A comparison of HIV risk behaviors between early and late initiators of injection drug use in Houston,Texas

Abstract

Background: Injecting drug use accounts for 10% of new HIV cases worldwide. Younger injecting drug users are more likely to engage in HIV risk behaviors. Objectives: To assess the association between the age at initiation of injecting drugs and HIV risk behaviors. Methods: Houston data from the National HIV Behavioral Surveillance System were analyzed. The primary exposure variable was the self-reported age at injecting drug initiation. This study assessed whether individuals who initiated injecting drugs before and after the age of 21 differ by selected socio-demographic characteristics and high risk behaviors. Results: Black race and lower education level were shown to be the only statistically significant factors with those self-reported to initiate injecting drugs before turning 21. The group initiating use before the age of 21 was found to be more likely to share needles. Conclusions: This study highlights that race and education are positively associated with younger injecting drug initiation and younger injectors tend to engage in HIV risk behaviors such as needle sharing.     

The identification of needle fixation: The development of the NEFPRO,a clinical screening tool

Aim: This article describes the development of a scale to identify needle fixation. Design: A series of statements were developed from qualitative interviews with 24 injecting drug users. The content of the interviews was used to generate 74 statements that had relevance to needle fixation. The 74 statements were developed into a 74-point questionnaire and administered to 80 injecting drug users. These statements were refined to 14 relevant questions with pairs of questions relating to a particular activity. This had a Cronbach reliability of .70. Following identification of needle fixation by interview these questions were reduced to the final 10. Participants: A total of 137 injecting drug users from Cardiff and surrounding area were used for different stages of the development. Results: The resulting 10-point scale has a utility in identifying needle fixation in individuals with the problem and specifies the role that needle fixation plays for them. Conclusions: This scale may help with the treatment of injecting drug users by identifying needle fixation.     

Gender differences in seeking care for hepatitis C in Australia

Hepatitis C is among Australia's most common notifiable infectious diseases and the majority of those affected develop chronic illness. Management of other chronic illnesses has been shown to be most effective when gender‐specific health education and support is offered. This paper examines gender differences in the health‐seeking behaviour of men and women with hepatitis C. Data are from two separate studies, recruited largely from non‐clinical sources, of women (n = 362) and of men (n = 308) with hepatitis C, conducted in Victoria, Australia in 2000 and 2002, respectively. Participants completed a self‐administered questionnaire that included questions on health and use of medical services. Women without symptoms (47%) were more likely than men (18%) to seek hepatitis C care (p<0.001), to rate their health poorly (47% vs. 35%; p = 0.002), and to perceive discrimination from health providers (47% versus 40%; p = 0.009). Men (36%) were less likely then women (6%) to acknowledge needing medical support for hepatitis C (p<0.001) and gender was an independent predictor of seeing a doctor specifically for hepatitis C. Both male and female current injecting drug users were less likely than others to access hepatitis C care, with male injecting drug users (18%) significantly less likely than female injecting drug users (33%) to be referred to a specialist (p = 0.002). Results suggest that the impact of hepatitis C is perceived differently by men and women. Strategies to address primary health care issues for people with hepatitis C need to take account of both gender and the additional complications of current injecting drug use.     

Reducing the risk of exposure to HCV amongst injecting drug users: Lessons from a peer intervention project in Northwest Wales

Aim: To assess the feasibility of a peer delivered educational intervention to reduce injecting risk behaviour amongst injecting drug users (IDUs) in Northwest Wales.

Methods: A team of 13 current IDUs were recruited to be peer educators. Recruits were regular users of illicit heroin and active within local drug using networks. Over the course of the project they carried out educational interventions amongst their peers. Risk behaviour data was collected throughout the project by the educators.

Results: A wide range of educational interventions were carried out by the peer educators. Research data collected by the peer educators indicated high levels of injecting risk. At baseline 80% (95% CI 61–92%) of IDUs questioned reported having used someone else's used needle or syringe in the month prior to interview. Data collected on injecting group size indicated that a small subgroup of individuals injected in the company of a considerable number of other individuals. It was clear that the symptoms of withdrawal were seen as potentially leading to higher risk behaviour.

Conclusions: Peer education intervention is a feasible approach to risk reduction amongst IDUs. Needle and syringe sharing is still a very common practice in Northwest Wales.     

