Prevalence and correlates of suicidal ideation among young injection vs. noninjection drug users

The objective of this study was to identify correlates of suicidal ideation and to examine the hypothesis that injection drug users (IDUs) were more likely to report suicidal ideation than noninjection drug users (NIDUs). Participants included IDUs (n = 244) and NIDUs (n = 73) from Baltimore, Maryland, aged 15-30 who began snorting or smoking heroin or cocaine/crack (NIDUs) or injecting drugs (IDUs) within the past 5 years who were recruited between August 2000 and March 2002. Among the 317 participants, 42% were female, 59% were white, and median age was 24. The prevalence of suicidal ideation was 27%. IDUs were more likely to report suicidal ideation than NIDUs (31% vs. 14%, p = 0.003). Adjusting for age, gender, and race, IDUs were 2.4 times more likely than NIDUs to report suicidal ideation [95% Confidence Interval (CI): 1.1-5.2]. However, on further adjustment for homelessness, depressive symptoms, and gay/lesbian/bisexual identity, IDU status was no longer independently associated with suicidal ideation. These results suggest that factors associated with injection drug users' lifestyles and mental health status may account for the higher prevalence of suicidal ideation in IDUs vs. NIDUs. Further study into these associations is warranted in identifying avenues for suicide prevention among these populations.     

Prevalence and Correlates of Suicidal Ideation Among Young Injection vs. Noninjection Drug Users

The objective of this study was to identify correlates of suicidal ideation and to examine the hypothesis that injection drug users (IDUs) were more likely to report suicidal ideation than noninjection drug users (NIDUs). Participants included IDUs (n = 244) and NIDUs (n = 73) from Baltimore, Maryland, aged 15–30 who began snorting or smoking heroin or cocaine/crack (NIDUs) or injecting drugs (IDUs) within the past 5 years who were recruited between August 2000 and March 2002. Among the 317 participants, 42% were female, 59% were white, and median age was 24. The prevalence of suicidal ideation was 27%. IDUs were more likely to report suicidal ideation than NIDUs (31% vs. 14%, p = 0.003). Adjusting for age, gender, and race, IDUs were 2.4 times more likely than NIDUs to report suicidal ideation [95% Confidence Interval (CI): 1.1–5.2]. However, on further adjustment for homelessness, depressive symptoms, and gay/lesbian/bisexual identity, IDU status was no longer independently associated with suicidal ideation. These results suggest that factors associated with injection drug users' lifestyles and mental health status may account for the higher prevalence of suicidal ideation in IDUs vs. NIDUs. Further study into these associations is warranted in identifying avenues for suicide prevention among these populations.     

Prevalence and risk factors for HIV among sniffers, short-term injectors, and long-term injectors of heroin

The prevalence of HIV and associated risk behaviors were assessed among three groups of heroin users: long term injection drug users (LTIDUs), new injection drug users (NIDUs), and heroin sniffers (HSs) with no history of injection. HIV seroprevalence was similar among NIDUs (13.3%) and HSs (12.7%). LTIDUs had almost twice as high a level of HIV infection (24.7%). After including drug use and sex behavior variables in logistic regression models, both drug and sexual risk factors remained in the models. Attributable risk percent (APR) from injection for HIV infection among injection drug users was estimated to be 55.7% for LTIDUs and 5.8% for NIDUs. High-risk sex behavior plays an important role in the prevalence of HIV among drug users and accounts for nearly all the infection among NIDUs. Both injection and sexual risk behaviors need to be stressed in HIV prevention and intervention programs aimed at drug users.     

