An appraisal of HIV antibody test counselling of injecting drug users

One-hundred and nine injecting drug users entering a methadone detoxification programme underwent HIV antibody test counselling. Approximately 80% of men and women were concerned because of sharing injection equipment ('works') in the previous year, although other reasons for considering an HIV antibody test, such as sexual contact with drug users and concern for sexual partners, was also given. Two-thirds of both men and women decided to be tested. Reasons for declining or deferring an HIV antibody test included an inability to cope with a positive result, recent sharing of 'works', and intoxication with drugs or alcohol at the time of counselling. Of the 74 clients tested, two were HIV antibody positive. Only 55% of clients reattended for results. Testing drug users for evidence of HIV infection requires careful pre-test counselling and adequate support should be readily available when results are given.     

Homelessness and gender in out-of-treatment drug users

This study examines 5225 out-of-treatment crack users and drug injectors drawn from five different geographic areas to examine selected factors associated with homelessness. Of these crack users, 27% considered themselves undomiciled, and 60% had previously entered some type of drug treatment. Logistic regression found that substance abusers who were married, female, and persons of color were less likely to be without a home when other variables were controlled. Trading sex for money and perceived chance of getting acquired immunodeficiency syndrome (AIDS) were associated positively with homelessness, while participating in methadone detoxification and methadone maintenance programs seemed to offer some protection from homelessness.     

Measuring injecting risk behaviour in the second decade of harm reduction: a survey of injecting drug users in England

Aims. To measure risk behaviour among injecting drug users (IDUs) using the Injecting Risk Questionnaire (IRQ). Methods. Data were analysed from the first multi-site survey of injecting risk behaviour among IDUs not in contact with drug services in England. A total of 1214 IDUs were recruited from community settings in seven sites. Findings. Fifty-two per cent reported sharing injecting equipment in the previous 4 weeks in response to a single question on sharing. This rose to 78% when asked more detailed and multiple questions on injecting risk practices. Levels of injecting risk behaviour did not differ substantially by gender, age, length of injecting career, main drug of injection, previous treatment contact or geographical location. However, sharing partners were restricted to a median of two others. Conclusion. These data raise questions concerning the extent to which levels of injecting risk behaviour have increased over recent years, or the extent to which previous monitoring systems underestimated levels of risk. None the less, the data confirm that the promotion of safer injecting continues to be an important public health issue with regard to reducing blood-borne infections.     

Temazepam misuse in a group of injecting drug users

It is well recognized that many injecting drug users are poly-drug users. The intravenous use of Temazepam has become popular recently. In response to the ease of misuse, the pharmaceutical industry produced a formulation that would be as ‘resistant’ as possible to injecting. The preparation is a gel-fitted formulation, one proprietary name being Temazepam Gelthix. General Practitioners have been encouraged to prescribe gel-filled capsules to potential drug misusers in order to reduce the harm Temasepam can cause by its misuse. This study of 23 Temazepam injectors shows that the group still find the gel-filled preparation readily injectable. It appears to be more problematic in causing medical complications including superficial thrombophlebitis, abscesses and deep venous thrombosis. Temazepam misuse can cause drug users to become more chaotic. The study group recognize this and suggest there should be stricter control on the supply of Temasepam to drug dependents. General Practitioners, who are the main source of Temazepam prescribing, require additional training in prescribing to drug users.     

Vaccine immunogenicity in injecting drug users: a systematic review

Injection drug use is a prevalent global phenomenon; one not bound by a country's level of development or geographical location. Injection drug users (IDUs) are at high risk for a variety of parenterally acquired and transmitted infections. Licensed vaccines are available for some of these infectious diseases, such as tetanus, influenza, and hepatitis A and B viruses; however, there have been conflicting reports as to their immunogenicity in IDUs. We summarise the lessons learned from studies evaluating the immunogenicity of vaccination strategies in IDUs. A common theme across these diseases is that although there is a tendency towards decreased antibody responses after immunisation, there is no conclusive evidence linking these observations to a decrease in clinical protection from infection. There is a clear need for definitive studies of vaccination strategies in IDUs; however, a synthesis of the available published evidence suggests that immunisation does result in effective clinical protection from disease in this population. The inclusion of IDUs as a high-risk study population in future trials evaluating HIV and hepatitis C virus vaccines will help to assess the immunogenicity of candidate vaccines against parenteral exposure, and also to evaluate the efficacy of candidates as promising antigens become available.     

