Combined effects of alcohol and hepatitis C: A secondary analysis of alcohol use biomarkers and high-risk behaviors from two medication trials for alcohol dependence

Objectives

The goal of this secondary analysis was to examine the combined effects of HCV infection and recent alcohol use on baseline biologic markers of alcohol consumption in two outpatient medication trials for alcohol dependence. In addition, the relationship between Hepatitis C virus (HCV) infection and behavioral risk factors for HCV infection in these clinical populations were examined.

Methods

Data (n = 345) from two randomized, placebo-controlled trials of naltrexone and psychosocial treatment for alcohol dependence (Study I, n = 212) and comorbid alcohol and cocaine dependence (Study II, n = 133) were used to examine baseline measures of HCV risk behaviors (injection drug use, needle sharing), and biomarkers of alcohol use (AST, ALT, GGT and CDT) were compared by HCV serostatus first within each study and then across studies.

Results

Although groups had differing sociodemographic profiles (as indicated by race, marital status, level of education) subjects in Study I exhibited no statistically significant differences from the Study II cohort in HCV prevalence (12.7 vs. 20.0%, p = 0.07), lifetime history of injection drug use (13.8 vs. 22.0%, p = 0.74), lifetime history of needle sharing (9.1 vs. 18.0%, p = 0.62). As such, the data from both studies were analyzed together. Regardless of drinking status, HCV infection was significantly associated with an upward shift in the baseline level of ALT, AST, and GGT (p < 0.006 for all measures) and a downward shift in baseline CDT (p = 0.002). When using standard laboratory cutoff values to determine clinically significant elevations, HCV seropositivity was significantly associated with elevations in ALT, AST, GGT (p < 0.001), and with decreases in CDT (p = .002).

Conclusions

These data emphasize the importance of evaluating HCV infection and HCV risk behaviors at intake in medication trials for alcohol dependence and also raise questions regarding the use of cutoff scores for ALT, AST, GGT and CDT levels as biologic markers of alcohol use in subjects when HCV status is unknown.     

Reinforcing integrated psychiatric service attendance in an opioid-agonist program: A randomized and controlled trial

Background

The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program.

Methods

Opioid-dependent outpatients (n = 125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.00) contingent on full adherence to each week of scheduled psychiatric services; or (2) standard on-site integrated care (SOIC). All participants received access to the same schedule of psychiatrist and mental health counseling sessions for 12-weeks.

Results

ROIC participants attended more overall psychiatric sessions at month 1 (M = 7.53 vs. 3.97, p < .001), month 2 (M = 6.31 vs. 2.81, p < .001), and month 3 (M = 5.71 vs. 2.44, p < .001). Both conditions evidenced reductions in psychiatric distress (p < .001) and similar rates of drug-positive urine samples. No differences in study retention were observed.

Conclusions

These findings suggest that contingency management can improve utilization of psychiatric services scheduled within an on-site and integrated treatment model. Delivering evidenced-based mental health counseling, or modifying the contingency plan to include illicit drug use, may be required to facilitate greater changes in psychiatric and substance abuse outcomes.     

Enhancing access and retention in substance abuse treatment: The role of Medicaid payment acceptance and cultural competence

Background

Health insurance coverage and quality of care are common factors believed to improve access for and retention of racial and ethnic minority groups in health care. However, there is little evidence that acceptance of public insurance and provision of culturally responsive care decrease wait time and retention of minority populations in community-based substance abuse treatment.

Methods

We analyzed client and program data collected in 2010–2011 from publicly funded treatment programs in Los Angeles County, CA. An analytical sample of 13,328 primarily African American and Latino clients nested within 104 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on count measures of days to initiate and days spent in treatment.

Results

Programs that accepted public insurance (p < .001) and in which staff reported personal involvement (p < .01) and linkages and resources with minority communities (p < .001) were negatively associated with client wait time. Similarly, programs with culturally responsive policies and assessment and treatment practices (p < .05) were positively associated with retention in treatment, after controlling for individual and program characteristics.

