HIV risk behaviour correlates among injecting drug users in Greek prisons

Aims. To identify the correlates of injecting drug use within prison. Design. A national cross-sectional study, participation being voluntary and anonymous. Setting. Ten Greek prisons. Participants. A representative sample of 1000 male inmates; 861 questionnaires were completed and analysed. Measurement. A self-report questionnaire for demographics, penal history, drug use and sharing injecting equipment. Findings. Two hundred and ninety inmates (33.7%) reported injecting drugs at some time in their lives, of whom 174 (60%) had injected while imprisoned. Among those who had injected while imprisoned, 145 (83%) had shared equipment while incarcerated. Logistic regression analysis suggested that total time in prison, previous drug conviction, being a convict (as opposed to on remand) and having multiple female sexual partners 1 year before incarceration were significant HIV risk behaviour correlates. For every year of imprisonment, the risk of injection in prison increased by about 17% \[OR = 1.17 (95% CI: 1.07-1.27)]. Inmates with a previous drug-related conviction were about twice as likely to inject within prison \[OR = 1.97 (95% CI: 1.16-3.33)]. Finally, convicted inmates were marginally significantly more prone to inject in prison \[OR = 1.58 (95% CI: 0.92-2.74)]. Conclusions. Variables related to the inmates' prison career influence HIV risk behaviours within prison. There is a need to assist IDUs in reducing the likelihood of high-risk behaviour by considering factors such as frequency of incarceration, length of time incarcerated and availability of detoxification programmes within prison.     

Global overview of injecting drug use and HIV infection among injecting drug users

OBJECTIVE: To provide global estimates of the prevalence of injecting drug use (IDU) and HIV prevalence among IDU, in particular to provide estimates for developing and transitional countries. METHODS: Collation and review of existing estimates of IDU prevalence and HIV prevalence from published and unpublished documents for the period 1998-2003. The strength of evidence for the information was assessed based on the source and type of study. RESULTS: Estimates of IDU prevalence were available for 130 countries. The number of IDU worldwide was estimated as approximately 13.2 million. Over ten million (78%) live in developing and transitional countries (Eastern Europe and Central Asia, 3.1 million; South and South-east Asia, 3.3 million; East-Asia and Pacific, 2.3 million). Estimates of HIV prevalence were available for 78 countries. HIV prevalence among IDU of over 20% was reported for at least one site in 25 countries and territories: Belarus, Estonia, Kazakhstan, Russia, Ukraine, Italy, Netherlands, Portugal, Serbia and Montenegro, Spain, Libya, India, Indonesia, Malaysia, Myanmar, Nepal, Thailand, Viet Nam, China, Argentina, Brazil, Uruguay, Puerto Rico, USA and Canada. CONCLUSIONS: These findings update previous assessments of the number of countries with IDU and HIV-infected IDU, and the previous quantitative global estimates of the prevalence of IDU. However, gaps remain in the information and the strength of the evidence often was weak.     

Differentiated risk behaviour for HIV and hepatitis among injecting drug users (IDUs)

Needle sharing is a risk factor for contracting blood-borne infections among injecting drug users (IDUs). We explored the relation of socio-financial, physical and mental health factors (ASI) to risk behaviour (Qr23) for contracting blood-borne infections among IDUs (Addiction Severity Index and Questionnaire for risk behaviour). 42 HIV negative IDUs were studied prospectively. The median age was 42.5 (range 18-61) y, 28 of 42 (67%) were males and median duration of injecting was 19.0 (range 0-43) y. HCV and HBV antibodies were found in 37 (88%) and 31 (71%) participants, respectively. Poly drug use was reported by 23 (55%) participants; amphetamine by 10 (24%) and heroin by 9 (21%). From the ASI data we were unable to find any statistically significant factor that was associated with needle sharing (n = 26/42, 61%) or sharing drug mixture/filter (n = 25/42, 59%). 19 (73%) of 26 participants who shared needles also shared drug mixture/filter. Of these 26 IDUs, 7 shared needles with partners, 11 with acquaintances, 3 with strangers and 5 with all categories. In conclusion, the study group showed differentiated risk behaviours for blood-borne infections with regard to various persons and to whom they were exposed. This suggests that IDUs may benefit from individualized counselling regarding risks for infections with HIV, HCV and HBV.     

