Prevalence of Infections,HIV Risk Behaviors and Factors Associated with HIV Infection Among Male Injecting Drug Users Attending a Needle/Syringe Exchange Program in Dhaka,Bangladesh

Injecting drug users (IDU) in Bangladesh are at the early stages of an HIV epidemic. To understand the dynamics of the HIV epidemic, male IDU (n = 561) were recruited from the needle/syringe exchange program in Dhaka in 2002, who underwent a risk-behavior survey and were tested for HIV, syphilis, hepatitis C, and hepatitis B. Correlates of HIV infection were determined by conducting bivariate and multiple regression analyses. The median age of the IDU was 35 years, 39.6% had no formal education, approximately half were married and/or living with their regular sex partner and 26% were currently homeless. The median age at first injection was 29 years. HIV was detected in 5.9% of the IDU and homelessness was the only factor independently associated with HIV (OR = 5.5). Urgent measures must be undertaken to prevent escalation of the HIV epidemic. The study's limitations are noted.     

Dominant Situational Determinants of Needle Sharing in Injecting Drug Users

The aim of this study was to assess the importance of situational, social and psychological contextual factors in injecting drug users' (IDUs) decisions concerning HIV risk behavior. The sample included 84 IDUs recruited in Sydney, Australia. A computer game-like format was used to generate hypothetical injecting events. Levels of situational factors were varied randomly between situations. These included needle availability, bleach availability, craving, how well known potential sharing partners were, previous sharing, privacy of site and the degree to which individuals were high drunk or stoned. Responses to choices in each injecting event included the likelihood of sharing in each situation, the frequency with which they had experienced the hypothetical situation in real life, and their satisfaction with their response. Canonical correlation analysis indicated that the association between situational influences and choice variables accounted for 87.78% of the variance. Sharing needles was negatively related to decision satisfaction and experience with an actual situation indicating that users had internalized HIV preventive norms and were not likely to share on a normal basis. Choices about needle sharing were primarily constrained by the trade-off between needle availability and craving while social factors played a secondary role. The probability of sharing increased as other people present were better known and previous sharing history increased. This pattern of results suggest that while needle exchanges will be effective, they may fail to reach their full potential unless factors related to substance use and social context are also addressed. The current methodology appeared to be a useful tool for studying the influence of the context of injecting events on behavior.     

Dominant Situational Determinants of Needle Sharing in Injecting Drug Users

The aim of this study was to assess the importance of situational, social and psychological contextual factors in injecting drug users' (IDUs) decisions concerning HIV risk behavior. The sample included 84 IDUs recruited in Sydney, Australia. A computer game-like format was used to generate hypothetical injecting events. Levels of situational factors were varied randomly between situations. These included needle availability, bleach availability, craving, how well known potential sharing partners were, previous sharing, privacy of site and the degree to which individuals were high drunk or stoned. Responses to choices in each injecting event included the likelihood of sharing in each situation, the frequency with which they had experienced the hypothetical situation in real life, and their satisfaction with their response. Canonical correlation analysis indicated that the association between situational influences and choice variables accounted for 87.78% of the variance. Sharing needles was negatively related to decision satisfaction and experience with an actual situation indicating that users had internalized HIV preventive norms and were not likely to share on a normal basis. Choices about needle sharing were primarily constrained by the trade-off between needle availability and craving while social factors played a secondary role. The probability of sharing increased as other people present were better known and previous sharing history increased. This pattern of results suggest that while needle exchanges will be effective, they may fail to reach their full potential unless factors related to substance use and social context are also addressed. The current methodology appeared to be a useful tool for studying the influence of the context of injecting events on behavior.     

Drug Use,Needle Sharing,and HIV Risk among Injection Drug-Using Street Youth

Injection drug use is the second most common HIV risk behavior in the United States, but little is known about injection drug use and needle-sharing behavior among street youth, a group at high risk for HIV infection. This study investigates the drug use histories, injection drug use behaviors, and needle-sharing practices of 106 injection drug using youth in Los Angeles, California. Respondents report high rates of injection drug use and needle sharing, indicating that these youth are at particularly high risk for HIV infection. Results suggest a need for outreach services tailored to the unique needs of injection drug-using adolescents.

El uso de la droga por injeccion es el segundo comportamiento de riesgo de VIH en los Estados Unidos, pero poco se conoce acerca de la utilizacion de la droga por injeccion y del compartir de aguijas hypodermicas por los jovenes drogadictos callejeros, que constituyen un grupo de alto riesgo de infection del VIH. Este estudio investiga la historia del uso de la droga, el comportamiento del compartir de agujas hypodermicas de 106 jovenes que utilizan droga en Los Angeles. Sujetos reportan un alto número de uso droga por injeccion y por compartir agujas hypodérmicas, indicando que estos jovenes estan en alto riesgo de infeccion del VIH. Los resultados de este estudio indican la necesidad de servicios sociales adaptados a las necesidades particulares de estos jovenes que utilizan drogas.