Conclusions

These preliminary findings provide an evidentiary base for the role of community-based financial and cultural practices in improving accessibility and treatment adherence in a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to expand public insurance and enhance culturally competent care, are discussed.     

Sex modulates approach systems and impulsivity in substance dependence

Background

Personality traits such as pathological engagement in approach behaviors, high levels of impulsivity and heightened negative affect are consistently observed in substance dependent individuals (SDI). The clinical course of addiction has been shown to differ between sexes. For example, women increase their rates of consumption of some drugs of abuse more quickly than men. Despite the potential influence of personality and sex on features of addiction, few studies have investigated the interaction of these factors in substance dependence.

Methods

Fifty-one SDI (26 males, 25 females) and 66 controls (41 males, 25 females) completed the Behavioral Inhibition/Behavioral Activation System (BIS/BAS) Scales, the Barratt Impulsiveness Scale, and the Positive and Negative Affect Schedule (PANAS-X). Data were analyzed with 2 × 2 ANCOVAs testing for main effects of group, sex and group by sex interactions, adjusting for education level.

Results

Significant group by sex interactions were observed for BAS scores [F(1,116) = 7.03, p < .01] and Barratt Motor Impulsiveness [F(1,116) = 6.11, p < .02] with female SDI showing the highest approach tendencies and impulsivity followed by male SDI, male controls, and finally female controls. SDI scored higher on negative affect [F(1,116) = 25.23, p < .001] than controls. Behavioral Inhibition System scores were higher in women than men [F(1,116) = 14.03, p < .001].

Conclusion

Higher BAS and motor impulsivity in SDI women relative to SDI men and control women suggest that personality traits that have been previously associated with drug use may be modulated by sex. These factors may contribute to differences in the disease course observed in male compared to female drug users.     

Public injecting and HIV risk behaviour among street-involved youth

Background

Although street-involved youth who inject illicit drugs are known to be at an increased risk of HIV and other adverse health outcomes, little is known about public injecting among this population and how injecting in public environments may impact HIV risk behaviour.

Methods

We used data derived from a study of 560 street-involved youth in Vancouver, Canada to examine the factors associated with injecting in public environments among youth who reported injecting drugs in the past 6 months.

Results

At baseline, 162 (28.9%) reported injecting drugs in the past 6 months. Among injectors, the 124 (76.5%) participants who reported injecting in public were more likely to be homeless (odds ratio [OR] = 6.39, p < 0.001), engage in unprotected intercourse (OR = 3.09, p = 0.004), deal drugs (OR = 2.26, p = 0.032), smoke crack cocaine (OR = 3.00, p = 0.005), inject heroin (OR = 3.48, p = 0.001), drop used syringes outdoors (OR = 8.44, p < 0.001), share syringes (OR = 4.43, p = 0.004), and were less likely to clean injection sites >75% of the time (OR = 0.36, p = 0.008). The majority (62.1%) reported feeling rushed while injecting in public.

Conclusions

Youth who inject in public are significantly more likely to engage in sexual and injection-related risk behaviour. Given the known elevated rates of HIV infection and other harms among this population, youth-focused interventions that target both sexual and drug-related risks associated with public drug-using environments are in urgent need of evaluation.     

Young adults who smoke cigarettes and marijuana: Analysis of thoughts and behaviors

Introduction

Smoking both cigarettes and marijuana is increasingly common among young adults, yet little is known about use patterns, motivations, or thoughts about abstinence. In a U.S. sample, this study explored young adults' severity of cigarette and marijuana co-use, quit attempts, and thoughts about use.

Methods

Young adults age 18-to-25 who had smoked at least one cigarette in the past 30 days completed an anonymous online survey.

