Preventing HIV/AIDS and other sexually transmitted diseases among injecting drug users in Rio de Janeiro

The harm reduction program (HRP) in Rio de Janeiro, sponsored by the Brazilian Ministry of Health, World Bank and UNDCP, and implemented in association with NEPAD-UERJ (State University of Rio de Janeiro’s drug treatment facility), began its field activities with the injecting drug users (IDUs) at the end of 1996, following the training of the outreach workers and the presentation of the project to authorities and other health and social institutions of the City. The program is based in a fixed place, close to a drug treatment facility, and equipped with a mobile unit (a van) to help in field activities. Among the activities offered by the HRP are: needle exchange, distribution of condoms and bleach, distribution of informative folders and other preventive materials, counselling, HIV testing, focus groups meetings, and referral to other clinical or drug treatment places. All IDUs attending the HRP are invited to fill a two-page voluntary anonymous questionnaire, adapted from a questionnaire used in harm reduction programs in Australia, with basic socio-demographic and risk behavior information. An evaluation study of the program was designed relying on a one-page follow-up anonymous questionnaire (questionnaires are identified by a code), collecting information on sexual and injecting risk behaviors. This study is still in its pilot phase and it is being used on those IDUs who adhere to the program. All questionnaires are administered by the program’s staff to insure that all IDUs will understand adequately the stated questions. Since its first needle exchange, in May 1997, until May 1998, the program reached a growing number of IDUs, among them 186 filled the voluntary questionnaire, 41 were referred to drug treatment places, 23 to clinical treatment and 42 to HIV testing. The HRP distributed/exchanged 8550 informative folders, 11 998 condoms, 13 344 needles/syringes and 488 kits (above material plus bleach and distilled water in a small package). Many non-injecting drug users and more than 300 sex workers, considered as potential bridges to IDUs (some of them are IDUs themselves), were also contacted. Distribution of preventive material among sex workers was very limited due to the scarce material resources and specificity of the program. Sex workers in Rio already receive assistance from many governmental and non-governmental organizations, while the harm reduction program is the unique program for IDUs in the city. The main problems faced were: (i) the legal constraints regarding needle exchange (which hampered this activity principally at the beginning of the project); (ii) the peculiar environment of Rio de Janeiro concerning IDUs networks (small, extremely segregated and with low interconnection); (iii) the great prejudice against IDUs in the city; and (iv) insufficient/inconstant financial support received by the program. Despite these problems, the program is progressively contacting an ever growing number of IDUs, allowing them to have access to preventive strategies. As needle exchange is slowly being accepted or legalized in other parts of the country, we expect positive effects in Rio, with a consequent better tolerance to the HRP activities in the City. The problems of finding IDUs on their scattered/segregated networks were solved mainly by a series of strategies implemented, and the cooperative work with religious and social care institutions.     

Sublethal exposure from microcystins to renal insufficiency patients in Rio de Janeiro, Brazil

In November 2001, a cyanobacterial bloom dominated by Microcystis and Anabaena occurred in the Funil Reservoir and the Guandu River, both of which supply drinking water to Rio de Janeiro, Brazil. Using ELISA, microcystins were detected at a concentration of 0.4 microg/L in the drinking water, whereas a concentration of 0.32 microg/L was detected in activated carbon column-treated water for use at the renal dialysis center of Clementino Fraga Filho Hospital (HUCFF) at the Federal University of Rio de Janeiro. A total of 44 hemodialysis patients who received care at this center were believed to be exposed. Initial ELISA analyses confirmed the presence of serum microcystin concentrations > or = 0.16 ng/mL in 90% of serum samples collected from these patients. Twelve patients were selected for continued monitoring over the following 2-month period. Serum microcystin concentrations ranged from < 0.16 to 0.96 ng/mL during the 57 days after documented exposure. ELISA-positive samples were found throughout the monitoring period, with the highest values detected 1 month after initial exposure. ESI LC/MS analyses indicated microcystins in the serum; however, MS/MS fragmentation patterns typical of microcystins were not identified. LC/MS analyses of MMPB for control serum spiked with MCYST-LR. and patient sera revealed a peak at retention time of 8.4 min and a mass of 207 m/z. These peaks are equivalent to the peak observed in the MMPB standard analysis. Taken together ELISA, LC/MS, and MMPB results indicate that these renal dialysis patients were exposed to microcystins. This documents another incident of human microcystin exposure during hemodialysis treatment.     

