乌鲁木齐市吸毒人群首次注射吸毒和共用器具注射吸毒的调查研究

目的：了解新疆乌鲁木齐市吸毒人群从首次注射吸毒到首次共用器具注射吸毒的发生情况及影响因素。方法：于2005年4-6月以社区为基础招募吸毒者，调查其社会人口学特征、首次吸毒、首次注射吸毒和首次共用器具注射吸毒情况。结果：在调查的静脉吸毒者401人中，68．6％（275／401）的吸毒者曾经共用器具注射吸毒。从首次吸毒到首次注射吸毒的发生率为23．58／100人年（95％CI=21。27-25．89），多因素Cox比例风险回归模型分析结果显示：女性（HR=1.65，95％CI=1．21-2，24）和首次吸毒年份为1994年及以后（HR=3．56，95％CI=2．84～4．47）与首次注射吸毒发生的关系有统计学意义；从首次注射吸毒到首次共用器具注射毒品的发生率为24．99／100人年（95％CI=22．04-27，94），多因素Cox比例风险回归模型分析结果显示：维族（HR=I，41，95％CI=1.08～1．85）、初中及以下文化程度（HR=1，41，95％CI=1.09-1．82）和首次注射吸毒年份为1998年及以后（HR=1．56，95％CI=1．20-2．04）与首次共用器具注射吸毒发生的关系有统计学意义。结论：近期开始滥用毒品的吸毒者易于从口吸转变为注射吸毒进而共用器具注射吸毒。注射吸毒是HIV感染和传播的主要途径。     

Prevalence and correlates of jugular injections among injection drug users

Background . Jugular injection of drugs has been reported, although little is known about the prevalence of and risk factors associated with this behaviour. We evaluated factors associated with jugular injection among a cohort of injection drug users (IDU) in Vancouver, Canada. Methods . We used univariate statistics and logistic regression to examine factors associated with jugular injection among participants in the Vancouver Injecting Drug Users Study (VIDUS), a large prospective cohort study of IDU recruited through snowball sampling methods in Vancouver, Canada. Findings . Between December 2004 and November 2005, 780 IDU were followed up as part of VIDUS and 198 (25%) reported jugular injection in the previous 6 months. In multivariate analyses, factors associated independently with jugular injection included: being of the female gender [adjusted odds ratio (aOR) = 1.72, 95% confidence interval (CI): 1.14–2.59; p = 0.010], daily heroin use (aOR = 2.89, 95% CI: 1.93–4.34; p < 0.001), daily cocaine use (aOR = 1.76, 95% CI: 1.12–2.76; p = 0.014], requiring help injecting (aOR = 4.44, 95% CI: 2.64–7.46; p < 0.001), and involvement in the sex‐trade (aOR = 2.71, 95% CI: 1.6–4.55; p < 0.001). Interpretation . Reporting a history of jugular injecting was alarmingly high in the cohort and was associated with several identifiable demographic and drug‐using characteristics. Given previous reports demonstrating the risk of infection and vascular trauma due to this behaviour, these populations should be considered seriously as a target for safer injecting education.     

Methadone use among HIV-positive injection drug users in a Canadian setting

We examined methadone maintenance therapy (MMT) use among HIV-positive injection drug users (IDU) in Vancouver. Among 353 participants, 199 (56.3%) were on MMT at baseline, and 48 initiated MMT during follow-up. Female gender (adjusted odds ratio [AOR] = 1.73, 95% confidence interval [CI] = 1.14–2.62) and antiretroviral therapy use (AOR = 2.04, 95% CI = 1.46–2.86) were positively associated with MMT use, whereas frequent heroin injection (AOR = 0.34, 95% CI = 0.23–0.50), public injection (AOR = 0.76, 95% CI = 0.59–0.97), syringe borrowing (AOR = 0.54, 95% CI = 0.32–0.90), and nonfatal overdose (AOR = 0.58, 95% CI = 0.36–0.92) were negatively associated with MMT use. The rate of discontinuation of MMT was 12.46 (95% CI = 8.28–18.00) per 100 person years. Frequent heroin use (adjusted hazards ratio = 4.49, 95%CI = 1.81–11.13) was positively associated with subsequent discontinuation of MMT. These findings demonstrate the benefits of MMT among HIV-positive IDU and the need to improve access to and retention in MMT.     

