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Biomedical subjects

Gerry V Stimson

Publications and source records attributed to Gerry V Stimson.

11 recordsLinked to original sources
PubMed2007

HIV in prison in low-income and middle-income countries.

High prevalence of HIV infection and the over-representation of injecting drug users (IDUs) in prisons combined with HIV risk behaviour create a crucial public-health issue for correctional institutions and, at a broader level, the communities in which they are situated. However, data relevant to this problem are limited and difficult to access. We reviewed imprisonment, HIV prevalence, and the proportion of prisoners who are IDUs in 152 low-income and middle-income countries. Information on imprisonment was obtained for 142 countries. Imprisonment rates ranged from 23 per 100,000 population in Burkina Faso to 532 per 100,000 in Belarus and Russia. Information on HIV prevalence in prisons was found for 75 countries. Prevalence was greater than 10% in prisons in 20 countries. Eight countries reported prevalence of IDUs in prison of greater than 10%. HIV prevalence among IDU prisoners was reported in eight countries and was greater than 10% in seven of those. Evidence of HIV transmission in prison was found for seven low-income and middle-income countries. HIV is a serious problem for many countries, especially where injection drug use occurs. Because of the paucity of data available, the contribution of HIV within prison settings is difficult to determine in many low-income and middle-income countries. Systematic collection of data to inform HIV prevention strategies in prison is urgently needed. The introduction and evaluation of HIV prevention strategies in prisons are warranted.

Africa↗
PubMed2006

Using standardized methods for research on HIV and injecting drug use in developing/transitional countries: case study from the WHO Drug Injection Study Phase II.

BACKGROUND: Successful cross-national research requires methods that are both standardized across sites and adaptable to local conditions. We report on the development and implementation of the methodology underlying the survey component of the WHO Drug Injection Study Phase II--a multi-site study of risk behavior and HIV seroprevalence among Injecting Drug Users (IDUs). METHODS: Standardized operational guidelines were developed by the Survey Coordinating Center in collaboration with the WHO Project Officer and participating site Investigators. Throughout the duration of the study, survey implementation at the local level was monitored by the Coordinating Center. Surveys were conducted in 12 different cities. Prior rapid assessment conducted in 10 cities provided insight into local context and guided survey implementation. Where possible, subjects were recruited both from drug abuse treatment centers and via street outreach. While emphasis was on IDUs, non-injectors were also recruited in cities with substantial non-injecting use of injectable drugs. A structured interview and HIV counseling/testing were administered. RESULTS: Over 5,000 subjects were recruited. Subjects were recruited from both drug treatment and street outreach in 10 cities. Non-injectors were recruited in nine cities. Prior rapid assessment identified suitable recruitment areas, reduced drug users' distrust of survey staff, and revealed site-specific risk behaviors. Centralized survey coordination facilitated local questionnaire modification within a core structure, standardized data collection protocols, uniform database structure, and cross-site analyses. Major site-specific problems included: questionnaire translation difficulties; locating affordable HIV-testing facilities; recruitment from drug treatment due to limited/selective treatment infrastructure; access to specific sub-groups of drug users in the community, particularly females or higher income groups; security problems for users and interviewers, hostility from local drug dealers; and interference by local service providers. CONCLUSION: Rapid assessment proved invaluable in paving the way for the survey. Central coordination of data collection is crucial. While fully standardized methods may be a research ideal, local circumstances may require substantial adaptation of the methods to achieve meaningful local representation. Allowance for understanding of local context may increase rather than decrease the generalizability of the data.

Adult↗
PubMed2006

Antiretroviral treatment for injecting drug users in developing and transitional countries 1 year before the end of the "Treating 3 million by 2005. Making it happen. The WHO strategy" ("3 by 5").

OBJECTIVE: To describe and estimate the availability of antiretroviral treatment (ART) to injecting drug users (IDUs) in developing and transitional countries. METHODS: Literature review of grey and published literature and key informants' communications on the estimated number of current/former injecting drug users (IDUs) receiving ART and the proportion of human immunodeficiency virus (HIV) attributed to injecting drug use (IDU), the number of people in ART and in need of ART, the number of people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) and the main source of ART. RESULTS: Data on former/current IDUs on ART were available from 50 countries (in 19 countries: nil IDUs in treatment) suggesting that approximately 34 000 IDUs were receiving ART by the end of 2004, of whom 30 000 were in Brazil. In these 50 countries IDUs represent approximately 15% of the people in ART. In Eastern European and Central Asia IDU are associated with > 80% of HIV cases but only approximately 2000 (14%) of the people in ART. In South and South-East Asia there were approximately 1700 former/current IDUs receiving ART ( approximately 1.8% of the people in ART), whereas the proportion of HIV cases associated to IDU is > 20% in five countries (and regionally ranges from 4% to 75%). DISCUSSION: There is evidence that the coverage of ART among current/former IDUs is proportionally substantially less than other exposure categories. Ongoing monitoring of ART by exposure and population subgroups is critical to ensuring that scale-up is equitable, and that the distribution of ART is, at the very least, transparent.

