HIV/AIDS risk behaviors and correlates of injection drug use among drug users in Pakistan

We studied prevalence and correlates of injection drug use, awareness of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and risky behaviors among drug users serviced by a nongovernmental organization catering to drug users in three Pakistani cities (Quetta, Peshawar, and Rawalpindi). Logistic regression analysis was used to identify correlates of injection drug use. Of 608 drug users, 99.8% were male; median age was 32 years, and 44% were married. Most (79.8%) were Pakistani; 15.3% were Afghani. The majority used heroin (98.7%), mostly by inhalation; 15.2% injected drugs. Only 41% had heard of HIV/AIDS, and 30% had been paid for donating blood. Injection drug use and needle sharing were highest in Quetta. Injecting drug users (IDUs) were nearly twice as likely to have donated blood and to have heard about HIV/AIDS compared to other drug users. Interventions to discourage transitions to injection, increase HIV testing, and safeguard the blood supply in Pakistan are urgently needed.     

AIDS risk reduction and reduced HIV seroconversion among injection drug users in Bangkok.

Human immunodeficiency virus (HIV) seroconversion was studied in a group of 173 injection drug users in Bangkok, Thailand, who had been previously tested for HIV and were interviewed and retested in the fall of 1989. Ten percent of the group had seroconverted. Two factors protected against HIV seroconversion: having stopped sharing injection equipment in response to the acquired immunodeficiency syndrome (AIDS) and having a regular sexual partner. The association between self-reported deliberate risk reduction and reduced HIV seroconversion among persons continuing to inject illicit drugs indicates that injection drug users can change their behavior in response to AIDS and will accurately report on the behavior change, and that the changes can protect against HIV infection.     

Reconstructing the AIDS epidemic among injection drug users in Brazil

The HIV/AIDS epidemic among injection drug users (IDUs) in Brazil has been unique in terms of temporal and geographical contrasts. This analysis explores these contrasts through the use of multilevel modeling. Standardized AIDS incidence rates among IDUs for Brazilian municipalities (1986-2000) were used as the dependent variable, with a set of social indicators as independent variables (covariates). In some States of the North/Northeast, the epidemic among IDUs has been incipient. The S?o Paulo epidemic extended to reach a network of municipalities, most of which located far from the capital. More recently, on a smaller scale, a similar extension has been observed in the southernmost States of the country. Both "number of physicians per inhabitant" and "standard distance to the State capital" were found to be associated with AIDS incidence. AIDS cases among IDUs appeared to cluster in wealthier, more developed municipalities. The relative weight of such extensive dissemination in key, heavily populated States prevails in the Brazilian IDU epidemic, defining a central-western-southeastern strip of wealthier middle-sized municipalities and more recently a southern strip of municipalities deeply affected by the epidemic in this population.     

Increased risk for hepatitis C associated with solvent use among Canadian Aboriginal injection drug users

Background  

Solvent abuse is a particularly serious issue affecting Aboriginal people. Here we examine the association between solvent use and socio-demographic variables, drug-related risk factors, and pathogen prevalence in Aboriginal injection drug users (IDU) in Manitoba, Canada.     

Homelessness and HIV risk behaviors among injection drug users

This article uses data from an 8-year study of injection drug users to examine whether homelessness independently influenced the likelihood of engaging in human immunodeficiency virus (HIV) risk behaviors. Fixed effects regression analyses are used to estimate the associations between four different housing contexts and four different behaviours related to transmitting HIV infections. Results showed that 16% of the study group experienced homelessness at some point during the study, and that homelessness was significantly associated with a higher likelihood of frequenting shooting galleries (odds ratio=2.05), but did not have a significant effect on sharing syringes, sharing other injection drug paraphernalia, or participating in paid sex. These results provide limited support for positing homelessness as independently associated with increased levels of HIV-related risk behavior among injection drug users and highlights the need for more research that examines the housing dynamics among this population.     