Treatment costs of hepatitis C infection among injection drug users in Canada, 2006-2026

Background

Canadian injection drug users (IDUs) are at high risk of hepatitis C virus infection (HCV). However, little is known about the costs associated with their HCV-related medical treatment. We estimated the medical costs of treating HCV-infected IDUs from 2006 to 2026.

Methods

We employed a Markov model of entry through birth or immigration to exposure-related behaviours or experiences, HCV infection, progression to HCV sequelae and mortality for active and ex-IDUs in Canada. We estimated direct and indirect treatment costs using data from the Ontario Case Costing Initiative (OCCI).

Result

Approximately 137,000 IDUs will suffer from HCV-related disease each year until 2026. Applying the OCCI cost data to the prevalence of HCV-related disease from 2006 to 2026 yielded an estimated cost of $3.96 billion CND to treat HCV-infected IDUs.

Conclusions

Substantial costs are associated with the treatment of HCV-related disease among Canadian IDUs. Given the lack of effective HCV prevention strategies in Canada, we must develop targeted evidence-based responses to prevent HCV transmission and ensure appropriate allocation of medical resources to meet the present and future treatment needs of HCV-infected IDUs.     

Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore, Maryland. The present study used a subset (N=651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ(2)=19.71, p<.01), cigarette (χ(2)=11.05, p<.01), marijuana (χ(2)=10.83, p<.01), and polysubstance use (χ(2)=23.48, p<.01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR=1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR=1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR=2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset of alcohol and polysubstance use is an important risk factor for IDU in adulthood.     

Factors associated with employment among a cohort of injection drug users

Introduction and Aims. One of the most substantial costs of drug use is lost productivity and social functioning, including holding of a regular job. However, little is known about employment patterns of injection drug users (IDU). We sought to identify factors that were associated with legal employment among IDU. Design and Methods. We describe the employment patterns of participants of a longitudinal cohort study of IDU in Vancouver, Canada. We then use generalised estimating equations (GEE) to determine statistical associations between legal employment and various intrinsic, acquired, behavioural and circumstantial factors. Results. From 1 June 1999 to 30 November 2003, 330 (27.7%) of 1190 participants reported having a job at some point during follow up. Employment rates remain somewhat stable throughout the study period (9–12.4%). Factors positively and significantly associated with legal employment in multivariate analysis were male gender (adjusted odds ratio [AOR] = 2.78) and living outside the Downtown Eastside (AOR = 1.85). Factors negatively and significantly associated with legal employment included older age (AOR = 0.97); Aboriginal ethnicity (AOR = 0.72); HIV‐positive serostatus (AOR = 0.32); HCV‐positive serostatus (AOR = 0.46); daily heroin injection (AOR = 0.73); daily crack use (AOR = 0.77); public injecting (AOR = 0.50); sex trade involvement (AOR = 0.49); recent incarceration (AOR = 0.56); and unstable housing (AOR = 0.57). Discussion and Conclusions. Our results suggest a stabilising effect of employment for IDU and socio‐demographic, drug use and risk‐related barriers to employment. There is a strong case to address these barriers and to develop innovative employment programming for high‐risk drug users.[Richardson L, Wood E, Li K, Kerr T. Factors associated with employment among a cohort of injection drug users. Drug Alcohol Rev 2010]     

Factors associated with methadone maintenance therapy use among a cohort of polysubstance using injection drug users in Vancouver

We identified methadone maintenance therapy (MMT) use during follow-up interviews and examined associations between MMT use and socio-demographic and drug-related variables using generalized estimating equations (GEE). Of the 1587 participants recruited into this cohort, 170 (11%) were enrolled in MMT at baseline and additional 498 (31%) initiated MMT during follow-up. Of those ever enrolled in MMT, 406 (61%) ceased MMT and re-initiated MMT on more than one occasion. The median treatment duration was 14.4 months. Factors that were negatively and significantly associated with MMT use in multivariate analyses included: Aboriginal ethnicity (adjusted odds ratio [AOR] = 0.40); recent incarceration (AOR = 0.79); sex trade involvement (AOR = 0.87); syringe lending (AOR = 0.72); heroin injection (AOR = 0.64), whereas female gender (AOR = 2.47), HIV positivity (AOR = 1.57), and crack cocaine smoking (AOR = 1.23) were positively and significantly associated with being on MMT. Unstable housing, syringe borrowing, non-fatal overdose, cocaine injection, and residence in Vancouver's Downtown Eastside were not associated with MMT use in multivariate analyses. Our study demonstrates high rates of initiation of and retention in MMT among local IDUs. While the use of MMT was associated with reductions in heroin use and HIV risk behavior, barriers to Aboriginal IDUs were evident, and the association with increased crack cocaine use deserves further study.     