HIV heterosexual sexual risk from injecting drug users among HIV-seronegative noninjecting heroin users

Noninjecting heroin users (NIUs) were recruited in New York City during 1996-2003. Cumulative logistic regression was used to analyze the correlates of HIV sexual risk from injecting drug users (IDUs) among HIV seronegative NIUs engaging in heterosexual vaginal or anal sex in the past 30 days (N = 347). Participants were 67% male and 70% African American or Latino, with a mean age of 32.6 years. Hierarchical categories of IDU partner sexual risk included (1) no unprotected sex and no IDU sex partners (21%), (2) unprotected sex but not with IDUs (55%), (3) IDU sex partners but no unprotected sex with them (6%), and (4) unprotected sex with IDUs (17%). Independent correlates (p < .05) of HIV sexual risk from IDU partners included female versus male gender (adjusted odds ratio [AOR] = 2.01), ex-IDU versus never IDU (AOR = 1.90), and lower versus higher perceived social distance from IDUs (AOR = 1.60). Interventions should target female NIUs, ex-IDUs, and NIU members of IDU social and sexual networks. The study's limitations are noted.     

HIV Heterosexual Sexual Risk From Injecting Drug Users Among HIV-Seronegative Noninjecting Heroin Users

Noninjecting heroin users (NIUs) were recruited in New York City during 1996–2003. Cumulative logistic regression was used to analyze the correlates of HIV sexual risk from injecting drug users (IDUs) among HIV seronegative NIUs engaging in heterosexual vaginal or anal sex in the past 30 days (N = 347). Participants were 67% male and 70% African American or Latino, with a mean age of 32.6 years. Hierarchical categories of IDU partner sexual risk included (1) no unprotected sex and no IDU sex partners (21%), (2) unprotected sex but not with IDUs (55%), (3) IDU sex partners but no unprotected sex with them (6%), and (4) unprotected sex with IDUs (17%). Independent correlates (p < .05) of HIV sexual risk from IDU partners included female versus male gender (adjusted odds ratio [AOR] = 2.01), ex-IDU versus never IDU (AOR = 1.90), and lower versus higher perceived social distance from IDUs (AOR = 1.60). Interventions should target female NIUs, ex-IDUs, and NIU members of IDU social and sexual networks. The study's limitations are noted.     

Poor criterion validity of self‐reported hepatitis B infection and vaccination status among injecting drug users: A review

Issues. Limited resources may dictate the use of self‐reported hepatitis B virus (HBV) status to determine the need for testing and/or vaccination in resource‐poor settings, as well as in research and surveillance. Approach. A synthesis of the literature on the criterion validity of self‐reported HBV infection and vaccination history among injecting drug users (IDU) in order to determine the utility or otherwise of self‐reports in this area. Key Findings. The degree of agreement between self‐reported and serological HBV status is consistently poor among IDU. In previous research, 46–95% of IDU with serological evidence of exposure to HBV did not report a history of infection, and serological evidence of vaccine‐conferred immunity was not detected among 50–73% of IDU who reported being vaccinated. Implications. A lack of awareness or misapprehension about their HBV status may lead some IDU to inadvertently engage in behaviours which place their injecting and sexual partners at risk, contributing to the continued potential for high incidence of HBV infection among this population. Conclusion. Self‐reported histories should not be used in lieu of serological testing when assessing infection history or immunisation status. Poor criterion validity also indicates that self‐reports of HBV infection status should not be used to estimate the prevalence and incidence of this infection. Due to their low sensitivity, self‐reports of HBV infection should at best be considered only as a lower bound prevalence estimate.[Topp L, Day C, Dore GJ, Maher L. Poor criterion validity of self‐reported hepatitis B infection and vaccination status among injecting drug users: A review. Drug Alcohol Rev 2009]     

The Modelling of Injecting Behaviour and Initiation into Injecting

The modelling of injecting by injecting drug users (IDUs) around non-injecting drug users (NIDUs) is examined as a precursor to NIDUs initiation into injecting. Structured self-report interviews were conducted with 86 IDUs. 86% of the sample had been initiated into injecting by an IDU: 78% of their initiators being either a friend, partner, or sibling. Only 7% of respondents reported being pressured into injecting. 70% of respondents assessed that modelled injecting had been an important influence on their decision to inject by making them curious about injecting. In turn 98% of the respondents had modelled injecting around NIDUs, but 59% reported being unsure, or thought it unlikely, that they had made someone want to try injecting. Of these respondents 90% had talked to an NIDU about injecting, and 77% had injected around an NIDU. The findings suggest the need for interventions that raise awareness about the socially transmitted nature of injecting drug use.     

