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.     

Injecting Equipment Provision in Australia: The State of Play

Injecting equipment provision measures in Australia can be judged reasonably successful as HIV prevention measures. In the capital cities of all Australian States and Territories, access to needles and syringes is easy, at least during the day in at least some areas. In conjunction with peer education and other activities, needle and syringe supply appears to have led to a change in norms away from the sharing of needles and other injecting equipment among at least older heroin injectors in large population centers. However, in many other areas, and in many subpopulations-particularly further marginalized groups such as Aboriginal and Vietnamese-Australian injectors-messages about HIV/AIDS risk are either not penetrating or are being ignored, and needle and other equipment sharing still appears to be common. The strategy of providing access to needles and syringes as a separate activity from peer education among injecting drug users (IDUs) needs to be reconsidered in the light of the widespread epidemic of hepatitis C among Australian IDUs. The level of supply of all injecting equipment also needs to be increased to assist all IDUs in learning and carrying out an aseptic injecting technique given the lack of an effective disinfection technique to prevent the spread of hepatitis C, and me problems surrounding both the promotion of disinfection and the promotion of noninjecting routes of administration.     

BRIDGE TO SERVICES: DRUG INJECTORS' AWARENESS AND UTILIZATION OF DRUG USER TREATMENT AND SOCIAL SERVICE REFERRALS,MEDICAL CARE,AND HIV TESTING PROVIDED BY NEEDLE EXCHANGE PROGRAMS

Using qualitative interviews conducted in 1999, we examine awareness and use of drug user treatment and social service referrals, medical care, and HIV testing provided by needle exchange programs (NEPs) among injectors who use NEPs (N = 26) and injectors who get their syringes from other sources (N = 20). A four-category typology of NEP service knowledge and use emerges from these interviews: “Active involvement”—use of services; “Steppingstone”—no use of services but knowledge that specific services are available; “Vague awareness”—nonspecific knowledge of service availability; and “Unaware:—no awareness of the service provision function of NEPs. We describe patterns of distribution of respondents among these categories and suggest policy implications.     

Distributive syringe sharing among young adult injection drug users in five U.S. cities

Blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are transmitted most commonly among injection drug users (IDUs) through the sharing of needles and syringes. Distributive syringe sharing (DSS) (i.e., passing on a used needle/syringe to another IDU) poses the potential risk of transmitting HIV and viral hepatitis to others. We studied the prevalence and correlates of DSS among IDUs enrolled in a randomized behavioral intervention trial designed to reduce behaviors associated with HIV and HCV transmission in five U.S. cities. Among 3129 IDUs ages 15-30 years who completed the baseline visit, 1432 (45.8%) engaged in DSS during the 3 months prior to baseline. Significant correlates of DSS were perception that peer norms condone needle sharing, frequent injection, not obtaining most syringes from needle exchange programs or pharmacies, injecting most frequently in shooting galleries and with sex partners, low perceived risk of HIV from sharing syringes, increased anxiety, low self-esteem, and having unprotected sex. Restricting to only those IDUs who reported not injecting with previously used syringes, similar independent correlates of DSS were found. These findings suggest that interventions to reduce ongoing transmission of blood-borne infections should focus on altering peer norms among networks of young IDUs.     

Psychiatric and Physiological Reactions Produced by Over-the-Counter Medications

Abstract

Injecting practices of illicit drug users in San Antonio, Texas, were studied by means of informal field interviews and participant observation. The methods injection drug users (IDUs) employed to obtain drugs seemed to affect their HIV risk behaviors. Many of the methods involve reciprocal exchanges between a person who has drugs and a person who wants drugs. The exchanges frequently occur in the context of asymmetrical social interactions. The person with the drugs usually occupies the dominant role in the interaction and determines the needle hygiene for both parties. Analysis of the decision-making process of IDUs indicates that the party in the dominant role may choose not to disinfect a syringe for a variety of reasons. An understanding of the subcultural rules that govern these interactions may provide valuable clues to researchers or educators who are designing interventions aimed at reducing HIV risk behaviors among IDUs. This research suggests that for IDUs in subordinate roles, education alone may be insufficient to produce behavior changes necessary to eliminate risk of HIV infection.     

