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Biomedical subjects

G V Stimson

Publications and source records attributed to G V Stimson.

At least 55 records · Page 3Linked to original sources
PubMed1994

HIV prevalence no higher among female drug injectors also involved in prostitution.

To assess the prevalence of HIV infection among female drug injectors involved in prostitution and female drug injectors not involved in prostitution, survey-based interviews were undertaken with 308 female drug injectors in 1990 and 1991. Confirmed saliva test results show 12.9% HIV prevalence among female drug injectors involved in prostitution and 14.4% HIV prevalence among drug injectors not involved in prostitution. This gives an HIV prevalence rate of 14.2% among female drug injectors overall. Findings also show that women not involved in prostitution were less likely to be in contact with a drug treatment or helping agency and were less likely to report having had an HIV test. Respondents in contact with a treatment agency and respondents involved in prostitution were more likely to be aware of their HIV status, and 72% of non-prostitute women confirmed HIV positive were unaware of their positive status. These findings of no higher HIV prevalence among female drug injectors also involved in prostitution lend some support to emerging evidence which associates HIV transmission among women prostitutes with an involvement in injecting drug use rather than with an involvement in prostitution per se. Findings also strengthen the need for greater expansion and greater accessibility of HIV testing, counselling and prevention facilities in community locales where drug injection and prostitution is prevalent.

Adolescent↗
PubMed1994

Sexual behaviour of drug injectors in London: implications for HIV transmission and HIV prevention.

The importance of sharing injecting equipment in the transmission dynamics of HIV is well established. Comparatively less is known about the sexual behaviour of drug injectors and the risks posed to themselves and their sexual partners through the sexual transmission of HIV. Findings are reported from survey-based interviews undertaken in 1991 which investigated the sexual behaviour of 516 drug injectors, both in and out of treatment in London. The majority of respondents (80%) were sexually active in the 6 months preceding interview. During this time, respondents had a mean of 2.1 non-commercial opposite sex partners. Most (66%) had vaginal intercourse at least once a week, although 68% never used condoms with primary partners and 34% never used condoms with casual partners. Those having sexual intercourse most often were less likely to use condoms. Many had non-injecting sexual partners, and 62% of respondents' primary and casual partners did not inject drugs. Confirmed saliva HIV test results show 10% of respondents to be antibody positive, with a higher rate of prevalence (14% positive) among those with no experience of treatment. This group were also more likely to report casual sexual intercourse. The average rate of partner change, the high proportion of drug injectors with non-injecting partners and the infrequency of condom use within primary and causal relationships indicates the potential for HIV transmission between injectors and their non-injecting sexual partners. The paper concludes by emphasizing the importance of outreach and community-based intervention in safer sex health promotion.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Prevalence and demographic factors of stimulant use.

The use of stimulants for recreation purposes has increased considerably during the 20th century. Cocaine was first considered to be a drug of potential abuse during the First World War but was only perceived as a serious threat when it became widely used in socially and economically deprived urban areas of the USA in the 1980s. Use of amphetamines was common among certain occupational groups as a means of remaining alert until the 1950s, when they were seen to be abused by a small minority of recreational users. Controls were then introduced in most developed countries. The public health issue of stimulant use is that of finding a balance between the prevention of serious social or personal harm caused by abuse of these drugs while not impeding their beneficial use.

Adolescent↗
PubMed1994

Potential development of community oriented HIV outreach among drug injectors in the UK.

Given the current epidemiological and behavioural risk profile of HIV infection among injecting drug users in the UK, the main strategic task continues to be to develop interventions to prevent the spread of HIV infection. Outreach to drug injectors is an important part of the wider UK HIV prevention strategy. This paper reviews critically and reassesses practically the role of outreach interventions among drug injectors in the UK. It is argued that despite the development of innovative outreach activity, the full potential of outreach has not been realized due to its theoretical orientation and in-built structural limitations. Outreach has predominantly operated with an 'individual' orientation, aiming to work with individual clients to help them to change their behaviour, gain access to services, or to become better users of services. The main thesis of this paper is that current outreach provision needs to be complemented by 'community change' models which seek to engender changes in the social etiquette of drug use within communities of drug injectors. The paper argues that the social networks through which HIV may be transmitted are the same social networks that may be coopted for HIV prevention. Future outreach services must turn to these networks as a way of targeting and encouraging changes among broad populations of drug injectors. Such models might use indigenous advocates, working within social networks, supported by community outreach facilitators.

Community Health Services↗
PubMed1993

HIV testing, and the care and treatment of HIV positive people in English prisons.