Results

Of 1987 completed surveys, 972 participants reported both past-month cigarette and marijuana use (68% male, 71% Caucasian, mean age 20.4 years [SD = 2.0]). Frequency of use, temptations to use, measures of dependence, decisional balance, and past-year quit attempts were associated across the two substances (all p < .05), but not motivation to quit. Relative to marijuana, participants reported greater desire and a later stage of change for quitting cigarettes and were more likely to endorse a cigarette abstinence goal, yet they had lower expectancy of success with quitting cigarettes and with staying quit (all p < .001).

Conclusions

Cigarette and marijuana use, temptations to use, and pros/cons of using were related in this young adult sample. Differences in motivation and thoughts about abstinence, however, suggest that young adults may be more receptive to interventions for tobacco than marijuana use. Use patterns and cognitions for both substances should be considered in prevention and intervention efforts.     

Randomized clinical trial examining duration of voucher-based reinforcement therapy for cocaine abstinence

Background

This is the first study to systematically manipulate duration of voucher-based reinforcement therapy (VBRT) to see if extending the duration increases abstinence during and following VBRT.

Methods

We randomized cocaine-dependent methadone-maintained adults to Standard (12 weeks; n = 62) or Extended (36 weeks; n = 68) VBRT and provided escalating voucher amounts contingent upon urinalysis verification of cocaine abstinence. Urinalysis was scheduled at least every 2 weeks during the 48-week study and more frequently during VBRT (3/week) and 12 weeks of Aftercare (2/week).

Results

Extended VBRT produced longer durations of continuous cocaine abstinence during weeks 1–24 (5.7 vs 2.7 weeks; p = 0.003) and proportionally more abstinence during weeks 24–36 (X² = 4.57, p = .03, OR = 2.18) compared to Standard VBRT. Duration of VBRT did not directly predict after-VBRT abstinence; but longer continuous abstinence during VBRT predicted abstinence during Aftercare (p = 0.001) and during the last 12 weeks of the study (p < 0.001). Extended VBRT averaged higher monthly voucher costs compared to Standard VBRT ($96 vs $43, p < .001); however, the average cost per week of abstinence attained was higher in the Standard group ($8.06 vs $5.88, p < .001). Participants in the Extended group with voucher costs exceeding $25 monthly averaged 20 weeks of continuous abstinence.

Conclusions

Greater abstinence occurred during Extended VBRT, but providing a longer duration was not by itself sufficient to maintain abstinence after VBRT. However, if abstinence can be captured and sustained during VBRT, then providing longer durations may help increase the continuous abstinence that predicts better long-term outcomes.     

Effectiveness of school-based smoking intervention in middle school students of Linzhi Tibetan and Guangzhou Han ethnicity in China

Purpose

The purpose of this paper is to assess the effectiveness of school-based intervention aimed to increase knowledge, to change attitudes and to reduce smoking-related behavior in both Linzhi Tibetan and Guangzhou Han middle school students in China.

Design

A concurrent intervention study was conducted in both Linzhi and Guangzhou. Two schools were randomly chosen and one was randomly assigned to the intervention group and the other to the control group in both settings.

Setting/participants

Participants were grade one and grade two middle school students drawn from two schools in Linzhi, Tibet Autonomous Region (southwest China) and two schools in Guangzhou, Guangdong Province (south China).

Intervention

The intervention program lasted for one year and covered three aspects: health policies in school, health environment in school and personal health skills.

Main outcome measures

Primary outcomes were smoking-related knowledge, attitudes and behavior (including ever smoking, daily smoking, weekly smoking and current smoking) and were measured by a self-administered questionnaire before and after the intervention.

Results

This intervention increased smoking-related knowledge in both Tibetan (β = 1.32, 95% CI (0.87–1.77)) and Han ethnic groups (β = 0.47, 95% CI (0.11–0.83)). It changed attitudes toward smoking in Tibetan (β = 1.47, 95% CI (0.06–2.87)) but not so in Han (β = − 0.33, 95% CI (− 1.68–1.01)). The intervention changed the prevalence of smoking in neither ethnic groups (P > 0.05).

Conclusions

The impact of school-based smoking intervention is different among Tibetan and Han students. This intervention was more effective for Tibetans when compared with the Han ethnic group. More research is needed on how intervention can be adapted to address ethnic and cultural differences.     

