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.     

Syringe access,syringe sharing,and police encounters among people who inject drugs in New York City: A community-level perspective

BackgroundInjection drug user (IDU) experience and perceptions of police practices may alter syringe exchange program (SEP) use or influence risky behaviour. Previously, no community-level data had been collected to identify the prevalence or correlates of police encounters reported by IDUs in the United States.MethodsNew York City IDUs recruited through respondent-driven sampling were asked about past-year police encounters and risk behaviours, as part of the National HIV Behavioural Surveillance study. Data were analysed using multiple logistic regression.ResultsA majority (52%) of respondents (n = 514) reported being stopped by police officers; 10% reported syringe confiscation. In multivariate modelling, IDUs reporting police stops were less likely to use SEPs consistently (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.40–0.89), and IDUs who had syringes confiscated may have been more likely to share syringes (AOR = 1.76; 95% CI = 0.90–3.44), though the finding did not reach statistical significance.ConclusionsFindings suggest that police encounters may influence consistent SEP use. The frequency of IDU-police encounters highlights the importance of including contextual and structural measures in infectious disease risk surveillance, and the need to develop approaches harmonizing structural policing and public health.     

HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn,Estonia: Implications for intervention

BackgroundFollowing a heroin shortage, fentanyl and 3-methylfentanyl, known as “China White” and “White Persian”, have become the most widely used drugs, along with amphetamine, among injecting drug users (IDUs) in Tallinn, Estonia.MethodsIn order to assess the relationships between the injection of fentanyl and amphetamine, and levels of HIV prevalence and risk behaviour, 350 current IDUs were recruited using respondent-driven sampling for an interviewer-administered unlinked cross-sectional survey and HIV testing. IDUs were categorised into groups based on self-report of the main drug used within the last 28 days.Results77% (256/331) of participants reported fentanyl and 23% (75/331) amphetamine as their main drug of injection. HIV prevalence was 27% (95% confidence interval [CI]: 18.45–35.51) and 62% (95% CI: 56.97–67.03) among amphetamine and fentanyl injectors, respectively. After adjustment, fentanyl injectors had three times the odds of being HIV positive (adjusted odds ratio [AOR] = 2.89; 95% CI: 1.55–5.39). They also had higher odds for injecting in the street with a previously used needle/syringe (AOR = 2.39; 95% CI: 1.14–5.04) and sharing a needle/syringe with somebody known to have HIV (AOR = 3.00, 95% CI: 1.33–6.79). Fentanyl injectors also had higher odds for lifetime overdose (AOR = 3.02, 95% CI: 1.65–5.54).ConclusionThe injection of fentanyl is associated with elevated injecting risk behaviour derived from injection practice and situational risk factors, and needs urgently targeted interventions.     

Social injecting and other correlates of high-risk sexual activity among injecting drug users in northern Vietnam

BackgroundSexual risk and STDs are relatively high among injecting drug users (IDUs) in Vietnam. We sought to determine characteristics of sexually active IDUs and correlates of high-risk sexual practices among IDUs in Bac Ninh province in northern Vietnam.MethodsWe used data collected for a community-based cross-sectional pilot study to identify correlates of recent high-risk sex (>1 sex partner and inconsistent/no condom use in the past year). Factors associated with high-risk sex were identified using logistic regression.ResultsAmong 216 sexually active male IDUs, one third (n = 72) had engaged in high-risk sex within the last year. IDUs who reported injecting with others more frequently, having someone else inject their drugs at last injection, sharing needles or sharing any injection equipment were more likely to have reported recent high-risk sex. Factors independently associated with high-risk sexual activity were not injecting oneself [AOR: 2.22; 95% CI (1.09–4.51)], and sharing needles in the past 12 months [AOR: 2.57; 95% CI (1.10–5.99)].ConclusionsIDUs who inject socially and IDUs who share needles are likely to engage in high-risk sexual behaviours and may serve as an important bridge group for epidemic HIV transmission in Vietnam. In addition to messages regarding the dangers of sharing needles and other injection equipment, preventive interventions among newly initiated IDUs should also focus on reducing sexual risk.     