Geographical injecting locations among injecting drug users in Sydney, Australia

Aims. To document the geographical injection locations of IDU, and the factors and harms associated with injecting in public places. Design. Cross-sectional survey. Setting. Sydney, Australia. Participants. Two hundred injecting drug users. Findings. Nearly all subjects (96%) had injected in a public place, and 89% had done so in the preceding 6 months. Large proportions had injected in all locations studied, including cars (90%), public toilets (81%), the street (80%) and trains (55%). Injecting in public places also occurred frequently, with 53% of subjects having injected often in at least one public location during the preceding 6 months. Twenty-seven per cent of subjects had injected often in the street over the preceding 6 months, 22% had injected often in cars and 17% had injected often in public toilets. Frequent injectors in public places were more likely to be male, and to have overdosed in the preceding 6 months, injected significantly more drug classes in the preceding 6 months, injected in more bodily injecting sites in the preceding 6 months and had more current injection-related problems than other IDU. Conclusions. Injecting in public places was practised by the overwhelming majority of the sample, and a pattern of increased harm was associated with frequent public injecting. In attempting to quantify the harm associated with injecting, and to reduce such harm, the locations injections take place in are of major importance.     

Health services utilization by injection drug users participating in a needle exchange program

OBJECTIVE: To determine the characteristics associated with health care and drug treatment utilization among a distinctly high-risk sub-population of injectors participating in a needle exchange program (NEP). METHODS: Between June 1998 and May 1999, study staff collected demographic and health services utilization data on participants of the Baltimore NEP. Odds ratios and logistic regression were used to identify the participant characteristics associateds with utilizing primary health care and drug treatment during the prior 3 years. RESULTS: Among 269 participants, 81% were African-American and 66% were male. Over half (56%) had not graduated from high school, 89% were unemployed, 70% did not have health insurance, and the median age was 39 years. Fifty-eight percent of the participants reported utilizing primary care (i.e., visited a physician or other health care provider) and 44% had utilized drug treatment during the prior 3 years. Primary care utilization was associated with age > or = 39 [adjusted odds ratio (AOR) = 1.82], having health insurance (AOR = 2.16), and exchanging a higher volume of syringes per NEP visit (AOR = 2.45). Recent drug treatment utilization was associated with African-American race (AOR = 0.41), unemployment (AOR = 2.72), having health insurance (AOR = 2.05), and exchanging a higher volume of syringes per NEP visit (AOR = 0.60). CONCLUSIONS: Health insurance was significantly associated with the recent utilization of both primary care and drug treatment, yet only one-third of NEP attenders were insured. Facilitating the uptake of health insurance services at NEP sites may improve the access to health care for drug users who are currently not utilizing the health care system.     

Gender differences in sharing injecting equipment by drug users in England

The study investigates whether the higher rates of sharing needles and syringes reported by female injecting drug users (IDUs) also occur in sharing other types of injecting equipment. Structured interviews were carried out with 181 IDUs in two cities (100 in Bournemouth, 81 in Bath), with almost equal numbers of males and females in each sample, recruited through needle exchanges and 'snowballing'. Almost all (92%) had shared some equipment in the previous six months: 40% had shared syringes in the month before interview. Several methods of assessing sharing found that women received previously used injecting equipment significantly more often than men. Significantly more males had passed on equipment other than syringes in the previous six months. Fine-grained analyses of 547 injecting episodes found that women received needles and syringes, and syringes significantly more often than did men. The pattern of gender differences reported suggests that women are at higher risk of blood borne viral infections because they receive more types of used equipment and do so more frequently. These results have implications for practice and research.     