Traveling young injection drug users at high risk for acquisition and transmission of viral infections

BACKGROUND: Young injection drug users (IDU) are highly mobile. It is not known how mobility affects their risk of acquiring and transmitting viral infections. METHODS: We conducted a cross-sectional study of young (under age 30) IDU in San Francisco (2004-2006). Participants completed a semi-structured interview and testing for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infection. We examined whether travel was independently associated with drug, alcohol, sexual risk behaviors, and infection status, after adjusting for demographic characteristics and years injecting. RESULTS: Two-thirds (62%) reported past (3 months) travel outside of San Francisco (n=355). Travelers, as compared to non-travelers, were more likely to be under age 20, female, and planned to leave San Francisco in the coming months. Travel was independently associated with heavy alcohol consumption, drinking alcohol until blackout, poly-substance use, more sexual and injecting partners, and receptive needle/syringe sharing, sharing drug preparation equipment, backloading syringes and pooling money to buy drugs. In an analysis of interactions with travel, younger travelers were more likely to be HCV positive than younger non-travelers. DISCUSSION: Traveling young IDU are at exceptionally high risk for acquiring and transmitting viral infections, while their mobility makes it challenging to effectively deliver interventions.     

Knowledge of hepatitis among active drug injectors at a syringe exchange program

Injecting drug users (IDUs) are at high risk for contracting and spreading viral hepatitis through nonsterile injection practices, unprotected sexual contact, and unsanitary living conditions. We sought to characterize hepatitis knowledge, prior testing, and vaccination history among IDUs at a New York City syringe exchange program (SEP). IDU subjects generally had a poor understanding of viral hepatitis transmission and prevention. We also found low vaccination rates: only 8% reported receiving hepatitis A vaccine and 11%, hepatitis B vaccine. Educating IDUs about risky behaviors and medical preventive interventions, such as vaccines for hepatitis A and B and treatment for hepatitis C, may help prevent disease and reduce transmission. Stronger linkages between health-care centers and SEPs, drug treatment programs, and other service delivery centers where IDUs are encountered may promote hepatitis education and vaccination.     

Not all injection drug users are created equal: heterogeneity of HIV, hepatitis C virus, and hepatitis B virus infection in Georgia

Injection drug users (IDU) are widely believed to have accelerated the looming HIV/AIDS epidemic now faced by the Russian Federation and countries of the former Soviet Union. However, IDUs may be heterogeneous with regard to risk behaviors, and a subpopulation may be responsible for the majority of blood-borne pathogen transmission. We studied 926 adult injection drug users (IDU) from the cities of Tbilisi, Batumi, and Poti in Georgia, a small country in the Caucuses region between the Black and Caspian Seas, between 1997 and 1998. Study participants were administered a confidential questionnaire and were tested for antibody to HIV, hepatitis C virus (HCV), hepatitis B virus surface antigen (HBsAg), and hepatitis B core antibody (anti-HBc). Five (0.5%) individuals were positive for HIV; 539 (58.2%), for HCV; 67 (7.2%), for HBsAg; and 475, for (51.3%) anti-HBc. Surveyed individuals, 88.7%, reported sharing needles with others, and needle sharing with more than 10 other individuals versus no sharing was a highly significant predictor (OR: 278.12, 95% CI: 77.57, 997.20) of HCV seropositivity. In adjusted analysis, individuals who usually injected stolen medical/synthetic drugs had significantly lower odds of HCV (OR: 0.38, 95% CI: 0.22, 0.68) and HBV (OR: 0.58, 95% CI: 0.37, 0.90) than individuals most commonly injecting opium. Despite some limitations, these results suggest the presence of substantial heterogeneity between different injection drug-using groups in Georgia. Identification of high-risk IDU subpopulations is vital to efficiently target risk reduction programs and to prevent confounding by risk status in large HIV/AIDS behavioral intervention and vaccine trials.     