In a study of 452 ex-prisoners in England in 1990, 66 people reported that they were tested for HIV antibodies when last in prison. The circumstances under which many of those who were tested were difficult: 36% found it an unpleasant experience, 17% had not taken the test voluntarily and 55% said they received no counselling. Further information was gathered about the experiences of those who were HIV positive or assumed to be. Most were accommodated in a 'special location', not allowed to associate with other prisoners and denied access to work or recreational facilities. These data highlight the difficulties arising from the policy of Viral Infectivity Restrictions, a set of regulations applied to the management of prisoners with HIV in English prisons. This policy created a distressing situation for those tested for HIV or identified as being HIV positive in prison. For the prison environment, these conditions may create a vicious circle reinforcing inaccurate beliefs and anxieties.

AIDS Serodiagnosis↗
PubMed1993

Reductions in HIV risk behaviour and stable HIV prevalence in syringe-exchange clients and other injectors in England.

Syringe-exchange attenders (n = 86) and a comparison group of injectors not attending exchanges (n = 121) were recruited and interviewed in 1989 to examine HIV risk behaviour and HIV antibody status. In 1990, 59% of attenders and 50% of non-attenders were re-contacted and re-interviewed to examine changes over time. Re-interviewed subjects did not differ demographically or in drug use from those not re-interviewed. At first interview, all were injecting, and 35% of attenders and 42% of non-attenders reported recent syringe-sharing. One year later, levels of HIV-risk were similar for both groups, but risk reduction had been achieved by different routes. At Time 2, 16% of attenders were injecting and sharing (IS), 70% injecting and not sharing (INS), and 14% not injecting (NI), compared to non-attenders, 22% IS, 47% INS and 31% NI. Attenders were more likely to continue injecting (86%) with low sharing (18% of those still injecting). Non-attenders were less likely to continue injecting (69%), but continuing injectors had higher sharing rates (32% of those still injecting). More non-attenders than attenders stopped injecting, but non-attenders who continued to inject were at a higher risk of HIV infection than attenders who continued to inject. Baseline HIV prevalence was 2.5% and there were no sero conversions. The levels of sharing for both groups were lower than levels in the UK before HIV prevention programmes commenced and are lower than 1990 sharing rates in the USA. The study indicates the importance of tracking individual change over time, and of measuring outcomes additional to changes in sharing.

Journal Article↗
PubMed1993

HIV testing and unreported HIV positivity among injecting drug users in London.

OBJECTIVE: To assess the importance of community-recruited drug injectors with no treatment experience and no previous testing history when estimating HIV prevalence among drug injectors. DESIGN: HIV testing behaviour and prevalence were measured in a serial point prevalence study of drug injectors recruited in community-based non-treatment and treatment settings. METHODS: Pearson's chi 2 and Fisher's exact tests were used to measure differences between treatment groups and non-treatment groups in demographic characteristics, including age and length of injecting career, recent drug use, recent syringe sharing, uptake of previous HIV testing, confirmed HIV-antibody status by saliva and self-reported HIV status. RESULTS: Rates of HIV-antibody testing were significantly lower in community-recruited drug injectors with no experience of treatment than those previously or currently in treatment. Confirmed HIV prevalence by saliva was highest in drug injectors with no experience of treatment. HIV-antibody-positive drug injectors with no treatment experience were less likely to be aware of their antibody status than injectors who were, or who had been, in treatment. CONCLUSIONS: Previous studies of HIV prevalence among drug injectors may be biased by drawing on samples primarily from treatment settings. Drug injectors with no treatment experience and no previous history of HIV testing should be included in HIV prevalence studies. Regular and repeat HIV testing in low-threshold community-based programmes should be considered a necessary part of interventions which seek to provide better access to treatment and other HIV prevention services.

Adult↗
PubMed1993

Evaluation of syringe-exchange for HIV prevention among injecting drug users in rural and urban areas of Wales.

This paper considers the prevention of HIV in rural and urban areas among both opiate and non-opiate drug injectors. A 2-year study evaluated specialist and community based syringe-exchange provision in Wales. Numbers of clients and patterns of attendance at eight syringe-exchange schemes were monitored together with comparative cross-sectional studies of attenders (n = 152) and non-attenders (n = 176) from the population of drug injectors in 1990 and 1991. A total of 1171 clients made 7553 visits in the 2-year period, 110,000 syringes were issued and 80% of needles and syringes were returned. There were few demographic differences between attenders and non-attenders, but large and significant differences in HIV risk behaviour; only 9% of attenders had recently shared syringes in 1990 (10% in 1991) compared to 41% of non-attenders (39% in 1991). The catchment areas of specialised services were limited (5 miles or less) and insufficient in rural areas. Alternative community approaches to syringe distribution and exchange are examined.

Cross-Sectional Studies↗
PubMed1993

Continued risk behaviour among HIV positive drug injectors in London: implications for intervention.

