing out' of drug use typically around 40 years old. The purpose of this study was to discriminate risk behaviors among newer injectors by age of initiation. This cross-sectional study includes volunteers enrolled using extensive community recruitment techniques in 1988 and 1989 in Baltimore, MD. Of the 722 injection drug users who had initiated injection within the prior six years, 124 were over 35 years old of whom 53 were 40 years and older. Rates of HIV were lower among those over 40 years (13.2%) than those who were 35-39 years (22.5%) or under 35 years old (20.9%). The behavioral characteristics of those aged 35-39 were similar to those under 35 years old, but those over 40 years old when compared with less than 39 years reported injecting at least daily less frequently (88.7% vs 76.5%, p = 0.042), using a needle from a sterile wrapper (19.0% vs 36.6%, p = 0.006), and injecting with their own works (52.6% vs 28.8%, p = 0.021). This study shows that people initiate injection drug use across a wide age range and that needle hygiene practices early after initiation tend to be safer in older compared to younger initiates.     

Demographic, HIV risk behavior, and health status characteristics of "crack" cocaine injectors compared to other injection drug users in three New England cities

OBJECTIVES: To compare demographic, HIV risk behaviors, and health status characteristics of injection drug users (IDUs) who have injected "crack" cocaine with IDUs who have not. METHODS: Nine hundred and eighty-nine IDUs were recruited in New Haven, CT, Hartford, CT and Springfield, MA from January 2000 to May 2002. Participants were administered a modified version of the National Institute on Drug Abuse Risk Behavior Assessment Questionnaire. RESULTS: Nine percent (n = 89) of participants reported "ever" injecting crack cocaine and 4.2% (n = 42) reported injecting crack in the past 30 days. Lifetime and current crack injectors did not differ significantly on any demographic characteristics. Lifetime and current crack injectors did not differ on gender, age or marital status from IDUs who have never injected crack. Significant differences were found on race, education, employment and residence, with crack injectors more likely to be white, employed, better educated and living in New Haven than IDUs who have never injected crack. After adjusting for current (past 30 day) speedball and powder cocaine injection, crack injectors reported higher rates of risky drug use behaviors and female crack injectors reported higher rates of risky sexual behaviors. Crack injectors reported higher rates of abscesses, mental illness and Hepatitis C infection, but not Hepatitis B or HIV infection. CONCLUSIONS: The emergence of crack cocaine injection requires urgent attention, as this new drug use behavior is associated with elevated rates of high risk behaviors.     

Strategies to avoid opiate withdrawal: Implications for HCV and HIV risks

BackgroundResearch on heroin withdrawal has primarily been done clinically, thus focussing on symptom severity, physiological manifestations, and how withdrawal impairs normal functioning. However, there is little scientific knowledge on how heroin withdrawal affects injection behaviour. This paper explores how withdrawal episodes heighten unsafe injection practices and how some long-term injectors manage such risks.MethodsWe interviewed 32 injection drug users in New York City who had been injecting drugs for 8–15 years (21 HIV and HCV uninfected; 3 HIV and HCV infected; and 8 singly infected with HCV). We used in-depth life history interviews to inquire about IDUs’ life history, injection practices and drug use behaviour over time. Analysis used grounded theory techniques.ResultsWithdrawal can enhance risk by undermining IDUs’ willingness to inject safely; increasing the likelihood of attending risky settings; raising the number of injection partners; and seeking ad hoc partners for drug or needle sharing. Some IDUs have developed practices to cope with withdrawal and avoid risky practices (examples include carrying clean needles to shooting galleries and sniffing rather than injecting). Strategies to avoid withdrawal include back up methods, resorting to credit, collaborating with others, regimenting drug intake, balancing drug intake with money available, and/or resorting to treatment.ConclusionWithdrawal periods can heighten risky injection practices. Some IDUs have applied strategies to avoid withdrawal or used practices to cope without engaging in risky practices. These behaviours might in turn help IDUs prevent an infection with hepatitis C or HIV.     