The social structural production of HIV risk among injecting drug users

There is increasing appreciation of the need to understand how social and structural factors shape HIV risk. Drawing on a review of recently published literature, we seek to describe the social structural production of HIV risk associated with injecting drug use. We adopt an inclusive definition of the HIV 'risk environment' as the space, whether social or physical, in which a variety of factors exogenous to the individual interact to increase vulnerability to HIV. We identify the following factors as critical in the social structural production of HIV risk associated with drug injecting: cross-border trade and transport links; population movement and mixing; urban or neighbourhood deprivation and disadvantage; specific injecting environments (including shooting galleries and prisons); the role of peer groups and social networks; the relevance of 'social capital' at the level of networks, communities and neighbourhoods; the role of macro-social change and political or economic transition; political, social and economic inequities in relation to ethnicity, gender and sexuality; the role of social stigma and discrimination in reproducing inequity and vulnerability; the role of policies, laws and policing; and the role of complex emergencies such as armed conflict and natural disasters. We argue that the HIV risk environment is a product of interplay in which social and structural factors intermingle but where political-economic factors may play a predominant role. We therefore emphasise that much of the most needed 'structural HIV prevention' is unavoidably political in that it calls for community actions and structural changes within a broad framework concerned to alleviate inequity in health, welfare and human rights.     

Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program.

OBJECTIVES. This case-control study examined the association between syringe exchange use and hepatitis B and C in injection drug users. METHODS. Case patients included 28 injection drug users with acute hepatitis B and 20 with acute hepatitis C reported to the health department in a sentinel hepatitis surveillance county; control subjects were injection drug users with no markers of exposure to hepatitis B or C (n = 38 and 26, respectively) attending health department services during the same period. Data were abstracted from clinic records. RESULTS. Seventy-five percent of case patients with hepatitis B and 26% of control subjects had never used the exchange; similar proportions were found for the hepatitis C case and control groups. After adjustment for demographic characteristics and duration of injecting drugs, nonuse of the exchange was associated with a sixfold greater risk of hepatitis B (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 1.5, 20.4) and a sevenfold greater risk of hepatitis C (OR = 7.3; 95% CI = 1.6, 32.8). CONCLUSIONS. The results suggest that use of the exchange led to a significant reduction in hepatitis B and hepatitis C in the county and may have also prevented a substantial proportion of human immunodeficiency virus infections in injection drug users.     

Case-reporting of acute hepatitis B and C among injection drug users

Although public health surveillance system data are widely used to describe the epidemiology of communicable disease, occurrence of hepatitis B and C virus (HBV and HCV, respectively) infections may be misrepresented by under-reporting in injection drug users (IDUs). This study was carried out to examine the relationship between HBV and HCV incidence and case-reporting of hepatitis B and C in Seattle IDUs. Names of participants in a Seattle IDU cohort study who acquired HBV or HCV infection over a 12-month follow-up period were compared to a database of persons with acute bepatitis B and C reported to the bealth department surveillance unit over the same period. Of 2,208 IDUs enrolled in the cohort who completed a follow-up visit, 63/759 acquired HBV infection, 53/317 acquired HCV infection, and 3 subjects acquired both HBV and HCV. Of 113 cohort subjects who acquired HBV or HCV, only 2 (1.5%) cases were reported; both bad acute bepatitis B. The upper 95% confidence limit for case-reporting of bepatitis C in the cohort was 5.7%, and for hepatitis B, it was 7.5%. In this study, reporting of acute bepatitis in IDUs was extremely low, raising questions regarding the use of community surveillance data to estimate underlying incidence in that population group.     

Satisfaction with access to health care among injection drug users,other drug users,and nonusers

This article examines the satisfaction of users of cocaine and/or opiates and non-drug users with access to the health care system. Data were obtained from a sample of 1,477 injection drug users, non-injection drug users, and non-drug users recruited from neighborhoods with high drug use. Multiple regression examined the relationship between satisfaction with access to health care and demographic, health status and health care utilization, ability to pay, and alcohol and drug use variables. Age, ethnicity, health status, having received health care in the last 12 months, not having received health care when needed, having received preventive health care, health insurance, and drug use were independently associated with satisfaction. Injection drug users and non-injection drug users were less satisfied with access to health care. The article discusses strategies to improve health care delivery to drug users.     

Syringe access for the prevention of blood borne infections among injection drug users

Background  

Approximately one-third of acquired immunodeficiency syndrome cases in the United States are associated with the practice of sharing of injection equipment and are preventable through the once-only use of syringes, needles and other injection equipment.     

Self-efficacy estimates for drug use practices predict risk reduction among injection drug users

We used baseline outcome efficacy (OE) estimates for human immunodeficiency virus (HIV) risk reduction to predict subsequent risk reduction 6 months hence among 792 injection drug users in a prospective study. Declines in drug use, frequency of injection, and needle sharing were found among those with high OE scores after adjustment for baseline behavior and antecedent factors. No OE effect was found in multivariate analysis for shooting gallery attendance, a risk that substantially declined in this cohort. OE for needle disinfection was associated with reduced drug risk behaviors, but not for improved needle hygiene practices over time. The self-efficacy model is useful in understanding psychological factors in risk reduction among injection drug users.     