Television-supported self-help for problem drinkers: A randomized pragmatic trial

Objectives

To test the effectiveness of a television-supported self-help intervention for problem drinking.

Methods

Dutch television viewers (N = 181) drinking in excess of the guidelines for low-risk alcohol use were randomly assigned either to the Drinking Less TV self-help course (consisting of five televised sessions supplemented by a self-help manual and a self-help website) or to a waitlisted control group. To ensure trial integrity, intervention delivery was mimicked beforehand by sending intervention participants weekly DVDs in advance of the actual telecasts in 2006. Pre-post assessments were carried out on both groups, as well as a 3-month follow-up assessment on the intervention group to study effect maintenance. The primary outcome measure was low-risk drinking.

Results

The intervention group was more successful than the waitlist group in achieving low-risk drinking at post-intervention (OR = 9.4); the effects were maintained in the intervention group at 3-month follow-up.

Conclusions

The low-threshold television-based course Drinking Less appears effective in reducing problem drinking.     

Young adult waterpipe smokers: Smoking behaviors and associated subjective and physiological effects

Introduction

The purpose of this pilot study was to investigate smoking behaviors and subjective and physiological effects of nicotine on young adult occasional waterpipe smokers.

Methods

This study utilized a repeated-measures design that included one repeated factor for condition (nicotine and non-nicotine). For each participant, the sequencing of the repeated factor was assigned using random allocation. The two nicotine conditions were nicotine (0.75 g) and non-nicotine (0 g placebo) tobacco. Over the course of two weeks, twenty-two participants completed subjective (Acute Subjective Effects of Nicotine) and physiological (blood pressure, heart rate, and CO level) measures. Additional measures (QSU and MNWS-R) were used to assess for withdrawal symptoms.

Sample

The participants (n = 22) were young adults (23 ± 3.1 years); 71% smoked waterpipe once a month in the past year and 29% smoked waterpipe 1–2 times per week. In addition, 60% reported sharing their waterpipe with friends while smoking. None of the participants reported using any other forms of tobacco products.

Results

Under the nicotine condition, participants tended to smoke longer (i.e. smoking duration, p = 0.004), take more puffs (p = 0.03), take shorter puffs (p = 0.03), and inhale less volume with each puff (p = 0.02). The repeated measures analysis of the factor headrush revealed an effect of the nicotine condition (F = 9.69, p < 0.001, partial η² = 0.31) and time (F = 8.17, p = 0.02, partial η² = 0.30). Heart rate increased significantly across the nicotine condition (F = 7.92, p = 0.01, partial η² = 0.31) and over time (F = 12.64, p = 0.01, partial η² = 0.41).

Conclusions

This study demonstrates how differences between nicotine and non-nicotine waterpipe smoking are associated with changes in smoking behaviors, experiencing a headrush and an increase in heart rate.     

Influence of reinforcer magnitude and nicotine amount on smoking's acute reinforcement enhancing effects

Background

Nicotine's acute effects on enhancing reinforcement from sensory rewards, shown in animal models, appear to occur with smoking in humans. These effects may vary due to reinforcer magnitude and amount of acute smoke intake (dose).

Methods

In a fully within-subjects design, dependent smokers (n = 23) participated in 3 sessions. Each session followed overnight abstinence and involved 4 trials to assess responding via progressive ratio (PR 50%) for sensory reinforcement from high, moderate, or low preference music, or no reward (counter-balanced, 30-s/reinforcer). Sessions differed in smoking prior to each trial: 8 puffs on arrival and 2 puffs/trial (“8 + 2″), 2 puffs/trial only (“0 + 2″), or no smoking. Puffs were consumed via CReSS (Clinical Research Support System) to control topography, and smoking involved own brand to ensure palatability and increase generalizability of results.