Prevalence and correlates of suicidal ideation among young injection vs. noninjection drug users

The objective of this study was to identify correlates of suicidal ideation and to examine the hypothesis that injection drug users (IDUs) were more likely to report suicidal ideation than noninjection drug users (NIDUs). Participants included IDUs (n = 244) and NIDUs (n = 73) from Baltimore, Maryland, aged 15-30 who began snorting or smoking heroin or cocaine/crack (NIDUs) or injecting drugs (IDUs) within the past 5 years who were recruited between August 2000 and March 2002. Among the 317 participants, 42% were female, 59% were white, and median age was 24. The prevalence of suicidal ideation was 27%. IDUs were more likely to report suicidal ideation than NIDUs (31% vs. 14%, p = 0.003). Adjusting for age, gender, and race, IDUs were 2.4 times more likely than NIDUs to report suicidal ideation [95% Confidence Interval (CI): 1.1-5.2]. However, on further adjustment for homelessness, depressive symptoms, and gay/lesbian/bisexual identity, IDU status was no longer independently associated with suicidal ideation. These results suggest that factors associated with injection drug users' lifestyles and mental health status may account for the higher prevalence of suicidal ideation in IDUs vs. NIDUs. Further study into these associations is warranted in identifying avenues for suicide prevention among these populations.     

Prevalence and correlates of opiate overdose among young injection drug users in a large U.S. city

OBJECTIVES: The current study examines the prevalence and correlates of witnessing and experiencing opiate overdoses among a sample of young, injection drug users (IDUs) and non-injection drug users (NIDUs) in Baltimore, MD. METHODS: Data were derived from a longitudinal study of 15-30 year old IDUs and NIDUs (N=309) who had initiated heroin, cocaine, and/or crack use within 5 years prior to study enrollment. Chi-square and Wilcoxon rank-sum tests were used in bivariate analyses of demographic and drug use variables with each of the two dependent variables. Multivariate logistic regression models were used to identify correlates of experiencing and witnessing overdose. RESULTS: Twenty-nine percent of participants reported having ever experienced an opiate overdose and 57% reported having ever witnessed an overdose. Having ever experienced an opiate overdose was independently associated with being White (Adjusted Odds Ratio [AOR]=3.2; 95% Confidence Interval [CI]: 1.6, 6.4) recent homelessness (AOR=2.9; 95%CI: 1.5, 5.7); and length of injection, 5.6-6.9 years versus <5.6 years (AOR=4.0; 95%CI: 1.8-8.9); injecting 7.0-7.9 years versus <5.6 years (AOR=2.5; 95%CI: 1.03-6.1); injecting >8 versus <5.6 years (AOR=4.7; 95%CI: 2.2-10.2). Having witnessed an opiate overdose was independently associated with being White (AOR=2.4; 95%CI: 1.4, 4.1) and injecting >8 years versus <5.6 years (AOR=2.2; 95%CI: 1.2, 4.0). CONCLUSIONS: This study documents the high prevalence of witnessing and experiencing opiate overdoses among young, newly initiated IDUs and NIDUs. The results could inform the growing number of overdose prevention efforts throughout the U.S.     

Low knowledge and perceived Hepatitis C risk despite high risk behaviour among injection drug users in Kathmandu,Nepal

BackgroundIn Nepal, prevalence of Hepatitis C (HCV) among injecting drug users (IDUs) has been measured at 50% and knowledge of the virus is low. Rehabilitation and harm reduction attendees constitute populations to whom health care providers can deliver services. As such, characterizing their drug use and risk profiles is important for developing targeted service delivery. We measured drug use and risk patterns of IDUs participating in residential rehabilitation as well as those contacted through needle exchanges to identify correlates of drug use frequency, risky injection practices as well as HCV testing, knowledge and perceived risk.MethodsWe collected cross-sectional data from one-on-one structured interviews of IDUs contacted through needle-exchange outreach workers (n = 202) and those attending rehabilitation centres (behaviour immediately prior to joining rehabilitation) (n = 167).ResultsRoughly half of participants reported injecting at least 30 times in the past 30 days and individuals with previous residential rehabilitation experience reported frequent injection far more than those without it. About one in fourteen respondents reported past week risky injection practices. Participants were over three times as likely to report risky injection if they consumed alcohol daily (17.2%) than if they did not (5.0%) (p = 0.002). Those who reported injecting daily reported risky injection practices (11.9%) significantly more than non-daily injectors (1.8%) (p < 0.001). Respondents reported high HCV infection rates, low perceived risk, testing history and knowledge. HCV knowledge was not associated with differences in risky injecting.ConclusionTreatment centres should highlight the link between heavy drinking, frequent injection and risky injecting practices. The link between rehabilitation attendance and frequent injection may suggest IDUs with more severe use patterns are more likely to attend rehabilitation. Rehabilitation centres and needle exchanges should provide testing and education for HCV. Education alone may not be sufficient to initiate change since knowledge did not predict lower risk.     