FSW和IDU艾滋病相关知识及行为调查

目的 了解广东省广州市番禺区女性性工作者(FSW)和静脉吸毒者(IDU)2类高危人群的艾滋病相关知识及行为现状,为进一步进行有针对性的行为干预提供依据。方法 在娱乐场所和监管场所按照随机抽样的方法选择407名FSW和437名IDU,由调查员对调查对象进行一对一的问卷调查,随后对2类人群的部分结果进行比较。结果 FSW、IDU人群的艾滋病知识知晓率分别为56.8%(231/407)和52.6%(230/437),差异无统计学意义;FSW人群中商业性行为未使用安全套的占19.4%(79/407),IDU人群有共用注射器吸毒行为的占27.5%(120/437);FSW和IDU人群获得艾滋病知识的途径均以电视为主,分别为85.5%(348/407)和89.5%(391/437);IDU在商业性行为时是否使用安全套的主要影响因素为年龄(OR=2.433,95% CI:1.162~5.095)。结论 FSW和IDU人群均存在感染和传播艾滋病的高风险,应采取有效措施对他们进行相关危险行为的干预。     

Gender differences in clinical manifestations before AIDS diagnosis among injecting drug users

We compared incidence rates of self-reported HIV-related symptoms and illnesses, verified clinical manifestations and findings on physical examination between female and male injecting drug users (IDU) stratified by HIV serostatus in the Amsterdam cohort study on the natural history of HIV infection. HIV-positive female IDU (n = 100) reported a higher frequency of several symptoms and illnesses than male IDU (n = 139). Symptoms were reported more chronically by women compared to men, while clinical manifestations were reported by a greater proportion of women affected by these illnesses compared to men. In HIV-negative IDU (163 women and 232 men) the incidence rates were lower compared to HIV-positives, and a similar gender effect on reported symptoms and illnesses was found. Adjusting for biological, behavioral, demographic and study related variables did not change the gender effect on clinical manifestations substantially. We conclude that the gender effect among HIV-positive IDU was not caused by a differential impact of HIV infection on the incidence of the studied clinical manifestations among female and male IDU, but reflects a higher morbidity of female IDU compared to male IDU.     

The consistency of self-reported HIV risk behavior among injection drug users.

OBJECTIVES. Most studies of risk factors for human immunodeficiency virus (HIV) rely heavily on retrospective self-reports. The degree to which these reports provide reliable information has received little research attention. The purpose of this study was to assess the extent to which the reliability of retrospective self-report data is affected over time. METHODS. Data were examined from a longitudinal study of risk behaviors among injection drug users. Structured interviews were administered to 366 injection drug users who were asked to recall behaviors that they had reported 6, 12, or 18 months earlier. RESULTS. Kappa coefficients showed moderate initial memory loss for injection and sexual risk behaviors. After 6 months, time had little effect on the ability of injection drug users to recall injection and sexual risk behaviors. For ordinal measures of risk, subjects who gave different reports over time were most likely to disagree by one response category. CONCLUSIONS. These findings support the use of retrospective self-reports in assessing HIV risk behaviors among injection drug users. Retrospective inquiry is likely to remain an important method for collecting data over time.     

Risk factors for hepatitis B in an outbreak of hepatitis B and D among injection drug users

During January-April, 2000, 12 cases of acute hepatitis B were reported in Pierce County, Washington, compared with seven in all of 1999. Seven (58.3%) case patients were injection drug users (IDUs), three of whom were coinfected with hepatitis D virus (HDV) and died of fulminant hepatitis. Vaccination clinics were implemented at the local health department and needle exchange program to control the outbreak. We investigated this outbreak to determine risk factors for hepatitis B virus (HBV) transmission among IDUs. Hepatitis B cases were ascertained through routine surveillance and prevaccination testing at vaccination clinics. We conducted a case-control study comparing IDU case patients with HBV-susceptible IDUs identified at the vaccination clinics. Fifty-eight case patients were identified during January-December, 2000, 20 (34.5%) of whom were coinfected with HDV. Thirty-eight case patients (65.5%) reported current IDU. In the case-control study, the 17 case patients were more likely than the 141 controls to report having more than one sex partner [odds ratio (OR) =4.8, 95% confidence interval (CI) =1.5-15.0], injecting more than four times a day (OR = 4.5, 95% CI =1.2-15.6) and sharing drug cookers with more than two people (58.8% vs. 14.0%, OR =14.0, 95% CI =2.4-81.5). Results were similar after controlling for syringe sharing in multivariable analysis. IDUs should be vaccinated against hepatitis B and should be advised against sharing drug injection equipment.     