L'utilisation de la drogue par injection est le deuxième comportement de risque de VIH aux États-Unis, mais on n'a que très peu d'informations sur l'utilisation de la drogue par injection et le partage d'aiguilles hypodermiques parmi les jeunes drogués de la rue, lesquels constituent un groupe à haut risque d'infection VIH. Nous avons étudié les histoires et comportements, y compris les comportements de parage de seringues, de 106 jeunes utilisateurs de drogue à Los Angeles. Les sondés ont fait état d'un taux élevé d'utilisation de la drogue par injection et de partage de seringues, ce qui laisserait croire que ces jeunes courent un risque élevé d'infection VIH. Les résultats de cette étude indiquent la nécessité de services sociaux adaptés aux besoins particuliers des drogués adolescents.     

Active and Former Injection Drug Users Report of HIV Risk Behaviors During Periods of Incarceration

American prisons have increasing numbers of inmates incarcerated for drug offenses. This population is at high risk for HIV-infection and may continue HIV transmission risk behaviors while incarcerated. We find that 31% of injection drug users with a history of imprisonment had used illicit drugs in prison, and nearly half of these persons had injected drugs while incarcerated. Male gender and number of times incarcerated were associated with drug use in prison. Interventions for drug-using prisoners that are advocated in some European prisons, such as needle exchange programs and methadone maintenance, need attention in the United States.     

Needle Sharing Among Puerto Rican Injection Drug Users in Puerto Rico and Massachusetts: Place of Birth and Residence Matter

This study explored whether place of birth and residence was associated with needle sharing for Puerto Rican injection drug users (IDUs) (N = 348). In-person interviews were conducted in Puerto Rico and Massachusetts during 2005–2007. Multivariate regression analyses revealed IDUs born and living in Puerto Rico were four times more likely to have shared needles compared to those residing in Massachusetts. Respondents residing in Massachusetts were 76% less likely to have ever shared needles with an HIV-positive individual, controlling for covariates. Findings highlight the increased HIV-risk of Puerto Rican IDUs born and residing in Puerto Rico. Prevention and treatment needs are discussed.     

Circumstances Surrounding Needle Use Transitions among Injection Drug Users: Implications for HIV Intervention

Injection drug users (IDUs) are at increased risk of infection with the human immunodeficiency virus (HIV). Intervention programs aimed at reducing the spread of HIV in this population typically incorporate a range of risk reduction strategies, including encouragement to move from injection to noninjection. However, very little is known about the factors associated with needle use transitions, either spontaneous or in response to intervention. We report a study in which a cohort of IDUs were asked about the reasons they stopped and restarted injection. Of 855 IDUs, 179 (21%) had had at least one 12-month period of noninjection since they first injected. Almost one-half of the reasons given for stopping injecting related to personal crises, characterized by major shifts in attitude to drugs and/or life more generally, and often generated by pressures in significant relationships. Concerns about HIV were cited by only one respondent. Many of the factors associated with transition out of needle use in the study population are not readily amenable to intervention. The implications of this for HIV risk reduction programs are discussed.     

A Comparison of HIV Related Risk Behaviors of Street Recruited and Treatment Program Recruited Injection Drug Users

SUMMARY

This paper compares the demographic traits and the risk behaviors of injection drug users (IDUs) not in treatment who were recruited into an AIDS risk reduction program in Miami, FL with attributes of IDUs who were clients of drug treatment programs. The majority of both IDU samples were male and in their 30's. Most street IDUs were African-American; a majority of treatment clients were White, non-Hispanic. Prevalence of HIV was high for African-Americans and Hispanics from both IDU samples. Prevalence of HIV was relatively low among both samples of White, non-Hispanic IDUs but somewhat higher among White street IDUs than among White treatment clients. Similar proportions of street and treatment IDUs injected daily, but street IDUs were more likely to share works, inject in shooting galleries, use crack and alcohol daily, have multiple sex partners and have IDU sex partners.     

Sexual Orientation and HIV Risk Behaviors in a National Sample of Injection Drug Users and Crack Smokers

SUMMARY

Literature on gender differences among those entering substance abuse treatment is limited. Using data from intake interviews in a large multisite prospective clinical epidemiological study, this study provides the opportunity to explore gender differences with implications for treatment response. Comparisons are made not only between women and men but also between four different treatment modalities.

Traditional gender differences were found with regard to age, education and employment. Although some drug use patterns were similar, men reported more alcohol use while women reported more daily use of cocaine. Women reported more problems related to health and mental health. In addition, women reported much greater proportions of past and current physical and sexual abuse. Women also reported greater concerns about issues related to children, although both women and men reported concern about drug treatment affecting custody of children.     

Continuing HIV Risk in New York City Injection Drug Users: The Association of Syringe Source and Syringe Sharing

Sterile syringe access is an important means to reduce HIV risk, but many injection drug users (IDU) who obtain syringes from sterile sources continue to share syringes. We examined the factors associated with continuing syringe sharing in New York City. We recruited 500 active IDU in 2005 through respondent-driven sampling. In multiple logistic regression, not obtaining all syringes in the past year exclusively from sterile sources was associated with increased syringe sharing. Ensuring adequate syringe availability as well as engaging and retaining nonusers and inconsistent users in sterile syringe services may increase sterile syringe access and decrease syringe sharing.     

