Moderate/heavy alcohol use and HCV infection among injection drug users in two Russian cities

Background

In Russia, injection drug use and transmission of blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are inextricably linked, however the burden of alcohol use remains unexplored among injection drug users (IDUs).

Methods

Individuals who were 18 years of age and older and had injected drugs in the previous 30 days were recruited in the cities of Novosibirsk and Ivanovo by respondent driven sampling. Consenting individuals were administered a quantitative survey instrument and provided blood samples for serological testing.

Results

In Novosibirsk and Ivanovo, 29% and 35% of respondents were categorized as moderate/heavy drinkers, respectively. Individuals reported problems related to alcohol use that affected their physical health (23%), family (55%), and induced financial hardships (43%). In the multivariate analysis, we found that methamphetamine injection in the past 12 months was a strong and significant correlate of moderate/heavy drinking in Novosibirsk (aOR = 5.63 95% CI: [1.01–31.47]) and Ivanovo (aOR = 3.81 95% CI: [2.20–6.62]). There was poor agreement between self-reported HCV status and HCV test results (κ = −0.05 and 0.26 in Novosibirsk and Ivanovo, respectively). IDUs who correctly knew their HCV seropositive status in Novosibirsk and IDUs who correctly knew their HCV seronegative status in Ivanovo were significantly more likely to be moderate/heavy drinkers.

Conclusion

Alcohol use is problematic among IDUs who are at high risk for HCV. Future interventions should target IDUs who are moderate/heavy drinkers in order to prevent liver complications resulting from HCV infection.     

Chronic hepatitis C virus infection and increases in viral load in a prospective cohort of young, HIV-uninfected injection drug users

Background

Chronic hepatitis C (HCV) infection, defined as persistent RNA (viral load) for at least 6 months, accounts for up to 50% of all cirrhosis, end-stage liver disease and liver cancer cases. Moreover, elevated HCV viral load is consistently associated with high infectivity and poor therapy response. This study aims to identify modifiable behavioral correlates both chronic HCV infection and increases in viral load over time among injection drug users (IDUs).

Methods

Cross-sectional and longitudinal analyses were performed using self-interview and serological data from a prospective cohort study (2002-2006) among young (age 18-35), HIV-negative, HCV therapy-naïve IDUs (n = 113) from metropolitan Chicago, Illinois, USA.

Results

After adjustment for age, gender and race/ethnicity, using drugs measured or mixed in someone else's syringe (odds ratio = 2.7, 95% confidence interval: 1.1, 6.7) was associated with chronic (n = 75, 66%) versus resolved (n = 38, 34%) HCV infection status. Among chronically-infected IDUs, injecting with a new, sterile syringe infrequently (<1/2 half the time when injecting) compared to frequently (1/2 the time or more when injecting) was associated with increases in viral load over time after adjusting for age, gender, race/ethnicity and time effects.

Conclusions

Reductions in risky injection-related practices among young IDUs may ameliorate both the burden of chronic HCV infection-related liver disease and elevated viral load-related poor treatment response.     

High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan

Background

This study investigates the prevalence and correlates of hepatitis C virus (HCV) infections among heroin dependent individuals who received methadone maintenance therapy in Taiwan. Also, we investigate users' awareness of HCV.

Methods

Participants were 773 heroin users entering the methadone maintenance treatment (MMT) program at Tsaotun Psychiatric Center in Taiwan. The presence of HCV antibodies was detected. Multivariate logistic regression was used to identify the relationship between HCV infection and correlates.

Results

The prevalence of HCV infection was 90.8%. All participants who were HIV-positive were also infected with HCV. Multivariate logistic regression analysis showed that the route of heroin administration (injection), HIV-infection, and criminal records were significantly related to HCV infection. Few (34.8%) HCV positive heroin users were aware of their infection.

Conclusion

An extremely high prevalence of HCV infection but low awareness of their infection status was found among MMT patients in Taiwan. These findings highlight the importance of education regarding risky behaviors and the necessity for HCV treatment for this population in Taiwan.     

Serosorting for hepatitis C status in the sharing of injection equipment among Seattle area injection drug users

Background

Hepatitis C virus (HCV) is a major health problem among injection drug users (IDU). One potential means of reducing risk of HCV transmission among IDU is serosorting, whereby IDU preferentially share injection equipment with persons of like HCV status.