The effect of personal use and family history on the attitudes of medical students toward alcohol and drug users

Objective: To investigate the effects of the personal exposure/usage of alcohol and drugs in medical students on their attitudes toward alcohol and drug users. Negative attitudes in health care practitioners about alcohol and drug users may lead to poor patient care. Personal experience on alcohol and drug use can influence the attitudes of health care professionals.

Method: This study used a quantitative cross-sectional methodology, utilizing a self-report survey on the personal use of alcohol and drug use, and the family history of alcohol and tobacco use. The “Substance Abuse Attitude Survey” (Chappel J. N., Veach, T. L., & Krug, R. S. (1985). The Substance Abuse Attitude Survey: An instrument for measuring attitudes. Journal of Studies on Alcohol, 46, 48–52.) measured attitudes (n = 417).

Results: The attitudes of medical students towards alcohol and drug users were weakly linked to their own personal use, and family history of alcohol and drug use. Increased use of alcohol was positively correlated with non-stereotyping. Length of time in medical school, number of years drinking alcohol, and high frequency of binge drinking were negatively correlated with non-moralism.

Conclusions: This study demonstrated that the attitudes of future medical professionals are fairly neutral toward alcohol and drug users. Given that alcohol and drug abuse are now considered medical illnesses health professionals themselves may attach fewer stigmas and stereotypes to the use and abuse of alcohol.     

‘It’s not what you know but who you know’: Role of social capital in predicting risky injection drug use behavior in a sample of people who inject drugs in Baltimore City

Background: Injection drug use is the third highest risk factor for HIV transmission. Injection drug users, marginalized population, continue to be at threat for several health problems, including HIV, Hepatitis B and C, and drug overdose. The area of social capital and risk behaviors is understudied. The current study aims to prospectively assess the relationship between social capital and the risk behaviors associated with injection drug use (IDU).

Methods: The sample of the present study is a subset of 130 drug users who reported IDU at both baseline and first follow-up wave for assessing the relationship between social capital and needle sharing in the city of Baltimore, MD. Factor analysis, structural equation modeling, and multivariate logistic regression were conducted to explore these relationships.

Results: A single-factor model fits well with factor loadings ranging from 0.20 to 0.95. Social capital is shown to be significantly and inversely associated (p < 0.05) with 35% decreased odds of the risk of sharing needles with every unit increase in social capital (AOR: 0.65, 95% CI: 0.06, 0.84).

Conclusion: The result from this study can be used to inform and fill gaps in the field of harm reduction. The interplay between social support, social participation and norms of trust, reciprocity generated from the index’s social network, and its relationship with behavior of needle sharing demonstrates that these leverage points should be emphasized in future harm reduction interventions.     

Needle phobia and stress-reducing medical devices in pediatric and adult chemotherapy patients.

Needle phobia--fear of medical devices--is a significant problem in pediatric and adult chemotherapy patients. Stress-reducing medical devices is a new, effective cognitive therapy for needle phobia. Twenty-five pediatric and 25 adult chemotherapy patients were randomly exposed to conventional or stress-reducing decorated butterfly needles and syringes. Emotional stress responses were determined with the Visual Aversion Scale, Visual Analogue Fear Scale, Visual Analogue Anxiety Scale, and Visual Overall Stress Score for each needle and syringe design. Sixty-eight percent of the pediatric and 52% of the adult patients were overtly needle phobic, but children demonstrated significantly more aversion and stress (P < .001). Stress-reducing medical devices effectively and significantly reduced aversion, anxiety, fear, and overall stress, and were 76% effective in preventing overt needle phobia in children and 92% effective in adults (P < .001). One hundred percent of children and adults felt that stress-reducing medical devices should be available in chemotherapy clinics. Needle phobia and stress in pediatric and adult chemotherapy patients are significantly reduced by the use of stress-reducing medical devices.     

High‐risk injecting behaviour in hostel accommodation for the homeless in Glasgow 2001–02: a study combining quantitative and qualitative methodology

Aims: The aim of this study was to determine whether injecting drug users (IDUs) living in hostels for the homeless were more likely to engage in blood‐borne virus associated injecting risk behaviour than those living elsewhere.