Development and implementation of a cross-border HIV prevention intervention for injection drug users in Ning Ming County (Guangxi Province), China and Lang Son Province, Vietnam

This paper describes the background and early implementation of a peer-based HIV prevention intervention involving social marketing of sterile needles and syringes for injection drug users (IDUs) in a border region of northern Vietnam and southern China. Peer educators collect and safely dispose of used needles and syringes and provide IDUs with a choice of new needles/syringes or vouchers redeemable in pharmacies and clinics for new needles/syringes. The project arose from a pattern of changing drug use and increasing HIV infection in the region but its development took 4 years and faced many challenges. Implementation of the intervention posed a new set of challenges for the participating health departments, police, peer educators, pharmacists, injection drug users, and the communities at large. Early implementation of the project has revealed successful multi-sectoral collaboration, and broad acceptance by IDUs of pharmacy vouchers and distribution of new needles/syringes. However, IDUs’ persistent fear of the police, particularly in Vietnam, has required reliance on separate collection by peer educators of used needles/syringes and distribution of pharmacy vouchers and new needles. In China, new needles/syringes and vouchers are largely being provided through exchange. Understanding the development and implementation challenges and the strategies that were successful in overcoming them (including the importance of being flexible and adaptable to contextual factors) may be useful to those interested in launching similar, much-needed interventions in other parts of the world.     

Bridge to services: drug injectors' awareness and utilization of drug user treatment and social service referrals,medical care,and HIV testing provided by needle exchange programs

Using qualitative interviews conducted in 1999, we examine awareness and use of drug user treatment and social service referrals, medical care, and HIV testing provided by needle exchange programs (NEPs) among injectors who use NEPs (N=26) and injectors who get their syringes from other sources (N=20). A four-category typology of NEP service knowledge and use emerges from these interviews: "Active involvement--use of services; "Stepping stone"--no use of services but knowledge that specific services are available; "Vague awareness"--nonspecific knowledge of service availability: and "Unaware:--no awareness of the service provision function of NEPs. We describe patterns of distribution of respondents among these categories and suggest policy implications.     

The role of "long-term" and "new" injectors in a declining HIV/AIDS epidemic in Rio de Janeiro, Brazil

BACKGROUND: A substantial decline of HIV prevalence has been observed in injection drug users (IDUs) from Rio de Janeiro, in recent years. Differential characteristics and behaviors of new (injecting for <6 years) and long-term (>=6y) injectors may help to understand recent changes and to implement appropriate prevention strategies. METHODS: Between October 1999 and December 2001, 609 active/ex-IDUs were recruited from different communities, interviewed, and tested for HIV. Contingency table analysis and t-tests were used to assess differences between new and long-term injectors. Multiple logistic regression was used to identify independent predictors of HIV serostatus for long-term and new injectors. RESULTS: HIV prevalence was 11.7% for 309 long-term injectors (95% CI 8.1-15.3) and 4.3% for 300 new injectors (95% CI 2.0-6.6). New injectors reported having engaged in treatment and having received syringes from needle exchange programs (NEPs) more frequently than long-term injectors in the last 6 months, but sharing behaviors remained frequent and even increased vis-à-vis long-term injectors. For male new injectors, "sexual intercourse with another man" was found to be the sole significant risk factor for HIV infection (Adj OR = 8.03; 95% CI 1.52-42.48). Among male long-term injectors, "to have ever injected with anyone infected with HIV" (Adj OR = 3.91; 95% CI 1.09-14.06) and to have "ever been in prison" (Adj OR = 2.56; 95% CI 1.05-6.24) were found to be significantly associated with HIV infection. DISCUSSION: New injectors are seeking help in drug treatment centers or needle exchange programs. They differ from long-term injectors in terms of their risk factors for HIV infection and have lower prevalence levels for HIV. Such differences may help to understand the recent dynamics of HIV/AIDS in this population and highlight the need to reinforce new injectors' help-seeking behavior and to reduce current unacceptably high levels of unprotected sex and syringe sharing in new injectors despite attendance of prevention/treatment programs.     

南宁市吸毒人群婚外性行为现状及影响因素分析

目的:了解南宁市吸毒人群婚外性行为现状,分析其影响因素。方法:采用匿名填写问卷的方式,对来自社区和戒毒所的781名吸毒人员进行艾滋病预防知识和行为调查。结果:当地吸毒人群最近一年与临时性伴、商业性伴发生性关系的比例分别达到了40.1%和15.0%。男性、低年龄组、非在婚状态的吸毒者发生婚外性行为的水平较高;有共用针具行为的吸毒者与临时性伴、商业性伴发生性关系的水平均明显高于不共用针具者。分别有47.6%、37.6%的吸毒人员在与临时性伴、商业性伴发生性关系时从不使用安全套。对与临时性伴发生性关系的多因素Lgistic回归分析显示,性别、年龄、婚姻状况、是否与他人共用过注射器、艾滋病预防知识得分是具有统计学显著意义的影响因素。对与商业性伴发生性关系的多因素Lgistic回归分析显示,性别、首次注射吸毒年龄、是否与他人共用过注射器是具有统计学显著意义的影响因素。结论:稳定的婚姻关系有助于减少吸毒人员与临时性伴发生性关系,但是无助于减少与商业性伴的性行为;共用注射器是增加吸毒人群与临时性伴、商业性伴发生性关系的影响因素;掌握艾滋病预防知识并不能减少吸毒人群的婚外性行为,在加强艾滋病防治知识宣教的同时,更加要侧重于行为的干预。     

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.     

