Paenibacillus larvae Bacteremia in Injection Drug Users

Paenibacillus larvae causes American foulbrood in honey bees. We describe P. larvae bacteremia in 5 injection drug users who had self-injected honey-prepared methadone proven to contain P. larvae spores. That such preparations may be contaminated with spores of this organism is not well known among pharmacists, physicians, and addicts.     

Effectiveness of HIV Interventions Among Women Drug Users

SUMMARY

A prospective cohort study was conducted among chronic injecting and crack cocaine drug using women. The hypothesis tested was that participation in a standard-plus-innovative intervention was more likely to produce behavior change than participation in a standard intervention. Standardized intervention protocols and corresponding instruments were designed. Data were collected on drug and sex risk behaviors at baseline and six-month follow-up intervals. The level of behavioral change in two intervention arms—standard and a standard-plus-innovative intervention—was measured by composite sex risk and drug risk scores using the generalized estimating equation approach. The results show that on four risk measures the enhanced intervention was significantly associated with positive change in both drug use and sexual behavior: less frequent drug use, less drug use during sex, and more frequent condom use during particular frequencies for specific types of sexual activities. Public health interventions are effective when targeting specific risk behaviors through interventions tailored to prevent HIV and reduce risk behaviors among specific cultural and gender groups.     

Prevalence and Characteristics of Femoral Injection among Seattle-Area Injection Drug Users

Injection drug use (IDU) into central veins, most common among long-term IDUs with no other options, can lead to severe infectious, vascular, and traumatic medical consequences. To follow-up on anecdotal reports of femoral vein injection and related medical problems in Seattle, we analyzed data from the annual survey of a community-based syringe exchange program. A total of 276 (81%) of 343 program attendees completed the survey in August 2010. Among 248 IDUs, 66% were male, 78% white, and 86% primarily injected opiates. One hundred respondents (40%) had injected into the femoral vein, 55% of whom were actively doing so, and 58% of whom reported medical complications that they attributed to the practice. Most (66%) used the femoral vein due to difficulty accessing other veins, although 61% reported other veins they could access and 67% reporting using other sites since initiating femoral injection. While injecting into muscle was more frequent among older IDUs with longer injection careers, the prevalence of femoral injection was highest among respondents in their late twenties with 2.5–6 years of injecting drugs. Multivariate analysis demonstrated an increased risk of initiating femoral injection each calendar year after 2007. Injecting into the femoral vein was also associated with white versus other race (odds ratio [OR] 2.7, 95% CI 1.3–5.4) and injection of primarily opiates versus other drugs (OR 6.3, 95% CI 1.2–32.9) and not associated with age, length of IDU career, or a history of injecting into muscle. These findings suggest a secular trend of increasing femoral injection among Seattle-area IDUs with a high rate of related medical problems. Interventions, such as education regarding the hazards of central venous injection and guidance on safe injection into peripheral veins, are needed to minimize the health consequences of femoral injection.     

Low-Frequency Heroin Injection among Out-of-Treatment, Street-Recruited Injection Drug Users

In this paper, we explore the understudied phenomenon of “low-frequency” heroin injection in a sample of street-recruited heroin injectors not in drug treatment. We conducted a cross-sectional study of 2,410 active injection drug users (IDUs) recruited in San Francisco, California from 2000 to 2005. We compare the sociodemographic characteristics and injection risk behaviors of low-frequency heroin injectors (low-FHI; one to 10 self-reported heroin injections in the past 30 days) to high-frequency heroin injectors (high-FHI; 30 or more self-reported heroin injections in the past 30 days). Fifteen percent of the sample met criteria for low-FHI. African American race, men who have sex with men (MSM) behavior, and injection and noninjection methamphetamine use were independently associated with low-FHI. Compared to high-FHI, low-FHI were less likely to report syringe sharing and nonfatal heroin overdose. A small but significant proportion of heroin injectors inject heroin 10 or less times per month. Additional research is needed to qualitatively examine low-frequency heroin injection and its relationship to drug use trajectories.     

Syringe Disposal Among Injection Drug Users in San Francisco

To assess the prevalence of improperly discarded syringes and to examine syringe disposal practices of injection drug users (IDUs) in San Francisco, we visually inspected 1000 random city blocks and conducted a survey of 602 IDUs. We found 20 syringes on the streets we inspected. IDUs reported disposing of 13% of syringes improperly. In multivariate analysis, obtaining syringes from syringe exchange programs was found to be protective against improper disposal, and injecting in public places was predictive of improper disposal. Few syringes posed a public health threat.Needlestick injuries resulting from injection drug users (IDUs) improperly disposing of syringes present a potential risk of transmission of viral infections such as hepatitis and HIV to community members, sanitation workers, law enforcement officers, and hospital workers.^1–8 There have been no reports of HIV, HBV, or HCV seroconversion among children who incurred accidental needlesticks.^6,7,9–11 Among IDUs, syringe exchange program (SEP) utilization is associated with proper disposal of used syringes.^12–16 In 2007, the San Francisco Chronicle published a series of articles containing anecdotal reports of widespread improper disposal of syringes on city streets and in Golden Gate Park. The reports implied that SEPs were responsible for improper disposal of syringes.^17–19 Concerned about public safety, the San Francisco Department of Public Health worked with other researchers to (1) determine the prevalence of improperly discarded syringes in San Francisco, and (2) examine syringe disposal practices of IDUs.     