The impact of compulsory drug detention exposure on the avoidance of healthcare among injection drug users in Thailand

BackgroundAlthough Thailand has relied on the use of compulsory drug detention centres as a strategy to try to address problematic drug use, little is known about the effects of exposure to these centres on people who inject drugs (IDU). Therefore, we undertook this study to explore whether exposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU.MethodsUsing Poisson regression analyses, we examined the relationship between compulsory drug detention exposure and avoiding healthcare among participants in the Mitsampan Community Research Project based in Bangkok.Results435 IDU participated in this study, including 111 (25.5%) participants who reported avoiding healthcare. In multivariate analyses, avoiding healthcare was positively associated with exposure to compulsory drug detention (adjusted prevalence ratio [APR] = 1.60; 95% confidence interval [CI]: 1.16–2.21), having been refused healthcare (APR = 3.46; 95% CI: 2.61–4.60), and experiencing shame associated with one's drug use (APR = 1.93; 95% CI: 1.21–3.09).ConclusionExposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU, suggesting that this system of detention may be contributing to the burden of preventable morbidity among IDU in this setting. Although further research is needed to confirm these findings, the results of this study reinforce previous calls to replace the system of compulsory drug detention with evidence-based public health interventions for IDU.     

Gonadal hormone levels in injection drug users

Levels of serum sex hormones, particularly testosterone, luteinizing hormone, and follicle-stimulating hormone, have been shown to change in various disease states. Hypogonadism has been well-documented in patients with HIV infection. As HIV infection and injection drug use are closely linked, we examined whether injection drug users (IDU's) exhibit hormone abnormalities. We evaluated men participating in the ALIVE study (AIDS Linked to Intravenous Experiences), a large cohort study conducted in Baltimore, MD. We found that 20% of 40 IDU subjects (20 HIV+, 20 HIV−) with a mean age 41.5±0.9, had low serum total testosterone concentration. We were unable to detect a direct correlation between drug use and hormone levels. Further study is needed on the hormonal milieu of the IDU patient.     

Prevalence of opioid analgesic injection among rural nonmedical opioid analgesic users

OBJECTIVE: The purpose of this study was to examine the prevalence and correlates of opioid analgesic injection (OAI) in a cohort of rural opioid analgesic users. METHODS: Cross-sectional study of 184 participants from rural Appalachian Kentucky. RESULTS: The majority of participants were male (54.9%), white (98.4%) and the median age was 30 years (interquartile range: 24-37). The self-reported lifetime prevalence of injection drug use (IDU) was 44.3%, with 35.3% of respondents reporting injection of oral opioid analgesic formulations. The prevalence of self-reported hepatitis C (HCV) was 14.8%, significantly greater than those not injecting opioid analgesics (1.7%) (p<0.001). Receptive needle sharing, distributive needle sharing and sharing of other injection paraphernalia was reported by 10.5%, 26.3%, and 42.1% of those currently injecting, respectively. CONCLUSIONS: Opioid analgesic injection was more prevalent in this rural population than has been found in previous reports. This study suggests a rising problem with injecting among rural opioid users, a problem more typically associated with urban drug users. Educating injectors of opioid analgesics on safe needle practices is necessary in order to curb the transmission of HIV, HCV, and other infectious diseases. Further study on the longitudinal course of opioid analgesic injection in this population appears warranted.     

Factors associated with sex-trade involvement among female injection drug users in a Canadian setting

Background: We undertook this study to evaluate the factors associated with sex-trade involvement among a cohort of female injection drug users (IDUs).

Methods: We performed a prospective analysis of factors associated with sex-trade involvement among female participants enrolled in a prospective cohort study of Vancouver injection drug users. We examined HIV-status during follow-up and measured time updated social, sex- and drug-related variables relating to activities engaged in during the previous six months. Variables potentially associated with sex-trade involvement were evaluated using generalized estimating equations (GEE) with logit link for binary outcomes.