The influence of Thailand's 2003 ‘war on drugs’ policy on self-reported drug use among injection drug users in Chiang Mai,Thailand

In February 2003, the Thai Government enacted a ‘war on drugs’ to reduce supply and demand for illicit drugs. This study aimed to examine the impact of this policy on injection drug users (IDUs) drug utilisation patterns and to explore IDU attitudes toward and experiences with the policy in Chiang Mai province. In April 2003, 263 IDU who participated in a study in the preceding year were followed up and 165 IDUs (63%) were available and consented to participate in a cross-sectional survey. Of these 85% had ceased injecting and 70% had done so since the implementation of the policy, with a higher percentage of rural compared to urban IDUs ceasing injection (78% versus 55%, p < 0.001). One-third of those who had ceased drug injection reported smoking opium or methamphetamine, with a lower percentage of urban compared to rural dwellers (24% versus 36%, p < 0.01). Paradoxically, 88% of participants reported that government policy was “good,” ostensibly because it might reduce the temptation to use drugs among the non-initiated by reducing the supply. The majority of study participants reported ceasing injection, often transitioning to other substance use. Differences in drug utilisation patterns were found between urban and rural dwellers. The fear produced by the policy probably led to an underreporting of injection practices and could lead to increased risky syringe behaviours. Continued research is needed to monitor the effects of the policy on patterns of drug use, routes of administration, and HIV risk behaviours.     

Longitudinal trajectories of ketamine use among young injection drug users

BackgroundKetamine is a dissociative anaesthetic that became increasingly popular in the club and rave scene in the 1980s and 1990s. Reports surfaced in the late 1990s indicating that ketamine was being injected in several U.S. cities by young injection drug users (IDUs). Since all studies on ketamine injection were cross-sectional, a longitudinal study was undertaken in 2005 to determine: characteristics of young IDUs who continue to inject ketamine; frequency of ketamine injection over an extended time period; risks associated with ongoing ketamine injection; and environmental factors that impact patterns of ketamine use.MethodsYoung IDUs aged 16–29 with a history of injecting ketamine (n = 101) were recruited from public locations in Los Angeles and followed during a 2-year longitudinal study. A semi-structured instrument captured quantitative and qualitative data on patterns of ketamine injection and other drug use. A statistical model sorted IDUs who completed three or more interviews (n = 66) into three groups based upon patterns of ketamine injection at baseline and follow-up. Qualitative analysis focused on detailed case studies within each group.ResultsIDUs recruited at baseline were typically in their early 20s, male, heterosexual, white, and homeless. Longitudinal injection trajectories included: “Moderates,” who injected ketamine several times per year (n = 5); “Occasionals,” who injected ketamine approximately once per year (n = 21); and “Abstainers,” who did not inject any ketamine during follow-up (n = 40). Findings suggest that ketamine is infrequently injected compared to other drugs such as heroin, cocaine, and methamphetamine. Most IDUs who begin injecting ketamine will stop or curb use due to: negative or ambivalent experiences associated with ketamine; an inability to find the drug due to declining supply; or maturing out of injecting drugs more generally.ConclusionReducing ketamine injection among young IDUs may best be accomplished by targeting particular groups of IDUs identified in this study, such as homeless youth and homeless travellers.     

HCV prevalence and risk behaviours among injectors of new psychoactive substances in a risk environment in Hungary—An expanding public health burden

