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Biomedical subjects

N Crofts

Publications and source records attributed to N Crofts.

At least 19 recordsLinked to original sources

Harm reduction - a historical view from the left.

The harm reduction movement formed during a period in which social movements of the working class and the excluded were weak, neo-liberalism ideologically triumphant, and potential opposition movements were viewed as offering "tinkering" with the system rather than a total social alternative. This climate shaped and limited the perspectives, strategies, and tactics of harm reductionists almost everywhere. In many countries, this period was also marked by a "political economy of scapegoating" that often targeted drug users as the cause of social woes. This scapegoating took the form of "divide and rule" political initiatives by business and political leaderships to prevent social unrest in a long period of worldwide economic trends toward lowered profit rates and toward increasing income inequality. However, times have changed. Mass strikes and other labor struggles, opposition to the World Trade Organisation and other agencies of neo-liberalism, community-based protests against belt-tightening, and other forms of social unrest have been increasing in many countries. This opens up the possibility of new allies for the harm reduction movement, but also poses difficult problems for which we need to develop answers. On-the-ground experience in alliance formation needs to be combined with careful discussion of and research about what approaches work to convince other movements to work for and with harm reduction, and which approaches do not. Class differences within the harm reduction movement are likely to become more salient in terms of (a) creating internal tensions, (b) increasingly, opening up new ways in which working class harm reductionists can organize within their own communities and workplaces, and (c) producing different strategic orientations that will need to be discussed and debated. As a movement, we will need to find ways to accommodate and discuss differing perspectives, needs, and assessments of opportunities and threats without paralyzing harm reduction activities.

Journal Article↗

Drug treatment services for ethnic communities in Victoria, Australia: an examination of cultural and institutional barriers.

Under-representation of ethnic minorities at drug treatment services represents under-utilisation rather than a lower need. To explore barriers to drug treatment among ethnic communities we undertook a comprehensive review of international and Australian literature to identify problems their members experience upon the discovery of illicit drug use in their community, how drug treatment is addressed and challenges for improved drug treatment outcomes. The concepts and themes derived from the literature were then compared with our research findings from key informant interviews and consultations with non-illicit drug-using spokespersons from eight ethnic communities in Victoria, Australia. Intense shame and loss of face linked to illicit drug use was common in ethnic communities and as a consequence seeking help for drug treatment was fraught with difficulties. Accessing drug treatment services often occurred following a crisis, but a sense of despair and confusion often prevailed owing to a lack of knowledge of available assistance. Even when treatment services were accessed most key informants and ethnic communities viewed them as culturally insensitive, inflexible and with language barriers that obstructed the flow of effective information. Understanding of the ethnic family ethos was of pivotal importance but frequently ignored by treatment services, contributing to the exclusion of ethnic communities from appropriate assistance. Ethnic communities need to be assisted to participate in drug issue discussions and community development strategies in order for their utilisation of drug treatment services to be improved.

Communication Barriers↗

Risk behaviours of young Indo-Chinese injecting drug users in Sydney and Melbourne.

OBJECTIVE: To investigate patterns of drug use and injection-related risk behaviours among young Indo-Chinese injecting drug users (IDUs). METHOD: Cross-sectional survey. A structured questionnaire was administered to 184 Indo-Chinese IDUs aged 15 to 24 in Sydney and Melbourne. Participants were recruited using snowball sampling techniques; measures included patterns of heroin and other drug use, injection-related risk behaviours, perceived susceptibility to HIV and HCV infection and access to services. RESULTS: Despite perceived high availability of sterile injecting equipment, 36% had ever shared a needle and syringe and 22% had done so in the preceding month. Lifetime sharing was significantly associated with duration of injecting, history of incarceration and residence in Sydney. Sharing of injecting paraphernalia other than needles and syringes was also common, with young women and Sydney residents significantly more likely to report sharing equipment in the preceding month. CONCLUSIONS: Young Indo-Chinese IDUs are at high risk of infection with hepatitis C and other blood-borne viruses. Results indicate an urgent need for culturally appropriate and sustainable risk reduction programs which specifically target this population. IMPLICATIONS: Health services must respond swiftly to implement effective blood-borne virus prevention programs for young Indo-Chinese IDUs. Failure to do so may sustain the current epidemic of hepatitis C among IDUs.

Adolescent↗

Going where the epidemic is. Epidemiology and control of hepatitis C among injecting drug users.

