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

Background  

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

Needle sharing and participation in the Amsterdam Syringe Exchange program among HIV-seronegative injecting drug users.

To enhance the prevention of human immunodeficiency virus infection, factors related to regular participation in the Amsterdam Syringe Exchange and the borrowing of syringes were studied in 131 HIV-seronegative injecting drug users in a 1989-90 survey. A total of 29 percent of the users reported borrowing syringes, that is injecting drugs at least once in the past 4-6 months with a needle or syringe previously used by someone else. Users at increased risk of borrowing are previous borrowers, long term moderate-to-heavy alcohol users, current cocaine injectors, and drug users without permanent housing. Regular clients of the syringe exchange, when compared with other injecting drug users, were found more often to be frequent, long term injectors. They borrowed slightly less often than other users, but this was not statistically significant, even after controlling for frequency of injecting or other potential confounders. The results suggest that, 5 years after the start of the Amsterdam Syringe Exchange, drug use characteristics govern an individual injecting drug user's choice of exchanging or not exchanging syringes. The conclusion is that it seems more important to direct additional preventive measures at injecting drug users with an increased risk of borrowing rather than at users who do not participate in the syringe exchange or who do so irregularly.     

Neighborhood differences in patterns of syringe access,use, and discard among injection drug users: Implications for HIV outreach and prevention education

The article presents results from the Syringe Access, Use, and Discard: Context in AIDS Risk research project comparing two neighborhoods by (1) socioeconomic and demographic characteristics; (2) patterns of syringe access, use, and discard; and (3) encounters with a local human immunodeficiency viruslacquired immunodeficiency syndrome (HIV/AIDS) outreach project targeted to injection drug users (IDUs). The results show that IDUs in more economically advantaged neighborhoods were more likely to acquire syringes from a single source (rather than multiple sources), more likely to inject alone in their own residence (rather than public injection locales), and more likely to dispose of syringes in private garbage cans rather alleys or dumpsters. These results are further associated with the likelihood of encountering street outreach workers, with IDUs in more affluent neighborboods much less likely to have any such contacts. Based on the different patterns of access, use, and discard evident in each neighborhood, the results indicate that different and more carefully tailored local outreach and prevention strategies are urgently needed. An earlier version of this article was presented at the Annual Meeting of the American Public Health Association, Atlanta, Georgia, October 21–25, 2001.     

A review of HIV prevention among young injecting drug users: A guide for researchers

Young people aged 15–24 years account for fifty percent of all new AIDS cases worldwide. Moreover, half of all new HIV infections are associated with injection drug use. The average age for initiation into injecting drug use is 20 years of age. This paper investigates whether HIV prevention programs have reduced risk behaviours in young people.     

Psychosocial considerations for the prevention of HIV infection in injecting drug users

In this article, the authors discuss a study that investigated the meaning that injecting drug users attribute to risk behaviors linked to HIV transmission, especially through the use of nonsterile syringes or the failure to use condoms. To do this, social discourses with respect to the prevention of HIV infection are evaluated. The discussion focuses on how these discourses affect the daily practices of heroin users, practices that in turn influence discourses. Ethnography was used to observe 78 heroin users and 35 people following a methadone treatment program. Observation was carried out in a central district of Barcelona, Spain, with a low socioeconomic level. The results are a useful starting point for generating strategies aimed at preventing HIV transmission among this population on personal, community, and sociostructural levels.     

广东省社区吸毒者针具交换项目试点效果评价

目的　探讨社区中开展针具交换预防艾滋病在吸毒人群中传播的可行性。方法　本研究为设立对照组的社区干预试验。干预区采用针具交换措施 (同伴教育员和医务人员在吸毒人群中宣传安全注射观念、提供免费针具、回收用过的注射器 ) ,对照区不采取任何干预措施 ,为期 10个月(2 0 0 2年 9月至 2 0 0 3年 6月 )。干预前后分别采用滚雪球的方式抽取注射吸毒者进行横断面调查以评估干预效果。结果　干预前后分别对干预区 (42 8名 )和对照社区 (42 9名 )静脉吸毒者进行调查。结果显示 ,干预区的艾滋病知识知晓率由 2 9 4 %上升到 5 8 7% ;多因素logistic分析结果表明 ,看过艾滋病宣传折页或宣传画者知晓率高 ;同基线调查相比 ,干预区中最近 30d内共用针具率由基线的4 8 9%下降到 2 0 4 % ,而在对照区中共用针具率同基线相比无明显改善 ;干预后干预区最近 30d共用针具的原因中“夜间买不到针、到朋友家打针人多针少、害怕被抓不敢买针和没钱买针”的现象相对基线情况有明显改善。结论　针具交换项目可以有效降低社区吸毒者共用针具现象。为控制艾滋病在吸毒人群中的传播 ,针具交换措施应尽快在全国范围内推广。     