Antiretroviral Therapy, Highly Active↗
PubMed2005

Rapid assessment and response studies of injection drug use: knowledge gain, capacity building, and intervention development in a multisite study.

OBJECTIVES: We evaluated the World Health Organization's rapid assessment and response (RAR) method of assessing injection drug use and its associated health problems, focusing on knowledge gain, capacity building, and whether RAR leads to the development of interventions reducing the health effects of injection drug use. METHODS: Data were derived from RAR studies conducted in Beijing, China; Bogotá, Colombia; Greater Rosario, Argentina; Hanoi, Vietnam; Kharkiv, Ukraine; Minsk, Belarus; Nairobi, Kenya; Penang, Malaysia; St. Petersburg, Russia; and Tehran, Iran. RESULTS: Substantial gains in knowledge and response capacity were reported at all of the study sites. Before RAR initiation, prevention and intervention programs had been absent or inadequate at most of the sites. The RARs resulted in many new or modified interventions; 7 sites reported 24 health-related interventions that were subsequently developed and influenced by the RARs. CONCLUSIONS: RARs, which require relatively little external funding, appear to be effective in linking assessment to development of appropriate interventions. The present results add to the evidence that rapid assessment is an important public health tool.

Health Knowledge, Attitudes, Practice↗
PubMed2005

HIV prevalence among injecting drug users in England and Wales 1990 to 2003: evidence for increased transmission in recent years.

OBJECTIVE: To describe trends in HIV prevalence among injecting drug users in England and Wales between 1990 and 2003. METHODS: Analysis of surveillance data from voluntary unlinked anonymous cross-sectional surveys collecting oral fluid samples and behavioural information from injecting drug users recruited from both drug agency (n = 24,304) and community settings (n = 3628). RESULTS: HIV prevalence in England and Wales declined from 5.9% in 1990 to 0.6% in 1996 and then remained stable until 1999, after which it increased to 1.4% in 2003. Few HIV infections were detected among short-term injectors between 1994 and 1999, but in recent years prevalence among this group has increased. Other factors associated with higher odds of HIV infection were being recruited in London and from community settings, and ever having had a voluntary confidential HIV test. Incidence estimated through a force of infection model was 2.8% per annum among those injecting for less than a year in London between 1998 and 2003. CONCLUSIONS: These data suggest that incidence and prevalence of HIV may have increased, whereas other indicators suggest an increase in risk behaviour. It is critical that harm reduction measures are reinvigorated, and evolve in response to changes in drug use risk behaviours and policy.

Adolescent↗
PubMed2005

Attitudes toward transplantation in U.K. Muslim Indo-Asians in west London.

The worldwide shortage of organs for transplantation makes it important to understand why some oppose donation. Attitudes vary with religion and ethnicity. Accordingly, we undertook a qualitative study of the attitudes of 141 U.K. Muslim Indo-Asians to organ donation. Participants were observed, focus group discussions held and in-depth individual interviews conducted. We identified a high level of alienation from the health care system in general. With respect to organ donation in particular, its importance was generally discounted, often in deference to authority figures within the community who appeared negatively disposed. The culture-specific issues arguing against donation included a sense of the sacredness of the body, a fatalistic approach to illness, a belief that organs took on an independent role as 'witnesses' to an individual's life on Judgement Day and an anxiety that the donor would have no control of the probity of the recipient of an organ. We believe these data suggest a need to improve in a culturally sensitive fashion the provision of health information provided to this community.

Asian People↗
PubMed2004

Global overview of injecting drug use and HIV infection among injecting drug users.

OBJECTIVE: To provide global estimates of the prevalence of injecting drug use (IDU) and HIV prevalence among IDU, in particular to provide estimates for developing and transitional countries. METHODS: Collation and review of existing estimates of IDU prevalence and HIV prevalence from published and unpublished documents for the period 1998-2003. The strength of evidence for the information was assessed based on the source and type of study. RESULTS: Estimates of IDU prevalence were available for 130 countries. The number of IDU worldwide was estimated as approximately 13.2 million. Over ten million (78%) live in developing and transitional countries (Eastern Europe and Central Asia, 3.1 million; South and South-east Asia, 3.3 million; East-Asia and Pacific, 2.3 million). Estimates of HIV prevalence were available for 78 countries. HIV prevalence among IDU of over 20% was reported for at least one site in 25 countries and territories: Belarus, Estonia, Kazakhstan, Russia, Ukraine, Italy, Netherlands, Portugal, Serbia and Montenegro, Spain, Libya, India, Indonesia, Malaysia, Myanmar, Nepal, Thailand, Viet Nam, China, Argentina, Brazil, Uruguay, Puerto Rico, USA and Canada. CONCLUSIONS: These findings update previous assessments of the number of countries with IDU and HIV-infected IDU, and the previous quantitative global estimates of the prevalence of IDU. However, gaps remain in the information and the strength of the evidence often was weak.