Gender differences in HIV risk behaviour of injecting drug users in Edinburgh

A multi-site sample of currently-injecting drug users (IDUs) comprising 344 men and 136 women was recruited in Edinburgh. Sixty-seven per cent of the sample said they had at some time used injecting equipment already used by another person and 25% admitted doing so in the 6 months before interview. Whereas women who injected with used equipment obtained it predominantly from a sexual partner, for men the source was more often a close friend or someone whose HIV status they were unlikely to know. In the 6 months before interview, 40% of men, compared with 20% of women, had more than one heterosexual partner. This difference was associated with a higher proportion of men with steady partners also having casual partners. Women IDUs were more likely to have regular partners who injected (57% vs 26%). Though sharing of injecting equipment has already diminished in Edinburgh, further measures are needed to eliminate it. For injectors here, the risk of infection from unprotected heterosexual intercourse may now be greater than that from sharing injecting equipment, particularly for women. Other methods of encouraging changes in sexual behaviour need to be investigated and successful ones promoted.     

注射吸毒人群HIV新发感染研究进展

目的了解注射吸毒人群HIV新发感染研究现状。方法查找收集相关文献并综合归纳分析。结果目前注射吸毒人群HIV新发感染的研究方法主要包括前瞻性队列研究、基于横断面调查的实验室检测法和数学模型3种方法;主要影响因素有共用针头或注射器、无保护性行为和毒品的注射频率等。结论艾滋病疫情不容乐观,不同时间和地点存在差异;各地应针对自身情况制定相应的禁毒防制艾滋病策略和措施。     

HIV risk among women injecting drug users who are in jail

Female offender populations and females in jail include large proportions of injecting drug users (IDUs), who are at high risk of contracting or transmitting HIV. Women IDUs (n = 165) were recruited and interviewed at New York City's central jail facility for women. The study examined these women's patterns of HIV risk behaviors related to drugs and sex and identified behavioral and attitudinal correlates of HIV serostatus. The women typically used both injectable and non-injectable drugs prior to arrest, primarily heroin, cocaine powder, crack, and illicit methadone. Self-reported HIV seropositivity was 43%. Variables correlated with HIV serostatus in the bivariate analysis were: cocaine injection frequency; lifetime injection risk behavior; providing oral sex during male crack use; Hispanic ethnicity; sharing of needles/syringes; sharing of cookers; sharing injection equipment with friends; heroin smoking (negative); injection risk acceptance; peer norms and behavior; lifetime sexual risk behavior; frequency of sex with men; provision of sex for money or drugs; and knowing people with AIDS. The first four variables listed retained statistical significance in a multiple logistic regression analysis. The paper considers the need to tailor AIDS prevention interventions for woman IDUs in jail, including taking into account risk behaviors that occur within frequently reported same-sex partnerships.     

HIV prevalence and risk behaviour among female injecting drug users in London, 1990 to 1996.

OBJECTIVE: To describe trends in HIV prevalence among female injecting drug users (IDU) in London between 1990 and 1996. DESIGN: HIV prevalence and risk behaviour were measured yearly between 1990 and 1993, and in 1996, in point prevalence HIV surveys of IDU recruited from both drug-treatment and community-based settings within Greater London. Sample sizes were 173 in 1990, 111 in 1991, 128 in 1992, 146 in 1993 and 200 in 1996. METHODS: Each survey used structured questionnaires and common sampling and interview strategies. Oral fluid specimens were collected for testing for antibodies to HIV (anti-HIV). Multiple logistic regression was used to assess the trend in HIV prevalence. RESULTS: The percentage of female IDU testing positive for antibodies to HIV showed a marked decline over the study period, from 15.0% in 1990 to 1.0% in 1996 (P < 0.001). This trend was independent of all other variables examined. Each year, higher HIV prevalences were found among IDU recruited from community settings compared with treatment agencies. CONCLUSIONS: These results concur with those of IDU recruited from treatment sites, although the yearly estimates in this study are higher. London benefits from low prevalence of HIV infection among IDU, coupled with behaviour change facilitated by early intervention. Continued surveillance of injectors recruited from both community and treatment settings is necessary in order properly to assess HIV prevalence among IDU.     

Sexual partners of injecting drug users: the risk of HIV infection

The sexual mediation of HIV infection by injecting drug users to the heterosexual population has become a major issue in AIDS prevention. Infection that is acquired through sharing contaminated injecting equipment can be passed on to non–injecting drug using partners and to non–drug using partners through sexual intercourse. A study of risk behaviour among injecting drug users in the North West of England focused, interalia, upon aspects of their sexual activity and attitudes that have relevance for HIV transmission. It was found that in those respondents with regular partners, the level of sexual activity was related to the partner's use of drugs. The use of condoms was low in the sample as a whole, including those who reported having casual sexual contacts and sharing others’ injecting equipment. These data confirm the need for concern and the advisability of targetting safer–sex education on drug users.     

