HIV / STDs and drug use

Unprotected sexual intercourse and sharing drug injecting equipment are the two major ways in which HIV is transmitted among adults. Despite considerable cultural disapproval of illicit drug injection, the health hazards associated with it, and expensive law enforcement efforts, there has been an enormous diffusion of illicit drug injection during the second half of the 20th century. HIV infection has spread very fast among some populations of injecting drug users (IDUs), with incidence rates of 10-50% observed in both developing and developed countries. Needle sharing occurs among large numbers of IDUs within short periods of time, promoting the rapid and efficient transmission of HIV within the IDU population. HIV and STDs are spread from IDUs to non-IDUs through unprotected sexual intercourse. Effective HIV prevention programs for IDUs provide ongoing and trusted communication links between health workers and IDUs. Such programs also provide ready access to the means of changing behavior. The relationships between sexual behavior and drug use are complex. Prevention efforts should be focused upon people who exchange sex to support an addiction, the partners of addicted sex workers, and people who have multiple problems in living. The successful prevention of HIV infection among drug users requires that politicians admit that drug use exists in the community, that such use is likely to persist indefinitely, and that it is necessary to work with drug users to change risk behaviors.     

洪雅县艾滋病流行现状

目的 分析洪雅县艾滋病流行现况.方法 对洪雅县1996 - 2011年艾滋病控制工作相关数据和资料,进行汇总分析.结果 洪雅从1996年发现首例艾滋病感染者,截至2011年底已确诊艾滋病感染者76例,1997 - 2004年无病例报告,2005 - 2011年分别报告13、9、18、9、4、5和17例.2009年以前以注射吸毒为主要传播途径,占77.36％,2009后以异性和同性性传播为主要途径,占90.91％.2010年以前未发现外来妇女艾滋病感染者,2010年和2011年分别在外来妇女中发现艾滋病感染者2人和3人.结论 洪雅县艾滋病疫情呈逐年上升趋势,注射吸毒传播逐年下降,性传播已成主要途径,外来妇女艾滋病感染者升高,需加强性工作者人群及外来妇女艾滋病防治.     

Encouraging innovation: ten research priorities for achieving universal access to HIV/AIDS prevention, treatment and care in Europe by 2010

When the HIV epidemic officially hit western Europe in the early 1980s, central and eastern Europe were almost completely spared due to the isolation of the Soviet Union. However, in the mid-1990s, reported new cases of HIV in eastern European countries began to increase exponentially. While there have been many declarations and strategies addressing HIV/AIDS, today the goal is universal access to HIV/AIDS prevention, treatment, care and support services by 2010. The articles included in this thematic issue of the Central European Journal of Public Health on HIV/AIDS reflect this, while the ten priorities listed below are immediate and sometimes innovative research needs in the context of preventing HIV among the most-at-risk populations. While by no means exhaustive, they are intended to point out gaps in existing knowledge and thus serve as inspiration for future research efforts.     

An age-period-cohort analysis of 50,875 AIDS cases among injecting drug users in Europe

BACKGROUND: The long average incubation time from HIV infection to AIDS makes it difficult to estimate recent HIV transmission from AIDS incidence data. Age-period-cohort (APC) analysis can separate out the effects of age, calendar time and birth cohort to provide a clearer picture of transmission trends. METHODS: AIDS incidence data from 1981 to 1994 among intravenous drug users (IDU) for 12 Western European countries were used. Yearly incidences per 100,000 population or 100,000 person-years were calculated by age at diagnosis and 5-year birth cohort (1950-1954, 1955-1959, 1960-1964, 1965-1969 and 1970-1974), and corrected for reporting delay. Incidence patterns were compared between birth cohorts and countries. RESULTS: For most countries the impact was greatest on the cohort born 1960-1964. Comparing incidence patterns in the 1965-1969 to 1960-1964 cohorts suggest the epidemic has plateaued at low to intermediate levels in Austria, Greece and the North-Western European countries, and at high levels in France, Italy and Switzerland. For most countries transmission amongst the 1970-1974 as compared to the 1965-1969 cohorts could not be assessed due to small numbers and short follow-up time. In Spain the epidemic was uncontrolled with a high incidence among recent birth cohorts. In Portugal the epidemic was still at an early and expanding phase. CONCLUSIONS: The APC analysis revealed large country differences in the dynamics of the HIV/AIDS epidemic among IDU. Full interpretation of these differences is dependent on information from other sources about the local public health response and trends in drug injecting behaviours. Earlier introduction of the virus and higher prevalence of injecting drug use may explain some of the generally higher incidence in Southern European countries, but the larger part of it is most likely explained by local characteristics of drug users, such as younger age and more frequent sharing of needles and syringes, and a less effective public health response.     

