Predictors of bacterial infections among HCV-negative injection drug users in Rhode Island

The prevalence and risk factors for treated bacterial infections (i.e., skin abscess or cellulitis, osteomyelitis, or endocarditis) were investigated among a community sample of drug users with a history of injection drug use (IDU) who tested negative for Hepatitis C (HCV). Participants were IDUs in an HCV reduction intervention trial followed for 24 months. Among 109 participants, 9.2% reported a bacterial infection during follow-up. Non-Caucasian participants and those who had injected for longer periods at baseline were less likely to experience a bacterial infection at follow-up. IDUs with no history of HCV infection experience bacterial infections, but at lower rates than other IDU cohorts. Behavioral interventions should target bacterial infections as well as HCV or HIV prevention outcomes.     

Survey of physician attitudes toward HIV testing in pregnant women in Ohio

HIV infection among women of childbearing age is still increasing in the United States. In most states, HIV testing of women or neonates during pregnancy is not mandatory. The current study assessed HIV prenatal testing practices among obstetrician-gynecologists and primary care physicians listed in a regional physician referral data base in a predominantly rural region. Between December 2000 and March 2001 a 20-question survey was sent by mail to regional physicians in obstetrics/gynecology and primary care regarding physician practice demographics and prenatal HIV testing practices. Of 1116 surveys sent, 431 were returned (38.6% response). Only 42% of physicians offered universal HIV prenatal testing. Factors associated with universal testing (p < 0.5) included obstetrics/gynecology as the practice specialty (90%) physicians' age younger than 50 years, and a practice with predominantly Medicaid or African American patients. Further educational and public health initiatives may be needed to increase nonselective, universal HIV testing in pregnant women.     

Accessing HIV testing and treatment among men who have sex with men in China: A qualitative study

Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, seven focus group (FG) discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, nondisclosure to families, misconceptions of domestically produced antiretroviral drugs (ARVs) and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed.     

A qualitative investigation into an HIV outbreak among injection drug users in Vancouver,British Columbia

The proportion of injection drug users (IDUs) testing positive for Human Immunodeficiency Virus (HIV) in British Columbia has increased from 3 to 7% since January 1993 (Patrick et al ., 1997). We conducted a qualitative study as a first step in a case control investigation aimed at identifying risk factors associated with HIV seroconversion. Sixteen subjects participated in in-depth interviews which were transcribed and analysed using grounded theory methods. Three dominant themes emerged: Addiction, Prevention, and Social Determinants. The results suggest that prevention efforts such as the availability of clean needles and condoms are not adequate to combat the complex social determinants of addiction-be they causal or consequential-which in turn contribute to unsafe injection practices.     

Attitudes toward and beliefs about prenatal HIV testing policies and mandatory HIV testing of newborns among drug users

BACKGROUND: Controversy remains about perinatal HIV testing in many clinical settings. We sought to examine the attitudes and health beliefs among drug users about mandatory HIV testing of newborns and about voluntary versus mandatory testing of pregnant women.We also examined to what extent negative experiences and stigmatization affected attitudes toward HIV testing. METHODS: To establish a baseline, we examined 610 structured interviews conducted from 1997 to 2001, of active drug users who were recruited using respondent-driven sampling. We then conducted five focus groups of five subjects per group to further analyze responses in September 2003. The responses of the members of the focus groups were transcribed, coded, and analyzed using Microsoft Word 2000. RESULTS: Quantitative Longitudinal Cohort Studies. Of the 610 drug users interviewed in the two longitudinal cohort studies conducted from 1997 to 2001, nearly all (89 percent) had been previously tested for HIV Nearly all subjects (91 percent) believed that pregnant women should be tested for HIV. More subjects who had prior HIV testing believed all pregnant women should be tested for HIV (92.9 percent versus 82.6 percent, p = 0.008). Although 86 percent of the subjects agreed that all newborns should be tested, only 57 percent of all of the subjects believed that it should be mandatory. Among the female subjects, however, more injectors than non-injectors would avoid prenatal care if HIV testing was required during pregnancy (16.2 percent versus 6.1 percent, p < 0.01). Of the 499 subjects who reported that they had a usual site for care, 31.8 percent believed that "certain types of people" received better treatment than others. Not using drugs, being of a certain race/ethnicity, and having private insurance were associated with receiving better care. The majority of subjects believed that being a drug user resulted in receiving suboptimal care from the healthcare establishment. Qualitative Focus Group Study. In the focus groups, arguments against mandatory testing of pregnant women included the loss of choice, the right not to know one's HIV status, and the belief that mandatory testing was both a means of provoking rebellion and promoting discrimination. Concern for a baby's health was the primary reason for supporting mandatory testing. Perceived discrimination by the healthcare system was cited as a barrier to acceptance of testing strategies, as it was in the structured interviews. CONCLUSIONS: The current practice of mandatory newborn and voluntary prenatal screening for HIV in the State of Connecticut appears to have been acceptable to a population of highly stigmatized drug users who have been or were at risk for HIV. Despite this acceptance, perceived discrimination by the healthcare system persists and may result in adverse outcomes for a minority of high-risk women, particularly where drug misuse is more highly stigmatized.     