BackgroundIn Hungary a large increase in injecting new psychoactive substances (NPS) coincided with decreasing harm reduction efforts and rising HCV infection. We describe these, and assess changes in HCV prevalence and risk behaviours, 2011–2014, among NPS injectors, using 2011–2015 syringe exchange programme (SEP) data as a key contextual (‘risk environment’) variable.MethodsWe conducted repeated national sero-behavioural surveys in people who inject drugs (PWID) injecting in the last month and attending SEPs or drug treatment centres (n = 399, 2011; 384, 2014), using face-to-face interviews and dried blood-spot samples. Prevalence of injected drugs and SEP coverage (2011–2015) were assessed through our national SEP monitoring system and using population size estimates.ResultsNPS injecting tripled among PWID attending SEPs in Hungary (2011: 26%; 2015: 80%). Among NPS injectors, HCV prevalence, sharing syringes and sharing any injecting equipment (last month), doubled (2011–2014: 37%–74%, 20%–48%, 42%–71%, respectively), significantly exceeding prevalence in other PWID groups. Among young NPS injectors (aged < 25), HCV prevalence increased 7-fold (12%–76%), among new injectors (injecting < 2 years) 4-fold (13%–42%), coupled with high levels of equipment sharing (79% and 72% respectively). Not using a condom at last intercourse (79%), ever-imprisonment (65%) and last-year homelessness (57%) were highly prevalent among NPS injectors (2014). The number of syringes distributed per estimated PWID nationally fell from 114 to 81 (2011–2014) and dropped to 28 in 2015.ConclusionNPS injectors in Hungary are at severe risk of blood-borne infections due to high levels of injecting and sexual risk behaviours within a high-risk environment, including continuously low SEP provision, imprisonment and homelessness. An HIV outbreak cannot be excluded. Stronger investment in evidence-based prevention measures, with special focus on young and new injectors, and expansion of hepatitis C treatment are urgently needed.     

Socio-demographic factors,health risks and harms associated with early initiation of injection among people who inject drugs in Tallinn,Estonia: Evidence from cross-sectional surveys

AimTo explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia.MethodsIDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation.ResultsA total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (n = 156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity.ConclusionsOur results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs.     

Strategies to avoid opiate withdrawal: Implications for HCV and HIV risks

BackgroundResearch on heroin withdrawal has primarily been done clinically, thus focussing on symptom severity, physiological manifestations, and how withdrawal impairs normal functioning. However, there is little scientific knowledge on how heroin withdrawal affects injection behaviour. This paper explores how withdrawal episodes heighten unsafe injection practices and how some long-term injectors manage such risks.MethodsWe interviewed 32 injection drug users in New York City who had been injecting drugs for 8–15 years (21 HIV and HCV uninfected; 3 HIV and HCV infected; and 8 singly infected with HCV). We used in-depth life history interviews to inquire about IDUs’ life history, injection practices and drug use behaviour over time. Analysis used grounded theory techniques.ResultsWithdrawal can enhance risk by undermining IDUs’ willingness to inject safely; increasing the likelihood of attending risky settings; raising the number of injection partners; and seeking ad hoc partners for drug or needle sharing. Some IDUs have developed practices to cope with withdrawal and avoid risky practices (examples include carrying clean needles to shooting galleries and sniffing rather than injecting). Strategies to avoid withdrawal include back up methods, resorting to credit, collaborating with others, regimenting drug intake, balancing drug intake with money available, and/or resorting to treatment.ConclusionWithdrawal periods can heighten risky injection practices. Some IDUs have applied strategies to avoid withdrawal or used practices to cope without engaging in risky practices. These behaviours might in turn help IDUs prevent an infection with hepatitis C or HIV.     

Does informing people who inject drugs of their hepatitis C status influence their injecting behaviour? Analysis of the Networks II study

BackgroundPeople who inject drugs (PWID) are at risk of hepatitis C virus (HCV). It is plausible that PWID who receive a diagnosis of HCV will reduce their injecting risk out of concern for their injecting partners, although evidence for this is currently limited. The aim of this study was to investigate whether informing PWID of their HCV diagnosis was associated with a change in injecting behaviour.MethodsProspective, longitudinal study of PWID recruited from street drug markets across Melbourne, Australia. Interviews and HCV testing were conducted at 3-monthly intervals. The association between receiving a diagnosis of HCV and (i) injecting frequency and (ii) injecting equipment borrowing, was examined using generalized estimating equations (GEE) analysis.ResultsThirty-five individuals received a diagnosis of HCV during the study period. Receiving a diagnosis of HCV was associated with a decrease of 0.35 injections per month (p = 0.046) but there was no change in injecting equipment borrowing (p = 0.750).ConclusionsA small reduction in injecting frequency was observed in PWID who received a diagnosis of HCV. This finding should be investigated further in larger studies examining a wider range of injecting risk behaviours.     