Correlates of sharing injection equipment among male injecting drug users in Kathmandu, Nepal

BackgroundHIV prevalence is high and risky injection practices occur frequently among injecting drug users (IDUs) in Nepal. We explored the correlates of sharing injection equipment (having injected with a needle or syringe previously used by another) among male IDUs in Kathmandu, Nepal.MethodsFrom August to September 2007, we anonymously interviewed 296 male IDUs in Kathmandu, Nepal, using a structured questionnaire. We performed bivariate and multivariable logistic regression analysis and identified variables associated with sharing injection equipment.ResultsOver half (n = 152) of the participants reported injecting drugs with a needle or syringe previously used by another in the past year. Of these, 70% reported engaging in sharing injection equipment with multiple persons. The unavailability of new needles and drinking alcohol were independently associated with sharing injection equipment among the study participants.ConclusionsIDUs who drank alcohol or who could not obtain new needles when needed were more likely to share injection equipment. Our results suggest that reducing alcohol use and increasing the availability of new needles and syringes might improve safer injection practices among male IDUs in Kathmandu, Nepal.     

Longitudinal predictors of injection cessation and subsequent relapse among a cohort of injection drug users in Baltimore, MD, 1988-2000

OBJECTIVE: To determine predictors of injection drug use cessation and subsequent relapse among a cohort of injection drug users (IDUs). METHODS: IDUs in Baltimore, MD were recruited through community outreach in 1988-1989. Among IDUs with at least three follow-up visits, parametric survival models for time to injection cessation (>or=6 months) and subsequent relapse were constructed. RESULTS: Of 1327 IDUs, 94.8% were African American, 77.2% were male, median age was 34 years, and 37.7% were HIV-infected. Among 936 (70.5%) subjects who ceased injection, median time from baseline to cessation was 4.0 years. Three-quarters subsequently resumed injection drug use, among whom median time to relapse was 1.0 year. Factors independently associated with a shorter time to cessation were: age <30 years, stable housing, HIV seropositivity, methadone maintenance treatment, detoxification, abstinence from cigarettes and alcohol, injecting less than daily, not injecting heroin and cocaine together, and not having an IDU sex partner. Factors independently associated with shorter time to injection relapse were male gender, homelessness, HIV seropositivity, use of alcohol, cigarettes, non-injection cocaine, sexual abstinence and having a longer time to the first cessation. CONCLUSIONS: This study provides strong support for targeting cessation efforts among young IDUs and severely dependent, unstably housed, and HIV-infected individuals.     

Mortality risk among recent-onset injection drug users in five U.S. cities

To quantify the risk of death among recent-onset (< 5 years) injection drug users, we enrolled 2089 injection drug users (IDUs) age 相似文献   

Injection frequency mediates health service use among persons with a history of drug injection

Drug injectors are known to have high rates of hospital and emergency room (ER) use. We hypothesized that out-of-treatment injection drug users (IDUs) have higher rates of health service use than methadone-maintained persons, and that heroin injection frequency mediates health service use among drug injectors (IDUs). HIV-negative individuals with a history of drug injection were recruited from a needle exchange program (NEP) and a methadone maintenance treatment program (MMT) in Providence, RI. ER visits, outpatient visits, and hospitalizations in the last 6 months were the dependent variables with number of heroin injections the hypothesized mediator variable. The 472 participants were predominately male (60.6%) and white (82%) with a mean age of 37. NEP clients were more likely than MMT clients to visit an ER (39.2% vs. 29.8%; P=0.03). NEP participants were somewhat more likely to report a hospital admission (16.0% vs. 10.6%; P=0.08). Relative to non-injecting MMT participants, the odds of visiting an ER were 1.80 and 1.67 times higher for subjects recruited through NEP and actively injecting MMT participants, respectively. Additionally, subjects recruited through NEP (OR=2.2) and actively injecting MMT participants (OR=2.3) were over twice as likely to report a hospital admission than non-injecting MMT participants. Each increase of one heroin injection per day increased the expected odds of injection-related infection by a factor of 1.92. NEP clients are more likely to have ER visits and hospitalizations than methadone clients. We describe a pathway by which injection frequency influences health service use.     

Injecting alone among young adult IDUs in five US cities: evidence of low rates of injection risk behavior

Illicit drug injection typically occurs in private or semi-public settings where two or more injectors are present. In a large sample of young adult injectors (aged 15-30) in five US cities, we describe those who reported consistently injecting by themselves in a recent period. Among 3199 eligible subjects, 85% were male, median age was 24 years, and median number of years injecting was four. Fifteen percent (n=467) who reported always injecting alone in the previous 3 months were compared to other IDUs to understand the relationship between this practice and injection risk behavior. IDUs who reported injecting alone were substantially less likely to report injection with a syringe (AOR=0.16, 95% CI 0.1-0.2) or other drug preparation equipment (AOR=0.17, 95% CI 0.13-0.2) previously used by another injector. Markedly low rates of injection risk behavior were observed in IDUs who reported injecting alone; this practice may facilitate safe injection by granting the individual greater control over the injection setting. However, risks may include accidental overdose with severe consequences.     