HIV, STD and hepatitis prevention among women in methadone maintenance: a qualitative and quantitative needs assessment

In the USA, as well as internationally, rates of HIV infection among women continue to grow. In addition, women who inject drugs are at further increased risk for hepatitis C co-infection. The purpose of this study was to conduct qualitative and quantitative needs assessments for HIV/STD/hepatitis prevention among women in methadone maintenance programmes. Qualitative interviews and a quantitative, self-administered questionnaire were used to develop an understanding of their needs, and perceptions of what they believed would constitute effective prevention intervention programmes. Results supported women's interest in these services and provided feedback on how to structure prevention programmes by placing them in the context of women's lives and addressing concrete barriers (e. g. transportation, child care, confidentiality concerns) to facilitate adherence to these programmes. Respondents indicated a desire for HIV prevention information, but also wanted information on hepatitis, relapse prevention, stress management and accessing services. The development of such programming would require partnering with the target population and their service providers to develop feasible and effective interventions.     

A continuing concern: HIV and hepatitis testing and prevalence among drug users in substitution programmes in Zurich, Switzerland

Phase I of the Zurich Prometheus Study is a cross-sectional study focusing on an up-to-date serology for HIV and hepatitis B/C and associated risk factors for all clients in four participating clinics offering opiate substitution in Zurich, Switzerland. The mean age of the 603 respondents is 30.7 years (SD = 6.2) and 38% of them are women. Seventy-five per cent of the respondents have a history of injecting drug use (IDU), and over half have injected within the past six months. Laboratory-confirmed seroprevalence for HBV (50%) and HCV (57%) is twice that of HIV (24%). There is an 80% risk reduction for all three viral infections among those starting IDU after 1991--when harm reduction efforts were in full swing--compared to those who began before 1988--before clean needles were widely available. These findings suggest a strongly protective effect of harm reduction measures. But while a stabilization in HIV prevalence at 15% can be seen among drug users who started injecting after 1991, prevalence rates for HBV and HCV still remain several times higher. The prevalence data in this study support data showing continued high incidence rates for HBV and HCV, even among new injectors in the harm reduction era.     

An evaluation of awareness: attitudes and beliefs of pregnant Nigerian women toward voluntary counseling and testing for HIV

The rate of HIV seroprevalence in Nigeria is troublesome because it is one of the highest prevalence rates worldwide. As in most developing countries, vertical transmission from mother to child accounts for most of the HIV infections in Nigerian children. The purpose of this study was to determine the awareness, attitudes, and beliefs of pregnant Nigerian women toward voluntary counseling and testing (VCT) for HIV. Two hundred forty pregnant women in Awka, Nigeria, completed questionnaires aimed at determining their willingness to accept or reject VCT. Furthermore, participants where questioned about their knowledge of HIV infection, routes of transmission, and treatment options. The majority of the women (87%) approved of VCT; of those who approved, 93% were aware that VCT could reduce the risk of transmission of HIV to their babies. All respondents who accepted VCT were willing to be tested if results remained confidential and 89% would accept if they were tested simultaneously with their partners. 69% of the women who refused VCT attribute their refusal to the social and cultural stigmatization associated with HIV. Overall, the acceptance of VCT appears to depend on the understanding that VCT has proven benefits for the unborn child. Sociocultural factors such as stigmatization of HIV-infected individuals appears to be the major barrier toward widespread acceptance of VCT in Nigeria, thus the development of innovative health education strategies is essential for providing women with information regarding the benefits of VCT and other means of prevention of mother-to-child transmission of HIV (PMTCT).     

As HIV spreads among injection drug users, treatment lags behind

Baltimore and Canadian studies are revealing that antiretroviral therapy (ART) is not being provided as often as it should be, and as a result, HIV rates are increasing. Many of the HIV-infected injection drug users (IDUs) that are not receiving ART are younger IDUs and women. Stereotyping and drug regimen complexity are part of the problem. Sometimes it is unfairly assumed that drug users will have problems adhering to a drug regimen. Ways to increase adherence are suggested.     

Voluntary HIV testing, disclosure, and stigma among injection drug users in Bali, Indonesia.