Decreased injecting is associated with increased alcohol consumption among injecting drug users in northern Vietnam

BackgroundReducing injecting frequency may reduce the risk of HIV infection and improve health outcomes among injection drug users (IDUs). However, the reduction of one risk behavior may be associated with an increase in other risk behaviors, including the use of other risk-associated substances. Our objective was to determine if an association exists between a reduction in injecting and level of alcohol use among IDU.MethodsWe conducted a longitudinal analysis of data collected for a randomized controlled trial examining the efficacy of a peer education intervention in reducing HIV risk among IDU and their network members in Thai Nguyen, Vietnam. Our analysis included active male injectors (n = 629) who were study participants and attended both baseline and 3-month visits. Frequency of alcohol consumption was assessed as the number of alcoholic drinks in the past 30 days. Change in risk and outcome behaviors was calculated as the difference in frequencies of behaviors between baseline and 3-month follow-up visits. The outcome of interest was concurrent decreased drug injection and increased alcohol consumption.ResultsThe mean difference between baseline and 3-month follow-up of alcohol consumption and injection frequency in the past 30 days was 19.03 drinks (93.68 SD) and 20.22 injections (35.66 SD), respectively. Participants who reported reduced injection frequency were almost three times as likely to report increased alcohol consumption (OR 2.8; 95% CI, 2.0, 4.0). The proportion that both decreased injecting and increased alcohol by any amount in the past 30 days was 35.6%. In multivariate analysis higher education was significantly associated with an increase in alcohol and decrease in injecting of any amount.ConclusionMale IDU may be at risk for increasing alcohol consumption when they reduce injection frequency. Interventions with male IDU that encourage reduction of injection may need to review specific strategies to limit alcohol consumption.     

Safer injecting education for HIV prevention within a medically supervised safer injecting facility

Background:Requiring help injecting has recently been independently associated with syringe sharing and HIV incidence among injection drug users (IDUs) in Vancouver. We examined IDUs who were receiving safer injecting education within a supervised injecting facility (SIF) in Vancouver.Methods:The Scientific Evaluation of Supervised Injecting (SEOSI) cohort is based on a representative sample of SIF users. We examined the prevalence and correlates of receiving safer injecting education within the SIF using univariate and logistic regression analyses.Results:Between May 31, 2003 and Oct 22, 2004, 874 individuals of the SEOSI cohort have completed the baseline questionnaire, among whom 293 (33.5%) received safer injecting education. In multivariate analyses, requiring help with an injection in the last 6 months (OR = 2.20 [95% CI: 1.62–2.98]) and sex-trade involvement in the last 6 months (OR = 1.54 [1.09–2.16]) were independently associated with receiving safer injecting education within the SIF.Conclusions:Since requiring help injecting has previously been associated with HIV incidence, it is encouraging that this risk factor was associated with receiving safer injecting education within the SIF. Nevertheless, prospective evaluation is necessary to examine if receiving safer injecting education is associated with reduced HIV risk behaviour and blood-borne disease incidence.     

Safe havens and rough waters: Networks,place, and the navigation of risk among injection drug-using Malaysian fishermen