Injecting-related harm and treatment-seeking behaviour among injecting drug users

Aims. This study aims to identify the physical harm associated with injecting drug use and examine the treatment-seeking behaviour of injecting drug users (IDUs). Specific attention is given to the factors associated with presentation and non-presentation of injecting-related problems. Design. Participants were interviewed by research staff using a semi-structured questionnaire, then physically examined by a medical team. Setting. Needles exchanges in Glasgow. Participants. One hundred and twelve injecting drug users. Findings . Respondents' accounts of their current injecting-related problems were found to be consistent with the clinician's findings, suggesting that IDUs are able to self-diagnose injecting-related harm. However, almost three-quarters had not sought help for these problems. Qualitative data suggest the main reasons for non-presentation, or delayed presentation, of injecting-related problems are normalization of injecting-related harm and a reluctance to attend available services. Almost half of those seeking treatment for injecting-related problems did so during an emergency or crisis. Conclusions . Low threshold services, such as needle exchanges, may have to take a more proactive stance to encourage injectors to present with injecting-related problems. This may help reduce injecting-related harms, especially the resulting medical complications, which would in turn relieve the pressure on other services such as hospital Accident and Emergency Departments .     

Risk behaviour change and HIV infection among injection drug users in Montreal

OBJECTIVE: To investigate the independent association between changes in risk behaviour and HIV seroconversion risk among Montreal injection drug users (IDU). DESIGN: A longitudinal study of risk behaviour change and the maintenance of low-risk practices. At baseline and semi-annually, subjects were tested for HIV, and questionnaires on risk behaviour were completed. RESULTS: A total of 833 IDU were recruited from January 1992 to June 1998, and completed a minimum of three visits. Large fluctuations in risk behaviour were observed, and the risk of HIV infection appeared to be dependent upon the consistency of risk behaviour practised. IDU who consistently engaged in risky behaviour were at high risk of HIV infection. IDU who attempted to practise low-risk behaviour but experienced relapses to risky behaviour were also at considerable risk of infection. IDU who managed to maintain low-risk practices were at minimal risk. Using Cox regression analysis, the hazard ratio (HR) of HIV seroconversion among IDU who consistently and inconsistently shared needles with an HIV-positive partner was 8.17 (95% CI 3.59-18.59) and 2.63 (95% CI 1.33-5.17), respectively, relative to non-needle sharers. Corresponding HIV incidence rates were 30.42 per 100 person-years (py) among consistent sharers, 13.78 per 100 py among inconsistent sharers and 2.51 per 100 py among non-sharers. CONCLUSION: Although some HIV risk reduction was evident, behaviour change seems to be effective only in IDU who adopt and maintain low-risk practices. Additional strategies may be needed to assist IDU in the maintenance of low-risk practices.     

Psychopathology, stress and HIV-risk injecting behaviour among drug users

The relations between psychopathology (or psychological morbidity) and stress (measured by the GHQ-30 and VOEG-13) and HIV-risk injecting behaviour were investigated among 151 and 166 drug users, respectively, participating in a HIV study in Amsterdam, The Netherlands. Scores indicative of psychopathology were obtained by 72% of respondents. Drug users with psychopathology are older, long-term polydrug users and injectors, who experience considerable stress. Drug users in the sample also have higher stress levels than the general population, but, in contrast to the general population, stress does not increase with age. Stress is associated with long-term polydrug use, with cocaine use and with the female sex. Among HIV-positive injecting drug users (IDU's) no positive relation was found between psychopathology or stress and lending of used needles to others. Among HIV-negative IDUs only psychopathology is associated with an increased HIV risk. Our findings suggest that HIV-risk reduction programmes should consider more seriously the role of psychopathology in attempts to persuade drug users to reduce their risks.     