HIV/AIDS in the countries of the former Soviet Union: societal and attitudinal challenges

For several years, some of the countries of the former Soviet Union have experienced the fastest growing HIV epidemic in the world, with the vast majority of reported infections contracted through injecting drug use. However, most governments of the region have been slow to recognize the severity of the problem. The scope and coverage of governmental HIV/AIDS programmes have remained very limited. Harm reduction programmes are mainly financed by external donors, while substitution treatment remains illegal in Russia and unavailable in some other countries of the region. Being based on a review of published and grey literature, this paper explores attitudinal and societal barriers to scaling up HIV programmes in the countries of the former Soviet Union. A major challenge in many countries is negative public attitudes towards people living with HIV, as well as towards those most at risk of contracting the disease: injecting drug users, sex workers, and men who have sex with men. This extends to the actions of state authorities which often pursue a punitive approach to drug users, with high rates of incarceration for minor drug offences. While many of the findings reported here relate to the Russian Federation, there is reason to believe that similar challenges exist in many other countries of the former Soviet Union. More needs to be done to document challenges to HIV prevention and treatment programmes across the region, so that policy interventions can be more effective.     

A survey of HIV and HCV among female prison inmates in Portugal

HIV and hepatitis C virus (HCV) monitoring among prison inmates is instrumental in countries with concentrated HIV/AIDS epidemics. Knowledge on these dynamics in imprisoned women in Portugal is scarce. The HIV and HCV prevalence was estimated among inmates in the largest Portuguese prison for women, which holds 57% of all female inmates in Portugal, according to sociodemographic and behavioural variables and characterised attitudes towards HIV/AIDS according to serological status. Collected variables included age, education, country of birth, penal status, and accumulated time in prison. Drug injection and sharing of injection material were inquired, as well as age at first sexual intercourse. Inmates also characterised their attitudes towards HIV/AIDS. A venous blood sample was collected and tested for anti-HIV and anti-HCV antibodies. In this sample of 445 female inmates, 10% were HIV-positive, while 11% were HCV-positive. Longer imprisonment periods were associated with relatively higher HCV prevalence and women with later ages at first sexual intercourse were less frequently HIV-positive, regardless of drug injecting behaviour. HIV prevalence was 44% in women who had ever injected drugs and 6% in those who had never injected. HCV frequency was 69% among injecting drug users (IDUs) and 4% among non-IDUs. In women who injected drugs both HIV and HCV were more frequent when the number of injections was higher and when women reported sharing of injection material. Similar attitudes towards HIV/AIDS were found for HIV-positive and negative women, but those living with HIV had more tolerant positions. This study emphasizes the role of injecting drug use in the transmission of HIV and HCV in women in Portuguese prisons and reinforces the need for the systematic adoption of harm reduction measures.     

High risk behavior for HIV transmission among former injecting drug users:a survey from Indonesia

Background  

Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs) are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs) in Indonesia, which has a rapidly growing HIV-epidemic largely driven by injecting drug use.     