BACKGROUND: The hepatitis C virus (HCV) is continuing to spread among injecting drug users (IDUs) in Australia; other forms of transmission are uncommon or rare. Control of the epidemic of this potentially serious viral infection will only be achieved when transmission among IDUs is addressed. OBJECTIVE: To briefly review current knowledge about transmission and impact of HCV, so as to provide an informed basis for patient counselling. DISCUSSION: As better understanding develops about the transmission of HCV and the diseases it causes, and as treatments for chronic HCV infection and knowledge of how to target these treatments improve, our ability to tackle this epidemic, both at personal and public health levels, increases. However, the mainstay of treatment will continue to be fully informed counselling, and we urgently need expansion of current harm reduction programs to stop continued transmission among IDUs.

Adolescent↗

Rapid assessment of drug use and HIV vulnerability in south-east and east Asia.

In an 8-week period in late 1997, an assessment of the situation of drug use and HIV vulnerability in east and south-east Asia was carried out for the United Nations Joint Programme on AIDS (UNAIDS). It served to assist UNAIDS' Asia-Pacific team in setting priorities for action at a regional level, it having been realised that epidemics of HIV among injecting drug users (IDUs) were playing an important role in the development of the AIDS epidemic in Asia at both country and regional levels. Though essentially a desk exercise, contact with the extensive membership of the Asian Harm Reduction Network allowed a deeper and more efficient investigation than would otherwise have been possible, with access to key informants and 'grey' literature. The assessment found a situation of massive epidemics of HIV among IDUs either occurring, or about to occur, in most Asian countries; and parlous or non-existent public health responses to these problems in a context void of policy. As well as providing evidence to guide UNAIDS, and useful for advocacy by a wide range of people, the process of the situation assessment also generated interest and in some cases activity on the part of many individuals and institutions throughout the region. It is hoped that this will be the beginning of an ongoing monitoring of the situation.

Journal Article↗

Assessment of long-term outcomes of community-acquired hepatitis C infection in a cohort with sera stored from 1971 to 1975.

The aim of this study was to examine the long-term effects of hepatitis C virus (HCV) infection on a cohort of patients admitted with acute viral hepatitis from 1971 through 1975. The availability of stored sera from this time enabled testing to identify those who were anti-HCV-positive on admission. Sixteen percent (n = 238) of the cohort tested anti-HCV-positive. The unexposed group was selected from those who were anti-HCV-negative. Systematic approaches were used to locate the cohort and health outcomes assessed by a study-specific questionnaire and clinical, serological, virological, and biochemical assessment. Complete follow-up was achieved on 98 anti-HCV-positive individuals and 201 negatives. Injecting drug use (IDU) was the presumed route of infection. At a mean of 25 years' follow-up, 54% of the anti-HCV-positive group had evidence of chronic HCV infection (both anti-HCV- and HCV-RNA-positive); the remainder were HCV-RNA-negative. Sixty-nine percent of those chronically infected had elevated serum alanine transaminase (ALT) levels, but only 8% had progressed to overt cirrhosis, and no cases of hepatocellular carcinoma (HCC) were identified. In summary, anti-HCV-positive subjects were 8 times more likely to have died from suicide or drug overdose than from HCV-related disease. Anti-HCV-positive study subjects were at increased risk of liver-related pathology after 25 years' follow-up, but few had progressed to overt cirrhotic liver disease. Excess mortality in this group was not the result of liver disease. This suggests that the natural history of community-acquired HCV may be more benign than previously thought.

Adult↗

A certain fate: spread of HIV among young injecting drug users in Manipur, north-east India.

This study aimed to measure risk behaviours and seroprevalence of HIV and hepatitis C virus in IDUs in Manipur, North-East India, and evaluate the impact of the recently established Syringe and Needle Exchange Program (SNEP). Sampling strategy was based on social networks. Peer interviewers administered the study questionnaire and collected blood for anti-HCV and anti-HIV testing. One hundred and ninety-one IDUs (85% male) took part. Average age at first injection was 19 years and average length of time injecting was 3.7 years. The main drug currently injected was heroin (66%). Most (93%) reported having shared injecting equipment and only 42% had used the SNEP. Three-quarters (74.7%) were infected with HIV and almost all (98%) with HCV. Age (p < 0.001) and length of time injecting (p < 0.001) were significantly associated with being HIV-positive. Over two-thirds were sexually active, but only 3% consistently used condoms. Almost three-quarters of IDUs in this study were infected with HIV, most within the first two years of injecting, indicating infection continues to spread at very high rates. Unsafe sexual practices place partners of infected IDUs at risk of infection. The SNEP must increase its coverage to young and new IDUs before they are exposed to blood-borne viruses.

Adolescent↗

Hitting up in the top end: characteristics of needle exchange clients in Darwin.