Findings are reported on the risk behaviour of 104 confirmed HIV-1 antibody positive drug injectors in London. Findings indicate that 41.3% of respondents had never received treatment or help for their drug use, and that 52.0% had never received a named test for HIV antibodies. The majority of confirmed HIV positive respondents (70.1%) were unaware of their HIV positive status. Respondents unaware of their HIV positive status were less likely to use condoms with primary sexual partners than respondents aware of their HIV status, and were marginally (though not significantly) more likely to report borrowing and lending used injecting equipment. Overall levels of risk-taking were similar to those reported in UK studies of injecting drug use as a whole. The paper concludes by emphasising the high potential for HIV transmission among the equipment sharing and sexual partners of HIV positive drug injectors and by stressing the importance of low-threshold HIV testing, education and treatment interventions in the community. If significant proportions of HIV positive drug injectors remain unaware of their antibody status, and if they also continue to engage in behaviours of risk to others, the spread of HIV among drug injectors and their partners may escape current efforts of prevention and prevalence control.

Adult↗
PubMed1993

The global diffusion of injecting drug use: implications for human immunodeficiency virus infection.

Long-standing patterns of drug injecting in mainly developed countries have been joined by the introduction and expansion of drug injecting in developing countries, often followed quickly by outbreaks of human immunodeficiency virus (HIV) infection. Drug injecting has been identified in 80 countries and HIV infection in 52 of these. Given the continued recruitment of new injectors where injecting is endemic, the diffusion of drug injecting in countries where the practice was formerly rare and the potential for this diffusion to occur, HIV prevention must also consider interventions that discourage drug injecting. Particularly at risk are countries in drug-producing regions and along drug transit routes in Africa, south-east and south-west Asia and South America. Injecting can spread in less time than it takes to introduce HIV prevention activities. The task of the public health system will be to find a balance between activities targeted at helping current injectors change their behaviour and activities targeted at discouraging the adoption of drug injecting.

Developing Countries↗
PubMed1992

Assessing AIDS prevention for injecting drug users; some methodological considerations.

There is an urgent need to develop strategies aimed at reducing the spread of HIV infection amongst injecting drug users. It is essential that any such initiatives are monitored and evaluated. It is the contention of this paper that evaluation should be rigorous, flexible and comparative. To achieve this we need to examine the basic principles of evaluation, both in terms of service delivery and process evaluation, as well as outcome measures. In the evaluation task it is important to distinguish clearly and unequivocally between implementation and impact, aims and objectives. At the practical level, researchers need to give due consideration to liaison with agency staff. Methodologically, issues such as demonstrating impact and rival explanations must be addressed. The paper concludes by proposing and illustrating a model for evaluation that has particular relevance to community-base initiatives aimed at reducing the spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Life-style factors and social circumstances of syringe sharing in injecting drug users.

Measures taken to reduce HIV risk by injecting drug users have been reported in many countries, but a minority of injectors continue to engage in risky practices. In an ongoing cohort study, 207 drug injectors were interviewed and anonymously tested for HIV antibodies in saliva in 1989. Injectors reporting recent syringe sharing were compared with those not recently sharing; injecting events where sharing did and did not take place were examined. Those recently sharing syringes differed significantly from the non-sharers on several factors, including: use of heroin, dihydrocodeine and temazepam; injection of heroin, temazepam and prescribed methadone; accommodation and contact with other injectors; means of financial support and recent involvement in crime; secondary sources of injecting equipment and unsafe disposal; employment of HIV protective strategies; treatment contact with general practitioners; number of sexual partners and injecting status of sexual partners. The two groups were not significantly different in terms of attendance at syringe-exchange schemes and self-reported HIV antibody status. Syringe sharing would appear to be related to social circumstances and life-style factors rather than just individual choices and motivation.

Adult↗
PubMed1991

HIV, drugs, and public health in England: new worlds, old tunes.

Since 1986 there has been a major reconceptualization of drugs policy in England in response to HIV and AIDS with new ideas about risk behavior and risk reduction, and health behavior and harm minimization. The debate appears to have a new public health emphasis, but historical examination shows public health concerns have emerged in earlier periods. We examine three models of public health and their influence on drugs policy. The current drugs debate is informed by late twentieth century concern for the individual body and life-style choices. While drug policy has been given new purpose by these developments, this model of public health is essentially individualistic in focus and limited in practice.

England↗
PubMed1990

The fourth Okey memorial lecture. AIDS and HIV: the challenge for British drug services.

British drug policies are undergoing a major reassessment and reformulation in response to problems raised by HIV disease and AIDS. The years from 1986 to 1989 are one of the key periods of crisis and transformation in the history of the British response to drug problems, with the emergence in current debate of a new public health paradigm of drug use. Drug policies can be analysed by examining their assumptions about the nature of (a) the problem (b) the drug user and (c) the task facing policy makers and practitioners; and their assumption about (d) the appropriate people to deal with the problem and (e) their relationships with clients. The emergent public health paradigm assumes that (a) the main problem with drug use is the injection of drugs (b) drug injectors are concerned about their health (c) the task is to promote change in health and risk behaviours (d) people dealing with the problem must be broadly skilled 'poly-drug workers' and (e) relationships with clients must be non-judgmental and 'user-friendly'.

Acquired Immunodeficiency Syndrome↗