Methods

We surveyed Seattle area IDU recruited by respondent-driven sampling as part of the National HIV/AIDS Behavioral Surveillance system in 2005.

Results

Of 337 participants, 91% reported ever having been tested for HCV. Fifty-three percent of participants who shared any injection equipment in the last 12 months reported knowing the HCV status of the last person with whom they shared injection equipment. Thirty-seven percent of self-reported HCV-positive participants reported that their last injection equipment sharing partner was also HCV-positive and 7% reported a HCV-negative partner. Among self-reported HCV-negative participants, 11% reported a HCV-positive partner and 23% a negative partner. The disproportionate tendency to share injection equipment with a partner of like HCV status persisted after control for characteristics associated with HCV positivity in stratified and logistic regression analyses. Among participants sharing injection equipment, 39% reported that they had intentionally shared injection equipment with a partner based on knowledge of their concordant HCV status.

Conclusions

We conclude that a measurable degree of serosorting by HCV status is occurring among Seattle area IDU. Promotion of serosorting among HCV-positive IDU may be a useful harm reduction strategy for IDU who continue to practice sharing injection equipment. If judged efficacious, serosorting would provide a further rationale to encourage and support HCV testing among IDU.     

Access to Sterile Injecting Equipment is More Important Than Awareness of HCV Status for Injection Risk Behaviors Among Drug Users

Awareness of hepatitis C virus (HCV) infection status is expected to influence risk behaviors. In 2004–2005, injection drug users (IDUs) recruited from syringe exchange programs (SEPs) and methadone clinics in Montreal, Canada, were interviewed on drug use behaviors (past 6 months) and HCV testing. Subjects (n = 230) were classified as low/intermediate risk (20.4% borrowed drug preparation equipment only) and high risk (19.6% borrowed syringes), and 54.5% reported being HCV positive. Logistic regression modeling showed that compared to no risk (60% borrowed nothing), low/intermediate risk was associated with fewer noninjecting social network members, poor physical health, and problems obtaining sterile injecting equipment. High risk was associated with all of these factors except social networks. HCV status was not associated with any level of risk. Improved access to sterile injecting equipment may be more important than knowledge of HCV status in reducing injection risks among this IDU population. The study limitations are noted and recommendations discussed.     

Prevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities

Background

HIV amongst injecting drug users (IDUs) has been described in Kabul but little data exists for other Afghan cities. We assessed HIV, hepatitis B virus (HBV), and C virus (HCV) prevalence and associated risk behaviours amongst IDUs in Hirat, Jalalabad, and Mazar-i-Sharif, Afghanistan.

Methods

Consented participants reporting injecting drugs within the previous 6 months completed interviewer-administered questionnaires and testing for HIV, hepatitis C antibody (HCV Ab), and hepatitis B surface antigen (HBsAg). Logistic regression was used to determine characteristics associated with each infection.

Results

Of 623 participants, most (98.7%) were male. Prevalence of HIV, HCV, and HBV was 1.8% (95% CI: 0.88-3.2), 36.0% (95% CI: 33-41), and 5.8% (95% CI: 3.9-7.6), respectively. All HIV cases and highest HCV prevalence were detected in Hirat; HBV prevalence was highest in Jalalabad. Amongst male IDUs, 62.9% had been imprisoned, of whom 17.2% (n = 66) injected in prison. High risk behaviours were common; 30.2% reported needle sharing in the last 6 months, 23.1% reported sex with another male, and 50.4% reported paying females for sex. Behaviours varied significantly by site; generally, Hirat participants reported fewer sexual risk behaviours. Sex with other males was negatively associated with both HBV and HCV in multivariate logistic regression analysis; no injecting behaviours were associated with both HBV and HCV.

Conclusions

Whilst HIV prevalence is low, HCV prevalence and high risk behaviours were common in these populations. Regional variations should be considered in programming to prevent transmission of HIV and viral hepatitis amongst IDUs in Afghanistan.     

