Characteristics of Aboriginal Injecting Drug Users in Sydney,Australia: Prison History,Hepatitis C Status and Drug Treatment Experiences

Abstract

Australian Aboriginals are overrepresented in prisons and tend to be overrepresented in studies of injecting drug users (IDU). The aim of this study was to examine differences between Aboriginal and non-Aboriginal IDUs in terms of gender, prison history and hepatitis C status and testing. Secondary analyses were conducted on data from three cross-sectional studies of IDUs. These studies employed similar methodologies, with recruitment being through needle and syringe programs, methadone clinics, snowballing and street intercepts. All studies were coordinated through the National Drug and Alcohol Research Centre. Aboriginal people were overrepresented in all studies, were more likely to have been incarcerated and to report heroin as their drug of choice than non-Aboriginal IDUs. Females tended to be overrepresented among Aboriginal IDUs, were more likely to have been incarcerated and had a longer period of time since their last hepatitis C test than non-Aboriginal female IDUs. Aboriginal people are overrepresented among IDUs in Sydney. Given their greater risk of incarceration, particularly among females, Aboriginal IDUs were at greater risk of hepatitis C exposure than non-Aboriginal IDUs. The prison setting provides an opportunity to promote drug treatment and hepatitis C testing, though more needs to be done to reduce drug use and incarceration.     

The Role of Physician and Nurse Attitudes in the Health Care of Injecting Drug Users

In 2005, 60 health care workers were recruited through services that attract injecting drug users (IDUs) and asked to complete attitude measures regarding IDU clients. Mediation analyses indicated that conservative health care workers displayed more negative attitudes toward their IDU clients because they believe that injecting drug use is within the control of the IDU. Negative attitudes toward IDU clients, in turn, were associated with worry about IDU clients’ behavior in the clinic and with beliefs that IDU clients should disclose their hepatitis C status to their health care worker. Perceptions of controllability of drug use were also associated with the belief that IDU clients’ ailments were caused by their IDU status. The study's limitations are noted.     

Exploring Associations Between Perceived HCV Status and Injecting Risk Behaviors Among Recent Initiates to Injecting Drug Use in Glasgow

The aim of this study was to explore the influence of testing for hepatitis C virus (HCV) and perceived HCV status on injecting risk behavior. A cross-sectional, community-wide survey was undertaken at multiple sites throughout Greater Glasgow during 2001–2002. Four hundred ninety-seven injecting drug users (IDUs) consented to participate and were interviewed using a structured questionnaire to ascertain HCV test history and injecting risk behavior. The average age of participants was 27 years and the majority of the sample were male (70.4%). Participants had been injecting for an average duration of 2.5 years. Logistic regression analysis revealed no significant associations between having been tested and injecting risk behavior. After adjustment for potential confounding variables, HCV-negatives were significantly less likely to borrow needles/syringes and spoons or filters as compared with unawares and were significantly less likely to borrow spoons or filters as compared with HCV-positives. Due to the cross-sectional design of the study, it is uncertain whether this reduction in risk behavior could be attributed to perception of HCV status. Further research is recommended to consolidate the evidence for this relationship.     

A Trial to Reduce Hepatitis C Seroincidence in Drug Users

ABSTRACT

To test whether a four-session motivational intervention would reduce hepatitis C virus (HCV) seroincidence among injection and non-injection drug users compared to an assessment-only condition, we performed a randomized 24-month clinical trial. At baseline, 277 participants reported using heroin or cocaine at least three times weekly were HCV antibody negative, 65% were male and 46% were Caucasian and 39% reported having injected drugs. Of the 15 (5.4%) individuals who seroconverted, all reported injecting drugs either at baseline or during follow-up. Seroconversion rates did not differ significantly by treatment assignment (p =.79). The annual HCV incident rate was 8.20 (95% confidence interval [CI] = 4.76–14.13) for injectors and 0.74 (95% CI = 0.19–2.98) for non-injectors per 100 person-years. Significantly fewer participants in the intervention group initiated injection drug use behaviors (p =.009). This intervention was no more effective at reducing HCV seroconversion than assessment alone but did decrease injection initiation.     