Neighborhood differences in patterns of syringe access,use, and discard among injection drug users: Implications for HIV outreach and prevention education

The article presents results from the Syringe Access, Use, and Discard: Context in AIDS Risk research project comparing two neighborhoods by (1) socioeconomic and demographic characteristics; (2) patterns of syringe access, use, and discard; and (3) encounters with a local human immunodeficiency viruslacquired immunodeficiency syndrome (HIV/AIDS) outreach project targeted to injection drug users (IDUs). The results show that IDUs in more economically advantaged neighborhoods were more likely to acquire syringes from a single source (rather than multiple sources), more likely to inject alone in their own residence (rather than public injection locales), and more likely to dispose of syringes in private garbage cans rather alleys or dumpsters. These results are further associated with the likelihood of encountering street outreach workers, with IDUs in more affluent neighborboods much less likely to have any such contacts. Based on the different patterns of access, use, and discard evident in each neighborhood, the results indicate that different and more carefully tailored local outreach and prevention strategies are urgently needed. An earlier version of this article was presented at the Annual Meeting of the American Public Health Association, Atlanta, Georgia, October 21–25, 2001.     

Risk perception, risk taking and risk management among intravenous drug users: implications for AIDS prevention.

The risks associated with AIDS transmission among intravenous drug users overlap with a constellation of other risk events common in the use of IV drugs. This paper explores the subcultural definition, meaning and use of risk from the experience of the active user. In assessing the extent and nature of risk among IV drug users, street-based ethnographic research was conducted over a sixteen month period and a survey was administered to sixty-six individuals in two drug treatment facilities. Risk-taking, risk perception and strategies for minimizing risks associated with maintaining a drug habit are analyzed in the context of how IV drug users are responding to the risks associated with HIV transmission. The research indicates that risk needs to be viewed within the context of the subculture to effect strategies to reduce HIV-related risk behavior.     

社区吸毒者艾滋病知识及高危行为调查

目的 了解静脉吸毒人群艾滋病相关知识的知晓情况和行为特征。方法 采用匿名填问卷的方式,对四川省南充市社区内的361名静脉吸毒人员进行艾滋病相关知识和行为的问卷调查。结果 静脉吸毒人群对艾滋病的传播途径和预防措施有一定程度的了解,但他们中存在着共用注射器吸毒和性交途径传播或感染人类免疫缺陷病毒(HIV)的双重危险,56.7%的调查者在最近6个月有共用注射器的行为,33.3%~52.8%的静脉吸毒者在进行临时性行为/商业性行为时从未使用过安全套;自愿到医疗机构寻求HIV抗体检测只占44.6%。结论 针对静脉吸毒人群的艾滋病相关知识的宣传教育仍有待于进一步加强。提供一次性的清洁针具,开展百分之百安全套推广以及自愿咨询检测应是该人群干预重点。     

以社区为基础的静脉吸毒人群丙型肝炎病毒感染危险因素研究

目的　了解四川省凉山州地区静脉吸毒人群丙型肝炎病毒感染情况及其危险因素。方法　以社区为基础调查静脉吸毒人群丙型肝炎病毒感染危险因素 ,通过检测研究对象的丙型肝炎病毒抗体确定是否感染丙型肝炎病毒。结果　静脉吸毒人群丙型肝炎病毒感染率为 71.0 % (2 6 9/379)。在多因素 logistic回归模型分析中 (P<0 .0 5 ) ,共用注射器具次数的 OR值为 2 .0 5 3,其 95 %CI为 1.4 5 8～ 2 .891。在单因素χ2 分析中 (P <0 .0 5 ) ,共用注射器具次数、共用注射器具吸毒年限、近 3个月平均每天静脉吸毒频率等多个因素同丙型肝炎病毒感染有关。结论　需进一步研究阐明静脉吸毒共用注射器具方式对丙型肝炎病毒感染的影响