广东省艾滋病防治策略分析

目的 了解广东省当前艾滋病防治策略及措施对防治工作方向的指导作用，为适时、有效的防治策略的制定与调整提供依据。方法 回顾性分析自开展艾滋病防治工作以来的历史文献、监测资料和机构发展情况及其相互关系。结果 全省监测网络基本形成，监测系统趋于完善；截至2002年11月底，广东省累计报告HIV感染者3640例，艾滋病患者139例；传播途径的构成中尽管仍以注射吸毒为主(75．7％)，但经性途径感染的比例已开始增加，2002年达4.2％;吸毒、暗娼等高危人群人数持续增加及其危险行为发生率较高。结论 广东省艾滋病流行日趋严重，HIV已经开始从吸毒人群再次进入性乱人群；尽可能地利用和开发政策支持，及时调整防治策略，动员全社会全面开展大范围宣传教育、行为干预活动，积极推广降低危害项目已刻不容缓。     

The hidden dimension: sexuality and responding to the threat of HIV/AIDS in South Sulawesi, Indonesia

Particular Asian countries (notably India, Thailand and Burma) are now estimated to have substantial numbers of HIV positive cases. The critical interacting factors which shape the HIV/AIDS epidemic in specific settings are the sexual and injecting drug using cultures and the governmental and societal responses to the threat of AIDS. This paper explores these factors in South (S.) Sulawesi in Eastern Indonesia. The paper presents recent quantitative and qualitative research findings on sexual culture, AIDS awareness and public health response in relation to the distinctive features of S. Sulawesi's geographical and socio-cultural setting. The paper concludes by discussing the major factors impeding and facilitating HIV/AIDS policy and programme implementation in S. Sulawesi.     

Reporting of newly diagnosed HIV infections in Catalonia, Barcelona, Spain. Implementation and results

OBJECTIVES: To describe newly diagnosed HIV infections from the HIV Reporting System in Catalonia (2001-2003), and to compare the characteristics of the epidemic based on the use of the HIV Reporting System and the Catalonian AIDS Registry versus those based on the Catalonian AIDS Registry alone. METHODS: Data were collected from newly diagnosed HIV infections and AIDS cases between 2001 and 2003 in Catalonia. RESULTS: Among the newly diagnosed HIV infections (1,765) the most frequent route of HIV infection was heterosexual transmission (46.8%), followed by men who had sex with men (26.7%), and injecting drug use (19.9%). Out of the 1,210 AIDS cases, the most common route of HIV transmission was injecting drug used (42.2%), followed by (heterosexual transmission 34.5%) and MSM (18.0%). Comparison of routes of HIV transmission in the two reporting systems (HIV/AIDS versus AIDS) revealed statistically significant differences. CONCLUSIONS: The HIV/AIDS Reporting System based on reporting of newly diagnosed HIV infections is feasible, since it has been useful in achieving the objectives of epidemiological HIV infection surveillance. It also provides more accurate information than does the AIDS Registry, which can be used to describe recent patterns of HIV transmission. The completeness of the new reporting system may be enhanced by including the diagnosis of HIV infection among the diseases of mandatory notification.     

Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran

Background  

In Iran, there are an estimated 200,000 injecting drug users (IDUs). Injecting drug use is a relatively new phenomenon for this country, where opium smoking was the predominant form of drug use for hundreds of years. As in many countries experiencing a rise in injecting drug use, HIV/AIDS in Iran is associated with the injection of drugs, accounting for transmission of more than two-thirds of HIV infections. This study aimed to: describe the range of characteristics of IDUs in Tehran, Iran's capital city; 2) examine the injecting-related HIV risk behaviors of IDUs, and 3) suggest necessary interventions to prevent HIV transmission among IDUs and their families and sex partners.     