Mycological survey and ochratoxin A natural contamination of swine feedstuffs in Rio de Janeiro State, Brazil

Mycotoxin contamination of animal feeds represents a hazard to human and animal health due to potential transmission to meat and milk. Barley by-products are alternative feeding supplies for animal production. The aims of this assay were to study the mycobiota of feedstuffs and finished swine feed, to determine the ability of Aspergillus and Penicillium isolates to produce ochratoxin A (OTA) and to evaluate OTA occurrence in these substrates. Corn, brewers' grains and finished swine feed samples were collected from different factories. Fungal counts were higher than 2.8 × 10⁴ CFU g⁻¹. Fusarium, Aspergillus and Penicillium genera were isolated at high levels. A 23.7% of the isolates produced 9-116 μg kg⁻¹ of OTA in vitro. Corn samples (44%) were contaminated with 42-224 μg kg⁻¹ of OTA. Finished feed (31%) and brewers' grains samples (13%) were contaminated with 36-120 μg kg⁻¹ and 28-139 μg kg⁻¹ of OTA, respectively. This is the first scientific report on contamination by OTA-producer molds and OTA in swine feedstuffs from Brazil. The presence of OTA in raw materials and finished feed requires periodic monitoring to prevent mycotoxicoses in animal production, reduce economic losses and minimize hazards to human health.     

The Thai HIV/AIDS epidemic at 15 years: sustained needle sharing among southern Thai drug injectors

To explore perceptions and attitudes towards needle sharing among clinic-based injecting drug abusers (IDUs) at a drug-treatment clinic in Hat Yai City, Songkla Province, Southern Thailand. Qualitative methods were used to gather data, including: in-depth interviews with 17 active IDUs and with three nurses, participant observation, review of the IDUs' files, and validation after interview completion to ensure data triangulation. A form of comparative content analysis, including thematic analysis, was used for data analysis. After 15 years of the Thai HIV/AIDS epidemic, most southern Thai IDUs still occasionally engaged in needle sharing although they reported reductions in sharing frequency. Withdrawal symptoms and craving were most commonly cited as compelling reasons to share. Misconceptions about how to determine "healthy" from the "sick" was another key factor underlying sharing. Pooling money for drugs (with subsequent cost-savings) was given priority over purchasing new needles/syringes among disadvantaged IDUs. Receiving HIV voluntary counseling and testing (VCT), however, promotes reduced sharing. Our findings suggest that southern Thai IDUs remain at high risk of acquiring HIV infection, primarily through needle sharing. Harm reduction strategies, such as, providing VCT to all IDUs and promoting needle exchange programs might be beneficial approaches to curbing the rapid spread of HIV.     

Acceptability of audio computer-assisted self-interview (ACASI) among substance abusers seeking treatment in Rio de Janeiro, Brazil

This study aimed to determine the acceptability of the ACASI approach to risk assessment and the impact of personal preference regarding mode of interview on reporting risk behaviors among drug users entering treatment in Rio de Janeiro, Brazil. We assessed 268 substance users who completed the ACASI arm in a randomized trial comparing the ACASI with the Interviewer-Administered Questionnaire (IAQ). The vast majority of interviewees (90.7%) reported no problem using the computer, and 37.3% felt that their privacy was best protected by the ACASI (vs. 16.4% who preferred the IAQ). Nearly half (45.5%) reported that the computer interview would produce more "honest" answers, whereas 30.6% selected the IAQ. In the adjusted regression analysis, problems using the computer were associated only with lower educational level (p<0.05). We found no evidence that preference had an impact on reporting risk behaviors or drug use. Our study showed both good feasibility and acceptability of the ACASI for interviewing drug users in Brazil. The findings extend our understanding of the role of the ACASI method by suggesting the utility of this approach in assessing HIV risk among low-to middle-income drug users in a cultural setting quite different from previous studies.     

Prevalence and risk factors for HIV among sniffers, short-term injectors, and long-term injectors of heroin

The prevalence of HIV and associated risk behaviors were assessed among three groups of heroin users: long term injection drug users (LTIDUs), new injection drug users (NIDUs), and heroin sniffers (HSs) with no history of injection. HIV seroprevalence was similar among NIDUs (13.3%) and HSs (12.7%). LTIDUs had almost twice as high a level of HIV infection (24.7%). After including drug use and sex behavior variables in logistic regression models, both drug and sexual risk factors remained in the models. Attributable risk percent (APR) from injection for HIV infection among injection drug users was estimated to be 55.7% for LTIDUs and 5.8% for NIDUs. High-risk sex behavior plays an important role in the prevalence of HIV among drug users and accounts for nearly all the infection among NIDUs. Both injection and sexual risk behaviors need to be stressed in HIV prevention and intervention programs aimed at drug users.     