The Australian Study of HIV and Injecting Drug Use. Part I: prevalence for HIV, hepatitis B and hepatitis C among injecting drug users in four Australian cities

The objective of this study was to assess differences in HIV, hepatitis B and hepatitis C seroprevalence among injecting drug users (IDU) in four Australian cities. Eight hundred and seventh-two current IDU were recruited in approximately equal numbers from each of Adelaide, Melbourne, Perth and Sydney, and interviewed individually using a structured questionnaire. Fingerprick blood samples were taken from the majority of respondents, and tested for past exposure to the three viruses. HIV and hepatitis B and C raw seroprevalences were compared across cities, and comparisons were made of age-standardized seroprevalences for hepatitis B and C. Three percent of all respondents were HIV seropositive; 19% (23% age-standardized) were hepatitis B seropositive and 55% (60% age-standarized) were hepatitis C seropositive. There were general city differences and gender, sexual preference and treatment status group differences between the cities. Sydney respondents had the highest risk of infection for all three viruses in all comparisons. This was particularly striking for HIV among non-heterosexual men. Various explanations for the findings were considered, including city differences in demographic and drug use variables, underlying patterns of risk behaviour, and period/cohort effects. It was concluded that none of these explanations appeared to fit the pattern of findings, and that these probably represented true underlying differences in size of pools of infection. The reasons for this, however, cannot be ascertained from this study.     

A Cross-Sectional Study on Prevalence of Non-Fatal Drug Overdose and Associated Risk Characteristics Among Out-of-Treatment Injecting Drug Users in North Vietnam

In a community-based cross-sectional survey among out-of-treatment male opiate injecting drug users (IDU) aged 18–45, data on non-fatal overdose were collected using a semi-structured questionnaire. From August to September 2003, 299 IDU were recruited in two districts of Bac Ninh, a semi-urban province in North Vietnam. Prevalence of lifetime and recent non-fatal overdose were 43.5 and 83.1%, respectively. Logistic regression analyses showed associations between non-fatal overdose and younger age, unemployment, residence in the provincial township, frequency of injecting, injecting heroin mixed with valium, and history of drug treatment. While recognizing the limitations of this study, it is the first in Southeast Asia to report on prevalence of drug use–related overdose. Future research is recommended on occurrence of fatal overdose in this population.     

Chronic Pain and Hepatitis C Virus Infection in Opioid Dependent Injection Drug Users

ABSTRACT

It is unknown whether infection with hepatitis C is a risk factor for pain among people who have used injection drugs. Multivariate regression was used to determine whether hepatitis C was associated with greater likelihood of reporting significant chronic pain and discomfort intolerance in a cohort of 97 injection drug users dependent on opioids. Study results suggest that participants with hepatitis C may be more likely to experience chronic pain (aOR = 1.98; 95% confidence interval = 0.76 to 5.12, p= 0.16). Furthermore, hepatitis C was found to be associated with a higher discomfort intolerance scale score, reflecting intolerance to physical discomfort (β= 2.34; 95% confidence interval = 0.06 to 4.62; p= 0.04). Hepatitis C may be a cause for chronic pain and discomfort intolerance that is overlooked among injection drug users dependent on opioids.     

The Australian study of HIV and injecting Drug Use. Part II: predicting exposure to hepatitis C and hepatitis B

Researchers agree that while hepatitis B maybe in control, hepatitis C is present in epidemic proportions among injecting drug users and that current HIV prevention strategies have not been sufficient to halt the spread of this hepatitis virus, although there is some evidence to suggest that incidence rates are stabilizing. Since there is no effective cure and it is unlikely that a vaccine will become available in the foreseeable future all efforts to control the spread of hepatitis C must rely on education and prevention strategies. The Australian Study of HIV and Injecting Drug Use is a cross-sectional national study designed to investigate exposure to and risks for infection with bloodborne viruses. Of those volunteering a usable blood sample for hepatitis C antibody and hepatitis B core antibody testing 55% and 19%, respectively, returned reactive test results. Logistic regression statistical models were used to identify risk factors for hepatitis C and hepatitis B. Risk factors for hepatitis C were identified as duration of use, use of opiates on last injecting occasion, education level, treatment status and having a history of sexually transmissible diseases. Risk factors associated with hepatitis B were duration of use, and use of opiates on last injecting occasion. The lack of identifiable risk factors for hepatitis B suggest that past rather than current injecting and sexual behaviour patterns are required to predict accurately risk of exposure to hepatitis B. In addition to this, one-third of respondents reported being vaccinated against hepatitis B. Respondents perceived themselves to be at greater risk from hepatitis C than from hepatitis B or HIV. A discussion of strategies needed to prevent the spread of the hepatitis viruses will be presented along with recommendations for further research.     

Hepatitis C Among Injecting Drug Users Is Two Times Higher in Stockholm,Sweden than in Rotterdam,the Netherlands

This study assessed risk behavior and preventive measures for hepatitis C among injecting drug users in Rotterdam, the Netherlands (452 participants, 2002–2003) and Stockholm, Sweden (310 participants, 2004–2006), two cities with contrasting drug policies. Uni- and multivariate logistic regression models were used. We found that the prevalence of hepatitis C was almost two times higher in participants from Stockholm than in participants from Rotterdam, even after adjustment for sex sharing paraphernalia (adjusted relative risk: 1.92, 95% confidence interval: 1.60–2.29). Follow-up comparative studies are needed to determine if policies with structured health programs can decrease transmission of hepatitis C.     