Modelling the prevalence of HCV amongst people who inject drugs: An investigation into the risks associated with injecting paraphernalia sharing

Background

In order to prevent the spread of the hepatitis C virus (HCV) amongst people who inject drugs (PWID), it is imperative that any injecting risk behaviour which may contribute to the transmission of disease has its role quantified. To inform public health organisations, mathematical modelling techniques were used to explore the risk of HCV infection through the sharing of injecting paraphernalia (including filters, cookers and water).

Methods

A mathematical model was developed for the spread of HCV based on the injecting behaviour of PWID in Scotland, with transmission occurring through the sharing of needles/syringes and other injecting paraphernalia. Numerical simulations were used to estimate the transmission probability for HCV through the sharing of injecting paraphernalia such that the modelled endemic HCV prevalence fitted with that observed amongst PWID in Scotland.

Results

The transmission probability of HCV through injecting paraphernalia was modelled to be over 8 times lower than that through needles/syringes (approximately 0.19–0.30% and 2.5%, respectively), assuming transmission occurs through a combination of at least filters and cookers. In the context of reported needle/syringe and paraphernalia sharing rates in Scotland, it is estimated that 38% and 62% of HCV infections are contributed by these practices, respectively. If needle/syringe sharing rates were to be twice those reported, the contributions would be 70% and 30%, respectively.

Conclusion

Given that the sharing of injecting paraphernalia among PWID is common, HCV transmission through this route could be contributing to the growing healthcare burden associated with this chronic disease. Every effort should therefore be made to establish (a) the contribution that paraphernalia sharing is making to the spread of HCV, and (b) the effectiveness of services providing sterile paraphernalia in preventing infection.     

High HIV and hepatitis C prevalence amongst injecting drug users in Mauritius: findings from a population size estimation and respondent driven sampling survey

Background

Mauritius, an Indian Ocean Island nation of approximately 1,000,000 people, has a large number of injecting drug users (IDUs), many of whom are infected with HIV and HCV. Mauritius has been expanding harm reduction and HIV services based in the belief that HIV prevalence amongst IDUs is somewhere between 30 and 60% and the IDU population size is around 20,000. In 2009, the government of Mauritius conducted a survey to estimate the infection prevalence and risk factors and to estimate the population size of IDUs in order to more effectively expand programmes.

Methods

Men and women aged >15 years living in Mauritius and injecting illicit drugs in the past three months were recruited using respondent driven sampling (RDS). Consenting participants were interviewed about HIV-risk behaviours and tested for HIV, syphilis, HCV and HBV. Six multipliers were collected from service data and by the ‘unique identifier’ method in conjunction with the RDS survey. Proportions were calculated using the RDS analysis tool.

Results

511 IDUs enrolled in the survey; 61.2% reported injecting 2-3 times/day and 29.3% reported past month injection with a previously used needle. Amongst the 60% of IDUs who reported having sexual intercourse in the past three months, 39.5% did so with ≥2 partners. Almost all IDUs (98.1%) reported inconsistent condom use in the past 12 months. HIV prevalence was 47.4%, HCV 97.3%, HBV 9.0%, and syphilis 2.7%; 99.7% of those infected with HIV were also infected with HCV. Our population size estimates put the number of IDUs in Mauritius at around 9500, lower than previous estimates.

Conclusions

We observed high rates of HCV and HIV infection amongst IDUs in Mauritius. The scale up of targeted HCV and HIV prevention, care and treatment services for IDUs should be a high priority.     

The relationship between social network factors, HIV, and Hepatitis C among injection drug users in Chennai, India

Objective

The purpose of this study was to examine whether social network factors predict HIV and Hepatitis C (HCV) serostatus after controlling for individual-level factors at baseline among a cohort of male injection drug users in Chennai, India.

Methods

The sample, which was recruited through street outreach, consists of 1078 males who reported having injected drugs in the last 6 months.

Results

The participants reported 3936 social support and risk network members. HIV and HCV positive serostatus were negatively associated with network member providing emotional support, and positively associated with network member providing material support. In addition, HCV positivity was associated with network member being an active drug user known for more than 10 years and network member being male kin networks, even after adjusting for individual demographic factors and risk behaviors.

Conclusions

These findings suggest that social network factors are significantly linked to HIV and HCV status among IDUs in Southern India and highlight the mixed effects of social capital on health. Future HIV/HCV prevention efforts should incorporate IDU peers to alter drug network injection risk norms. For drug users who have minimal network support, support groups and other informal and formal support mechanisms may be need to help them with health care and psychological support needs for dealing with HIV/HCV.     