西安市戒毒者吸毒行为和性行为定性研究

目的:了解吸毒者的吸毒行为和性行为方式以及行为意识。方法:2001年10月-2002年6月采用单独个人深入访谈方式对西安市长安区和碑林区戒毒所的46名吸毒者进行调查。结果:73.9%的调查对象采取烫吸、口服或口含方式吸毒;主要原因是认为注射方式吸毒对健康危害比较大,容易感染疾病、害怕过量致死、害怕感染艾滋病。在静脉注射毒品者中,33.3%的人在不方便携带、晚上不方便购买或犯毒瘾时来不及购买注射器的情况下,共用或重复使用注射器。大多数吸毒者已经不是第一次戒毒,复吸的原因主要是不能脱离原来的环境,其次是不能控制心瘾;社会和家人的歧视,生活压力等也是导致高复吸率的常见原因。戒毒人员发生婚前、婚外性行为的比例分别为71.7%(33人)和28.3%(13人);71.7%(33人)的人有2个以上性伙伴,有性行为的戒毒者中,经常使用安全套的比例不到15%。结论:尽管西安市吸毒者主要以烫吸为主要吸毒方式,但仍存在注射毒品高危行为和高危性行为。     

Resilience Among IDUs: Planning Strategies to Help Injection Drug Users to Protect Themselves and Others From HIV/HCV Infections

Many long-term injection drug users (IDUs) engage in planning strategies. In this pilot study, we examine the relation of one planning strategy to IDUs’ engaging in safer injection practices. Sixty-eight IDUs were recruited in from a New York City (NYC) needle exchange program and referrals to participate in an innovative Staying Safe Intervention that teaches strategies to stay HIV/HCV uninfected. Responses to a baseline 185-item survey were analyzed using correlations and odds ratios. Planning ahead to have steady access to clean equipment was correlated with both individually based and networks-based safety behaviors including storing clean needles; avoiding sharing needles, cookers, and filters with other injectors; and providing clean needles to sex partners. Implications related to resilience in IDUs are discussed and the study's limitations have been noted.     

Harm Reduction and Street-Based Program: Looking into Nepal

In August 1991 the Lifesaving and Lifegiving Society (LALS) became the first nongovernmental organization in Nepal to work with injecting drug users (IDUs) to reduce the harm caused by drugs in order to prevent HIV/AIDS. Its mission is to provide education, counseling, and primary health care, as well as bleach, sterile water, condoms, and new needles and syringes to IDUs to lower their risk of acquiring blood-borne diseases. An evaluation of the program found diat the prevalence of HIV infection among IDUs who were in regular contact with the program from 1991 to 1994 was 1.6%. No new cases of HIV infection were detected among participants in either 1993 or 1994. Though a harm reduction program is expensive to implement and sustain in Nepal, through its nonjudgmental, noncoercive, and confidential philosophy, LALS has engaged drug users into recovery and given them a platform by which they are able to address their concerns in a public forum.     

云南四川部分城市注射毒品人群高危行为的快速需求评估

目的 :评估云南省和四川省部分城市注射毒品人群感染HIV的高危险行为。方法 :采用随机抽样和“滚雪球”的方法 ,对云南省和四川省四个地区注射毒品人群进行高危行为的流行学调查 ,并将结果做分析比较。结果 :四川省的吸毒者主要以静脉注射毒品和烫吸毒品为主 ,而云南省的吸毒者则更多以静脉注射毒品为主。 4个城市吸毒者共用注射器的比例分别为 :昆明市 74 5 % ,西昌市 5 8 8% ,绵阳市 34 1%和保山市 2 8 8%。这些吸毒者都很少消毒注射器 ,平均每天的吸毒次数云南 2 - 3次 ,四川 2次。安全套使用率都比较低 ,特别是在与非固定性伴的性行为中 ,昆明市吸毒者安全套的使用率为 2 7% ,保山市为 4 1 7% ,绵阳市和西昌市分别为 33 3%和 30 8%。结论 :四川省和云南省被调查的吸毒者都存在有不同程度的与HIV传播相关的高危险行为     

Public Health Interventionists,Penny Capitalists,or Sources of Risk?: Assessing Street Syringe Sellers in Hartford,Connecticut

Improved access to sterile syringes decreases risks related to blood-borne transmission of HIV and hepatitis among injection drug users (IDUs). While syringe exchange programs and pharmacy sales of over-the-counter syringes have received considerable attention from researchers and interventionists during the past decade, little is known about informal economy street syringe sellers. In Hartford, CT, as well as other regions throughout the United States a large percentage of IDUs utilize street sellers to facilitate their injection activities. A qualitative and ethnographic study was conducted in Hartford between 1999 and 2001 to help elucidate the public health risks and benefits of street syringe sellers.     