BackgroundHIV prevalence among Malaysian fishermen is ten times that of the general population. Fishing boats are a key place where drug use occurs, but we know little about how these environments shape HIV risk behaviour. Utilizing Rhodes’ ‘risk environment’ framework, we assessed drug use contexts and how characteristics of place associated with fishing and fishermen's social networks served as key axes along which drug use and HIV risk behaviour occurred.MethodsData were collected during 2009–2011 in Kuantan, a fishing port on the eastern coast of Malaysia, and include 28 in-depth interviews and 398 surveys collected using RDS. Logistic regression was used to determine the effect of occupational, network and risk environment characteristics on unsafe injection behaviour and access to clean needles/syringes; qualitative data were coded and analyzed thematically.ResultsDrug injecting was common and occurred on boats, often with other crewmembers. Captains and crewmembers were aware of drug use. Unsafe injection practices were significantly associated with having a larger proportion of drug injectors in network (OR = 3.510, 95% CI = 1.053–11.700) and having a captain provide drugs for work (OR = 2.777, 95% CI = 1.018–7.576). Size of fishermen network (OR = 0.987, 95% CI = 0.977–0.996), crewmembers’ knowledge of drug use (OR = 7.234, 95% CI = 1.430–36.604), and having a captain provide drugs for work (OR = 0.134, 95% CI = 0.025–0.720) predicted access to clean needles/syringes. Qualitative analyses revealed that occupational culture and social relationships on boats drove drug use and HIV risk.ConclusionsWhile marginalized in broader society, the acceptance of drug use within the fishing community created occupational networks of risk. Fishing boats were spaces of both risk and safety; where drug users participated in the formal economy, but also where HIV risk behaviour occurred. Understanding the interplay between social networks and place is essential for developing HIV prevention and harm reduction policies appropriate for the unique needs of this fishing population.     

Cross-border injection drug use and HIV and hepatitis C virus seropositivity among people who inject drugs in San Diego,California

BackgroundThe prevalence of HIV and Hepatitis C Virus (HCV) are significantly lower among people who inject drugs (PWID) in San Diego, CA, USA compared with PWID in Tijuana, Mexico, located directly across the border. We investigated associations between cross-border injection drug use (IDU), HIV and HCV seroprevalence and engagement in injecting risk behaviours while on each side of the border.MethodsUsing baseline interviews and serologic testing data from STAHR II, a longitudinal cohort study of PWID in San Diego, bivariate and multivariable logistic regression analyses examined associations between recent (past six months) cross-border IDU and HIV and HCV antibody seropositivity, socio-demographics, drug use characteristics, and participants’ connections to, and perceptions about Mexico. Chi-squared tests and McNemar tests examined associations between cross-border IDU and injecting risk behaviours.ResultsOf the 567 participants (93% U.S.-born, 73% male, median age 45 years), 86 (15%) reported recent cross-border IDU. Cross-border IDU was not associated with HIV (OR: 0.85, 95% CI: 0.37–1.95) or HCV seropositivity (OR: 1.01, 95% CI: 0.62–1.65). Age, identifying as Hispanic or Latino/a, and being concerned about risk of violence when travelling to Mexico were independently associated with decreased odds of recent cross-border IDU. Injecting cocaine at least weekly, having ever lived in Mexico and knowing PWID who reside in Mexico were associated with increased odds of recent cross-border IDU. PWID who reported cross-border IDU were significantly less likely to engage in receptive needle sharing, equipment sharing, and public injection while in Mexico compared with in San Diego (all p < 0.001).ConclusionPrevalence of HIV and HCV infection was similar among PWID who had and had not injected in Mexico, possibly due to practising safer injecting while in Mexico. Research is needed to elucidate contextual factors enabling U.S. PWID to inject safely while in Mexico.     

Within-prison drug injection among HIV-infected Ukrainian prisoners: Prevalence and correlates of an extremely high-risk behaviour

BackgroundIn Ukraine, HIV-infection, injection drug use, and incarceration are syndemic; however, few services are available to incarcerated people who inject drugs (PWIDs). While data are limited internationally, within-prison drug injection (WP-DI) appears widespread and may pose significant challenges in countries like Ukraine, where PWIDs contribute heavily to HIV incidence. To date, WP-DI has not been specifically examined among HIV-infected prisoners, the only persons that can transmit HIV.MethodsA convenience sample of 97 HIV-infected adults recently released from prison within 1–12 months was recruited in two major Ukrainian cities. Post-release surveys inquired about WP-DI and injection equipment sharing, as well as current and prior drug use and injection, mental health, and access to within-prison treatment for HIV and other comorbidities. Logistic regression identified independent correlates of WP-DI.ResultsComplete data for WP-DI were available for 95 (97.9%) respondents. Overall, 54 (56.8%) reported WP-DI, among whom 40 (74.1%) shared injecting equipment with a mean of 4.4 (range 0–30) other injectors per needle/syringe. Independent correlates of WP-DI were recruitment in Kyiv (AOR 7.46, p = 0.003), male gender (AOR 22.07, p = 0.006), and active pre-incarceration opioid use (AOR 8.66, p = 0.005).ConclusionsAmong these recently released HIV-infected prisoners, WP-DI and injection equipment sharing were frequent and involved many injecting partners per needle/syringe. The overwhelming majority of respondents reporting WP-DI used opioids both before and after incarceration, suggesting that implementation of evidence-based harm reduction practices, such as opioid substitution therapy and/or needle/syringe exchange programmes within prison, is crucial to addressing continuing HIV transmission among PWIDs within prison settings. The positive correlation between Kyiv site and WP-DI suggests that additional structural interventions may be useful.     