HIV-Risk Behavior Among Injecting or Non-Injecting Drug Users in Cape Town,Pretoria, and Durban,South Africa

The rapid assessment aimed to describe drug use and sexual practices that place injection and noninjection drug users (IDUs/NIDUs) at risk for HIV in South Africa. The sample comprised 85 key-informant (KI) and focus-group (FG) interviewees in or serving locations with high levels of drug use in Cape Town, Durban, and Pretoria. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. The findings indicated that commonly used drugs had differing effects on sexual and drug-use practices. Risky injecting behaviors among IDUs were common, and most interviewees engaged in sex when on drugs, some without condoms. These behaviors were also influenced by trust in intimate relationships. Injection drug users seemed more knowledgeable about HIV transmission than NIDUs, and 20% of IDUs who agreed to HIV screening tested positive. Views about drug- and HIV-intervention services, accessibility, and their efficacy were mixed. The findings suggest greater synergy is needed between drug- and HIV-intervention sectors and that consideration should be given to making various risk-reduction strategies more accessible. The study's limitations have been noted.     

Not All Injection Drug Users Are Created Equal: Heterogeneity of HIV,Hepatitis C Virus,and Hepatitis B Virus Infection in Georgia

Injection drug users (IDU) are widely believed to have accelerated the looming HIV/AIDS epidemic now faced by the Russian Federation and countries of the former Soviet Union. However, IDUs may be heterogeneous with regard to risk behaviors, and a subpopulation may be responsible for the majority of blood-borne pathogen transmission. We studied 926 adult injection drug users (IDU) from the cities of Tbilisi, Batumi, and Poti in Georgia, a small country in the Caucuses region between the Black and Caspian Seas, between 1997 and 1998. Study participants were administered a confidential questionnaire and were tested for antibody to HIV, hepatitis C virus (HCV), hepatitis B virus surface antigen (HBsAg), and hepatitis B core antibody (anti-HBc). Five (0.5%) individuals were positive for HIV; 539 (58.2%), for HCV; 67 (7.2%), for HBsAg; and 475, for (51.3%) anti-HBc. Surveyed individuals, 88.7%, reported sharing needles with others, and needle sharing with more than 10 other individuals versus no sharing was a highly significant predictor (OR: 278.12, 95% CI: 77.57, 997.20) of HCV seropositivity. In adjusted analysis, individuals who usually injected stolen medical/synthetic drugs had significantly lower odds of HCV (OR: 0.38, 95% CI: 0.22, 0.68) and HBV (OR: 0.58, 95% CI: 0.37, 0.90) than individuals most commonly injecting opium. Despite some limitations, these results suggest the presence of substantial heterogeneity between different injection drug-using groups in Georgia. Identification of high-risk IDU subpopulations is vital to efficiently target risk reduction programs and to prevent confounding by risk status in large HIV/AIDS behavioral intervention and vaccine trials.     

瑞丽市中国与缅甸静脉吸毒人员高危行为及干预现状比较研究

目的:比较中国与缅甸静脉吸毒人员(IDUs)高危行为及干预现状,为后续跨境综合干预活动提供依据。方法:2009-2010年瑞丽市为调查点,戒毒所缅甸注射吸毒人员整群抽样,结合社区中缅IDUs滚血球抽样。问卷调查收集艾滋病相关知识、共用针具、接受干预服务、高危性行为等方面的情况。SPSS 18.0软件包数据分析,秩和检验和χ2检验。结果:缅甸及中国IDUs中HIV感染率分别为35.6%及41.6%。缅甸籍IDUs新检测为阳性的比例27.6%,远高于中国籍的比例3.5%。中国IDUs最近1年接受过干预服务得分高于缅甸籍吸毒人员。缅甸、中国IDUs上个月注射时都使用新针具的比例为40.6%和46.2%,上个月使用别人用过的针具比例为33.3%和33.8%。上一次付费的性交易中没有使用安全套的比例,缅甸为91.0%,中国为57.8%,而最近一次发生性行为时没有使用安全套的比例缅甸(87.2%)高于中国(59.6%)。结论:边境区域中缅IDUs高危行为明显,应采用多种方法加大对中国缅甸籍IDUs减少伤害综合服务力度。     