Cultural Approach to HIV/AIDS Harm Reduction in Muslim Countries

Muslim countries, previously considered protected from HIV/AIDS due to religious and cultural norms, are facing a rapidly rising threat. Despite the evidence of an advancing epidemic, the usual response from the policy makers in Muslim countries, for protection against HIV infection, is a major focus on propagating abstention from illicit drug and sexual practices. Sexuality, considered a private matter, is a taboo topic for discussion. Harm reduction, a pragmatic approach for HIV prevention, is underutilized. The social stigma attached to HIV/AIDS, that exists in all societies is much more pronounced in Muslim cultures. This stigma prevents those at risk from coming forward for appropriate counseling, testing, and treatment, as it involves disclosure of risky practices. The purpose of this paper is to define the extent of the HIV/AIDS problem in Muslim countries, outline the major challenges to HIV/AIDS prevention and treatment, and discuss the concept of harm reduction, with a cultural approach, as a strategy to prevent further spread of the disease. Recommendations include integrating HIV prevention and treatment strategies within existing social, cultural and religious frameworks, working with religious leaders as key collaborators, and provision of appropriate healthcare resources and infrastructure for successful HIV prevention and treatment programs in Muslim countries.     

Policy responses to HIV/AIDS in Central Asia

The countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) are confronted with one of the fastest growing HIV/AIDS epidemics worldwide, largely driven through injecting drug use. This article, based on a review of academic and grey literature, explores how they have responded. We find major similarities and differences across the region. At one extreme is Turkmenistan, which denies that there is any problem, does not offer harm reduction services or HIV/AIDS treatment and does not report any meaningful data to the international community. Uzbekistan is also pretty closed to outside influences, has discontinued its opioid substitution project and shares with Turkmenistan the legal prohibition of male-to-male sex. Kyrgyzstan originally led many progressive approaches in the region and, like neighbouring Tajikistan, has received substantial assistance by international agencies, in particular the Global Fund. Kazakhstan, with a much higher gross domestic product per capita, has taken on the financing of harm reduction activities through its national budget and has liberalised its drug policies. Yet, across the region punitive approaches to injecting drug use and people living with HIV/AIDS persist as do stigma and discrimination, while coverage with harm reduction programmes and treatment services is still low although with substantial variation across countries.     

HIV/AIDS knowledge and sexual behavior among high school students

Data from the 1989 Secondary School Student Health Risk Survey indicate that 54 percent of all high school students in the United States had had some form of HIV/AIDS education in school. Responses to a questionnaire on HIV/AIDS knowledge show that nearly all students knew the two main modes of HIV transmission--intravenous drug use and sexual intercourse. Students who had been taught about HIV and AIDS in school gave correct answers to questions about the virus more often than those who had not received instruction. Students who knew more about HIV transmission were less likely to report having had two or more sexual partners and more likely to report consistent condom use.     

1996～2007年玉林市艾滋病病毒感染者资料分析

[目的]了解玉林市艾滋病疫情动态,为制定适合本市的防治措施提供科学依据。[方法]对玉林市1996~2007年艾滋病病毒(HIV)感染者资料进行分析。[结果]1996~2007年合计报告HIV感染者831例,其中艾滋病病人135例,死亡75例。男性611例,女性220例;年龄1.5~84岁,20~39岁525例,占63.18%;农民516例,占62.09%。1996~2003年吸毒途径传播的占69.35%,性途径传播的占21.77%;2004~2007年经性途径传播的占46.53%,吸毒途径传播的占32.53%。[结论]玉林市艾滋病流行已进入快速增长期,吸毒途径传播速度减慢,经性途径传播比例增加。     

HIV in prison: what are the risks and what can be done?

Prisons are recognised worldwide as important sites for transmission of blood-borne viruses (BBVs). There are two reasons why transmission risks in prison are higher than in the community. First, in most western countries, many prison entrants have histories of injecting drug use, and thus already have high prevalences of BBVs. Second, the lack or under-supply of preventive measures (such as clean needle and syringes or condoms) in most prisons, combined with extreme social conditions, creates extra opportunities for BBV transmission. HIV prevalence in prisoners in more developed countries ranges from 0.2% in Australia to over 10% in some European nations. There are case reports of HIV being transmitted by sharing injecting equipment and sexual activity. Tattooing has been reported as a risk factor for the transmission of BBVs in prison. Access to condoms and needle and syringe programmes in prisons is extremely limited, despite success when they have been introduced. The vast majority of prison inmates are incarcerated for only a few months before returning to the community--thus they are, over the long term, more appropriately regarded as 'citizens' than 'prisoners'. Public health policy must involve all sections of the community, including prison inmates, if we are to reduce transmission of HIV and other BBVs.     