Results

Reinforced responding was influenced by main effects of smoking condition (p < .05) and music reward type (p < .001). Compared to no smoking, responding for music was increased after smoking 8 + 2/trial puffs (p < .005), but not after 0 + 2/trial puffs. Smoking condition significantly increased reinforced responding only for the high preference music (p = .01), and not for moderate or low preference music, or for no reward. Withdrawal did not differ between the two smoking sessions, ruling out withdrawal relief as an explanation for differential reinforcement enhancement.

Conclusions

Our findings confirm that just one cigarette after abstinence is sufficient for reinforcement enhancing effects and suggest that such enhancement is greater as magnitude of a reward's reinforcing efficacy increases.     

Phone-delivered brief motivational interventions for mandated college students delivered during the summer months

Objective

Across the United States, tens of thousands of college students are mandated to receive an alcohol intervention following an alcohol policy violation. Telephone interventions may be an efficient method to provide mandated students with an intervention, especially when they are away from campus during summer vacation. However, little is known about the utility of telephone-delivered brief motivational interventions.

Method

Participants in the study (N = 57) were college students mandated to attend an alcohol program following a campus-based alcohol citation. Participants were randomized to a brief motivational phone intervention (pBMI) (n = 36) or assessment only (n = 21). Ten participants (27.8%) randomized to the pBMI did not complete the intervention. Follow-up assessments were conducted 3, 6, and 9 months post-intervention.

Results

Results indicated the pBMI significantly reduced the number of alcohol-related problems compared to the assessment-only group. Participants who did not complete the pBMI appeared to be lighter drinkers at baseline and randomization, suggesting the presence of alternate influences on alcohol-related problems.

Conclusion

Phone BMIs may be an efficient and cost-effective method to reduce harms associated with alcohol use by heavy-drinking mandated students during the summer months.     

Positive smoker identity as a barrier to quitting smoking: Findings from a national survey of smokers in England

Background

It has been proposed that positive smoker identity may be an important factor undermining smoking cessation but very little research exists on this. This study tested the hypothesis that a simple measure of positive smoker identity would predict quit attempts over and above other known predictors in a population sample. More tentatively it explored whether this measure would also predict quit success.

Methods

A representative sample of adult smokers in England (n = 9456) was included at baseline and 2099 were followed-up at six months. Demographic and smoking characteristics, a single item measure of positive smoker identity (endorsing the statement: ‘I like being a smoker’), measures of smoking-related attitudes, quit attempts and quit success were included.

Results

A total of 18.3% (95% CI = 17.5–19.2) of smokers reported a positive smoker identity. Adjusting for all other predictors, those with a positive smoker identity were more likely to be older (p < 0.001), male (p = 0.013), more nicotine dependent (p < 0.001), have lower motivation to stop (p < 0.001), have not made a quit attempt in the past year (p = 0.025), enjoy smoking (p < 0.001), and consider themselves to be addicted (p < 0.001). Having a positive smoker identity independently predicted failure to make a quit attempt at six months (p = 0.007). The independent association with quit success was similar in magnitude but did not reach statistical significance (p = 0.053).

Conclusions

Only a minority of smokers in England have a positive smoker identity. However, where it is present it may be an important barrier to quitting smoking and merits further study.     

Socialization to binge drinking: A population-based,longitudinal study with emphasis on parental influences

Background

Binge drinking is associated with considerable harm. However, too little is known about socialization to this pattern of alcohol consumption.

Aim

To identify longitudinal predictors of young adult binge drinking, with an emphasis on possible parental influences.

Methods

A population-based prospective study, in which respondents (N = 2558) were surveyed from mid-adolescence until their late 20 s. The data set was linked to national registers. Data were collected on parental alcohol consumption, parental binge drinking and parental alcohol problems, as well as on other aspects of the family milieu. The respondents’ frequency of alcohol consumption was assessed, as well as a number of binge drinking measures: (i) frequency of intoxication episodes, (ii) frequency of consuming 5+ units, and (iii) “usual” consumption patterns of 5–6+ units, 7–9+ units, and 10+ units.