Commentary: reaching women drug users with methadone treatment and other HIV prevention services in Tehran

The Dolan study shows that establishment of a methadone treatment clinic for women in Tehran, Iran, is a significant step toward addressing an urgent need: if the access threshold for services is lowered, uptake among female drug users is dramatic. Implementation of effective harm reduction and other HIV prevention for women should interest policymakers, program managers, and providers in the drug prevention, treatment, and rehabilitation community, and in the HIV community at large - in and beyond Iran.     

Sexual practices,sexually transmitted diseases and other risk factors for HIV among injecting drug users

Abstract: Data were collected from 814 clients attending anonymously for counselling before tests for human immunodeficiency virus (HIV) infection at the Burnett Clinic in Auckland. Just over 10 per cent of clients (n = 83) reported ever having injected drugs. This group was matched according to age, gender, ethnicity and sexual orientation with an equal sized control group drawn from clients who had not injected drugs. The groups were compared in terms of their sexual practices, sexual partnerships, other drug use, current and past health status and their perception of HIV risk. The injecting drug users reported more sex partners than the nonusers, they were less likely to be in a relationship and they were less likely to be monogamous. Vaginal and oral sex were the most common practices in both groups but anal sex was more common among users than the nonusers. Regular condom use was reported by less than a quarter of each group. The health status of drug users was generally poorer than that of the nonusers. They reported greater use of alcohol and other drugs, more mental health problems, and more symptoms of ill health. They also had experienced more sexually-transmitted diseases. Only 1 per cent of users and 2 per cent of nonusers tested positively for HIV, although users saw themselves and their partners as at greater risk of HIV infection than the nonusers.     

AIDS-free time and survival of an injecting drug users HIV seroconvertors cohort

OBJECTIVE: To analyze AIDS free time, survival and the pre-AIDS survival for a injecting drug users cohort (IDU) of HIV seroconvertors. SUBJECT AND METHODS: Interval for seroconversion was available for 276 IDUs from Centers for AIDS Information and Prevention (CIPS) recruited between 1987 and until June of 1996. AIDS diagnosis and vital status dates were obtained by follow up at hospitals, mortality and AIDS registries, and CIPS visits. The end of follow up was December of 1996. Seroconversion date was estimated as the middle point between last HIV- and first HIV+. Kaplan-Meier extension and Cox regression for truncated data were fitted to estimate AIDS-free and survival times and to observe differences by sex, age consumption time and year of seroconversion. Weibull, and Log-normal parametric models were fitted to estimate median and percentiles of AIDS-free and survival times distribution. RESULTS: 34 cases have been identified as AIDS, 24 as deaths, 9 of them being before AIDS. 63.5% of the individuals were AIDS-free 7 years after seroconversion, and the probability of death was 25.50. Pre-AIDS mortality is around 8.7%. There were not significant differences by sex, age, consumption time and year of seroconversion. Log-normal model fitted better estimating an AIDS-free median time of 10.93 years and 13.67 survival years. CONCLUSION: The incubation period of HIV infection in a cohort of seroconvertors in our environment was around 11 years, not different from that observed out of the Mediterranean area as Holland, Scotland or United States     

Estimation of the number of injecting drug users attending an outreach syringe-exchange program and infection with human immunodeficiency virus (HIV) and hepatitis C virus: the AjUDE-Brasil project

This study estimated the number of street injecting drug user (IDU) clients of a syringe-exchange program (SEP) who were infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). A two-sample capture-recapture method was carried out. The first capture listed all interviewed IDUs outreached for syringe exchange from April 1 to May 1, 1998; the second capture involved those outreached from May 2 to June 6, 1998. Blood spots were collected for HIV and HCV serologies. Analysis used captured probability model varying with time. We interviewed 55 IDUs in the first capture and 99 in the second; 17 participated in both samples. An estimate of 317 IDUs attending the SEP was obtained (95% confidence interval [CI] 235–467). Based on the overall seroprevalence rates for HIV (47.7%) and HCV (53.1%), it was estimated that 151 IDUs were HIV infected (95% CI 112–223) and 168 (95% CI 125–248) were HCV infected. Enumeration of IDUs associated with estimates of the total number of HIV and HCV seropositives provide a powerful tool for SEPs to help monitor the number of IDUs, to plan for provisions, and to organize the new demands on existing health facilities for HIV and HCV care.     

