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.     

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.     

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.     

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.     

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.     

Young and recent-onset injecting drug users are at higher risk for HIV

Aims. To determine whether young or recent-onset injecting drug users (IDUs) are at increased risk of HIV infection, and to compare trends in risk behaviours and HIV incidence among subgroups of IDUs. Design. Associations of age and onset of injecting with HIV prevalence and injecting risk behaviours were determined among current IDUs who entered an Amsterdam cohort between 1989 and 1995, and compared with current IDUs recruited in two street surveys in 1990 and 1993. In the cohort, trends from 1986 through 1995 in injecting risk behaviour (as reported at entry) and in HIV seroconversion (among current IDUs during follow-up) were determined using logistic and Poisson regression. Findings. IDUs were young ( 25 years: 14-30%) or had recently started injecting (within the last 3 years: 17-21%). Between 37% and 50% of young IDUs recently started injecting. HIV prevalence was 12-24% among young IDUs, and 5-12% among recent-onset IDUs. Young IDUs more often reported current borrowing than older IDUs. Borrowing declined significantly in all subgroups, except young IDUs. The crude HIV incidence declined from 18/100 person-years (PY) in 1986 to 5/100 PY in 1995. Trends in HIV incidence were not significantly different for subgroups of age or onset of injecting. In a multivariate analysis, recent onset of injecting was an independent predictor ( p= 0.04) for HIV seroconversion, but age was not ( p= 0.68). Conclusions. Important proportions of drug users are young or have recently started injecting. HIV prevalence is relatively high among young and recent-onset IDUs. Recent onset of injection is an independent predictor for HIV seroconversion. Our observations may be explained by non-random patterns of borrowing used needles/syringes. Recent-onset IDUs should be approached more actively for HIV counselling and testing. Sizable portions of     

Measuring injecting risk behaviour in the second decade of harm reduction: a survey of injecting drug users in England

Aims. To measure risk behaviour among injecting drug users (IDUs) using the Injecting Risk Questionnaire (IRQ). Methods. Data were analysed from the first multi-site survey of injecting risk behaviour among IDUs not in contact with drug services in England. A total of 1214 IDUs were recruited from community settings in seven sites. Findings. Fifty-two per cent reported sharing injecting equipment in the previous 4 weeks in response to a single question on sharing. This rose to 78% when asked more detailed and multiple questions on injecting risk practices. Levels of injecting risk behaviour did not differ substantially by gender, age, length of injecting career, main drug of injection, previous treatment contact or geographical location. However, sharing partners were restricted to a median of two others. Conclusion. These data raise questions concerning the extent to which levels of injecting risk behaviour have increased over recent years, or the extent to which previous monitoring systems underestimated levels of risk. None the less, the data confirm that the promotion of safer injecting continues to be an important public health issue with regard to reducing blood-borne infections.     

High HIV prevalence among injecting drug users in Estonia: implications for understanding the risk environment

We found a high prevalence of HIV among injecting drug users (IDU) 54% in Tallinn and 90% in Kohtla Jarve, Estonia. Risk factors for HIV in Tallinn included use of the drug 'china white', being registered as an IDU at a drug treatment clinic, and sharing injecting equipment with sex partners. Differences existed in risk behaviour between the cities. An urgent scale-up of HIV prevention is needed. It is also important to explore how local 'risk environments' mediate the risk of HIV transmission.     

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.     

Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection

Pregnant injecting drug users were randomly assigned to: (i) individually receive a six-session cognitivebehavioural intervention in addition to their usual methadone maintenance treatment (intervention condition (I) ( n = 40)); or (ii) their usual methadone maintenance treatment only (control condition (C) ( n = 40)). There was no change in drug use per se in either group after the intervention. However, at 9-month follow-up the I group had significantly reduced some HIV risk-taking behaviours (in particular injecting risk behaviours). The I group reduced the needle risk associated both with "typical" use (drug use in the month before interview) and "binge" use (drug use in the month nominated as the heaviest month of drug use in the previous 6 months). The intervention had no effect on sexual risk behaviours. The finding of reduced injecting risk behaviour following the six-session intervention suggests that such an intervention may be of benefit for individuals persisting with injecting risk behaviours despite methadone maintenance treatment and the availability of sterile injection equipment.     

Male circumcision for HIV prevention: female risk compensatory behaviour in South Africa