Results: Between May 1, 1996 and November 30, 2003, 565 participants were recruited into the cohort of whom 336 (59%) reported being involved in the sex-trade at baseline. Factors associated with reporting sex-trade involvement among women in the adjusted model included incarceration, daily injected cocaine use, daily crack use, borrowing syringes, lending syringes, and having sought but been unable to access addiction treatment during the previous six months.

Conclusions: Our study demonstrates significant risky sexual and injection behaviours as well as difficulties with access to addiction treatment among female IDUs involved in the sex-trade in Vancouver.     

Factors associated with methadone treatment among injection drug users in Bangkok, Thailand

Little is known about the characteristics of injection drug users (IDU) who take methadone treatment in Thailand. We examined prevalence and correlates of methadone treatment among a community-recruited sample of IDU in Bangkok, Thailand. Among 273 participants, 143 (52.4%) reported accessing methadone treatment within the previous 6 months. Older age (adjusted odds ratio [AOR] = 1.90, 95% confidence interval [CI] = 1.10-3.30) and more than weekly midazolam injection (AOR = 1.85, 95% CI = 1.04-3.29) were positively associated, whereas alcohol use (AOR = 0.34, 95% CI = 0.18-0.63) and noninjection methamphetamine use (AOR = 0.49, 95% CI = 0.29-0.85) were negatively associated with methadone treatment. In subanalyses, 98.6% of IDU on methadone continued to inject drugs, and the most common reason for stopping methadone was becoming incarcerated (49%). Evidence-based addiction treatment in the form of methadone maintenance therapy, with attention paid to concomitant midazolam injection in this setting, should be implemented.     

Activity spaces among injection drug users in San Francisco

BackgroundRepresentations of activity spaces, defined as the local areas within which people move or travel in the course of their daily activities, are unexplored among injection drug users (IDUs). The purpose of this paper is to use an activity space framework to study place and drug user health.MethodsData for this analysis is from an epidemiological study of street-recruited IDUs in San Francisco (N = 1084). Study participants reported geographic intersections of where they most often slept at night, hung out during the day, and used drugs during a 6 month time period. We used GIS software to construct and map activity space routes of street-based network paths between these intersections. We further identified if syringe exchange program (SEP) locations intersected with, participant activity space routes. We used logistic regression to estimate associations between activity space variables and HIV serostatus, syringe sharing, and non-fatal overdose, after adjusting for individual and Census tract covariates.ResultsMean activity space distance for all participants was 1.5 miles. 9.6% of participants had a SEP located along their activity space. An increase in activity space distance was associated with a decrease in odds of being HIV positive. An increase in residential transience, or the number of different locations slept in by participants in a 6 month time period, was associated with higher odds of syringe sharing. Activity space distance was not independently associated with overdose or syringe sharing.DiscussionResearch that locates individuals in places of perceived importance is needed to inform placement and accessibility of HIV and overdose prevention programs. More attention needs to be given to the logistics of collecting sensitive geospatial data from vulnerable populations as well as how to maximize the use of GIS software for visualizing and understanding how IDUs interact with their environment.     

Physical violence among a prospective cohort of injection drug users: a gender-focused approach

Although dramatically heightened rates of violence have been observed among injection drug users (IDU), little is known about the gender differences associated with violence among this population. Employing a risk environment framework, we performed an analysis of the factors associated with experiencing violence among participants enrolled in a prospective cohort study of IDU during the years 1996-2005 using generalized estimating equations (GEE). Among 1114 individuals, 291 (66%) of females and 470 (70%) of males reported experiencing violence during the study period. In multivariate analyses, mental illness, frequent alcohol use, frequent crack use, homelessness, Downtown Eastside residency, and requiring help injecting were positively associated with experiencing violence for both sexes (all p<0.05). For females, binge drug use (AOR=1.30) and drug dealing (AOR=1.42) were positively associated with violence, while younger age (AOR=1.02), frequent heroin injection (AOR=1.24), and incarceration (AOR=1.50) were significant for males. Women were more likely to be attacked by acquaintances, partners, and sex trade clients, while men were more likely to experience violence from strangers and the police. These findings indicate that susceptibility to violence among IDU is structured by environmental factors such as homelessness and drug-related factors such as frequent alcohol use and involvement in drug economies. Furthermore, important gender differences with respect to the predictors and characteristics of violent attacks do exist. These findings indicate an urgent need for the development of comprehensive programs and structural interventions that take a gender-focused approach to violence among IDU.     