A matter of convenience: factors influencing secondary syringe exchange in Baltimore, Maryland, USA

Distribution of sterile syringes to reduce the circulation of HIV-infection among injection drug user (IDU) communities is vital in curbing the spread of HIV among IDUs. In addition to other methods of distribution, syringe exchange programmes (SEPs) have been shown to be necessary in the dissemination of sterile syringes. Secondary syringe exchange (SSE) is an organic process by which IDUs distribute syringes to other IDUs and is an important complement to SEPs. This paper examines the motivations for people who provide SSE to other IDUs and the reasons why some IDUs do not use the Baltimore Needle Exchange Program (BNEP). Approximately 5000 individuals had obtained clean syringes from the BNEP between 1994 and 1997. In 1997, qualitative interviews were conducted in Baltimore with 20 providers of SSE and 10 SSE recipients who had never used the BNEP. Data from qualitative interviews were transcribed, coded and compiled. SSE providers reported economic gain and altruism as incentives. SSE recipients reported privacy, convenience of location and time, force of habit, and concern for carrying paraphernalia around as reasons influencing them to obtain syringes from secondary syringe exchangers rather than the needle exchange programme. Results from this study illuminate the social context in which SSE occurs and indicate the importance of SSE as a method for distributing sterile syringes.     

Drug use,AIDS Knowledge,and HIV Risk Behaviors of Cuban-, Mexican-, and Puerto-Rican-Born Drug Injectors who are Recent Entrants into the United States

To date, relatively little research attention has been devoted to the HIV-risky behaviors of persons who are newly arrived in the United States and who use drugs. Data gathered from street-recruited injection drug users (IDUs) recruited in 10 United States cities who were born in Mexico, Cuba, and Puerto Rico and who are recent entrants into the United States suggest that, in comparison to US-born IDUs, Mexican-born subjects are at elevated risk for acquiring and transmitting HIV as a result of sharing needles with friends and running partners; sharing drug injection implements such as cookers, cotton, and rinse water; frequent injection in HIV-risky settings; use of unsterilized needles; and relatively frequent trading of sex for drugs or money. Puerto-Rican-born IDUs were found to inject drugs relatively frequently, and to do so relatively often in high-risk settings in which sterile injecting equipment and cleaning materials often are scarce. These data also show generally lower levels of AIDS knowledge among the in-migrant IDUs than among US-born IDUs. Respondents from each nationality group most often cited television as the source of their most useful and reliable AIDS information, but also tended to regard community outreach workers as a significant source of reliable AIDS and needle cleaning information. The high levels of involvement in HIV-risky behaviors, deficits in knowledge concerning the means of HIV transmission, and relative ease of mobility of the at-risk (for HIV) individuals examined here indicate a need for a comprehensive public health prevention initiative to limit the future spread of HIV. At a minimum, such an undertaking would do well to incorporate group-specific, culturally appropriate behavioral interventions as well as an information campaign.     

Resilience among IDUs: planning strategies to help injection drug users to protect themselves and others from HIV/HCV infections

Many long-term injection drug users (IDUs) engage in planning strategies. In this pilot study, we examine the relation of one planning strategy to IDUs' engaging in safer injection practices. Sixty-eight IDUs were recruited in 2010 from a New York City (NYC) needle exchange program and referrals to participate in an innovative Staying Safe Intervention that teaches strategies to stay HIV/HCV uninfected. Responses to a baseline 185-item survey were analyzed using correlations and odds ratios. Planning ahead to have steady access to clean equipment was correlated with both individually based and networks-based safety behaviors including storing clean needles; avoiding sharing needles, cookers, and filters with other injectors; and providing clean needles to sex partners. Implications related to resilience in IDUs are discussed and the study's limitations have been noted.     

Multiple routes of drug administration and HIV risk among injecting drug users

This study assesses relationships between drug administration routes and HIV serostatus, drug use, and sexual behaviors among current injecting drug users (IDUs) in Tallinn, Estonia. We recruited 350 IDUs for a cross-sectional risk behavior survey. Adjusted odds ratios (AORs) were calculated to explore injection risk behavior, sexual behavior, and HIV serostatus associated with multiple route use. Focus groups explored reasons why injectors might use non-injecting routes of administration. Those reporting multiple drug administration routes were less likely to be HIV seropositive (AOR = 0.49, 95% confidence interval [CI] = 0.25-0.97) and had almost twice the odds of having more than one sexual partner (AOR = 1.90, 95% CI = 1.01-3.60) and of reporting having sexually transmitted diseases (AOR = 2.38, 95% CI = 1.02-5.59). IDUs who engage in noninjecting drug use may be reducing their risk of acquiring HIV though sharing injection equipment, but if infected may be a critical group for sexual transmission of HIV to people who do not inject drugs.