Acceptability of hepatitis C virus testing methods among injecting drug users

Introduction and Aims . The acceptability of testing methods and procedures has implications for uptake of blood‐borne virus screening in sentinel samples of injecting drug users (IDUs) likely to participate in surveillance. The aim of the current study was to determine the acceptability of three methods of hepatitis C virus (HCV) testing among injecting drug users (IDUs): oral fluid, capillary blood and venous blood sampling. Design and Methods . A cross‐sectional survey of IDUs was conducted in inner‐city Sydney in 2005 for a laboratory validation study of HCV antibody testing. Participants were tested using the three different specimen collection methods and asked about the acceptability of each method and a particular preference documented. Results . Two‐hundred and twenty‐nine IDUs participated in the study. Before and after specimen collection, the acceptability of all three collection methods for HCV testing was high (>85%). Oral fluid remained the preferred method after sample collection, with females (65%) significantly more likely than males (49%) to report a preference (unadjusted odds ratio 2.0; 95% confidence interval 1.1–3.5, p = 0.03) for that method. Discussion and Conclusions . Findings suggest that oral fluid testing is an acceptable and preferred alternative for HCV testing among IDUs. However, concerns reported by participants in the study indicate that information and education regarding the nature and diagnostic value of oral fluid testing is necessary prior to its implementation for surveillance purposes among this population.     

The Threat of Hepatitis C as an Influence on Injecting Amphetamine Users' Change Towards Non-Injecting

ABSTRACT

Young injecting drug users are a particularly vulnerable group for Hepatitis C (HCV) infection. One method for minimising the risk of contraction of Hepatitis C for amphetamine users (not widely explored in the research to date) is through encouraging non-injecting routes of administration (NIROA). Self-report data from 150 young injecting amphetamine users was analysed to investigate the influence of Hepatitis C threat on the decision to cease injecting and the worth of promoting the use of NIROA. Application of the Transtheoretical Model of Behaviour Change and the Expanded Health Belief Model showed that threat of Hepatitis C was not perceived as reason to cease injecting at any stage in the injecting career. Cessation was a result of personal choice, rather than response to any type of threat. This supports the promotion of harm reduction rather than abstinence campaigns. Furthermore, the deficits in knowledge of Hepatitis C threat are worthy of campaign attention.     

An Examination of Beliefs and Opinions about Drug Use in Relation to Personal Stigmatization towards Drug Users

Abstract

Stigma can be harmful to drug users, particularly those in need of treatment. Beliefs and opinions about drug use may influence how individuals view or treat drug users, so research was needed to examine whether specific beliefs and opinions are related to stigma towards users. A sample of 531 adults was assessed to examine how stigmatization relates to specific beliefs and opinions about drug use. Eighty percent of the sample reported lifetime use of an illicit drug. While controlling for demographic characteristics, lifetime drug use and exposure to users, stigmatization towards users more than doubled the odds of reporting that addiction is a choice, and more than tripled the odds for reporting that marijuana and heroin are equally dangerous. Stigmatization, however, lowered the odds of reporting that drugs would be okay to use if legal. Individuals who stigmatize drug users may be under-educated about drug use; however, such individuals appear to be at low risk for use. Beliefs and opinions guided by misinformation may negatively affect users, so public health efforts are needed to educate individuals about drug use and addiction in an objective manner, and treat use as more of a health behavior and less of a moral behavior.     

注射吸毒人群HCV感染相关因素的分析

为了探讨注射吸毒人群丙型肝炎病毒(HCV)感染的影响因素,以2006~2008年江苏省5市部分戒毒所、劳教所新入的1 358例注射吸毒人员为调查对象。对调查对象进行问卷调查,采血并对血液标本行ELISA法检测抗-HCV,数据用SPSS13.0行单因素和多因素分析。1 358例注射吸毒者中共检测出HCV抗体阳性者798例,阳性率为58.8%;男性注射吸毒者易感染HCV(χ2=8.30,P<0.05);随着年龄的增长HCV的感染率呈下降趋势(χ2=11.87,P<0.05);共用注射器、注射吸毒时间大于10年、商业性性行为是该人群HCV感染的危险因素。注射吸毒人群中HCV感染率远高于一般人群,说明该人群是HCV防治重点人群。因此,对该人群HCV感染的危险因素需进行针对的健康教育和行为干预综合防治措施。     

Self-Reported Drug and Alcohol Use and Attitudes Toward Drug Testing in High Schools With Random Student Drug Testing

Many schools implement random student drug testing (RSDT) programs as a drug prevention strategy. This study analyzes self-report surveys of students in eight secondary schools with well-established RSDT programs, comparing students who understood they were subject to testing and students who understood they were not subject to testing. Students subject to testing reported significantly less marijuana and other illegal drug use than students in the same schools who were not subject to testing, and also had more positive attitudes toward testing. Alcohol use, which was not tested for in seven of the eight schools, did not differ between groups. This study provides evidence that awareness of eligibility for drug testing in schools with well-established RSDT programs is associated with lower rates of drug use.     