Unsafe Injection and Sexual Risk Behavior among Injecting Drug Users in Georgia

Injection drug users (IDUs) are at risk for acquiring human immunodeficiency virus (HIV) through parenteral and sexual transmission. In this paper, we describe the prevalence and correlates of unsafe drug injecting and sexual behaviors among IDUs recruited across five cities in Georgia in 2009. IDUs were administered a questionnaire collecting information on demographics, drug use, sexual behaviors, and HIV testing behaviors. Correlates of risky injecting and sexual behaviors were determined using logistic regression. Of 1,127 IDUs, the majority (98.7%) were men, and the median duration of injecting drugs was 7 years. Unsafe injecting behavior at last injection was reported by 51.9% of IDUs, while 16.8% reported both unsafe injecting behavior and not using condoms with last occasional and/or commercial partner. In the multivariate analysis, independent correlates of unsafe injecting behavior at last injection were types of drugs injected [p = 0.0096; (for ephedrine, adjusted odds ratio (aOR) = 7.38; 95% CI, 1.50–36.26)] and not using condoms at last commercial sex (aOR = 2.29, 1.22–4.32). The following variables were significantly associated with unsafe injecting behavior at last injection and not using condoms at last sex with commercial and/or occasional partners in the multivariate analysis: marital status [p = 0.0002; (for divorced, widowed, and separated aOR = 2.62, 1.62–4.25; for single aOR = 1.61, 1.08–2.39)], being a member of a regular injecting group (aOR = 0.62, 0.44–0.88), types of drugs injected in the past month [p = 0.0024; (for buprenorphine aOR = 0.34, 0.18–0.63)], city of residence (p = 0.0083), and not receiving information on HIV (aOR = 1.82, 1.07–3.09). Though only ephedrine was injected by a smaller number of IDUs (9.1%), the vast majority of these (81.4%) reported unsafe injecting practices at last injection. High prevalence of unsafe injecting behaviors and diverse and at-risk sexual partnerships highlight the need to implement complex and targeted HIV interventions among IDUs in Georgia.     

静脉吸毒人员艾滋病知识知晓率影响因素的非条件Logistic回归分析

[目的]探讨静脉吸毒人员艾滋病知识知晓率的影响因素,以便制定该人群预防艾滋病病毒(HIV)传播的措施.[方法]2002～2003年,在广东省选取2个社区,1个为干预区,采用针具交换干预措施;另1个为对照区,不采取任何干预措施,进行10个月的干预,于干预前后采用方便抽样,利用结构问卷对抽取的注射吸毒者分别进行面对面的断面调查,进行艾滋病防治知识知晓率及其影响因素的非条件Logistic回归分析.[结果]干预前后分别调查静脉吸毒人员428、429名,干预组艾滋病知识知晓率分别为29.36%和58.67%(P＜0.01).多因素非条件Logistic回归分析结果,进入回归模型的因素按照贡献率依次为干预地区(OR=0.337),看过宣传资料(OR=2.815)、初中文化(OR=2.207)、高中及以上文化(OR=2.799)、40岁以上年龄(OR=0.510).[结论]静脉吸毒人员初中以上文化程度、接受过针具交换项目宣传者艾滋病知识知晓率高,40岁以上及干预地区的吸毒人员艾滋病知识知晓率较低.     

Differences in Condom Behaviors and Beliefs Among Female Drug Users Recruited from Two Cities

SUMMARY

This paper examines predictors of condom cognitions and condom use for vaginal sex within women's main and paying partnerships. The sample consisted of active injection drug and crack-using women recruited from two cities with disparate HIV rates. A total of 338 drug-using women who reported vaginal sex with a main and/or paying partner in the prior 30 days were recruited for this study. Recruitment site was a significant predictor for several of the variables examined, for both main and paying partners. Ethnicity and prior HIV test result were also significant predictors, but only for main sex partners. Findings support previous research and suggest that the factors which predict condom beliefs, intention, and behaviors are different for main versus paying partners. Interventions designed to increase condom use must recognize that cognitive factors associated with condom use may vary by partner type, ethnicity, and recruitment site, particularly when important contextual variables, such as local seroprevalence, vary.     