Design: Four‐hundred‐and‐fifty‐three IDUs who had commenced injecting post‐1995 were recruited from community settings in Glasgow and interviewed during 2001–02 using a structured questionnaire (quantitative component). Respondents who had commenced injecting post‐1998 were also invited to participate in an in‐depth interview to explore contextual factors that influence injecting risk behaviour (qualitative component).

Results: Individuals interviewed during the qualitative component of the study reported witnessing prolific sharing of needles and syringes (n/s) in hostels. Multi‐factorial logistic regression found that hostel residence was independently associated with injecting with a n/s previously used by a friend, acquaintance or family member (OR 1.58, 95% CI 1.01–2.49), passing on used n/s (OR 1.70, 95% CI 1.08–2.69), borrowing used n/s in a ‘shooting gallery’ (OR 2.23, 95% CI 1.04–4.77), borrowing used n/s from multiple sharing partners (OR 2.33, 95% CI 1.17–4.64) and sharing spoons during drug preparation (OR 1.68, 95% CI 1.03–2.73) in the 6 months prior to interview.

Conclusions: The hostel environment appears to be conducive to high‐risk injecting behaviour.     

Abdominal and pelvic needle aspiration biopsies: can we perform them well when using small needles?

Background: The aim of this study was to compare abdominal fine-needle aspirations (FNAs) performed with large (≥20-gauge) or small (≤21-gauge) needles for diagnostic rate, number of samples required for diagnosis, diagnostic accuracy, and complication rates. Methods: Abdominal and pelvic FNA procedures were retrospectively reviewed. Needle size, imaging guidance used, number of pathology slides created, complications, and cytologic and final diagnoses were obtained by reviewing radiologic, medical, and cytology records. Results: Two hundred ninety procedures were included in the study. Two hundred fifty-seven were performed in patients having only one biopsy during the study interval. Of these, 159 had biopsies using small needles and 98 using large needles. Small needle biopsies had as high a diagnostic rate as did large needle biopsies (97.5% vs. 92.9%, p= 0.11). Small and large needle biopsies showed high diagnostic accuracy (96.1 and 98.9%, respectively; p= 0.27). Incorrect cytologic diagnoses plus nondiagnostic examinations composed 6.3% of biopsies using small needles and 8.2% of biopsies using larger needles (p= 0.62). Complication rates were low. Average number of needle passes tended to be lower when small needles were used. Conclusion: Small needles can be successfully used for abdominal and pelvic FNAs. Small needles require the same or fewer needle passes, have low risk, have the same or improved ability to obtain diagnostic material, and achieve correct diagnoses compared with larger needles. Received: 29 April 1998/Revision accepted: 15 July 1998     

The development of a psychological theory of needle fixation

Aim: This article describes the development and validation of a psychological theory of needle fixation. Design: Participants were interviewed about their injecting behavior using a semi-structured interview paying particular attention to those behaviors likely to be associated with needle fixation. A battery of psychometric tests was then administered to validate the differentiation of the two groups. Participants: Participants were 33 injecting drug users recruited in Cardiff and the surrounding area. Measurements: In addition to the semi-structured interview three psychometric tests were used: the needle fixation profile, the Leeds addiction scale, and the Padua scale to measure obsessive-compulsive traits. Findings: The interviews successfully identified those injectors with needle fixation and the components of this. The psychometric tests indicated the differences between the two groups with regard to needle fixation. The results also showed that some obsessive-compulsive traits were found in those with a needle fixation. Conclusions: The results showed that there are differences between those with a needle fixation and other injectors. This identification of the components of needle fixation has led to the development of a psychological theory of the phenomenon.     

Book reviews

Aims: Determine the prevalence and frequency at which injecting drug users (IDU) continue to inject whilst incarcerated and to identify factors associated with in-prison injecting. Design: A nationally coordinated cross-sectional convenience sample. Participants: A total of 355 regular IDUs who had been imprisoned within the past 10 years.

Measurements: Data concerning demographics, drug use history and injection whilst imprisoned were collected by participant self-report.

Findings: Almost half, 46% (n = 162), of the participants reported that they had ever injected whilst imprisoned. Most of these (n = 150; 42% of all participants) reported injecting during their last imprisonment. Factors identified as significantly associated with prison injecting were being male, receiving income from criminal activity in the month prior to interview and length of last sentence. Frequency of injection varied from isolated instances to multiple times daily. Half (n = 75) of those who injected during their most recent imprisonment reported injecting at a lower frequency while incarcerated than they did in the month prior to survey. Two individuals reported initiation to injection during their most recent period of imprisonment.