A randomized trial of audio computer and in-person interview to assess HIV risk among drug and alcohol users in Rio De Janeiro, Brazil

This study compares drug patterns and prevalence of risk behaviors in a randomized trial using two methods of administration, Audio Computer-Assisted Self-Interview (ACASI) and Interviewer-Administered Questionnaire (IAQ), among drug users seeking treatment in a drug treatment center. We randomized 735 participants: 367 to ACASI and 368 to IAQ. No significant difference in sociodemographic variables were found between subjects in the two arms of the study. Those interviewed by ACASI were more likely to report use on 7 of 10 substances assessed. Rates of reporting of sexual risk behaviors (male-to-male and commercial sex) were higher among participants in the ACASI arm. ACASI seems to be a key resource in improving the reporting of sensitive data in Brazil, as it has been in prior international studies.     

The social geography of HIV/AIDS among injection drug users in Brazil

The paper addresses the socio-geographical spread of HIV/AIDS among injection drug users (IDUs) in Brazil, highlighting patterns and trends of the epidemic in different Brazilian regions. Data relative to the Southeast are reviewed and original analyses for the South are presented. The results indicate that the epidemic is diminishing in the Southeast, after a significant increase in the late 1980s, following major cocaine trafficking routes. On the other hand, the AIDS epidemic is far from leveling off in the South. In this region, IDUs have been pivotal in the dynamics of the epidemics. This explains, at least partially, the recent spread in the South, affecting a large number of women, most of them partners of IDUs, and their offspring, and contributing for a less significant decline of AIDS related deaths, when compared with other Brazilian regions.     

昭通市艾滋病流行现状与防治策略

目的了解昭通市艾滋病流行特征,为制定有效的防治策略提供依据。方法回顾性分析昭通市1996～2010年艾滋病疫情、监测和流行病学资料。结果截至2010年12月底,昭通市累计报告HIV/AIDS共计1619例,其中AIDS患者309例,死亡报告186例;传播途径的构成中性传播占39.87%,注射吸毒39.57%,母婴传播1.09%,义务献血人群0.42%,不详19.06%;外出流动人口感染者占总数的44.09%。结论传播途径以性传播为首,艾滋病流行由高危人群向普通人群扩散,感染者以外出人群为主,提高外出流动人口对艾滋病的防护意识,切实加强外出流动人口高危行为干预措施是当前昭通市防治艾滋病主要策略。     

我国HIV/AIDS流行现状与防治对策

我国自1985年首次发现HIV感染者后,HIV/AIDS病例数逐年增长,传播途径由单一逐渐趋向多样化,通过性传播和母婴传播的HIV/AIDS病例日益增多,我国正面临着HIV/AIDS大流行的危险,当前是防御HIV/AIDS流行的关键时期. 1我国HIV/AIDS流行现况 据卫生部疾病控制司报告,1985年-2002年上半年全国累计报告HIV感染者26 058例,估计累计HIV感染者已增至近100万人,其中艾滋病患者1111例,死亡584例[1];HIV疫情涉及我国31个省、自治区、直辖市,但各地的流行严重程度不一,累计报告例数最多的是云南,其次是新疆、广西、河南、四川、广东和贵州[2];HIV的感染与发病年龄以20-39a的青壮年为主,尤以20-29a为最,分别占感染与发病人数的47.9%和36.4%[3];HIV/AIDS的传播以经血传播为主,其中注射毒品滥用者(IDU)感染人数占68.0%,经采供血途径占9.7%,输血和注射血液制品者占1.5%,经性途径占7.2%[4];已发现经母婴传播的病例.     

西部少数民族地区艾滋病疫情及防治策略

据联合国艾滋病规划署<全球艾滋病流行报告2002年>公布的数据,人类发现艾滋病病毒(HⅣ)以来的短短20年间,全球已有6000万人被感染,其中死亡人数超过2000万.仅2002年一年新增感染者就达500万人,死亡人数300万.人类显然正面临着有史以来破坏性最大的疾病流行.     

镇雄县2004～2011年艾滋病病毒感染者／艾滋病患者疫情监测报告

目的了解镇雄县艾滋病病毒感染者／艾滋病患者（HIV／AIDS）流行病学特征,分析其流行趋势,为镇雄县的艾滋病采取控制措施提供科学依据。方法对镇雄县2004～2011年报告的260例HIV／AIDS病例资料进行统计、归纳、整理及流行病学分析。结果2004～2011年全县报告HIV感染者260例,外地报告193例。占74．23％：男女性别构成比为1．55：1,年龄以20～49岁为主,文化程度偏低,注射毒品占23．5％,异性接触史占55．0％,2004年首次在吸毒人员中检测出HIV阳性,2004～2006年感染途径以注射吸毒为主,2007年以后以性传播为主。结论镇雄县属艾滋病中度流行区,外出务工等流动人员艾滋病病毒感染严重,艾滋病疫情呈快速增长发展的趋势,性接触成为镇雄县HIV传播的主要方式。     

