Prevalence and factors related to syringe sharing behaviours among female injecting drug users who are also sex workers in China

Background

Female injecting drug users who are sex workers (IDUFSWs) are at high risk of contracting HIV. They may bridge HIV transmissions from injecting drug users to clients of female sex workers.

Methods

A total of 216 non-institutionalised IDUFSWs were recruited by snowball sampling methods. Anonymous face-to-face interviews were conducted to collect data. Univariate, multivariate and hierarchical logistic regression models were fitted to investigate the associations between background characteristics, cognitive variables, psychological stress and syringe sharing behaviours among IDUFSWs.

Results

Respectively 33.8% and 27.8% of the respondents injected drugs with others’ used syringes and gave used syringes to others for drug injection in the last month. These two syringe sharing behaviours were significantly associated with inconsistent condom use during commercial sex (OR = 5.00 and 1.92, p < 0.05). Over 90% of the respondents reported at least one type(s) of psychological distress included in this study. Adjusting for significant background variables, all variables that are related to the Theory of Planned Behaviour (attitude, norm, perceived control and behavioural intention) and psychological distress (except for depression) were significantly associated with injecting drugs with others’ used syringes (adjusted OR = 2.08-6.25, p < 0.05), whilst variables related to perceived control, behavioural intention and insomnia were significantly associated with providing used syringes to others for injection (adjusted OR = 2.00-3.56, p < 0.05). In two separate summary multivariate models, variables related to the Theory of Planned Behaviours and psychological distress were independently associated with injecting drugs with others’ used syringes (OR = 1.98-4.02, p < 0.05) and giving used syringes to others for injection (OR = 2.06-3.59, p < 0.05).

Conclusions

Syringe sharing behaviours were prevalent among IDUFSWs and were associated with cognitive and psychological factors. Effective integrative intervention programmes targeting IDUFSWs are warranted.     

Multiple routes of drug administration and HIV risk among injecting drug users

This study assesses relationships between drug administration routes and HIV serostatus, drug use, and sexual behaviors among current injecting drug users (IDUs) in Tallinn, Estonia. We recruited 350 IDUs for a cross-sectional risk behavior survey. Adjusted odds ratios (AORs) were calculated to explore injection risk behavior, sexual behavior, and HIV serostatus associated with multiple route use. Focus groups explored reasons why injectors might use non-injecting routes of administration. Those reporting multiple drug administration routes were less likely to be HIV seropositive (AOR = 0.49, 95% confidence interval [CI] = 0.25-0.97) and had almost twice the odds of having more than one sexual partner (AOR = 1.90, 95% CI = 1.01-3.60) and of reporting having sexually transmitted diseases (AOR = 2.38, 95% CI = 1.02-5.59). IDUs who engage in noninjecting drug use may be reducing their risk of acquiring HIV though sharing injection equipment, but if infected may be a critical group for sexual transmission of HIV to people who do not inject drugs.     

梧州市娱乐场所406名暗娼HIV／STI感染调查及高危行为分析

目的：了解暗娼性病、艾滋病感染状况以及高危行为的影响。方法：采取整群随机抽样方法抽取娱乐场所406名暗娼,进行面对面无关联匿名从业基本情况以及艾滋病知识问卷调查并采血做HIV和梅毒抗体的检测、采宫颈拭子进行淋球菌以及沙眼衣原体检测。结果：艾滋病基本知识总正确回答率为82．54％（2681／406×8）,最小年龄为17岁,年龄小于或等于20岁的占16％,年龄大于或等于40岁的占6．4％。第一次发生商业性行为年龄小于或等于20岁占34．24％（139／406）。性伴侣数平均每天2．6个,最近一次发生商业性行为安全套使用率72．91％（296／406）;不使用安全套的主要原因有客人／本人不愿用占34．73％（141／406）。HIV抗体阳性率0．74％（3／406）,梅毒ELISA阳性率10．34％（42／406）,梅毒TRUST阳性率4．68％（19／406）,衣原体阳性88人,占21．67％,淋球菌阳性31人,占7．63％。56．00％的人选择到专科医院或综合医院就诊,27％的人自行购买药物治疗,17％到私人诊所就诊。结论：暗娼人群性病感染率较高,应加强对暗娼人群开展性病艾滋病的官传教育工作。     

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.     