Conclusions: Most IDUs who experience imprisonment either suspend injecting whilst incarcerated or reduce the frequency at which they inject. However, injection is still common in Australian prisons, highlighting the need for continued harm-minimisation efforts with this population.     

Correlates of interpersonal problems among current and former drug users in Slovakia

Abstract

Introduction: This cross-sectional study examined correlates of interpersonal problems in a sample of 139 current and former drug users from three types of settings in Slovakia (1 needle-exchange program, 1 twelve-week inpatient treatment and 14 long-term therapeutic communities).

Methods: The Inventory of Interpersonal Problems (IIP-32) was correlated with selected psychological constructs, for example, social support, impulsivity, anxiety and the drug abuse screening test.

Results: Contrary to expectations, there were no differences between current and former drug users with respect to their interpersonal problems. Certain interpersonal problems (intrusiveness) tended to be lower, while social resources (affectionate support) were higher in current versus former users. Social support was negatively correlated with risky injecting practices among injectors.

Conclusion: Interpersonal problems among drug users and drug-free populations seem to be of enduring nature and their measurement remains a complex issue. As the findings suggest, addiction can be best understood by studying psychosocial along with biomedical factors, including interpersonal problems, of current drug users as they may differ from treated users.     

The complex array of antecedents of depression in women with physical disabilities: Implications for clinicians

Purpose. This article discusses the complex interrelation of elements of the physical, psychological, social, and environmental life context of women with physical disabilities and the association of these elements with significant disparities in rates of depression and access to mental health care for this population.

Method. Literature and concept review.

Results. High rates of depression in women with physical disabilities are well documented in the literature. Many elements that are disproportionately common in the lives of women with physical disabilities, including socio-economic disadvantage, functional limitations, pain and other chronic health conditions, poor diet, physical inactivity, smoking, violence, low self-esteem, sexuality problems, chronic stress, environmental barriers, and barriers to health care, have also been linked with higher rates of depression and depressive symptomatology. Depression self-management interventions tailored for women with disabilities have been developed and proven effective.

Conclusions. Many women who must deal with the stresses surrounding an array of health problems may experience symptoms of depression without necessarily meeting the criteria for clinical depression. Psychologists, counselors, primary care physicians, specialists, and other medical and rehabilitation professionals are challenged to recognize the symptoms of depression in women with physical disabilities and assist them in obtaining appropriate psychological and pharmacological interventions.     

Hepatitis C treatment and injecting drug users in Perth,Western Australia: Knowledge of personal status and eligibility criteria for treatment

Background: Few injecting drug users (IDU) in Australia take part in antiviral therapy for chronic hepatitis C (HCV). To assess whether IDU are aware of the eligibility criteria for treatment and their personal HCV status, we surveyed 78 IDU attending the fixed-site needle exchange in the city of Perth.

Method: Participants were eligible for the study if they self-reported having ever been diagnosed as HCV antibody positive. Each participant completed a semi-structured questionnaire administered by a peer HCV educator at the needle exchange.

Results: Knowledge of personal HCV status was poor with more than half of the group not knowing the purpose of a polymerase chain reaction test. Knowledge of treatment eligibility was also poor especially around issues relating to alcohol consumption, the need for a liver biopsy, and treatment during pregnancy.

Conclusion: Up-to-date information about eligibility criteria for HCV treatment has not filtered down to this group of older IDU. Furthermore, knowledge of personal HCV status (chronic infection and infectivity) needs to be improved. Informed decisions about treatment cannot be made if knowledge of status is poor and IDU are not familiar with treatment eligibility.     

Cross-sectional study of HIV prevalence and the characteristics of injecting drug users in Colombia

Abstract

Objective: To determine socio-demographic characteristics, prevalence and risk behaviors of HIV in injecting drug users in three cities of Colombia.

Method: A cross-sectional study was conducted in three cities of Colombia; information was obtained from 796 participants over 18 years of age, with prior signed informed consent. Statistical analysis of the data and generated output tables were conducted in RDSAT and SPSS.