Patterns of ketamine use among young injection drug users

Ketamine is a dissociative anesthetic that has emerged as an increasingly popular choice among young drug users. Recent research indicates the presence of hidden populations of young people who inject ketamine in New York and other U.S. cities. Applying an ethno-epidemiological approach, the authors recruited 40 young injection drug users (IDUs) (< 25 years old) in New York City to explore health risks associated with ketamine use. This analysis looks at the varying patterns and frequencies of ketamine injection by examining personal, social, and cultural aspects of these young people's lives. We learned that drug-using histories, experiential dimensions, sociocultural characteristics, and associations with other young people help account for the different patterns of injecting ketamine within the sample. In particular, these findings indicate that young people who were more frequent ketamine injectors had the following characteristics: initiated injection drug use with ketamine; enjoyed the effects of ketamine, were stably housed; lived in the vicinity of New York City; and associated with others who also injected ketamine.     

Evaluation of a Brief Intervention to Prevent Initiation into Injecting

Background: strategies to prevent initiation of non-injectors into injecting are rare. A brief intervention with this aim, offered to current injecting drug users (IDUs), has been evaluated. Methods: baseline behavioral and attitudinal data were collected using structured interviews with 86 IDUs. Participants were re-interviewed immediately after the intervention and at 3-month follow-up (n = 73). Results: it was feasible to deliver the intervention, which was acceptable to both drug users and drug workers. IDUs' disapproval of initiating non-injectors significantly increased after the intervention. Participants injected in front of fewer non-injectors in the subsequent 3 months (falling from 97 to 49). Requests for initiation fell from 36 to 15 and the number of people initiated dropped from 6 to 2. Conclusions: these results, the cheapness and ease With which such an intervention can be delivered, suggest that by incorporating such interventions into drug work it may be possible to reduce the number of people who begin injecting. Areas for further research are suggested.     

Prevalence and Correlates of Needle-Sharing Among New and Long-Term Injection Drug Users in Southwest China

Three community-based surveys recruited 4,310 injection drug users (IDUs) in China from 2004 to 2006. Of the participants, 54.4% were ≤3-year new IDUs; 63.9% reported injecting more than two times daily; 31.5% shared needles in the last six months; 37.4% shared equipments in the last month; 30.2% reported their regular sex partners injected drugs; and 23.5% had commercial sex, with 52.2% reporting no condom use during last sex. The risky injection practices (sharing needles/equipments and high injection frequency) were less frequent among new IDUs, emphasizing that effective prevention needs to identify and intervene with IDUs early on. The study's limitations are noted.     

Heroin overdose among young injection drug users in San Francisco

OBJECTIVES: We sought to identify prevalence and predictors of heroin-related overdose among young injection drug users (IDU). METHODS: A total of 795 IDU under age of 30 years were interviewed in four neighbourhoods in San Francisco, California, USA. Participants were recruited as part of a broader study of HIV, hepatitis B and C among injecting drug users in San Francisco using street outreach and snowball techniques. Independent predictors of recent heroin overdose requiring intervention were determined using regression analysis. RESULTS: Of 795 injecting drug users under age of 30 years, 22% (174/795) of participants reported a heroin overdose in the last year. In stepwise multiple logistic regression, independent predictors of recent heroin overdose were lifetime incarceration exceeding 20 months (odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.52-5.88); heroin injection in the last 3 months (OR = 4.89, 95% CI = 2.03-11.74); cocaine injection in the last 3 months (OR = 1.67, 95% CI = 1.14-2.45); injection of heroin mixed with methamphetamine in the last 3 months (OR = 1.74, 95% CI = 1.15-2.65); ever tested for hepatitis B or C (OR = 1.66 per year, CI = 1.09-2.54) and ever having witnessed another person overdose (OR = 2.89, 95% CI = 1.76-4.73). CONCLUSIONS: Individuals with high levels of incarceration are at great risk of overdose, and prison or jail should be considered a primary intervention site. Further research on the role of cocaine and amphetamine in heroin-related overdose is indicated.     