Drinking and driving among immigrant and US-born Hispanic young adults: results from a longitudinal and nationally representative study

Objective

To evaluate the risk factors associated with the initiation of driving under the influence (DUI) among Hispanics in a longitudinal and nationally-representative sample of adolescents and young adults. Specifically, this study tests the effect of demographic variables, individual-level risk factors, and eco-processes (e.g., peer drug use, parental involvement) during adolescence on DUI among Hispanic young adults.

Methods

Data were derived from 1734 Hispanic adolescents surveyed for the National Longitudinal Study of Adolescent Health (Add Health). Survey logistic regression procedures were used to examine the effects of nativity status on DUI initiation, to evaluate the independent effect of each risk factor (demographic, individual-level, and eco-processes), and to identify whether and to what extent these factors are associated with the initiation of DUI.

Results

The overall prevalence of DUI initiation was 18.3%. Differences were observed in the rates of DUI initiation by nativity status: first-generation immigrants reported the lowest rates of DUI initiation (15.4%) when compared with second-generation US-born Hispanic youth (17.4%) and third-generation and beyond US-born Hispanic youth (21.5%). US-born Hispanic youth were also more likely to report higher frequency of alcohol use (t = 3.46, p = 0.001) and marijuana use (t = 2.34, p = 0.021) compared to immigrant adolescents. After adjusting for a number of risk factors, men (OR = 2.86), marijuana users (OR = 1.98), and those who reported feeling safe in their neighborhoods (OR = 2.02) were at an increased risk DUI initiation.

Conclusions

Findings provide support for the “immigrant paradox”: immigrant youth reported lower rates of DUI initiation and other high-risk behaviors when compared with US-born Hispanic youth.     

Patterns of alcohol use and sexual behaviors among current drinkers in Cape Town, South Africa

Objective

This study examined the association between alcohol use and sexual behaviors among South African adults who reported current drinking.

Method

Street-intercept surveys were administered to adults residing in neighborhoods in a South African township.

Results

Analyses were restricted to participants reporting current drinking (N = 1285; mean age = 32; 27% women; 98% Black). Most participants (60%) reported heavy episodic drinking (i.e., 5 or more drinks on a single occasion) at least once per week in the past 30 days. Compared to non-heavy episodic drinkers, participants who reported heavy episodic drinking were more likely to drink before sex (79% vs. 66%) and have sex with a partner who had been drinking (59% vs. 44%). Overall, drinking before sex (self or partner) and heavy episodic drinking was associated with multiple sexual partners, discussing condom use with sexual partner(s), and proportion of protected sex. The frequency of condom use varied among participants with steady, casual, or both steady and casual sexual partners.

Conclusions

Alcohol use among South African adults is associated with sexual risk behaviors, but this association differs by partner type. Findings suggest the need to strengthen alcohol use components in sexual risk reduction interventions especially for participants with both steady and casual sex partners.     

The relationship between drug use stigma and HIV injection risk behaviors among injection drug users in Chennai,India

Background

The purpose of this study was to examine the relationship between perceived drug use stigma, acquiescence response bias, and HIV injection risk behaviors among current injection drug users in Chennai, India.

Methods

The sample consists of 851 males in Chennai, India who reported having injected drugs in the last month and were recruited through street outreach.

Results

Results indicate a strong and consistent positive association between drug use stigma and HIV injection drug use risk behaviors. This association held across the injection behaviors of frequency of sharing needles, cookers, cotton filters, rinse water, pre-filled syringes and common drug solutions, even after controlling for acquiescence response bias, frequency of injection, and HIV/HCV serostatus.

Conclusions

These findings suggest that future HIV prevention and harm reduction programs for injection drug users and service providers should address drug use stigma.     

Latent classes of heroin and cocaine users predict unique HIV/HCV risk factors

Background

Patterns of heroin and cocaine use vary and may be associated with unique risk factors for bloodborne infections.

Methods

Latent class analysis identified sub-populations of 552 heroin and cocaine users in Baltimore, Maryland. Using latent class regression, these classes were analyzed for associations with demographic characteristics, risky behaviors, Hepatitis C, and HIV.