Results: There are extensive networks of injection drug users (IDUs). The population of IDUs was characterized as mostly men between 18 and 34. The data suggest a recent introduction of HIV into networks and a high degree of risk behavior for HIV spread in networks and used syringes. People who reported sharing syringes, were at greater risk of not using a condom when having sex with casual partners, this factor is increased when controlling for other variables consulted (OR?=?4.10, 95% CI 1.23 to 16.05; p?<?0.00).

Conclusions: The data in this report indicate a high risk for a possible expansion of HIV among injecting networks, supported the introduction of HIV into networks of injectors. For Colombia, this research constitutes a first step in the search for strategies to prevent the further spreading of the infection.     

Laboratory study of the effectiveness of filters used by heroin injectors

Aims: (a) To compare in the laboratory the effectiveness of various filters at removing particles from heroin injections; (b) To measure the amount of heroin retained by the filters; and (c) To describe the relevance of these preliminary findings to future research.

Design: A laboratory‐based investigation. Injections were prepared with street heroin obtained from the police, copying the methods of injectors. Pieces of cigarette filter, hand‐rolling cigarette filter, cotton wool from buds and commercially produced syringe filters were tested. The Coulter Multisizer (IIe) was used to count and size particles; Capillary Zone Electrophoresis was used to measure the amount of heroin retained in the filters.

Findings: All methods of filtration reduced the amount of particles, with the commercially produced syringe filter producing the largest reduction. The syringe filter retained the most heroin after use; however, less drug material was evident on the spoon, suggesting further work is needed with a range of quantities. The cigarette, hand‐rolling and cotton bud filters all retained some drug with no significant difference detected between the different filters.

Conclusions: This preliminary study suggests all the filters tested may convey health benefits. Further work is needed with varying quantities of drug, acid and water and to establish safety in use. Then future studies can establish the health consequences for injecting drug users from the use of such filters.     

Partner notification among HCV-positive couples who inject drugs

Background: This study examines predictors of partner notification (PN) confirmed by a test counselor among people who inject drugs (PWID) and their sexual partners in Kazakhstan.

Methods: We used baseline data from an HIV couple-based intervention study, restricting the sample to couples where both partners knew they were hepatitis C virus (HCV)-positive prior to participation in the study (N?=?136 individuals). Cross-tabulation and logistic regression were used to examine predictors of PN, including socio-demographic characteristics, sexual and drug risk behaviors, and access to health services.

Results: Of the sample, 68 (50%) participants notified their partners of their HCV status. PN was associated with participation in a needle/syringe exchange program and sexually transmitted infection counseling or education in the past 6 months. In the adjusted model, concurrent HIV infection (OR?=?2.4, p?<?0.05), having more than one sexual partner (OR?=?2.5, p?<?0.05), and participation in a needle exchange program (OR?=?4.3, p?<?0.01) were positively associated with notifying one's partner.

Conclusions: The findings from this study emphasize the importance of service access among PWID and point to the need for additional research on HCV counseling and notification strategies as a component of health services for injection drug users.     

Methamphetamine use among incarcerated women

Problem Women face greater vulnerability to using stimulant drugs, their rate of incarceration for methamphetamine use is increasing, and women's issues have been historically neglected in substance abuse research. This study examined demographic, social and psychological characteristics of incarcerated methamphetamine‐using women that could influence service needs and utilization during incarceration.

Method Incarcerated women completed individual interviews and questionnaires regarding drug use and other psychosocial variables. Psychosocial factors were examined according to lifetime drug use history. Comparison groups were: (1) nonstimulant drug users (n=16); (2) noninjection methamphetamine users (n=24); and (3) injection methamphetamine users (n=31). Psychosocial factors were also examined according to recent methamphetamine use. Recent use comparison groups were: (1) no recent drug use (n=18); (2) nonstimulant drug use (n=17); (3) noninjected methamphetamine (n=22); and (4) injected methamphetamine (n=20).

Findings Nearly one‐third of these incarcerated drug‐using women had never before received substance abuse treatment. Drug abuse, sexual assault and concomitant psychiatric symptoms were high across the entire sample, but greatest for methamphetamine users.

Conclusion Results revealed the complex psychosocial needs and risks that confront incarcerated methamphetamine‐using women and pose serious threats to eventual drug recovery.