Social Context of Needle Selling in Baltimore,Maryland

Although much of the debate surrounding the distribution of sterile syringes to injection drug users (IDUs) has focused on needle exchange programs (NEPs), IDUs acquire their syringes from three major sources: NEPs, pharmacies, and secondary exchangers or needle sellers. The purpose of the present study is to examine types and frequencies of social interactions among drug injectors who sell needles, most of which come from NEPs, compared with individuals who do not sell needles. Specifically, we compared engagement in drug-related behaviors, roles in the drug economy, and social network membership. Data were collected as part of the SHIELD study, an HIV prevention intervention targeted at drug users and their social networks (n = 910) from February 2001 through September 2003 in Baltimore, Maryland (USA). In this sample, 56 participants reported selling needles. Needle sellers had higher levels of engagement in drug-related social interactions, including using drugs with others, giving or receiving drugs from others, and buying drugs with other users. Participants who sold needles had a significantly higher number of roles in the drug economy. Also, they had more social network members who were injectors, with whom they talked about risky drug behaviors, gave needles to, and shared cookers and bleach with. Compared with nonselling injectors, needle sellers engage in HIV risk-related behaviors, such as injecting daily and sharing injection equipment, more frequently. The study's findings may be useful to determine whether secondary exchangers should be targeted for HIV prevention activities both to reduce their own risk and to diffuse risk reduction information throughout the drug using community.     

Predictors of increased condom use following HIV intervention with heterosexually active drug users

Research with injection drug users (IDUs), at risk for acquiring and transmitting HIV, has focused primarily on their risky drug practices, with far less attention paid to their risky sex behaviors. The purpose of this study was to determine what variables were associated with an increase in condom use following an HIV intervention with 3357 IDUs in nine cities. Participants reported using condoms during 15% of their sexual encounters prior to the HIV intervention, and during 22% of their sexual encounters six months later. A logistic regression analysis indicated that individuals who increased their condom use were likely to be HIV seropositive (odds ratio OR = 2.49), to have received AIDS information prior to the intervention (OR = 1.28), to have multiple sex partners (OR = 2.14), to be single with multiple sex partners (OR = 1.34), or to have exchanged drugs or money for sex (OR = 1.33). Discussion focuses on the generally low incidence of condom use and the need for increased intervention, particularly among drug users in monogamous relationships and sex workers.     

Heroin dependence and bloodborne virus transmission behaviors for HIV infection among newly incarcerated injection drug users in Taiwan

The purpose of the study was to determine heroin dependence and risky behaviors associated with human immunodeficiency virus (HIV) infection among newly incarcerated injection drug users (IDUs). Three self-administrated questionnaires were collected among 450 newly incarcerated male heroin users during 2005-2007. Inmates were categorized as heroin-dependent if they met three or more of the six ICD-10 criteria. Heroin-dependent inmates had higher scores of bloodborne virus transmission risk than non-dependent IDUs (12.8 ± 16.0 vs. 7.2 ± 11.5, p?< 0.001). Multiple logistic regression analysis indicated that heroin dependence was a significant moderator of the association between risky injection behaviors and HIV infection. It is crucial to integrate substance treatment with behavioral interventions into harm reduction programs to prevent bloodborne virus transmission among IDUs.     

Social injecting and other correlates of high-risk sexual activity among injecting drug users in northern Vietnam

BackgroundSexual risk and STDs are relatively high among injecting drug users (IDUs) in Vietnam. We sought to determine characteristics of sexually active IDUs and correlates of high-risk sexual practices among IDUs in Bac Ninh province in northern Vietnam.MethodsWe used data collected for a community-based cross-sectional pilot study to identify correlates of recent high-risk sex (>1 sex partner and inconsistent/no condom use in the past year). Factors associated with high-risk sex were identified using logistic regression.ResultsAmong 216 sexually active male IDUs, one third (n = 72) had engaged in high-risk sex within the last year. IDUs who reported injecting with others more frequently, having someone else inject their drugs at last injection, sharing needles or sharing any injection equipment were more likely to have reported recent high-risk sex. Factors independently associated with high-risk sexual activity were not injecting oneself [AOR: 2.22; 95% CI (1.09–4.51)], and sharing needles in the past 12 months [AOR: 2.57; 95% CI (1.10–5.99)].ConclusionsIDUs who inject socially and IDUs who share needles are likely to engage in high-risk sexual behaviours and may serve as an important bridge group for epidemic HIV transmission in Vietnam. In addition to messages regarding the dangers of sharing needles and other injection equipment, preventive interventions among newly initiated IDUs should also focus on reducing sexual risk.