Results

Three classes were found: Crack/Nasal-Heroin users (43.5%), Polysubstance users (34.8%), and Heroin Injectors (21.8%). Compared to Polysubstance users, Crack/Nasal-Heroin users were almost 7 times more likely to identify as Black (OR = 6.97, 95% CI = 4.35–11.2). Sharing needles was over 2.5 times more likely among Polysubstance users than among Heroin Injectors (OR = 2.66, 95% CI = 1.49–4.75). Crack/Nasal-Heroin users were 2.5 times more likely than Polysubstance users to exchange drugs for sex (OR = 2.50, 95% CI = 1.22–5.13). Crack/Nasal-Heroin users were less likely than Heroin Injectors to have Hepatitis C (OR = 0.10, 95% CI = 0.06–0.18), but no significant differences were found for HIV.

Conclusions

Subpopulations of cocaine and heroin users differed in demographic classifications, HIV-risk behaviors, and Hepatitis C infection. All subpopulations included substantial numbers of HIV-positive individuals. Findings provide further evidence that non-injection drug users face significant infectious disease risk.     

Subjective sleep disturbance during a smoking cessation program: associations with relapse

Background

Sleep disturbance may affect smoking cessation efforts. We describe sleep changes across three months among women in a smoking cessation program and tested whether sleep disturbances at baseline and 1 month post-quit attempt predicted smoking status at three months.

Methods

Participants (N = 322) were women in a randomized, clinical trial for smoking cessation. Sleep disturbances, as well as, insomnia, drowsiness, and sleep quality were evaluated prior to and during three months of cessation treatment. Repeated measures mixed models evaluated change in sleep over time by smoking outcome status. Logistic regression analyses determined whether sleep disturbances at baseline and 1 month post-quit were associated with smoking status at 3 months.

Results

Sleep disturbances were reported by more than 25% of women. Drowsiness, insomnia, and sleep quality changed over time. However, contrary to our hypotheses, none of the sleep variables at either baseline or 1 month post-quit attempt was associated with relapse (p's > .05).

Conclusions

Although mild to severe drowsiness was reported by more women who relapsed than those who remained abstinent, none of the sleep disturbance symptoms predicted smoking relapse. Given high rates of sleep disturbances among women smokers, better prospective evaluations of the relationship of sleep disturbances to smoking cessation treatment outcome are needed.     

Alcohol misuse,alcohol-related risky behaviors,and childhood adversity among soldiers who returned from Iraq or Afghanistan

Background

Soldiers face a great number of traumatic combat exposures while deployed, which research has shown to contribute to the development of alcohol misuse. In addition to this known risk factor, we hypothesize that adverse childhood experiences (ACEs) also contribute to the likelihood that soldiers will engage in these behaviors, even after adjusting for deployment-related factors (mental health problems and combat exposure).

Methods

Soldiers were surveyed anonymously approximately 3 months upon return from Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF) from 2003 to 2006. Six brigade combat teams were included in the analyses (n = 7849). Participants were asked about ACEs, mental health symptoms, alcohol misuse, risky behaviors related to alcohol misuse, and combat exposure.

Results

Of the 7849 soldiers in the sample, 31.5% screened positive for alcohol misuse and of those almost half also screened positive for risky behaviors related to alcohol misuse (43.3%). Having an alcoholic in the household and experiencing sexual abuse were significantly associated with screening positive for alcohol misuse and alcohol misuse with risky behaviors. Experiencing sexual abuse was a strongly associated ACE item, with an almost 2-fold increase in risk of both outcomes even after adjusting for mental health problems and combat exposure.

Conclusions

Findings suggest that ACEs are a substantial risk factor for alcohol misuse with and without risky behaviors among soldiers returning from deployments and should be considered when directing prevention efforts.     

Uptake of paraphernalia from injecting equipment provision services and its association with sharing of paraphernalia among injecting drug users in Scotland

Background

There has been a significant increase in the provision of injecting paraphernalia from Scottish injecting equipment provision (IEP) services. However, there is currently a lack of evidence on whether uptake of paraphernalia has any impact on paraphernalia sharing among injecting drug users (IDU). The aim of this study was to examine the factors associated with paraphernalia sharing; in particular, whether uptake of filters, spoons and sterile water from IEPs is associated with a reduction in the sharing of these items.