Polysubstance use in treatment seekers who inject amphetamine: Drug use profiles,injecting practices and quality of life

BackgroundThe injection of amphetamine is becoming increasingly common. However, there has been a lack of research examining people who inject amphetamine as the primary drug of use, limiting the potential to ensure services address the unique needs of this group. The current study used latent class analysis to identify classes of polydrug use among people who report injecting amphetamine during the past 12 months. It also examined differences between classes and drug use patterns, injecting practices, quality of life and psychological distress.MethodsParticipants who were attending non-government specialist alcohol and other drug treatment across New South Wales, Australia and had identified amphetamine as their principle drug of concern and reported injecting amphetamine in the previous 12 months were included in the current study (N = 827). Latent class analysis was performed to identify polydrug profiles of participants.ResultsThe large majority of people in the current study (85%) demonstrated low probability of heroin or other opiate use. Three distinct classes of polydrug use were identified: (1) Low-polydrug (n = 491), (2) Opiates-polydrug (n = 123), and (3) Alcohol-polydrug (n = 213). There was a trend for the Low-polydrug class to demonstrate better functioning and safer injecting practices than the Opiates-polydrug and Alcohol-polydrug classes.ConclusionThe results suggest that the majority of people accessing treatment who inject amphetamine as their primary drug of choice have a low probability of heroin or other opiate use. It is important that future research consider whether traditional harm minimisation strategies are appropriate for people who primarily inject amphetamine.     

Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner and other city areas in Montréal,Canada

BackgroundArea-level socioeconomic conditions are associated with epidemic rates of viral hepatitis and HIV amongst urban injection drug users (IDUs), but whether specific socioeconomic markers are uniformly related to IDU outcomes across different urban environments is unclear. We evaluated whether injection behaviour is differentially related to neighbourhood socioeconomic characteristics for IDUs in inner city vs. surrounding urban areas.MethodsThe study population was 468 active IDUs on the Island of Montréal. Neighbourhoods were represented as 500 m radius buffers around individual IDU dwelling places. High-risk injection behaviour (HRIB) was defined dichotomously. Relations between neighbourhood socioeconomic disadvantage (percentage households below low-income cutoff), neighbourhood educational attainment (percentage adults with university degree), and HRIB were assessed using multivariate logistic regression. Stratified analyses were conducted for inner city IDUs (n = 219), and those in surrounding areas (n = 249).ResultsSimilar proportions of IDUs in inner city and surrounding areas reported HRIB. Neighbourhood socioeconomic characteristics were not associated with HRIB for IDUs in surrounding areas. For inner city IDUs, those in socioeconomically disadvantaged neighbourhoods were more likely to practice HRIB (OR 4.34; 95% CI 1.15–16.35). Conversely, inner city IDUs residing in lower educational attainment neighbourhoods had a lower odds of HRIB (OR 0.41; 95% CI 0.21–0.80).ConclusionHRIB did not vary according to urban environment but for inner-city IDUs was differentially related to socioeconomic markers. Associations between HRIB and neighbourhood socioeconomic disadvantage and lower educational attainment, positive and negative, respectively, indicate that adverse socioeconomic circumstances are not related to a uniformly greater likelihood of HRIB.     

A profile on HIV prevalence and risk behaviors among injecting drug users in Nigeria: Should we be alarmed?