Recently, large increases have been noted in injection drug use and HIV prevalence in Indonesia. Because voluntary HIV counseling and testing can play an important role in HIV prevention, it is important to understand factors related to its use. The objective of this study was to identify factors related to the use of voluntary HIV testing among drug users. In-depth interviews were conducted with a sample of 40 drug users in the Denpasar area of Bali, Indonesia. Drug users may be interested in testing if they have enough information about AIDS to know that they are at risk and that they need this information to protect themselves and others from infection. Barriers toward testing included the fear of a positive result, fear of reactions from family and community members and stigmatization. Other obstacles include a feeling of hopelessness, problems with testing, unavailability and side effects of AIDS drugs and other factors. Many persons would not disclose their status to community members and sexual partners. There were serious concerns about others being ashamed of them and the impact of HIV on relationships with spouses and sexual partners and on employment.     

HIV attitudes, awareness and testing among older adults in Africa

In Africa, older adults aged 50 and older are still sexually active and play a critical role as caregivers, yet little is known about their attitudes towards HIV and awareness of services. In this study, surveys were conducted in nine African sites. A multilevel model was fitted to evaluate the relationship between age and outcome variables. The study reveals that people aged 50 years and older have lower levels of HIV-related knowledge and awareness than those aged 25–49. Older adults were less likely to have been tested for HIV and women aged 50 and older showed particularly low levels of awareness.     

Attitudes toward needle-sharing and HIV transmission risk behavior among HIV+ injection drug users in clinical care

Risky behavior related to injection drug use accounts for a considerable proportion of incident HIV infection in the United States. Large numbers of injection drug users (IDUs) currently receive antiretroviral therapy in clinical settings and are accessible for risk-reduction interventions to reduce transmission of drug-resistant HIV and spread of HIV to uninfected others. The current study examined attitudes toward needle- or equipment-sharing among 123 HIV-positive IDUs in clinical care in an effort to understand the dynamics of such behavior and to create a basis for clinic-based risk-reduction interventions. Results indicate that at baseline, participants who reported extremely negative attitudes toward needle-sharing were less likely to have shared during the past month than those with less-extreme negative attitudes. Demographic, behavioral, and attitudinal variables were entered into a logistic regression model to examine needle-sharing group membership among HIV-positive IDUs. Being female and having less-extreme negative attitudes toward sharing were independent and significant correlates of sharing behavior. Interventions targeting needle-sharing attitudes deployed within the clinical care setting may be well-positioned to reduce HIV transmission among HIV-positive IDUs.     

Barriers to and facilitators of hepatitis C testing, management, and treatment among current and former injecting drug users: a qualitative exploration

Hepatitis C (HCV) infection is common among injecting drug users (IDUs), yet accessing of HCV care, particularly HCV treatment, is suboptimal. There has been little in-depth study of IDUs experiences of what enables or prevents them engaging at every level of HCV care, including testing, follow-up, management and treatment processes. This qualitative study aimed to explore these issues with current and former IDUs in the greater Dublin area, Ireland. From September 2007 to September 2008 in-depth interviews were conducted with 36 service-users across a range of primary and secondary care services, including: two addiction clinics, a general practice, a community drop-in center, two hepatology clinics, and an infectious diseases clinic. Interviews were analyzed using a grounded theory approach. Barriers to HCV care included perceptions of HCV infection as relatively benign, fear of investigations and treatment, and feeling well. Perceptions were shaped by the discourse about HCV and "horror stories" about the liver biopsy and treatment within their peer networks. Difficulties accessing HCV care included limited knowledge of testing sites, not being referred for specialist investigations and ineligibility for treatment. Employment, education, and addiction were priorities that competed with HCV care. Relationships with health care providers influenced engagement with care: Trust in providers, concern for the service-user, and continuity of care fostered engagement. Education on HCV infection, investigations, and treatment altered perceptions. Becoming symptomatic, responsibilities for children, and wanting to move on from drug use motivated HCV treatment. In conclusion, IDUs face multiple barriers to HCV care. A range of facilitators were identified that could inform future interventions.     