Association between Pregnancy and Active Injection Drug Use and Sex Work among Women Injection Drug Users in Saint Petersburg,Russia

Widespread use of unsafe sexual practices among women injecting drugs both practicing and not practicing sex work leads to high levels of unplanned pregnancies in this population. The goal of this study was to investigate the association between pregnancy and active drug use and sex work. Data were collected using a convenience sample of 500 women in Saint Petersburg, Russia, in 2013. All women had recent experience of drug use, of which 200 were pregnant at the time of the study. The study consisted of a structured interview followed by a rapid HIV test. Pregnancy was protective against both active drug use and sex work. For HIV-positive women, these associations were stronger than for HIV-negative women: drug use prevalence ratio (PR) was 0.59 vs 0.85; for sex work, the PRs were 0.36 vs 0.64. Higher levels of education were associated with a lower prevalence ratio for active drug use and sex work in all models. Having children was not associated with active drug use or sex work. Pregnancy might be an optimal time for conducting interventions aimed at cessation of drug use and sex work among women injecting drugs.     

Limited Uptake of Hepatitis C Treatment Among Injection Drug Users

We characterized hepatitis C virus (HCV) treatment knowledge, experience and barriers in a cohort of community-based injection drug users (IDUs) in Baltimore, MD. In 2005, a questionnaire on HCV treatment knowledge, experience and barriers was administered to HCV-infected IDUs. Self-reported treatment was confirmed from medical records. Of 597 participants, 71% were male, 95% African-American, 31% HIV co-infected and 94% were infected with HCV genotype 1; 70% were aware that treatment was available, but only 22% understood that HCV could be cured. Of 418 who had heard of treatment, 86 (21%) reported an evaluation by a provider that included a discussion of treatment of whom 30 refused treatment, 20 deferred and 36 reported initiating treatment (6% overall). The most common reasons for refusal were related to treatment-related perceptions and a low perceived need of treatment. Compared to those who had discussed treatment with their provider, those who had not were more likely to be injecting drugs, less likely to have health insurance, and less knowledgeable about treatment. Low HCV treatment effectiveness was observed in this IDU population. Comprehensive integrated care strategies that incorporate education, case-management and peer support are needed to improve care and treatment of HCV-infected IDUs.     

The Effect of a Case Management Intervention on Drug Treatment Entry Among Treatment-Seeking Injection Drug Users With and Without Comorbid Antisocial Personality Disorder

We examined the effect of a case management intervention on drug treatment entry among injection drug users (IDUs) with and without comorbid antisocial personality disorder (ASPD). Injection drug users attending the Baltimore Needle Exchange Program who sought and were granted referrals to opioid agonist treatment were randomized to receive a strengths-based case management intervention or passive referral. Of 162 IDUs, 22.8% met the DSM-IV criteria for ASPD. Compared to those without ASPD, IDUs with comorbid ASPD who spent 25 or more minutes with their case manager prior to their treatment entry date were 3.51 times more likely to enter treatment than those receiving less than 5 min, adjusting for intervention status, race, and treatment site (95% confidence interval 1.04–11.89). Providing case management services to IDUs with comorbid ASPD may facilitate treatment entry and reduce the negative consequences of drug abuse. Havens is with the Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, USA; Cornelius is with the School of Social Work, University of Maryland, Baltimore, MD, USA; Ricketts, Huettner, and Strathdee are with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Latkin is with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Bishai is with the Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Lloyd is with the School of Social Administration, Temple University, Philadelphia, PA, USA; Strathdee is with the Division of International Health and Cross-cultural Medicine, Department of Family Health Sciences, University of California San Diego School of Medicine, San Diego, CA, USA.     

四川省西昌市吸毒人群首次静脉注射吸毒情况调查

目的了解四川省西昌市吸毒人群从首次口吸毒到首次静脉注射吸毒的发生情况。方法于2004-05／07从社区中招募吸毒人群，调查其社会人口学、首次吸毒前吸烟、饮酒情况、首次吸毒的时间和方式及种类、首次静脉注射吸毒情况。结果在调查的451名吸毒人员中，首次使用的毒品均为海洛因，其中，首次为口吸和静脉注射的分别为80．7％（364／451）和19．3％（87／451）。从首次口吸到首次静脉注射的发生率为21．82／100人年（95％ CI为19．60～24．05），多因素Cox比例风险模型分析结果显示，初中以下文化（HR=1．38；95％ CI为1．12～1．70）和15岁以前开始吸烟（HR=1．41；95％ CI为1．15～1．73）与首次口吸到首次静脉注射发生的关系有统计学意义。结论首次口吸到静脉注射毒品的时间与文化程度有关，这一转变的发生率也与吸毒人群吸烟早迟有关。但需进一步了解吸毒人群首次静脉注射吸毒的发生情况及其影响因素。     