Risk factors for HIV infection among drug injectors in southern Thailand

BACKGROUND: To determine HIV sero-prevalence and risk factors for HIV infection among injecting drug users (IDU) in southern Thailand. METHODS: Using a cross-sectional HIV sero-prevalence and behavioral survey, 272 active IDU were interviewed about background, life-style, drug use patterns, and sexual behaviors at six drug-treatment clinics in southern Thailand. RESULTS: Ninety-one percent reported lifetime needle sharing; 96% had tried HIV risk-reduction by either stopping/decreasing visits to sex workers and/or stopping/decreasing needle sharing. Only 5% knew that bleaching needles could reduce transmission risks. Overall, 51% tested HIV-positive (43% ethnic Thai vs. 64% ethnic Malay). HIV seropositivity among ethnic Thai was independently correlated with past history of needle sharing (OR 6.95; 1.89-25.58), injecting immediately at drug onset (OR 2.53; 1.25-5.13), and starting first injection at younger age (OR 2.61; 1.31-5.22). Injecting immediately at drug onset (OR 4.32; 1.23-15.14) and not carrying new needles (OR 4.47; 1.27-15.69) were risk factors among minority ethnic Malay. CONCLUSION: A high rate of HIV infection persists among southern-Thai IDU. HIV-infected individuals may act as a bridge of HIV transmission to their sex partners. AIDS prevention efforts should more intensely focus on minority ethnic Malays, discouraging needle sharing and increasing protected sex with regular sexual partners.     

Demographic, HIV risk behavior, and health status characteristics of "crack" cocaine injectors compared to other injection drug users in three New England cities

OBJECTIVES: To compare demographic, HIV risk behaviors, and health status characteristics of injection drug users (IDUs) who have injected "crack" cocaine with IDUs who have not. METHODS: Nine hundred and eighty-nine IDUs were recruited in New Haven, CT, Hartford, CT and Springfield, MA from January 2000 to May 2002. Participants were administered a modified version of the National Institute on Drug Abuse Risk Behavior Assessment Questionnaire. RESULTS: Nine percent (n = 89) of participants reported "ever" injecting crack cocaine and 4.2% (n = 42) reported injecting crack in the past 30 days. Lifetime and current crack injectors did not differ significantly on any demographic characteristics. Lifetime and current crack injectors did not differ on gender, age or marital status from IDUs who have never injected crack. Significant differences were found on race, education, employment and residence, with crack injectors more likely to be white, employed, better educated and living in New Haven than IDUs who have never injected crack. After adjusting for current (past 30 day) speedball and powder cocaine injection, crack injectors reported higher rates of risky drug use behaviors and female crack injectors reported higher rates of risky sexual behaviors. Crack injectors reported higher rates of abscesses, mental illness and Hepatitis C infection, but not Hepatitis B or HIV infection. CONCLUSIONS: The emergence of crack cocaine injection requires urgent attention, as this new drug use behavior is associated with elevated rates of high risk behaviors.     

Characteristics of injection drug using parents who retain their children

While it is known that injection drug users (IDUs) often have their children removed or place them voluntarily, little is known about factors associated with whether IDU parents live with their children. We identified a community sample of 391 IDU parents with at least one child under age 14 (index IDU parents). For these IDU parents, 62% did not have any of their children under age 14 living with them. We assessed whether certain health factors, risk related behaviors, social indicators, and active drug use were related to whether children of IDUs were living with the index IDU parent. IDU parents who were living with their children were overwhelmingly more likely to be female, more likely to have health insurance, and engage in no-risk or low-risk drug practices, as compared to moderate/high-risk practices. Additionally, HIV negative and HIV positive asymptomatic parents were about three times more likely to be living with their children than HIV positive parents with clinical symptoms commonly seen among those suffering from HIV-related illnesses. HIV-related clinical symptoms, rather than HIV status per se, seem to be associated with retention of children.     