Knowledge and perception of risk for HIV and condom use among male injecting drug users in Cebu City,Philippines

Injecting drug users (IDU) represent a small fraction of the HIV and AIDS cases in the Philippines. To determine if these people are engaging in behaviors that put them at risk for HIV, interviews were conducted with 360 male IDUs in Cebu City, Philippines, from 1997 to 1999, as part of a national surveillance system. The interviews assessed knowledge about HIV transmission, sources of information about HIV/AIDS, perceived risks of contracting HIV, needle-sharing practices, condom use, self-reported signs and symptoms of STDs and number of sex partners. Although most of the men were able to recognize behaviors accurately that put them at risk for HIV, more than two-thirds claimed that they shared needles and almost two-thirds of those who were sexually active claimed that they never used condoms. Intervention strategies must be developed for this population if the nation is to avoid the dramatic increase in HIV infection among IDUs that has been witnessed in neighboring Southeast Asian nations such as Malaysia and Vietnam.     

Prevalence of IGRA-positivity and risk factors for tuberculosis among injecting drug users in Estonia and Latvia

BackgroundIllegal drug use and HIV are independent risk factors for tuberculosis (TB) among injecting drug users (IDU). Estonia and Latvia have experienced high rates of TB as well as IDU and HIV outbreaks. There is a lack of knowledge about TB among IDUs in these countries. The purpose of the current study was to estimate the prevalence and risk factors of Mycobacterium tuberculosis (MTB) infection among IDUs in Estonia and Latvia.MethodsParticipants for this cross-sectional study were recruited from syringe exchange programmes using respondent-driven sampling. For assessing infection with MTB interferon-gamma release assay (IGRA) was used.ResultsThe study included 375 participants from Estonia and 313 from Latvia. The prevalence of IGRA-positivity among IDUs was 7.7% in Estonia and 25.6% in Latvia. HIV-prevalence was 62% in Estonia and 23% in Latvia. In both countries, IGRA-positivity rates did not differ between HIV-positive and HIV-negative participants. IGRA-positivity was independently associated with a prior diagnosis of TB in Estonia and with imprisonment (ever within a lifetime) and preceding contact with a TB patient in Latvia.ConclusionOur findings indicate there is an urgent need for a more vigorous approach in providing IDUs with TB screening services.     

High dead-space syringes and the risk of HIV and HCV infection among injecting drug users

This study examines the association between using and sharing high dead-space syringes (HDSSs)—which retain over 1000 times more blood after rinsing than low dead-space syringes (LDSSs)—and prevalent HIV and hepatitis C virus (HCV) infections among injecting drug users (IDUs). A sample of 851 out-of-treatment IDUs was recruited in Raleigh–Durham, North Carolina, between 2003 and 2005. Participants were tested for HIV and HCV antibodies. Demographic, drug use, and injection practice data were collected via interviews. Data were analyzed using multiple logistic regression analysis. Participants had a mean age of 40 years and 74% are male, 63% are African American, 29% are non-Hispanic white, and 8% are of other race/ethnicity. Overall, 42% of participants had ever used an HDSS and 12% had shared one. HIV prevalence was 5% among IDUs who had never used an HDSS compared with 16% among IDUs who had shared one. The HIV model used a propensity score approach to adjust for differences between IDUs who had used an HDSS and those who had never used one. The HCV models included all potential confounders as covariates. A history of sharing HDSSs was associated with prevalent HIV (odds ratio = 2.50; 95% confidence interval = 1.01, 6.15). Use and sharing of HDSSs were also associated with increased odds of HCV infection. Prospective studies are needed to determine if sharing HDSSs is associated with increased HIV and HCV incidence among IDUs.     

A peer-led mobile outreach program and increased utilization of detoxification and residential drug treatment among female sex workers who use drugs in a Canadian setting

Background

The objectives of this study were to examine the determinants of using a peer-led mobile outreach program (the Mobile Access Project [MAP]) among a sample of street-based female sex workers (FSWs) who use drugs in an urban Canadian setting and evaluate the relationship between program exposure and utilizing addiction treatment services.

Methods

A detailed questionnaire was administered at baseline and bi-annual follow-up visits over 18 months (2006-2008) to 242 FSWs in Vancouver, Canada. We used bivariate and multivariate logistic regression with generalized estimating equations for both objectives, reporting unadjusted and adjusted odds ratios (AOR) with 95% confidence intervals (CIs).