Bloodborne viral infection in Irish injecting drug users

Aims. In Dublin, harm reduction strategies have greatly expanded since 1990. We sought to determine the prevalence of, and factors associated with, hepatitis C (HCV), hepatitis B (HBV) and HIV infections among injecting drug users (IDUs) against this background. Design. Cross-sectional survey. Setting. Addiction treatment clinic. Participants. Seven hundred and thirty-five IDU tested for antibody to HCV (anti-HCV) between September 1992 and September 1997. Measurements. Socio-demographic and drug use characteristics. Serology tests for anti-HCV, HBV surface antigen (HBsAg) and HIV. Findings. The vast majority (89%) commenced injecting since 1990. Prevalence of anti-HCV was 61.8% (453/733), of HBsAg was 1.0% (7/729) and of HIV was 1.2% (7/600). Logistic regression analyses indicated that longer history of injecting and increased daily drug expenditure were the only independent variables associated with significantly increased risk of HCV. The only characteristic associated with increased prevalence of HBsAg was a history of injecting prior to 1990 (3.8%, 3/80). HIV prevalence was significantly higher when aged over 24 years (3.7%, 6/162), when injecting commenced prior to 1990 (6.3%, 4/64) and when injecting over 5 years (6.5%, 4/62). Conclusions. HIV prevalence has sustained a low level in this population. Interventions which aim to halt transmission of HCV are necessary and will need to target IDU very early in their injecting careers and also those at risk of commencing to inject.     

Help-seeking and referrals in a needle exchange: a comprehensive service to injecting drug users

From November 1987 to March 1989 total number of clients, visits made, including numbers of new clients and second visits, and referrals to other agencies were routinely monitored at The Cleveland Street Needle Exchange, the Middlesex Hospital, London. During the study period a total of 510 onward referrals were made, involving 277 clients. Of these, 305 (59.7%) were to drug agencies and 187 (36.7%) to medical services. A sample of clients were interviewed to identify demographic and behavioural characteristics. Comparisons were made between those clients receiving referrals and the general client population; no significant differences were found in terms of sex, age and current patterns of drug use. However, those who accepted and took up referrals were found to have begun opiate use, injecting drug use and daily injecting at an earlier age than the general client population. The scheme attracts and retains its clients and provides a comprehensive service to a client group not currently in contact with other services.     

Longitudinal sexual behavior changes in injecting drug users.

OBJECTIVE: To determine whether injection drug users (IDU) maintained sexual behavior risk reduction over an 18-month period that had been noted previously over a 4-month period. DESIGN: A repeated measures design was utilized with IDU assessed initially at study enrollment and again 18 months later. METHODS: Sexual behaviors of a group of 220 IDU (148 men and 72 women) were assessed by a structured interview at the start of an AIDS prevention project and again 18 months later. RESULTS: Having multiple sex partners during the 12 months before initial assessment was reported by 42.6% of the men and 35.7% of the women. Significantly fewer had multiple sex partners during the 10 months before follow-up assessment (men, 20.9%; women, 14.3%). Condom use for vaginal intercourse increased from a mean of 11.9% initially to 27.8% at follow-up for men. The increase in condom use was greater for those with multiple sex partners. Women did not report significant increases in condom use. Continued involvement in unsafe sexual behaviors was associated with exchanging sex for money or drugs, using drugs to help meet sexual needs, alcohol use and drug use. CONCLUSIONS: Risk reductions noted previously were maintained over 18 months for the majority of the sample. Drug-use treatment and interventions that closely examine the interplay between drug use and sexuality for individual IDU are recommended as strategies to further reduce the sexual risk of HIV transmission among IDU.     

Transmission of HIV from injecting drug users to their wives in India

We aimed to identify factors associated with transmission of human immunodeficiency virus (HIV) from injecting drug users (IDUs) to their wives in Manipur, northeast India, where the prevalence of HIV among IDUs is 80% via a case-control study. One hundred and sixty-one HIV-infected IDUs and their wives were recruited from September 1996 to August 1997 inclusive. HIV status was determined by enzyme-linked immunosorbent assay (ELISA) plus Western blot, Interviews were administered anonymously. Regression analysis identified factors associated with transmission of HIV from IDU husbands to their non-injecting wives. Seventy-two wives (45%) were HIV-positive. Only 15% of the couples reported regular usage of condoms during intercourse. On multivariate analysis, a sexually transmitted disease (STD) in either member, reported by the husband, estimated duration of HIV in the husband for >8 years, and a history of blood transfusions were associated with infection in the wife. In conclusion, STDs are associated with transmission of HIV from husband to wife. Improved control of STDs, condom promotion, and improved blood screening are urgently needed in Manipur.