美沙酮维持治疗门诊受治人群HCV感染及影响因素分析

目的：了解西安市美沙酮维持治疗门诊受治人群丙型肝炎病毒（HCV）感染现状及其特点,为制订相应的干预措施提供科学依据。方法：对西安市美沙酮维持治疗门诊（MMT）2007年5月1日至2008年5月31日入组的404名海洛因依赖者进行问卷调查,并采静脉血检测抗-HCV抗体。结果：404名吸毒者中,抗-HCV阳性率为60．6％。静脉注射史中,曾静脉注射吸毒者280人,抗-HCV阳性率为75．4％,高于非静脉吸毒者的27．4％,差异有统计学意义（P〈0．01）。有14人曾共用注射器具,占3．5％（14／404）。共用注射器具的感染率为78．6％。未共用注射器具者的HCV感染率为60．0％。多性伴者HCV感染率明显高于单一性伴或无性伴者．P〈0．01．有统计学意义。结论：西安市海溶因依籁人群HCV感染率高．相关危险行为普谝存在。     

天津市不同人群2594例病毒性乙型肝炎感染/免疫状况流行病学调查分析

目的 了解天津市不同人群病毒性乙型肝炎的感染/免疫状况,为制订防治对策提供科学依据.方法 采用不等比例分层整群抽样抽取1 ～59岁人群2 594例,用ELISA方法对其进行乙型肝炎病毒感染标志物检测.结果 2 594例中,HBV感染/免疫检出率为51.54％,HBs-Ag、抗-HBs和抗-HBc阳性率分别为2.62％、46.72％和10.60％.结论 HBV感染/免疫、HBs-Ag及抗-HBc阳性率均显著低于天津市1992年的调查结果,抗-HBs阳性率显著高于1992年结果,这与近年来实施以接种乙肝疫苗为主的综合措施有关.     

Strong HIV and hepatitis disclosure norms and frequent risk behaviors among Hungarian drug injectors

Ethnographic interviews and focus groups were conducted between May 2003 and January 2004 among injection drug users (IDUs; n=29) in Budapest, Hungary, to assess knowledge related to HIV, hepatitis B (HBV), and hepatitis C (HCV) and norms, attitudes, and behaviors. Participants perceived themselves at low risk for infection with HIV but at high risk for hepatitis through injection but not sexual exposure. They reported strong disclosure norms for HIV and hepatitis infections, while sexual and injection risk behaviors were influenced by trust about partners' self-report of infection status. Injection networks were small, with infrequent syringe sharing among a few close friends. Cookers and drug filters often were shared, and filters were reused as a backup drug supply. Most sexual relationships were monogamous, and condoms were used rarely. Although participant norms supported HIV/HBV/HCV testing, the lack of available behaviors with injection and sex partners who are close friends. Network interventions among IDUs in Hungary should build on disclosure norms and trust to reduce injection and sex risk. Testing services should be expanded and access increased so that IDUs can act on and reinforce their norms for testing.     

Hepatitis B vaccination: an unmet challenge in the era of harm reduction programs

The prevalence of vaccination against hepatitis B virus (HBV), factors associated with vaccination, and missed opportunities for vaccination were assessed among 949 street-recruited young injecting heroin users (IHUs) and noninjecting HUs (NIHUs). A cross-sectional study was carried out in Madrid, Barcelona, and Seville. Face-to-face interviews were held using a structured questionnaire with computer-assisted personal interviewing. Dried blood spot samples were tested for anti-HBV core antigen and HBV surface antigen. Bivariate and logistic regression analyses were performed. The prevalence of HBV vaccination was 21.7%, with significant differences among the cities (13.3% in Madrid, 18.4% in Seville, and 33.2% in Barcelona) and between IHUs (23.8%) and NIHUs (17.9%). In the logistic regression analysis, living in Barcelona and being aged 25 years or younger were associated with HBV vaccination in IHUs and NIHUs; in IHUs, vaccination was also associated with living in the street or in institutions for most of the last 12 months. Practically all those susceptible to HBV infection had missed at least one opportunity for vaccination, and most of them had missed such an opportunity in the last year. The proportion of vaccinated HUs remains very low despite efforts to set up harm reduction programs. New and more active strategies must be incorporated in these programs.