Results

Over 18 months, 42.2% (202) reports of peer-led mobile outreach program use were made. High-risk women, including those servicing a higher weekly client volume (10+ compared to <10; AOR: 1.7, 95%CIs: 1.1-2.6) and those soliciting clients in deserted, isolated settings (AOR: 1.7, 95%CIs: 1.1-2.7) were more likely to use the program. In total, 9.4% (45) reports of using inpatient addiction treatment services were made (7.5% detoxification; 4.0% residential drug treatment), and 33.6% (161) using outpatient treatment (28.8% methadone; 9.6% alcohol/drug counsellor). Women who used the peer-led mobile outreach were more likely to use inpatient addiction treatment (AOR: 4.2, 95%CIs: 2.1-8.1), even after adjusting for drug use, environmental-structural factors, and outpatient drug treatment.

Discussion

Our findings demonstrate that FSWs at higher risk for sexually transmitted infections and violence are more likely to access this peer-led mobile outreach program and suggest that the program plays a critical role in facilitating utilization of detoxification and residential drug treatment.     

Injection drug use among female sex workers in Iran: Findings from a nationwide bio-behavioural survey

BackgroundGlobally, one in three women who inject drugs is involved in sex work which increases their vulnerability to sexually transmitted infections including HIV. This study was conducted to improve our understanding of injection drug use practices among Iranian female sex workers (FSWs) and shed light on the high-risk profile of FSWs who inject drugs (FSW-IDUs).MethodsThis survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 13 cities in Iran. Data were collected through face-to-face interviews and lifetime injection drug use was assessed through the responses to the question “Have you ever injected any illicit drugs?”. Independent variables included a range of socio-demographic and risk characteristics. Logistic regression models were applied to investigate the correlates of lifetime history of injection drug use.ResultsMedian (Q1, Q3) age of the participants was 30 (25, 37) and a total of 127 (14.6%, 95% confidence interval (CI): 12.3–17.1) had ever injected drugs. In the multivariable logistic regression model, older age (adjusted odds ratio (AOR) = AOR_{25–34 vs. <18} = 3.37, 95% CI: 1.64, 7.70; AOR_{≥35 vs. <18} = 2.80, 95% CI: 1.11, 7.10), longer duration (>5 years) of involvement in sex work (AOR = 1.06, 95% CI: 1.02, 1.10), and history of drinking alcohol (AOR = 4.42, 95% CI: 2.67, 7.32) were positively associated with lifetime history of drug injection and younger age at sex work debut (AOR = 0.52, 95% CI: 0.28, 0.96) was negatively associated with lifetime history of illicit drug injection among FSWs.ConclusionThe prevalence of injection drug use among FSWs in Iran is concerning. Given the potential of this sub-population in bridging HIV into the general population, gender-sensitive and peer-led harm reduction programs should be further scaled up to meet the special needs of this vulnerable population.     

HIV risk exposure of injecting drug users in Sydney

One thousand two hundred and forty-five Sydney injecting drug users (IDUs) were interviewed by questionnaire in 1989 to determine demographic and behavioural characteristics. One-sixth (16.7%) were considered to be at low risk of HIV from either needle sharing or sexual transmission as they had either never shared injecting equipment, or had not shared for years, or cleaned their injecting equipment effectively on 100% of the occasions when they did share; and were either celibate or monogamous or, if they had multiple partners, had not had unsafe sex in the previous 6 months. Over half (50.7%) had either unsafe injecting or sexual behaviour with the remaining third (32.6%) engaging in both unsafe injecting and sexual practises. Women were more at risk from sharing injection equipment than men but men were more at risk from sexual transmission than women. Increasing age was associated with greater likelihood of safer sex but age had no effect on injecting practises. There was no relationship between unsafe injecting and sexual practises. Amphetamine use was associated with low risk injecting practises while heroin use was associated with low risk sexual transmission. These findings indicate appreciable residual risk behaviour sufficient to allow for at least a slow diffusion of HIV among injecting drug users.     

HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania

BackgroundMen who have sex with men and inject drugs (MSM-IDU) are particularly vulnerable to HIV infection and have the potential to transmit HIV across multiple populations through their male and female sexual partners and injection drug-using partners.MethodsRespondent-driven sampling was used to recruit men who reported engaging in anal sex with another man in the past 3 months, aged ≥15 years, and living in Unguja, Zanzibar. Participants responded to a face-to-face interview about their HIV and injecting risk behaviours and were tested for HIV, Hepatitis B (HBV) and C (HCV) and syphilis.ResultsAmong the 509 MSM who enrolled in the survey, 14% (n = 66) reported injecting drugs in the past 3 months among which 66% used heroin, 60% used a needle after someone else had and 68% passed a needle to someone else after using it. MSM-IDU were significantly more likely to have two or more non-paying male receptive sex partners and to have engaged in group sex in the past month, to have symptoms of a sexually transmitted infection in past 6 months, to have been arrested or beaten in the past 12 months and to be infected with HIV and co-infected with HIV and HCV compared to MSM who did not inject drugs. MSM-IDU were less likely to have used a condom at last sex with a non-paid female partner, to know where to get a confidential HIV test and to have ever been tested for HIV compared to MSM who did not inject drugs.ConclusionMSM-IDU, and MSM in general, in Unguja practice multiple high-risk behaviours that put them at risk for blood-borne and sexual transmission of HIV and HCV infection. Targeted interventions for MSM-IDU must account for the overlap of high-risk sexual and drug-using networks and integrate injection drug use and HIV services.     

The characteristics and risk factors for HIV infection among Beijing drug users in different settings

Background

Treatment for drug addiction in China can take place in mandatory detoxification centers (MDC), voluntary detoxification centers (VDC), or at outreach programs located in the community. To date little is known about HIV prevalence or associated risk factors among the current and past drug users (DU) in each setting.

Methods

Cross-sectional surveys were conducted at three different settings in Beijing, China; 795 subjects were enrolled at MDC, 824 at VDC, and 520 within the community. Subjects who provided informed consent took part in face-to-face interviews and provided blood samples for HIV and syphilis testing.

Results

Significant differences were found across enrollment sites in terms of demographic, drug use and sexual behavior characteristics. Overall HIV sero-prevalence was 2.9%, and was particularly high in MDC (5.2% versus 1.0% in VDC and 2.3% among community drug users). Adjusted odds ratios (OR) for HIV infection were 50.5 (95% CI: 19.07-133.85) for being of Yi ethnicity, 29.4 (95% CI: 15.10-57.24) for Uyghur ethnicity, 3.4 (95% CI: 1.57-7.52) for injection drug users who did not share equipment, and 18.8 (95% CI: 8.31-42.75) among injection drug users who shared injection equipment.

Conclusions

The vast differences among DU in various enrollment sites in terms of demographic characteristics, socioeconomic status, and HIV related risk profiles underscore the importance of familiarity with population characteristics and drug user environment to better inform targeted prevention programs. Prevention programs targeting DU in Chinese settings must also consider differences in ethnicities, culture, and residential status.     

Uptake of paraphernalia from injecting equipment provision services and its association with sharing of paraphernalia among injecting drug users in Scotland

Background

There has been a significant increase in the provision of injecting paraphernalia from Scottish injecting equipment provision (IEP) services. However, there is currently a lack of evidence on whether uptake of paraphernalia has any impact on paraphernalia sharing among injecting drug users (IDU). The aim of this study was to examine the factors associated with paraphernalia sharing; in particular, whether uptake of filters, spoons and sterile water from IEPs is associated with a reduction in the sharing of these items.

Methods

A cross-sectional voluntary anonymous survey of 2037 IDUs was administered during 2008–2009. Participants were asked whether they had shared filters, spoons or water (paraphernalia) in the previous 6 months, and their uptake of these items from an IEP during an average week in the previous 6 months.

Results

Self-reported uptake of paraphernalia in an average week during the previous 6 months was associated with reduced odds of sharing paraphernalia: (i) uptake of >30 filters was associated with a reduced odds of sharing filters (adjusted odds ratio (AOR) 0.50, 95% confidence interval 0.32–0.79); (ii) uptake of >30 spoons was associated with a reduced odds of sharing spoons (AOR 0.46, 95% confidence interval 0.28–0.74); and (iii) uptake of sterile water was associated with a reduced odds of sharing water (AOR 0.36, 95% confidence interval 0.22–0.61) compared to no uptake of each of these items.

Conclusions

Uptake of paraphernalia appears to be associated with safer injecting practice. Further research is needed to establish the impact of paraphernalia provision on HCV transmission.     

Prevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities

Background

HIV amongst injecting drug users (IDUs) has been described in Kabul but little data exists for other Afghan cities. We assessed HIV, hepatitis B virus (HBV), and C virus (HCV) prevalence and associated risk behaviours amongst IDUs in Hirat, Jalalabad, and Mazar-i-Sharif, Afghanistan.

Methods

Consented participants reporting injecting drugs within the previous 6 months completed interviewer-administered questionnaires and testing for HIV, hepatitis C antibody (HCV Ab), and hepatitis B surface antigen (HBsAg). Logistic regression was used to determine characteristics associated with each infection.

Results

Of 623 participants, most (98.7%) were male. Prevalence of HIV, HCV, and HBV was 1.8% (95% CI: 0.88-3.2), 36.0% (95% CI: 33-41), and 5.8% (95% CI: 3.9-7.6), respectively. All HIV cases and highest HCV prevalence were detected in Hirat; HBV prevalence was highest in Jalalabad. Amongst male IDUs, 62.9% had been imprisoned, of whom 17.2% (n = 66) injected in prison. High risk behaviours were common; 30.2% reported needle sharing in the last 6 months, 23.1% reported sex with another male, and 50.4% reported paying females for sex. Behaviours varied significantly by site; generally, Hirat participants reported fewer sexual risk behaviours. Sex with other males was negatively associated with both HBV and HCV in multivariate logistic regression analysis; no injecting behaviours were associated with both HBV and HCV.

Conclusions

Whilst HIV prevalence is low, HCV prevalence and high risk behaviours were common in these populations. Regional variations should be considered in programming to prevent transmission of HIV and viral hepatitis amongst IDUs in Afghanistan.     

A tale of two cities: HIV risk behaviours among injecting drug users in Hanoi and Ho Chi Minh City, Vietnam

The aim of this study was to describe and highlight HIV drug risk behaviours among injecting drug users (IDUs) in Hanoi and Ho Chi Minh City, Vietnam. Using a cross-sectional design 470 IDUs (Hanoi, n = 302; Ho Chi Minh City, n = 168) were recruited and interviewed by trained interviewers. The IDUs in Ho Chi Minh City were older, more likely to be employed and less likely to be single than those in Hanoi. History of injecting also varied: on average, IDUs in Ho Chi Minh City had been injecting longer (17 years in Ho Chi Minh City compared with 3 years in Hanoi). Three-quarters of the IDUs injected at least once a day and a similar proportion had their last injections administered by someone else. Eighty-two per cent had seen and/or read something on HIV/AIDS and 73% mentioned to have initiated risk reduction; however, no significant difference was found between two cities. Even though there is a significant difference between IDUs in Hanoi and Ho Chi Minh City in terms of certain risk behaviours, the IDUs in both cities continue to expose themselves to HIV infection. In addition, no significant difference was observed between the IDUs in these two cities in terms of initiating HIV risk reduction, even though prevention programmes were implemented in Ho Chi Minh City earlier than in Hanoi. The presence of high-risk behaviours and absence of any meaningful risk reduction among IDUs in both cities indicate the need for intensive targeted intervention.     

Structure and measurement of dimensions of risk for HIV transmission in injecting drug users

Dimensions of HIV infection risks were investigated in 1,245 injecting drug users (IDUs) in Sydney, Australia. Factor analysis of the degree of risk of the 33 items of risk behaviours revealed ten dimensions, which covered the domains of oral sex, withdrawal before ejaculation, protected intercourse, unprotected vaginal intercourse, saliva, blood products, manual sex, needles and syringes, unprotected anal sex, and social transmission. The perceived riskiness of particular activities closely approximated the objectively assessed risk of particular practices. Women assessed the risks of classes of activities (with the exception of oral sex) as being higher than did men. IDUs appear to have readily interpretable and consistent perceptions of HIV transmission risks, and these dimensions have utility for measuring perception and knowledge of HIV transmission risks.     