The Acquisition and Maintenance of Safer Sexual Behaviors among Injection Drug Users

The current research tests stage-sequential models of safer sexual behavior using a new method for data analysis called Latent Transition Analysis (LTA). Results are presented from data collected on 359 injection drug users participating in a seroconversion study conducted by the UCLA Drug Abuse Research Center. We identified a six-stage model that adequately represented the data. Results indicate that respondents moved back and forth among high, medium, and low risk stages. This finding highlights the need for continual, sustained interventions to help maintain safer sex and drug-using behaviors in high-risk groups.     

四川省凉山地区静脉吸毒人群药物滥用及其行为特征调查

目的:了解四川省凉山地区静脉吸毒人群药物滥用及行为特征情况,为采取有针对性的戒毒干预措施预防艾滋病病毒的传播提供数据.方法:以社区为基础招募了379名静脉吸毒人员,调查其人口学特征,艾滋病病毒感染情况,药物滥用的种类、吸毒方式和频率,口吸和静脉吸毒时间,共用注射器具情况等.结果:静脉吸毒人群艾滋病病毒感染率为11.3%(43/379).379名被调查者全部为海洛因滥用者,其中247人(65.2%)单独使用过海洛因,297人(78.4%)混合注射过海洛因与安定,滥用过的其他药物有安定(8.2%)和鸦片(1.3%).300人(79.2%)每天静脉注射吸毒一次及以上;曾经共用注射器具静脉吸毒的为247人(65.2%),87人(35.2%)首次静脉注射吸毒即与他人共用注射器具;初次口吸吸毒和静脉注射吸毒的平均年龄分别为22.37岁和25.35岁,口吸吸毒和静脉注射吸毒的平均时间分别为6.41年和3.42年.结论:加强青少年、吸毒人员关于毒品危害和拒绝毒品的健康教育活动,以及开展美沙酮或丁丙诺啡口服治疗海洛因依赖者,降低静脉注射吸毒行为,控制艾滋病病毒的传播.     

The Damage Done: A Study of Injection Drug Use,Injection Related Abscesses and Needle Exchange Regulation

This study investigated the impact of a needle exchange policy change on community health. Data were collected from a needle exchange program in Eureka, California, for clients who participated in the program between the weeks (n = 112) of January 1, 2002, and February 28, 2004. Analysis was done using an autoregressive integrated moving average (ARIMA), indicating that greater utilization of the needle exchange program, in terms of needles exchanged and number of visits, is related to fewer numbers of abscesses treated. Additionally, self-report data collected from former intravenous drug users (n = 62) demonstrated that more needles exchanged were related to fewer occurrences of abscesses. The limitations of this research are discussed.     

Access to Sterile Injecting Equipment is More Important Than Awareness of HCV Status for Injection Risk Behaviors Among Drug Users

Awareness of hepatitis C virus (HCV) infection status is expected to influence risk behaviors. In 2004–2005, injection drug users (IDUs) recruited from syringe exchange programs (SEPs) and methadone clinics in Montreal, Canada, were interviewed on drug use behaviors (past 6 months) and HCV testing. Subjects (n = 230) were classified as low/intermediate risk (20.4% borrowed drug preparation equipment only) and high risk (19.6% borrowed syringes), and 54.5% reported being HCV positive. Logistic regression modeling showed that compared to no risk (60% borrowed nothing), low/intermediate risk was associated with fewer noninjecting social network members, poor physical health, and problems obtaining sterile injecting equipment. High risk was associated with all of these factors except social networks. HCV status was not associated with any level of risk. Improved access to sterile injecting equipment may be more important than knowledge of HCV status in reducing injection risks among this IDU population. The study limitations are noted and recommendations discussed.     

Impact of Social Network Characteristics on High-Risk Sexual Behaviors Among Non-Injection Drug Users

Sexually active non-injection drug users in New York City and their sexual partners or fellow drug users (N = 264) were recruited from 2002 to 2005, and associations between social network characteristics and sexual risk behaviors were examined. We assessed social networks, sexual practices, and drug use. Results suggest having a drug-centered social network, i.e., a network that includes a high proportion of individuals who provide, receive, or use drugs, increases the risk of engaging in high-risk sexual behaviors. The study's limitations are noted and longitudinal studies are needed to ascertain whether these associations are causal. Funding was provided by the National Institute on Drug Abuse.     

HIV Risk Behaviors Associated with the Injection Process: Multiperson Use of Drug Injection Equipment and Paraphernalia in Injection Drug User Networks

This study examines drug acquisition and multiperson use of paraphernalia, drugs, and needles/syringes. Ethnographers observed 54 injection episodes in which IDUs were linked by HIV risk behaviors, and developed a typology of higher-risk, lower-risk, and nonsharing-risk networks. Multiperson use of injection paraphernalia or drug solution occurred in most injection events (94%). Serial use of syringes/needles occurred infrequently (14%) relative to “backloading” (37%) and reuse of paraphernalia (cookers 84%, cotton 77%, water 77%). Higher-risk injection networks were characterized by larger size and pooling of resources for drugs. Prevention messages must include avoiding reuse of injection paraphernalia and transfer of drug solution.