社区注射吸毒人群前瞻性队列5年HIV和HCV新发感染研究

目的:探索社区注射吸毒人群HIV和HCV发病率。方法:自2014年6月至2019年6月,在云南省保山市隆阳区以当地的清洁针具交换点为平台,开展前瞻性队列研究,招募社区注射吸毒者200人作为研究对象。队列每6个月进行1次随访评估,调查高危吸毒行为和性行为情况,并采集血样进行HIV和HCV血清抗体检测。采用开放队列,每12...     

Knowledge of HIV serostatus and preventive behaviour among European injecting drug users: Second study

The objective of the study was to analyse the effect of knowledge of HIV serostatus on behaviours preventing the acquisition or transmission of HIV among European IDU, and to compare results with a previous similar study conducted 3 years before. Data were gathered in 1992–1993 during a retrospective multicentre cross-sectional study of IDU recruited in 11 European countries, in specialized centers and on the street. We compared, between groups with different HIV serological status (IDU who knew well before their HIV-positive serological status, IDU who knew their HIV-negative serostatus and IDU who did not know before their serological status), the respective proportions of IDU who reported that, during the six months prior to interview, (1) always used condoms, (2) never gave their used injecting equipment to other IDU, (3) always injected drugs safely. We only included IDU who had known their serological status for at least six months prior to interview. Results were compared to the similar survey conducted in 1990. From 2171 IDU recruited, data of 1334 IDU were included in the analysis. Compared with IDU who did not know their HIV serostatus, only IDU knowing their HIV-positive serostatus used condoms significantly more often (37% compared to 15%, rate ratio (RR): 2.4; 95% confidence interval (CI): 1.8–2.3) and never gave their used injecting equipment to other IDU (69% compared to 53%, RR: 1.3; 95% CI: 1.2–1.4). In comparison with the 1990 study, only condom use significantly improved and only for IDU who knew their HIV-negative serostatus (13% compared to 9%, RR: 1.6; 95% CI: 1.1–2.3). This study confirms among European IDU the relation between knowing own HIV serological status to preventive behaviours. However, there were only minor improvements between 1990 and 1992–1993, indicating that prevention of HIV transmission among IDU must be reinforced.     

Risk behaviours among HIV positive injecting drug users in Myanmar: a case control study

Background  

The severity of HIV/AIDS pandemic linked to injecting drug use is one of the most worrying medical and social problems throughout the world in recent years. Myanmar has one of the highest prevalence rates of HIV among the IDUs in the region.     

Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran

Aim  

This study aimed to examine drug use, drug treatment history and risk behaviour among a sample of Iranian drug users seeking treatment through a general practice clinic in Iran.     

HIV prevalence and risk behaviours among injecting drug users in six indonesian cities implications for future HIV prevention programs

ABSTRACT: BACKGROUND: The HIV prevalence among injecting drug users (IDUs) in Indonesia reached 50% in 2005. While drug use remains illegal in Indonesia, a needle and syringe program (NSP) was implemented in 2006. METHODS: In 2007, an integrated behavioural and biological surveillance survey was conducted among IDUs in six cities. IDUs were selected via time-location sampling and respondent-driven sampling. A questionnaire was administered face-to-face. IDUs from four cities were tested for HIV, syphilis, gonorrhoea and chlamydia. Factors associated with HIV were assessed using generalized estimating equations. Risk for sexual transmission of HIV was assessed among HIV-positive IDUs. RESULTS: Among 1,404 IDUs, 70% were daily injectors and 31% reported sharing needles in the past week. Most (76%) IDUs received injecting equipment from NSP in the prior week; 26% always carried a needle and those who didn't, feared police arrest. STI prevalence was low (8%). HIV prevalence was 52%; 27% among IDUs injecting less than 1 year, 35% among those injecting for 1-3 years compared to 61% in long term injectors (p < 0.001). IDUs injecting for less than 3 years were more likely to have used clean needles in the past week compared to long term injectors (p < 0.001). HIV-positive status was associated with duration of injecting, ever been imprisoned and injecting in public parks. Among HIV-infected IDUs, consistent condom use last week with steady, casual and commercial sex partners was reported by 13%, 24% and 32%, respectively. CONCLUSIONS: Although NSP uptake has possibly reduced HIV transmission among injectors with shorter injection history, the prevalence of HIV among IDUs in Indonesia remains unacceptably high. Condom use is insufficient, which advocates for strengthening prevention of sexual transmission alongside harm reduction programs.     