Correlates of injecting in an HIV incidence hotspot among substance users in Tijuana,Mexico

BackgroundSubstance use and HIV are growing problems in the Mexico–U.S. border city of Tijuana, a sex tourism destination situated on a northbound drug trafficking route. In a previous longitudinal study of injection drug users (IDUs), we found that >90% of incident HIV cases occurred within an ‘HIV incidence hotspot,’ consisting of 2.5-blocks. This study examines behavioral, social, and environmental correlates associated with injecting in this HIV hotspot.MethodsFrom 4/06 to 6/07, IDUs aged ≥18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and interviewer-administered surveys eliciting information on demographics, drug use, sexual behaviors, and socio-environmental influences. Participants were defined as injecting in the hotspot if they most frequently injected within a 3 standard deviational ellipse of the cohort's incident HIV cases. Logistic regression was used to identify individual and structural factors associated with the HIV ‘hotspot’.ResultsOf 1031 IDUs, the median age was 36 years; 85% were male; HIV prevalence was 4%. As bivariate analysis indicated different correlates for males and females, models were stratified by sex. Factors independently associated with injecting in the HIV hotspot for male IDUs included homelessness (AOR 1.72; 95%CI 1.14–2.6), greater intra-urban mobility (AOR 3.26; 95%CI 1.67–6.38), deportation (AOR 1.58; 95%CI 1.18–2.12), active syphilis (AOR 3.03; 95%CI 1.63–5.62), needle sharing (AOR 0.57; 95%CI 0.42–0.78), various police interactions, perceived HIV infection risk (AOR 1.52; 95%CI 1.13–2.03), and health insurance status (AOR 0.53; 95%CI 0.33–0.87). For female IDUs, significant factors included sex work (AOR 8.2; 95%CI 2.2–30.59), lifetime syphilis exposure (AOR 2.73; 95%CI 1.08–6.93), injecting inside (AOR 5.26; 95%CI 1.54–17.92), arrests for sterile syringe possession (AOR 4.87; 95%I 1.56–15.15), prior HIV testing (AOR 2.45; 95%CI 1.04–5.81), and health insurance status (AOR 0.12; 95%CI 0.03–0.59).ConclusionWhile drug and sex risks were common among IDUs overall, policing practices, STIs, mobility, and lack of healthcare access were correlated with injecting in this HIV transmission hotspot. Although participants in the hotspot were more aware of HIV risks and less likely to report needle sharing, interventions addressing STIs and structural vulnerabilities may be needed to effectively address HIV risk.     

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.     

Mortality among injecting drug users in Melbourne: a 16-year follow-up of the Victorian Injecting Cohort Study (VICS)

Multiple factors affect injecting drug-related mortality, many of which will vary over time and between jurisdictions. There are relatively few studies of mortality among injecting drug users (IDU) in Australia. We aimed to provide data comparable to those reported internationally on the rate of mortality among IDU in Australia. We retrospectively examined mortality among participants (N=220) from the first Australian cohort study of IDU by linking coded personal identifier records with a national death register. The overall mortality rate among those followed-up was 0.83 per 100 PY (95% CI, 0.56-1.21 per 100 PY). This rate is lower than those reported internationally but comparable to the limited Australian data from other cohorts of IDU. Mortality was higher among males, most common among those aged in their early thirties and drug-related mortality occurred typically after substantial injecting careers. Extensive experience of incarceration (>or=3 times) was associated with increased risk of mortality. These results suggest that rates of mortality among Australian IDU may be lower than those reported internationally, with low HIV prevalence and Australia's long-held harm reduction framework potentially contributing to this result. Further studies using defined cohorts followed over time are needed to examine long-term outcomes among IDU in Australia.     

中缅边境社区静脉注射吸毒人员高危注射行为对比分析

目的 分析中缅边境社区静脉注射吸毒人员（IDUs）高危注射行为情况,为下一步加强边境地区跨境吸毒人员综合干预提供有利依据.方法 2009年在云南2个边境县,采用滚雪球方法选取社区内跨境缅甸籍和中国籍IDUs,知情同意后,采用自行设计并经预测试的双语问卷进行调查并进行血清学检测.调查内容包括基本情况、艾滋病知识、人类免疫缺陷病毒（HIV）相关高危行为等.数据采用Excel2003建库录入,SPSS16.0 软件进行统计分析.结果 两地共调查249例吸毒人员,其中中国籍100例,缅甸籍149例.20.0%中国籍及10.1%缅籍IDUs上月注射时有共针现象,中缅IDUs的HIV感染率分别为32.0%、19.5%.两地吸毒人员上月注射时是否共用针具、或共用过毒品稀释溶液或容器及上次注射使用新针具体情况比较,差异有统计学意义（P＜0.05）.结论 为控制边境吸毒人员HIV感染传播,加强跨边境吸毒人员的综合干预,特别是边境中国吸毒人员的综合干预十分重要.