Results

A surprisingly high proportion of the sample met the criteria for binge drinking. After control for parental, peer and individual characteristics, parental binge drinking predicted respondents’ binge drinking, using all definitions, at age 28 years (p < .001). Parental frequency of alcohol consumption predicted frequency of alcohol consumption in their offspring at age 28 (p < .001).

Conclusion

The findings suggest a socialization pattern of alcohol role modeling from parents to offspring. The findings are also consistent with genetic research showing alcohol use to have moderate heritability. We may witness new binge drinking cultures in Norway, but binge drinking patterns also seem to echo parental influences.     

Impulsivity and substance-related attentional bias: A meta-analytic review

Background

Previous research demonstrates the role of attentional bias in addictive behaviors. Impulsivity is thought to affect the strength of attentional biases, and thus, attentional biases might be one mechanism by which impulsivity affects addictive behaviors. However, whether or not impulsivity is related to attentional biases across different conceptualizations of impulsivity and attentional biases has yet to be examined as an initial test of such causal models.

Methods

The authors completed a meta-analysis of 13 published research studies examining the relationship between substance-related attentional bias and different conceptualizations of impulsivity.

Results

There was a small and significant effect size between impulsivity and substance-related attentional bias (r = 0.20), which was moderated by impulsivity measurement type (Q_b = 5.91, df = 1, p < 0.05): there was a stronger relationship between behavioral impulsivity and substance-related attentional bias (r = 0.22) than trait impulsivity and substance-related attentional bias (r = 0.10). Different components of behavioral impulsivity and trait impulsivity did not affect the relationship.

Conclusions

This study is the first systematic and empirical demonstration of the relationship between substance-related attentional bias and impulsivity and suggests viability of future examinations of casual models relating these constructs. Since trait and behavioral conceptualizations differentially relate to substance-related attentional bias, the current review further supports research suggesting how disaggregation of multidimensional constructs can lead to more robust relationships.     

Understanding the role of cessation fatigue in the smoking cessation process

Background

To understand the dynamic process of cessation fatigue (i.e., the tiredness of trying to quit smoking) with respect to its average trend, effect on relapse, time-varying relations with craving and negative affect, and differences among genders and treatment groups.

Method

Randomized placebo-controlled clinical trial. Participants received either placebo, monotherapy (bupropion SR, nicotine patch, nicotine lozenge), or combined pharmacotherapy (bupropion SR + nicotine lozenge, nicotine patch + nicotine lozenge). Data were collected from 1504 daily smokers who were motivated to quit smoking. The participants completed baseline assessments and ecological momentary assessments for 2 weeks post-quit.

Results

Cessation fatigue reduced the likelihood of 6-month post-quit abstinence (OR = 0.97, 95% CI (0.95, 0.99)), and was positively associated with craving and negative affect. After controlling for these two factors, average cessation fatigue increased over time. Compared to men, women experienced greater fatigue (t = −10.69, p < 0.0001) and a stronger relation between fatigue and craving (t = −8.80, p < 0.0001). The relationship between fatigue and negative affect was significantly stronger in men (t = 5.73, p < 0.0001). Cessation fatigue was significantly reduced by combined pharmacotherapy (t = −13.4, p < 0.0001), as well as monotherapy (t = −6.2, p < 0.0001).

Conclusions

Cessation fatigue was closely related to craving, negative affect, and cessation outcomes. Women reported greater cessation fatigue than men. Current treatments appeared to reduce fatigue and weaken its relations with craving and negative affect.     

Internal mouthpiece designs as a future perspective for enhanced aerosol deposition. Comparative results for aerosol chemotherapy and aerosol antibiotics

Background

In an effort to identify factors producing a finest mist from Jet-Nebulizers we designed 2 mouthpieces with 4 different internal designs and 1–3 compartments.

Materials and methods

Ten different drugs previous used with their “ideal” combination of jet-nebulizer, residual-cup and loading were used. For each drug the mass median aerodynamic diameter size had been established along with their “ideal” combination.