Adolescent↗
PubMed2004

Rapid assessment: an international review of diffusion, practice and outcomes in the substance use field.

'Rapid assessment' (RA) methods have the potential to generate important public health information. This potential is now the subject of debate within the substance use field. Despite this, much remains unknown about the application and outcomes of RAs on substance use, a situation compounded by the absence of published studies. Consequently, we undertook a retrospective review of the use of RA in the substance use field drawing on three methods: literature review (n=300 published and unpublished documents); survey of RA practitioners/commissioners (n=1200 contacts); in-depth expert consultation (n=10 interviews). Study findings indicated: (i) earliest identified RAs were conducted in 1993, with 83 identified studies conducted by 2001; (ii) RAs have been conducted in 70 countries, with seven out of 10 assessments undertaken between 1998 and 2001; (iii) RAs were reported as taking 9-486 days (69 weeks) to complete; and (iv) important outcomes can follow RA on substance use--one in two studies were followed by medical or non-medical interventions, workshops, training, policy change, community participation, network building, or other outcomes (45/83; 54%), whilst more than one in four RAs were followed by medical and non-medical interventions, or policy impact and change (25/83; 30%). In conclusion, we argue that to fully realise the potential of RA in the substance use field, investment has to be made in RA's evidence and knowledge base: in short, a culture of learning, reflection and discussion has to be introduced into a methodology currently premised on rapidity and pragmatism.

Diffusion of Innovation↗
PubMed2002

Over a decade of syringe exchange: results from 1997 UK survey.

AIMS: To describe syringe exchange provision in the United Kingdom. DESIGN: Two-phase cross-sectional survey: phase I, establishing a sampling frame of syringe exchange coordinators (n=420); phase II, surveying the coordinators seeking data on the number of syringe exchange outlets, visits and syringes distributed during April 1997 (68% response rate). SETTING: United Kingdom. FINDINGS: In 1997, nearly all Health Authorities in the United Kingdom (96%) operated some form of syringe exchange service, except Northern Ireland. In April 1997, 1 707 000 syringes were reported as being distributed. Assuming that non-responders coordinated the median number of outlets and distributed the median number of syringes as responders, we estimate that 27 million syringes were distributed annually from over 2000 outlets in the United Kingdom. The number distributed in Scotland was 3-4 times less than in England when measured as a number per adult (15-44), drug user in treatment, or estimated injecting drug user. CONCLUSIONS: Overall, there has been a 6.5-fold increase in syringe distribution in England since 1991. The number of syringes distributed in the United Kingdom may be higher than the United States. However, there appears to be unequal distribution of syringes within the United Kingdom, which may be associated with higher levels of HCV among injectors in Scotland compared to England.

Adolescent↗
PubMed2002

Survey of doctors prescribing diamorphine (heroin) to opiate-dependent drug users in the United Kingdom.

AIM: To determine the scale and practice of diamorphine (heroin) prescribing for opiate dependence in the United Kingdom in 2000. DESIGN: Postal survey. SETTING: England, Scotland and Wales. PARTICIPANTS: One hundred and eleven of the 164 doctors in the United Kingdom on the Home Office record as holding a licence to prescribe diamorphine (response rate 68%), and 59 of the 108 doctors in the United Kingdom eligible to hold a licence (working in drug clinics), but not doing so (response rate 54%). MEASUREMENTS: The characteristics of doctors (a) holding a licence and (b) currently prescribing; the number of opiate users receiving a prescription; current treatment delivery, clinical criteria for patient eligibility; and reasons for prescribing or not prescribing diamorphine. FINDINGS: Seventy of the 111 doctors actually held a licence. While the majority were consultant psychiatrists, five were general practitioners. Forty-six were currently prescribing to 448 patients. The majority of prescribers reported that they had not initiated a prescription for diamorphine but had inherited patients already receiving such a prescription. Most of those who prescribed considered that in selected cases it could produce clinical and social improvement. There were great variations in clinical criteria for patient eligibility, prescribing practice, daily dose prescribed (range 5-1500 mg) and the daily dose-equivalent of 100 mg methadone (range 50-900 mg). Many respondents cited lack of appropriate resources as a reason for not prescribing to more patients. Reasons for non-prescribing varied from lack of resources to little evidence of its effectiveness. CONCLUSIONS: The prescribing of diamorphine to opiate dependent drug users remains rare in the United Kingdom. Not all eligible doctors seek a licence to prescribe, and not all those with licences actually prescribe it. There is no clear consensus on who should be treated with diamorphine and in what way.

Health Surveys↗