Migration and transmission of blood-borne infections among injection drug users: understanding the epidemiologic bridge

Migration is one of many social factors contributing to the spread of HIV and other blood-borne or sexually transmitted infections (STI). Bringing together large numbers of people from diverse settings, the process of migration moves infected individuals to diverse geographic locations. Injection drug users (IDU) are a relatively mobile group, often moving between cities, smaller communities, and across international borders for reasons of work, security, or access to narcotics. This mobility indicates the potential for IDU who engage in risky behavior outside their home areas to transmit HIV infection to other IDU, their sex partners, and others in the population. The objectives of this review are to examine: (1) the influence of drug trafficking and the spread of drug use on the diffusion of HIV, (2) the influence of migration on drug use and HIV-related risk behaviors among migrants, and (3) the mobility patterns of IDU and its role in the spread of HIV. We also discuss the potential policy implications of addressing prevention and care issues in mobile drug using populations.     

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.     

The relationship between drug use stigma and HIV injection risk behaviors among injection drug users in Chennai,India

Background

The purpose of this study was to examine the relationship between perceived drug use stigma, acquiescence response bias, and HIV injection risk behaviors among current injection drug users in Chennai, India.

Methods

The sample consists of 851 males in Chennai, India who reported having injected drugs in the last month and were recruited through street outreach.

Results

Results indicate a strong and consistent positive association between drug use stigma and HIV injection drug use risk behaviors. This association held across the injection behaviors of frequency of sharing needles, cookers, cotton filters, rinse water, pre-filled syringes and common drug solutions, even after controlling for acquiescence response bias, frequency of injection, and HIV/HCV serostatus.

Conclusions

These findings suggest that future HIV prevention and harm reduction programs for injection drug users and service providers should address drug use stigma.     

Impact of HIV testing on uptake of HIV therapy among antiretroviral naive HIV-infected injection drug users

Improving access to antiretroviral therapy among injection drug users remains an urgent public health concern. We examined the time to antiretroviral therapy (ART) use among antiretroviral naive HIV-infected injection drug users who were unaware of their HIV status to examine the impact of receipt of HIV test results on uptake of ART. Time to ART use was examined using Kaplan - Meier methods, and factors associated with the time to ART were evaluated using Cox proportional hazards regression. Between May 1996 and May 2003, 312 HIV-infected individuals were enrolled into the Barriers to Antiretroviral Therapy (BART) cohort, among whom 105 (33.7%) reported not knowing their HIV status at baseline. At 24 months post-baseline, those participants who returned for test results within 8 months initiated ART at a significantly elevated rate [adjusted relative hazard = 1.87 (95% CI: 1.05 - 3.33)]. These findings demonstrate the potential to improve uptake of ART among injection drug users through targeted HIV testing and counselling initiatives that encourage the receipt of HIV test results, and suggest that strategies to improve awareness of HIV infection may improve access to antiretroviral therapy. [Wood E, Kerr T, Hogg RS, Palepu A, Zhang R, Strathdee SA, Montaner JSG. Impact of HIV testing on uptake of HIV therapy among antiretroviral naive HIV-infected injection drug users. Drug Alcohol Rev 2006;25:451 - 454]     

Correlates of sharing injection equipment among male injecting drug users in Kathmandu, Nepal

BackgroundHIV prevalence is high and risky injection practices occur frequently among injecting drug users (IDUs) in Nepal. We explored the correlates of sharing injection equipment (having injected with a needle or syringe previously used by another) among male IDUs in Kathmandu, Nepal.MethodsFrom August to September 2007, we anonymously interviewed 296 male IDUs in Kathmandu, Nepal, using a structured questionnaire. We performed bivariate and multivariable logistic regression analysis and identified variables associated with sharing injection equipment.ResultsOver half (n = 152) of the participants reported injecting drugs with a needle or syringe previously used by another in the past year. Of these, 70% reported engaging in sharing injection equipment with multiple persons. The unavailability of new needles and drinking alcohol were independently associated with sharing injection equipment among the study participants.ConclusionsIDUs who drank alcohol or who could not obtain new needles when needed were more likely to share injection equipment. Our results suggest that reducing alcohol use and increasing the availability of new needles and syringes might improve safer injection practices among male IDUs in Kathmandu, Nepal.