南京地区吸毒人群丙型肝炎的常见基因型分型研究

目的了解南京地区吸毒人群丙型肝炎病毒（hepatitis C virus,HCV）常见基因型分布特点。方法对南京市强制戒毒所收集提供的198份抗-HCV阳性吸毒人员血清进行HCV RNA检测,对阳性标本按照Simmonds分型方法,采用5′非编码区（5′NCR）1、2、3、1b型特异性引物进行PCR扩增与分型,同时分析不同类型吸毒人员丙型肝炎感染者上述基因型分布差异。结果198份血清中,有168份为HCV RNA阳性。单一基因型占77.4%,其中1b亚型106份（63.1%）,2型15份（8.9%）,3型9份（5.4%）;混合基因型占20.2%,其中1b/2型25份（14.8%）,1b/3型5份（3.0%）,2/3型4份（2.4%）;未确定基因型4份（2.4%）。静脉和非静脉吸毒人群HCV基因型分布差异无统计学意义（χ^2=3.614,P〉0.05）,单一基因型和混合基因型分布差异亦无统计学意义（χ^2=0.018,P〉0.05）。结论南京地区吸毒人群HCV基因型1b型为主,其他多种基因型并存,总体分布特点介于中国南北方之间。     

Use of and Attitudes Toward Club Drugs by Medical Students

ABSTRACT

This study assesses medical students' use of and attitudes towards club drugs, classified as “Generation I” (i.e., cocaine and lysergic acid diethylamide), and “Generation II” (ie, methylenedioxymethamphetamine [MDMA], ketamine, gamma hydroxybutyrate, methamphetamine, rohypnol, dextromethorphan) club drugs based on their initial widespread use in club settings. An anonymous questionnaire was administered to 340 medical students. The prevalence of any club drug use was 16.8%, with MDMA (11.8%) and cocaine (5.9%) the most commonly used. Results discussed also include the relationship of age and gender to having ever used club drugs and to their attitudes regarding use. Additionally, the study identifies differences in patterns of use and attitudes toward Generation I versus Generation II club drugs based on age, gender, and participants' prior club drug use. Findings are compared to those of earlier studies about medical students and those in a similar age group in the general population.     

Internalized Stigma Among People Who Inject Drugs

Background: Perceived experiences of stigma have been found to be associated with poorer psychosocial outcomes and engagement in risk practices among people who inject drugs. Yet the extent to which people internalize or accept the stigma surrounding their injecting drug use, and whether this is associated with risky injecting practices, is not well known. Objectives: The aim of this study was to assess the extent of internalized stigma among a sample of people who inject drugs in Australia and identify socio-demographic, injecting risk, and mental health correlates. Methods: People who inject drugs were recruited from a needle and syringe program located in Sydney, Australia to complete a brief survey. The survey included measures of internalized stigma, severity of drug dependence, self-esteem, depression, and shared use of injecting equipment. Results: The sample comprised 102 people who inject drugs. Internalized stigma was higher among participants who reported being depressed in the past month, and was also associated with greater severity of drug dependence and diminished self-esteem. There was no relationship between internalized stigma and shared use of needles or other injecting equipment in the past month. Conclusions/Importance: Findings underscore the need for further investigation of internalized stigma among people who inject drugs. In particular, future research should assess the impact of implicit (i.e., subconscious) internalized stigma on mental health.     

Sex and Drugs: The Correlations of Injecting Drug Users' Risk Perception and Behavioral Patterns

A low-level blood-borne virus infection exists among Hungary's injecting drug users (IDUs). Assessing the relationship between risk perception and risk behaviors is necessary in order to predict future drug-injecting trends. During 1999 –and 2000, 197 IDUs were interviewed in Budapest using the Risk Assessment Questionnaire developed by the National Institute on Drug Abuse. Certain IDUs perceived high risks but did not act accordingly. High-risk perception of sexual behavior correlates with high-risk perception of drug use, which should be taken into consideration when planning intervention strategies targeting IDUs. Additional research with a larger sample is needed to explain our results in more detail. The study's limitations have been noted.