Methods

A cross-sectional voluntary anonymous survey of 2037 IDUs was administered during 2008–2009. Participants were asked whether they had shared filters, spoons or water (paraphernalia) in the previous 6 months, and their uptake of these items from an IEP during an average week in the previous 6 months.

Results

Self-reported uptake of paraphernalia in an average week during the previous 6 months was associated with reduced odds of sharing paraphernalia: (i) uptake of >30 filters was associated with a reduced odds of sharing filters (adjusted odds ratio (AOR) 0.50, 95% confidence interval 0.32–0.79); (ii) uptake of >30 spoons was associated with a reduced odds of sharing spoons (AOR 0.46, 95% confidence interval 0.28–0.74); and (iii) uptake of sterile water was associated with a reduced odds of sharing water (AOR 0.36, 95% confidence interval 0.22–0.61) compared to no uptake of each of these items.

Conclusions

Uptake of paraphernalia appears to be associated with safer injecting practice. Further research is needed to establish the impact of paraphernalia provision on HCV transmission.     

Sex specific trajectories in cigarette smoking behaviors among students participating in the unplugged school-based randomized control trial for substance use prevention

Objectives

Understanding the developmental pathways and sex differences in cigarette smoking behaviors in adolescents has the potential to positively impact substance abuse prevention and to reduce smoking-related health problems. Using data from the Unplugged school-based prevention trial, we investigated different patterns of smoking behavior development among secondary school students in the Czech Republic.

Methods

Growth mixture modeling was used to examine different trajectories in cigarette smoking behaviors among male and female students (N = 1874 6th graders; 50.4% male, mean age 11.8 years at baseline) participating in the Unplugged school-based randomized control trial for substance use prevention.

Results

A two-class model characterized cigarette use as a function of sex and Unplugged intervention status. More rapid cigarette use increases were observed in females (OR = 1.17, p = 0.01 in both rapid/moderate and slow smoking escalator classes) as compared to males. Further, in both classes, more rapid increases in smoking were observed for the control group as compared to the intervention group (OR = 1.22, p < 0.01 slow escalators; OR = 1.54, p = 0.08 rapid/moderate escalators). There was no difference in sex distribution when comparing the two classes (OR = 1.02, p = 0.98).

Conclusions

This study adds to a growing literature on developmental and sex differences in cigarette use among adolescents. This research supports additional multi-year prevention strategies aimed at adolescent females and early treatment programs for adolescent smokers to prevent increasing cigarette use with age.     

Smoking family, secondhand smoke exposure at home, and nicotine addiction among adolescent smokers

Introduction

Smoking family predicts adolescent smoking, but whether the level of nicotine addiction is affected by exposure to secondhand smoke (SHS) is unclear. We investigated the associations of smoking family and SHS exposure at home with morning smoking and heavier smoking among Chinese adolescent smokers.

Methods

In a school-based anonymous survey, 2182 adolescent smokers reported their smoking behaviors, smoking status of family members and peers, and SHS exposure at home and outside home in the past 7 days. Families with one or more smoking members (excluding the subject) were classified as smoking families and otherwise as non-smoking families. Smoking or wanting to smoke first thing in the morning (morning smoking), and consuming more cigarettes (heavier smoking) denoted higher levels of nicotine addiction. Regression analysis yielded adjusted odds ratios (AORs) for morning smoking and β-coefficients for heavier smoking adjusting for potential confounders.

Results

Living with siblings and other co-residing family members who smoked was significantly associated with morning smoking and heavier smoking. Compared with non-smoking families without SHS exposure at home, the AORs (95% CI) for morning smoking were 0.99 (0.76 to 1.29) for 0 day/week, 1.19 (0.95 to 1.50) for 1–3 days/week, 1.76 (1.41 to 2.21) for 4–7 days/week (p for trend < 0.001) and 1.50 (1.23 to 1.83) for any days/week of SHS exposure at home in smoking families. Similarly, 4–6 days/week of SHS exposure at home significantly predicted heavier smoking.

Conclusion

Living with smoking family members and SHS exposure at home are associated with nicotine addiction in Chinese adolescent smokers.