ObjectiveInjecting drug use is now recognized as a significant risk factor for HIV in sub-Saharan Africa. We evaluated prevalence and correlates of HIV among injecting drug users (IDUs) in Nigeria.MethodsA cross sectional design using respondent driven sampling was conducted in six states in 2010. Weighted HIV prevalence and injecting risk behaviors calculated using RDS analytic tool. Logistic regression was used to determine correlates of HIV infection, stratified by state.ResultsTotal numbers of IDUs ranged from 197 in Lagos to 273 in Cross River and Oyo states. HIV prevalence was highest in Federal Capital Territory (FCT) at 9.3%, Kaduna 5.8%, Oyo 5.1%, Kano 4.9%, CR 3.3% and Lagos 3.0%. Although >90% of participants were male, females had higher HIV prevalence in all states surveyed except FCT (range: 7.4% in CR to 37.7% in Kano). Logistic regression showed that females were significantly more likely to be HIV positive in Kano [OR = 33.2, 95% CI: 6.8–160.4], Oyo [AOR = 15.9, 95% CI: 3.69–68.51], Lagos [OR = 15.5, 95% CI: 2.41–99.5] and Kaduna states [AOR = 19.6, 95% CI: 4.4–87.6]. For injecting risk behavior, only receptive sharing was associated with HIV [AOR = 7.6, 95% CI: 1.2–48.7] and [AOR = 0.2, 95% CI: 0.04–0.92] in Oyo and Kaduna states respectively.ConclusionsConsiderable heterogeneity in the prevalence of HIV and associated risk behaviors exist among IDUs across Nigeria. Females had higher HIV prevalence among IDUs in five of six states, suggesting a need for targeted interventions for this hidden subgroup. Further research is needed to understand HIV transmission dynamics of IDUs in Nigeria. Community-based opioid substitution therapy and needle exchange programs should be implemented without delay.     

Social mixing and correlates of injection frequency among opioid use partnerships

BackgroundAs resources are deployed to address the opioid overdose epidemic in the USA, it is essential that we understand the correlates of more frequent opioid injections—which has been associated not only with HIV and HCV transmission, but also with overdose risk—to inform the development and targeting of effective intervention strategies like overdose prevention and naloxone distribution programs. However, no studies have explored how characteristics of opioid use partnerships may be associated within injection frequency with opioid partnerships.MethodsUsing baseline data from a trial of a behavioural intervention to reduce overdose among opioid users in San Francisco, CA, we calculated assortativity among opioid use partnerships by race, gender, participant-reported HIV- and HCV-status, and opioids used using Newman’s assortativity coefficient (NC). Multivariable generalized estimating equations linear regression was used to examine associations between individual- and partnership-level characteristics and injection frequency within opioid use partnerships.ResultsOpioid use partnerships (n = 134) reported by study participants (n = 55) were assortative by race (NC = 0.42, 95%CI = 0.33–0.50) and participant-reported HCV-status (NC = 0.42, 95%CI = 0.31–0.52). In multivariable analyses, there were more monthly injections among sexual/romantic partnerships (β = 114.4, 95%CI = 60.2–168.7, p < 0.001), racially concordant partnerships reported by white study participants (β = 71.4, 95%CI = 0.3–142.5, p = 0.049), racially discordant partnerships reported by African American study participants (β = 105.7, 95%CI = 1.0–210.5, p = 0.048), and partnerships in which either member had witnessed the other experience an overdose (β = 81.8, 95%CI = 38.9–124.6, p < 0.001).ConclusionSocial segregation by race and HCV-status should potentially be considered in efforts to reach networks of opioid users. Due to higher injection frequency and greater likelihood of witnessing their partners experience an overdose, individuals in sexual/romantic opioid use partnerships, white individuals in racially homogenous partnerships, and African American individuals in heterogeneous partnerships may warrant focused attention as part of peer- and network-based overdose prevention efforts, as well as broader HIV/HCV prevention strategies. Developing and targeting overdose prevention education programs that provide information on risk factors and ways to identify overdose, as well as effective responses, including naloxone use and rescue breathing, for more frequently injecting networks may help reduce opioid morbidity and mortality in these most at risk groups.