Perceptions of Health-Related Community Reentry Challenges among Incarcerated Drug Users in Azerbaijan,Kyrgyzstan, and Ukraine

Facing competing demands with limited resources following release from prison, people who inject drugs (PWID) may neglect health needs, with grave implications including relapse, overdose, and non-continuous care. We examined the relative importance of health-related tasks after release compared to tasks of everyday life among a total sample of 577 drug users incarcerated in Ukraine, Azerbaijan, and Kyrgyzstan. A proxy measure of whether participants identified a task as applicable (easy or hard) versus not applicable was used to determine the importance of each task. Correlates of the importance of health-related reentry tasks were analyzed using logistic regression, with a parsimonious model being derived using Bayesian lasso method. Despite all participants having substance use disorders and high prevalence of comorbidities, participants in all three countries prioritized finding a source of income, reconnecting with family, and staying out of prison over receiving treatment for substance use disorders, general health conditions, and initiating methadone treatment. Participants with poorer general health were more likely to prioritize treatment for substance use disorders. While prior drug injection and opioid agonist treatment (OAT) correlated with any interest in methadone in all countries, only in Ukraine did a small number of participants prioritize getting methadone as the most important post-release task. While community-based OAT is available in all three countries and prison-based OAT only in Kyrgyzstan, Kyrgyz prisoners were less likely to choose help staying off drugs and getting methadone. Overall, prisoners consider methadone treatment inapplicable to their pre-release planning. Future studies that involve patient decision-making and scale-up of OAT within prison settings are needed to better improve individual and public health.     

Migrant Drug Users: Predictors of HIV-Related Sexual and Injection Risk Behaviors

Background Puerto Rican drug users recruited in NY who previously used drugs in Puerto Rico (PR) have been found to have higher HIV injection and sex-related risk behaviors than those who had not used in PR. This study examined predictors of risk among migrant Puerto Rican drug users. (For the purpose of this paper, the term “migrant” was used to designate Puerto Rican drug users who had used drugs in Puerto Rico and were recruited in New York or New Jersey). Methods A total of 290 drug users who had previously used drugs in PR were recruited in NY and New Jersey and interviewed regarding drug use history and HIV risk behaviors. Results Participants engaged in high risk behaviors, e.g., 39% shared injection paraphernalia and 62% reported unprotected sex. Multivariate analyses found that predictors of injection-related risk included being born in PR and purchasing drugs jointly with other drug users; predictors of sex-related risk included younger age and homelessness. Discussion Addressing risk reduction among those drug users who were born in Puerto Rico and are younger or homeless was indicated, and efforts to reach those at highest risk through NEPs was recommended.     

静脉吸毒人群按约定日期随访的影响因素队列研究

目的　探讨我国静脉吸毒人群前瞻性研究队列按约定日期随访的方法。方法　 2 0 0 2 - 11在四川省凉山州社区中招募了HIV抗体阴性静脉吸毒人群前瞻性研究队列 333人 ,于第 12个月随访期间 ,分阶段抽取 133名随访的研究对象进行调查 ,分析与研究对象按约定日期随访相关的社会人口学和队列保持方法等影响因素。结果　调查的 133名研究对象按约定日期随访率为 6 0 2 % (80 / 133) ,其多因素Logistic回归模型分析有统计学意义 (P <0 0 5 )的变量是住处距门诊点距离、种子通知、 6个月回访和愿意继续参加项目。结论　通过种子帮助外勤组联系参加者是吸毒人群研究队列重要的随访方法之一 ,同时随访过程中应尽力寻找住处距离门诊点较远或曾有失访史的参加者     

针具交换对注射吸毒人群高危吸毒行为及HIV感染的影响

目的评价广西针具交换项目通过影响注射吸毒人群高危吸毒行为达到预防艾滋病传播的效果。方法选择吸毒较严重的2个市(县/区)的针具交换点作为研究现场,采取面对面访谈的方式开展结构式问卷调查,内容包括人口学特征、参加针具交换情况及其影响因素、高危吸毒行为等;并采集研究对象的血样进行HIV抗体检测。采用χ2检验、单因素及多因素Logistic回归分析来评价针具交换项目对注射吸毒人群高危吸毒行为及HIV感染的影响。结果共调查355名注射吸毒者,其中近1年参加针具交换项目的为304人,未参加者51人。多因素Logistic分析结果显示,参加针具交换者有利于降低注射吸毒者重复使用1支针(OR=0.15,95%CI=0.07~0.33)和共用针具(OR=0.08,95%CI=0.07~0.33)注射吸毒的不安全注射行为;而长时间的吸毒年限、每天注射吸毒、重复使用及共用针具是注射吸毒者感染HIV的危险因素。结论针具交换项目能有效降低注射吸毒人群共用针具的行为,在预防艾滋病传播中具有重要作用。