静脉吸毒人群直接和间接共用注射器具行为特征调查

目的 了解四川省凉山彝族自治区静脉吸毒人群直接和间接共用注射器具吸毒的行为学特征。方法 通过访谈和填写调查表，对379名静脉吸毒人员的社会人口学情况、近3个月内静脉吸毒共用注射器具吸毒方式、性行为等有关的行为学特征进行了调查。结果 近3个月内，43．8％(166人)的参加者与他人共用过注射器具(直接或间接共用)；41．2％(156人)的参加者与他人有过直接共用注射器具行为；33．3％(126人)的参加者与他人有过间接共用注射器具行为。直接共用注射器具的多因素logistic回归模型分析中，有统计学意义的人口学变量是汉族。间接共用注射器具的多因素logistic回归模型分析中，有统计学意义的变量为较低的文化程度和住自己的房子或租房。近6个月有新性伴的为115人(30．3％)。近1个月与非主要性伴进行异性性交每次都使用安全套的占14．6％(13／89)。结论 静脉吸毒人群中间接共用注射器具静脉吸毒行为、高危性行为普遍，在进行健康教育时，应加强对此类行为的干预。     

Developing an HIV behavioral surveillance system for injecting drug users: the National HIV Behavioral Surveillance System

While disease surveillance for HIV/AIDS is now widely conducted in the United States, effective HIV prevention programs rely primarily on changing behavior; therefore, behavioral data are needed to inform these programs. To achieve the goal of reducing HIV infections in the U.S., the Centers for Disease Control and Prevention, in cooperation with state and local health departments, implemented the National HIV Behavioral Surveillance System (NHBS) for injecting drug users (IDUs) in 25 selected metropolitan statistical areas (MSAs) throughout the United States in 2005. The surveillance system used respondent-driven sampling (RDS), a modified chain-referral method, to recruit IDUs for a survey measuring HIV-associated drug use and sexual risk behavior. RDS can produce population estimates for specific risk behaviors and demographic characteristics. Formative assessment activities-primarily the collection of qualitative data-provided information to better understand the IDU population and implement the surveillance activities in each city. This is the first behavioral surveillance system of its kind in the U.S. that will provide local and national data on risk for HIV and other blood-borne and sexually transmitted infections among IDUs for monitoring changes in the epidemic and prevention programs.     

Mobility of Scottish injecting drug users and risk of HIV infection

Nine hundred and nineteen injecting drug users (IDUs) were interviewed in Glasgow, Scotland during 1990 and 1991, as part of a wider study of HIV risk behaviour, about their injecting and sexual behaviour outside the city in the previous two years. Forty-five percent of respondents injected outside Glasgow, 6% shared needles and syringes (n/s) and 20% had sexual intercourse. Much activity occurred outside Scotland but mainly within the UK, particularly London. Predictors of n/s sharing outside Glasgow during the previous two years included current injecting with and passing on of used n/s and sexual intercourse with casual partners. Predictors of sexual behaviour outside Glasgow included passing on used n/s, having sexual intercourse with casual partners and, for females, engaging in prostitution. Glasgow IDUs are a highly mobile group and although HIV prevalence remains low within this population, considerable potential for importation/ exportation of HIV and other bloodborne and sexually transmitted infections exists. Further work is required to establish why IDUs travel to, and engage in high-risk activities in locations outside their home environment, and detailed data about activities such as frequency of condom usage and n/s cleaning practices need to obtained. While there is a widespread network of services for IDUs in the UK, information provided usually relates to local services and may not fully address the needs of this mobile population. Therefore, we recommend that IDUs be provided with details of facilities such as n/s exchange schemes and drug-treatment establishments in centres to where they most commonly travel.