吸毒人员自愿戒毒相关因素Logistic分析

目的 探讨吸毒人员自愿戒毒的相关因素，为有关部门控制艾滋病提供理论依据。方法 通过现场流行病学方法进行调查。结果 对968名吸毒人员进行调查，通过Logistic分析筛选出吸毒人员自愿戒毒的相关因素为年龄、民族、一个看上去娃康的人会是艾滋病感染者、蚊虫叮咬是否会传染艾滋病、感染的孕妇会将艾滋病病毒传染给胎儿、性交时使用安全套可以预防艾滋病、由静脉注射吸毒转为口吸可以预防艾滋病、静脉注射毒品时间。结论 吸毒人员自愿戒毒的相关因素主要是年龄、性别、静脉注射毒品时间和艾滋病预防传播知识。     

2010-2012年南京市浦口区吸毒人群艾滋病哨点监测分析

目的了解南京市浦口区吸毒人群艾滋病相关知识行为及HIV/HCV/梅毒感染现况。方法 2010-2012年根据《全国艾滋病哨点监测实施方案》要求,每年随机选取浦口区戒毒所新羁押吸毒人群400名进行问卷调查以及HIV/HCV/梅毒抗体检测。结果监测对象羁押前吸食的毒品主要为海洛因和冰毒,分别占71.1%、25.8%;注射吸毒者占46.8%,其中曾共用针具者占35.8%;发生过商业性行为者占12.8%,其中每次均使用安全套的比例为86.3%。3年间吸毒人群主要吸食海洛因的比例在逐年下降,而吸食冰毒的比例在逐年上升,注射吸毒比例呈逐年下降趋势(P0.001)。吸毒人群艾滋病知识的知晓率为99.4%,HIV、梅毒、HCV抗体阳性率分别为0.3%、7.6%、47.0%。有注射吸毒史者HCV抗体阳性率(61.7%)显著高于无注射吸毒史者(33.4%)(P0.001)。结论浦口区吸毒人群HIV感染率较低,但HCV感染率较高。注射吸毒比例呈现逐年下降趋势,但存在一定比例的共针行为。应继续对该人群进行艾滋病宣传教育及行为干预,加大监测力度。     

Rural perspectives on HIV/AIDS prevention: a comparative study of Thailand and Ghana

The paper compares rural perspectives in Thailand and Ghana on the level of condom acceptance in sexual relations, willingness to test oneself for HIV before and in marriage and sources of information on HIV/AIDS. We also compared the policy approaches to combating HIV/AIDS in both countries. The results indicates that in the villages studied in Thailand, all single men and the majority of the single women were in favour of using condoms in sexual relations. This group also showed a positive attitude to HIV/AIDS test before and in marriage. However, married men in rural Thailand disapproved of the use of condoms with their wives but married women in the sample population were open to the possibility of using condoms. Both married men and women were strongly against HIV/AIDS test in marriage. In contrast to Thailand, most single men in the communities studied in Ghana showed a disapproval to the use of condoms in sexual relations. However, they condoned HIV test before marriage. Married men and women in rural Ghana were against the use of condoms in sexual relations as well as HIV/AIDS test in marriage. In order to mitigate mother-to-child transmission, the Thais applied anti-retroviral drug care for HIV positive pregnant women during pregnancy and after delivery. In Ghana on the other hand, pregnant women were subject to HIV test and counselling. The mode of information acquisition on HIV/AIDS in both countries were through the media, campaigns and village volunteers. Finally, we observed that fighting poverty is a sine qua non for the success of any HIV/AIDS eradication programme.