Risk factors for methadone outside treatment programs: implications for HIV treatment among injection drug users

BACKGROUND: Diversion of methadone outside treatment programs occurs, yet reasons for use of 'street methadone' are characterized poorly. Self-medication for withdrawal symptoms is one plausible hypothesis. Among HIV-infected drug users, some antiretroviral medications can reduce potency of methadone, yet any association between such effects and the use of supplemental methadone sources remains undetermined. OBJECTIVE: To estimate the frequency and risk factors for use of street methadone. METHODS: Injection drug users (IDUs) recruited through extensive community outreach in 1988-89 and 1994 were followed semi-annually with questionnaires about health history, use of licit and illicit drugs including methadone and HIV-related assays. Analyses were performed using generalized estimating equation logistic regression. RESULTS: Of 2811 IDUs enrolled and eligible for analysis, 493 people reported use of street methadone over 12 316 person-years of follow-up (4.0/100 person-years). In multivariate analyses, street methadone use was more common among women, whites, those 40-59 years old, those who reported withdrawal symptoms, past methadone program attendance (6-12 months before visit), recent heroin injection with or without cocaine (but not cocaine alone), smoking or sniffing heroin and reported trading sex. Street methadone was not associated with HIV infection or treatment. CONCLUSION: The results suggest that older IDUs still using heroin may be using street methadone to treat signs of withdrawal. The absence of a higher rate of street methadone use in HIV seropositive IDUs reveals that antiretroviral/methadone interactions are not a primary determinant of use outside of treatment settings.     

A review of barriers and facilitators of HIV treatment among injection drug users

Globally, injection drug use continues to account for a substantial proportion of HIV infections. There have not, however, been any evidence-based reviews of the barriers and facilitators of HIV treatment among injection drug users. For this review, published studies were extracted from nine academic databases, with no language or date specified in the search criteria. Existing evidence demonstrates that, although injection drug users often have worse outcomes from HIV treatment than non-injection drug users, major antiretroviral-associated survival gains still have been observed among this population. Inferior outcomes are explained by a range of barriers to antiretroviral access and adherence, which often stem from the negative influences of illicit drug policies, as well as issues within medical systems, including lack of physician education about substance abuse. Evidence demonstrates that several under-utilized interventions and novel antiretroviral delivery modalities have helped to greatly address these barriers in several settings, and there is sufficient evidence to support immediate scale-up of these programmes. These interventions include coupling antiretroviral therapy with opioid substitution therapies as well as directly administered antiretroviral therapy programmes. Of particular interest for future evaluation is the coupling of HIV treatment programmes within comprehensive services, which also provide low-threshold (harm reduction) HIV prevention programmes. Scale-up of evidence-based HIV treatment and prevention to injection drug users, however, will require increasing political will among both national policy-makers and international public health agencies.     

Attitudes toward HIV treatments influence unsafe sexual and injection practices among injecting drug users

OBJECTIVE: To determine if HIV treatment-related attitudes are associated with unprotected sex and needle sharing among HIV-seropositive and -seronegative injecting drug users (IDU) in Baltimore, Maryland. DESIGN AND METHODS: IDU participating in a cohort study seen between December 2000 and July 2001 completed an interviewer-administered questionnaire on attitudes toward HIV treatment and risk behaviors (593 HIV-seronegative, 338 HIV-seropositive), including: perceived HIV transmissibility through unprotected sex and needle sharing, and safer sex and injection fatigue. Logistic regression was used to examine the role of attitudinal factors on needle sharing and unsafe sex. RESULTS: Almost two-thirds of sexually active participants engaged in unprotected sex and approximately half of those injecting drugs shared needles. Among HIV-seropositive IDU, perception of reduced HIV transmissibility through unprotected sex was significantly associated with unprotected sex [adjusted odds ratio (AOR), 3.33; 95% confidence interval (CI), 1.05-10.55). Safer injection fatigue was independently associated with needle sharing among HIV-seropositive IDU (AOR, 6.55; 95% CI, 1.69-25.39). Among HIV-seronegative IDU, safer sex fatigue and safer injection fatigue were independently associated with unprotected sex (AOR, 3.12; 95% CI, 1.17-8.35) and needle sharing (AOR, 5.15; 95% CI, 2.33-11.37), respectively. CONCLUSION: Among HIV-seropositive IDU, perceiving that HIV treatments reduce HIV transmission was significantly associated with unprotected sex. Risk reduction fatigue was strongly associated with unsafe sexual and injection behaviors among HIV-seronegative individuals. HIV prevention interventions must consider the unintended impact of HIV treatments on attitudes and risk behaviors among IDU.     

HIV/AIDS,treatment adherence,and lifestyle: A qualitative study

ABSTRACT

HIV treatment and medication adherence remain significant to prolonging the life of people with HIV/AIDS. Challenges to and beneficial factors that promote treatment adherence and the maintenance of a healthy HIV-positive lifestyle were examined among N?=?100 participants from three HIV/AIDS support networks in California. This study employed an anonymous, open-ended methodology, whereas much of the previous research has used interviews, focus groups, or researcher-generated Likert-type surveys. In addition, most of our participants were from small towns in Central California, whereas past studies have largely been based on urban samples. Although most of the thematic categories that emerged in our data confirmed previous research, several novel and understudied factors also were important. Implications for healthcare providers and counselors are discussed.