论女性在预防吸毒和控制艾滋病的蔓延中的作用

近年来女性吸毒与感染艾滋病病毒(HIV)的人数不断地增加,影响和危害日益严重.据世界卫生组织的统计,截止2002年底,全世界已有4200万人感染HIV或罹患艾滋病,其中43%为妇女,在世界许多地区,艾滋病已成为年轻妇女和儿童的主要死亡原因之一.我国艾滋病发病率呈几何级数急剧上升,到2003年HIV感染者达到84万人[1],注射吸毒感染是主要的传播途径,约占63%左右[2],经采血途径和性传播途径次之.在吸毒者中女性所占的比例约为20%左右,比十年前增长了近一倍[3].女性吸毒者比例的增高预示着毒品蔓延速度的加快,这是一个值得警惕的信号.女性吸毒还引起了许多社会及公共卫生问题,尤其以卖淫、传播性病及艾滋病等问题最为严重[4].     

HIV/AIDS and drug use in China--interactions, impacts, and issues

The interrelationships of HIV/AIDS and drug use and misuse result in complex problems that have been addressed by a variety of sociolegal approaches that often are in contrast to evidence-based medical practices proven effective in reducing associated harms. Like other countries struggling to reduce the incidence and consequences of addiction and HIV/AIDS, China is working to improve systems of care and to revise policies toward drug use and misuse and HIV/AIDS. Greater interaction with researchers and clinicians from around the world can foster increased awareness of effective practices and help implement effective strategies to deal with the problems of HIV/AIDS, and addiction.     

HIV transmission from drug injectors to partners who do not inject,and beyond: Modelling the potential for a generalized heterosexual epidemic in St. Petersburg,Russia

Background

HIV infection is prevalent among drug injectors in St. Petersburg and their non-injecting heterosexual partners (PIDUs). There are fears that sexual transmission of HIV from IDUs to PIDUs may portend a self-sustaining, heterosexual epidemic in Russia.

Methods

Our model combines a network model of sexual partnerships of IDUs and non-IDUs to represent sexual transmission of HIV and a deterministic model for parenteral transmission among IDUs. Behavioural parameters were obtained from a survey of St. Petersburg IDUs and their sexual partners. We based our model fits on two scenarios for PIDU prevalence in 2006 (5.6% and 15.1%, calculated excluding and including HCV co-infected PIDUs respectively) and compared predictions for the general population HIV prevalence.

Results

Results indicate that sexual transmission could sustain a non-IDU HIV epidemic. The model indicates that general population prevalence may be greater than current estimates imply. Parenteral transmission drives the epidemic and the PIDU bridge population plays a crucial role transferring infection to non-IDUs. The model indicates that the high PIDU prevalence is improbable because of the high risk behaviour this implies; the lower prevalence is possible.

Conclusion

The model implies that transmission through PIDUs will sustain a heterosexual epidemic, if prevalence among IDUs and PIDUs is as high as survey data suggest. We postulate that current estimates of population prevalence underestimate the extent of the HIV epidemic because they are based on the number of registered cases only. Curtailing transmission among injectors and PIDUs will be vital in controlling heterosexual transmission.     

越南媳妇艾滋病相关知识及人类免疫缺陷病毒梅毒丙型肝炎感染状况调查

目的了解广西壮族自治区凭祥市越南媳妇预防艾滋病相关知识及人类免疫缺陷病毒(HIV)、梅毒、丙型肝炎感染状况,为制定有针对性的防治措施提供依据。方法对越南媳妇进行面对面的问卷调查和采集静脉血进行HIV、梅毒、丙型肝炎抗体检测。结果共调查406名越南媳妇,艾滋病总体知识知晓率为34.9%,对艾滋病相关知识存在混淆、错误的认知,尤其是对非传播途径的错误认识较多。查出1例HIV抗体阳性者,HIV抗体阳性率为0.3%;查出梅毒7例,梅毒检出率为1.7%;查出丙型肝炎2例,丙型肝炎检出率为0.5%。结论针对越南媳妇艾滋病知识的薄弱环节,开展宣传教育。同时对该人群加强监测,才能有效地阻止艾滋病病毒在配偶间的传播和母婴传播。     

社会歧视下艾滋病患者的心理困境及迫切需求

目的分析在社会歧视下艾滋病患者的心理困境和需求,提出构建艾滋病患者社会支持系统的建议。方法采用深度访谈、小组讨论、现场观察等研究方法。结果在社会歧视下,艾滋病患者的心理面临巨大挑战,主要存在的问题有悲观、绝望、自杀意念、退缩、逃避、被动等。艾滋病患者提出最为迫切的需求为直接的经济救助,消除社会歧视位居第二。结论艾滋病患者提出的迫切需求与心理状态之间具有联系,在社会支持的构建中心理关怀工作急需开展,真正激发艾滋病患者主动寻求帮助、解决自己困境的愿望和行为,并提高这种能力才是最重要的。