HIV risk-taking behaviour among injecting drug users currently, previously and never enrolled in methadone treatment

This study compares the injecting and sexual risk-taking behaviour among injecting drug users (IDUs) currently, previously and never enrolled in methadone maintenance treatment (MMT). All subjects had injected during the 6 months prior to the day of interview. The current MMT group showed significantly lower injecting risk-taking behaviour subscale scores on the HIV Risk-taking Behaviour Scale (HRBS) of the Opiate Treatment Index than the previous MMT and non-MMT groups together. The current MMT group differed from the other two groups in the frequency of injecting and cleaning of injection equipment with bleach. There was no difference between the current MMT group and the other two groups combined in sexual risk-taking behaviour scores on the HRBS. There were no differences between the previous MMT and non-MMT groups in injecting and sexual risk-taking behaviour. HIV seroprevalence was low and there was no difference in seroprevalence between groups. Thus, IDUs currently enrolled in MMT are at reduced risk for HIV infection when compared with IDUs who have previously or never been enrolled in MMT. However, the absence of a difference between the current MMT and other two groups in frequency of sharing behaviours suggests the need for additional strategies among MMT clients to reduce needle-sharing. Possible strategies include the application of relapse prevention interventions and the availability of sterile injecting equipment in MMT clinics. Further research is needed to identify factors which increase attraction and retention of IDUs to MMT.     

Hepatitis C virus infection, HIV co-infection, and associated risk among injecting drug users in Togliatti, Russia

The objective of this study was to estimate the prevalence of hepatitis C virus (HCV) infection and co-infection with HIV among injecting drug users (IDUs) in Togliatti City, Russia. Unlinked anonymous cross-sectional survey of IDUs recruited from community settings, with oral fluid sample collection for HCV and HIV antibody (anti-HCV, anti-HIV) testing, was carried out. The anti-HCV prevalence was 87% (357/411), anti-HIV prevalence 56% (234/418), and 93% (214/230) of HIV-positive IDUs were co-infected with HCV. Only 23% (94/411) of those HCV positive self-reported as such. In an adjusted model, increased odds of HCV positivity were associated with needle and syringe, as well as injecting paraphernalia sharing in the last four weeks. IDUs injecting more than once with the same needle also had raised odds. There were no marked associations between HCV positivity and the duration of injecting or age group. Almost all IDUs were HCV positive, and almost all HIV-positive IDUs were HCV co-infected. There is an urgent need to maximize syringe distribution coverage, develop health promotion targeting HCV prevention for IDUs, and improve access among IDUs to treatments for HIV and HCV infection.     

Sexual behaviour of injecting drug users and associated risks of HIV infection for non-injecting sexual partners

The sexual behaviour of 142 clients of syringe-exchange schemes was measured using a questionnaire interview based survey method. Two to four months later the questionnaire was repeated to provide measures of behavioural change. The majority of these clients were sexually active, 77% having one or more sexual partners in the 3 months prior to the first interview. Many of these clients (46% of those sexually active) had sexual partners who did not inject drugs. There is evidence that this group modified their sexual behaviour towards reducing their own risk of HIV infection, with more having no sexual partners (from 23% to 31%), a reduction in those having multiple partners (from 26% to 21%) and a slight increase in those with regular partners (from 49% to 52%). Not all clients in this group reduced their risk of infection by modifying their sexual behaviour. Some clients continued to engage in high risk sexual behaviour, having multiple partners (21%) and not using condoms (79%). Whilst overall there is evidence of changes in the sexual behaviour of the clients towards a reduced risk of infection, we have identified an associated increase in risk of transmission from them to their sexual partners. Drug injectors who continued to have sexual partners were more likely to have sexual partners who did not inject drugs.     

Injecting equipment sharing and perception of HIV and hepatitis risk among injecting drug users in Budapest

In central European states, rates of HIV among injection drug users (IDUs) have been low although Hepatitis C (HCV) infection is widespread. The goal of our study was to assess HIV infection, risk perceptions and injecting equipment sharing among IDUs in Budapest, Hungary. Altogether 150 IDUs were interviewed (121 structured interviews between 1999 and 2000 and 29 ethnographic interviews between 2003 and 2004). The majority of them injected heroin (52% and 79%) and many injected amphetamines (51% and 35%). One person tested positive for HIV. Two thirds (68%) shared injecting equipment (syringes, cookers and filters). Some participants said they shared syringes because they were not carrying them for fear of police harassment and that they reused filters as a backup drug supply. In multivariate analysis, sharing of injecting equipment was associated with higher perceived susceptibility to HIV/AIDS, lower self-efficacy for sterile equipment use, higher motivation to comply with peer pressure to use dirty injecting equipment and with having a criminal record. The high levels of injecting risk-behaviors found in this study are a cause for serious concern. Interventions for HIV-prevention need to address not only sharing syringes but also sharing and reusing of other injecting equipment and drug filters.