South Africa promotes male circumcision (MC) as an HIV prevention method and implemented a national plan to scale-up MC in the country from 2012 to 2016. Literature has suggested that female risk compensatory behaviours (RCBs) are occurring in countries where these programmes have been implemented. Behaviours such as decreased condom use, concurrent sexual partners and sexual activity during the circumcision wound-healing period have the potential to jeopardise the campaigns’ objectives. Literature has shown that directly providing women with MC information results in correct knowledge however, previous studies have not directly sought women’s views and ideas on engagement with the information. This study aims to identify and explore female RCBs in relation to MC campaigns in South Africa, and to identify interventions that would result in greater female involvement in the campaigns. Snowball sampling was used to conduct twelve qualitative vignette-facilitated semi-structured interviews with women residing in a municipal housing estate in Durban, Kwa-Zulu Natal, South Africa. Interviews were audio-recorded, verbatim transcribed and analysed using framework analysis. MC knowledge and understanding varied, with some participants mistaking MC as direct HIV protection for females. Despite a lack in knowledge, the majority of women did not report signs of RCBs. Even with a lack of evidence of RCBs, misinterpretation of the MC protective effect has the potential to lead to RCBs; a concept acknowledged in the literature. Several women expressed that MC campaigns are directed to males only and expressed a keenness to be more involved. Suggested interventions include couple counselling and female information sessions in community clinics. Exploring women’s attitude towards involvement in MC campaigns fills in a research knowledge gap that is important to international health, as women have a vital role to play in reducing the transmission of HIV.     

Determinants of HIV infection and recent risk behaviour among injecting drug users in Berlin by site of recruitment

This study investigated differences in prevalence and determinants of HIV infection, and in recent risk behaviour (previous 6 months) among injecting drug users (IDUs) who are in contact with different types of services for IDUs in Berlin. Participants (n = 557) were recruited from drug-free long-term treatment centres, a storefront agency and a syringe exchange bus. HIV seroprevalence was lowest (3.9%) at the treatment centres, and highest among IDUs at the storefront agency (20.7%). In logistic regression, independent risk factors for HIV infection were duration of injecting drug use, borrowing syringes in prison, sex with HIV-positive partners, and prostitution. Syringe sharing in prison was the most important independent determinant of HIV infection among all three subpopulations of IDUs. Participants entering long-term treatment were most likely, and IDUs at the syringe exchange bus were least likely to have borrowed and passed on syringes in the previous 6 months. In logistic regression, site of recruitment was independently associated with recent borrowing of syringes, but not with condom use. Injection of drugs other than heroin only, and injecting in prisons, were also independent predictors of recent borrowing. The results indicate that IDUs entering treatment form an important target group for health education. There is a need for AIDS prevention measures in prisons. The comparatively low levels of recent injection risk behaviour among IDUs at the syringe exchange bus suggest that this type of intervention may be effective in harm reduction.     

Self reported risk behaviour among injecting drug users: self versus assisted questionnaire completion

The current study aimed to compare self-reported injecting and sexual risk behaviour among Needle and Syringe Program (NSP) attendees who self-completed a questionnaire to that of those who received assistance in completing the questionnaire. Information on demographic, injecting and sexual risk behaviour was collected via a self-completed questionnaire for an annual cross-sectional survey of injecting drug users (IDUs) recruited from sentinel NSPs around Australia. Assistance was provided when necessary and recorded. Of 2,035 participants, 1,452 (71%) reported completing the questionnaire without assistance. Being male and nominating a language other than English spoken at home was independently associated with receiving assistance with questionnaire completion. Participants who reported heroin as the drug last injected were also more likely to receive assistance. Multivariate analyses revealed those who received assistance with questionnaire completion were less likely to report re-using a syringe after someone else and less likely to report sex work in the past month. The current findings suggest self-completion of risk behaviour questionnaires should be considered as an alternative to interviewer administered questionnaires to maximise accuracy of self-reports.     

Differences across sexual orientation on HIV risk behaviours in injecting drug users.

Injecting drug users (IDUs) play a disproportionate role in the spread of HIV given their injecting and sexual contacts, and thereby act as conduits between these risk groups. We investigated differences in risk behaviour and HIV seroprevalence in a Sydney sample of 1,245 IDUs. Significant differences were observed across sexual orientation in HIV serostatus for males, with homosexual men having the highest HIV seroprevalence rate (35%), bisexual men intermediate (12%) and heterosexual men lowest (3%). Sexual HIV risk behaviours were lowest for homosexual men, intermediate for bisexual men, and highest for heterosexual men in the case of condom use: however, for numbers of partners, seroprevalence, and anal sex the trends were reversed. There were no differences across sexual orientation for either sex for injecting drug risk behaviours. Both male and female respondents reported having more than 50% of sexual contacts while under the influence of drugs. This study suggests that risk reduction in the sexual domain has not generalized to the injecting risk domain regardless of sexual orientation, and demonstrates that sexual risk behaviours in IDUs are lowest in homosexual, intermediate in bisexual, and highest in heterosexual IDU men.     

Self-reports of HIV risk behavior by injecting drug users: are they reliable"

While most studies of AIDS risk behavior rely on self-reports, few studies have assessed the reliability of these reports. The present study examines self-reports of drug-related and sexual risk behavior among pairs of injecting drug users (IDUs) recruited from the streets in New York City. Since both members of the pair were interviewed, it was possible to compare their responses in order to assess reliability. Subjects reported on their contacts' demographic data (age, gender, race/ethnicity) and on shared risk behaviors, including syringe sharing. Despite the private and/or illegal nature of AIDS risk behaviors, IDU subjects were generally reliable in their reports of both demographic and AIDS risk behaviors.