Results

For both mouthpiece, drug was the most important factor due the high F-values (F_large = 251.7, p < 0.001 and F_small = 60.1, p < 0.001) produced. The design affected the droplet size but only for large mouthpiece (F_large = 5.99, p = 0.001, F_small = 1.72, p = 0.178). Cross designs create the smallest droplets (2.271) so differing from the other designs whose mean droplets were greater and equal ranging between 2.39 and 2.447. The number of compartments in the two devices regarding the 10 drugs was found not statistically significant (p-values 0.768 and 0.532 respectively). Interaction effects between drugs and design were statistically significant for both devices (F_large = 8.87, p < 0.001, F_small = 5.33, p < 0.001).

Conclusion

Based on our experiment we conclude that further improvement of the drugs intended for aerosol production is needed. In addition, the mouthpiece design and size play an important role in further enhancing the fine mist production and therefore further experimentation is needed.     

Injecting practices in sexual partnerships: Hepatitis C transmission potentials in a ‘risk equivalence’ framework

Background

Evidence indicates minimal hepatitis C (HCV) sexual transmission risk among HIV negative heterosexual partners. Limited HCV literacy has been demonstrated among people who inject drugs, yet there is a dearth of research exploring perceptions of HCV heterosexual transmission risk among this high risk population.

Methods

We conducted a qualitative life history study with people who had been injecting drugs for over six years, to explore the social practices and conditions of long-term HCV avoidance. Participants were recruited through London drug services and drug user networks. The sample comprised 10 women and 27 men (n = 37), of whom 22 were HCV antibody negative. Participants were aged from 23 to 57 years and had been injecting for 6 to 33 years. Twenty participants were in long term heterosexual partnerships.

Findings

The majority of participants in relationships reported ‘discriminate’ needle and syringe sharing with their primary sexual partner. Significantly, and in tension with biomedical evidence, participants commonly rationalised syringe sharing with sexual partners in terms of ‘risk equivalence’ with sexual practices in regard to HCV transmission. Participants’ uncertain knowledge regarding HCV transmission, coupled with unprotected sexual practices perceived as being normative were found to foster ‘risk equivalence’ beliefs and associated HCV transmission potential.

Conclusion

HCV prevention messages that ‘add on’ safe sex information can do more harm than good, perpetuating risk equivalence beliefs and an associated dismissal of safe injecting recommendations among those already practicing unprotected sex.     

Moderate/heavy alcohol use and HCV infection among injection drug users in two Russian cities

Background

In Russia, injection drug use and transmission of blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are inextricably linked, however the burden of alcohol use remains unexplored among injection drug users (IDUs).

Methods

Individuals who were 18 years of age and older and had injected drugs in the previous 30 days were recruited in the cities of Novosibirsk and Ivanovo by respondent driven sampling. Consenting individuals were administered a quantitative survey instrument and provided blood samples for serological testing.

Results

In Novosibirsk and Ivanovo, 29% and 35% of respondents were categorized as moderate/heavy drinkers, respectively. Individuals reported problems related to alcohol use that affected their physical health (23%), family (55%), and induced financial hardships (43%). In the multivariate analysis, we found that methamphetamine injection in the past 12 months was a strong and significant correlate of moderate/heavy drinking in Novosibirsk (aOR = 5.63 95% CI: [1.01–31.47]) and Ivanovo (aOR = 3.81 95% CI: [2.20–6.62]). There was poor agreement between self-reported HCV status and HCV test results (κ = −0.05 and 0.26 in Novosibirsk and Ivanovo, respectively). IDUs who correctly knew their HCV seropositive status in Novosibirsk and IDUs who correctly knew their HCV seronegative status in Ivanovo were significantly more likely to be moderate/heavy drinkers.

Conclusion

Alcohol use is problematic among IDUs who are at high risk for HCV. Future interventions should target IDUs who are moderate/heavy drinkers in order to prevent liver complications resulting from HCV infection.