OBJECTIVE: Little is known about injecting drug use (IDU) and blood-borne viral (BBV) infection in rural Australia. METHOD: These repeat cross-sectional studies were conducted during a two-week period in July and October-November 1998 at the Darwin needle exchange, with 129 and 121 respondents respectively. RESULTS: The commonest drug of choice was heroin, but the commonest drug injected was morphine. Self-reported sharing of needles and syringes was uncommon. Self-reported serostatus for HIV was high (8% and 11.4% respectively), but seemingly mostly associated with sexual rather than IDU risk; for hepatitis C (HCV) status, these were 54% and 37%. Among IDUs of Aboriginal or Torres Strait Islander (ATSI) background, who made up 14% of the first round respondents, patterns of IDU and of BBV infection were the same as among non-ATSI respondents. CONCLUSIONS: These surveys reveal patterns of IDU in Darwin that have both similarities and differences with those in the major urban centres in Australia. In the absence of a comprehensive methadone maintenance program, many participate in a more or less informal morphine substitution program. HIV is present among these IDUs, and the risks of further sexual transmission may be high. IMPLICATIONS: These surveys confirm the presence among injecting drug users in Darwin of HIV, HBV and HCV, and of the risk for further spread of these viruses. Control of blood-borne virus transmission among IDUs requires an even greater commitment to abolishing sharing of needles and syringes, and therefore continued support and enhancement of needle and syringe availability.

Adult↗

Late presentation of HIV infection associated with prolonged survival following AIDS diagnosis--characteristics of individuals.

Individuals who present late with human immunodeficiency virus (HIV) infection do not benefit from advances in drug therapies that delay their progression to acquired immunodeficiency syndrome (AIDS). This paper describes these individuals and their subsequent survival and investigates predictors of late presentation. All AIDS diagnoses from 1992-1998 notified to the Victorian State AIDS Registry were included. Subjects were grouped as individuals diagnosed with AIDS within 8 weeks of a first positive HIV test (late presenters), or individuals for whom there was more than 8 weeks between AIDS diagnosis and first positive HIV test (non-late presenters). Of 1021 AIDS diagnoses notified, 24% were late presenters. Late presentation was associated with increasing age, being bisexual or heterosexual, being born in Asia, southern Europe or South America and being diagnosed at a hospital. Late presenters survived longer following AIDS diagnosis (P < 0.0001). This increased survival may indicate a positive response by drug naïve patients to antiretroviral therapies following AIDS diagnosis.

AIDS Serodiagnosis↗

The impact of diagnosis of hepatitis C virus on quality of life.

The aim of this study was to examine the effects of diagnosis of hepatitis C virus (HCV) infection on quality of life in a cohort admitted to Fairfield Infectious Diseases Hospital with acute hepatitis from 1971 to 1975. Sera stored from the original admission were tested for antibody to HCV. Systematic approaches were used to locate anti-HCV-positive individuals and outcomes assessed by the Short Form 36 (SF-36) scale and a study-specific questionnaire as well as clinical review. Study subjects' SF-36 scores were compared with Australian population norms. Anti-HCV and HCV-RNA positive individuals (n = 15) aware of their serostatus rated significantly worse on 7 of 8 SF-36 scales compared with population norms. However, HCV-seropositive and RNA-positive individuals unaware of their HCV serostatus (n = 19) scored significantly worse in only 3 scales. Those aware of their serostatus did not differ sociodemographically, clinically, virologically, or serologically from those who were unaware, nor was there a link between quality of life (QOL) scores and objective measures of ill health. All subjects had injected drugs in the past. In conclusion, HCV-RNA and anti-HCV-positive individuals in our study have significantly poorer subjective health status 26 years after original infection compared with population norms. QOL measures were significantly worse for HCV-seropositive individuals aware of their serostatus compared with those unaware. We feel that the reduced QOL in the diagnosed group may be partially an effect of labeling and that the impact of the diagnostic process per se on QOL in individuals with HCV requires further evaluation.

Adult↗

Hepatitis infection among adolescents resident in Melbourne Juvenile Justice Centre: risk factors and challenges.

OBJECTIVE: To describe patterns of infection with, and risks for, hepatitis A, B and C viruses (HAV, HBV, and HCV) in male adolescents detained in the Melbourne Juvenile Justice Centre (MJJC). METHODS: A cross-sectional serosurvey for HAV, HBV, and HCV among 90 male adolescents aged 15-18 years who were resident in MJJC for more than 1 week in 1996. RESULTS: Nine percent had been exposed to HAV, 8% were positive or equivocal for exposure to HBV, and 21% were antibody positive for HCV. All those with hepatitis markers except one positive for HAV had been injection heroin users for more than 1 year. Of those who were not HBcAb positive, only 28% were immune to HBV. For most respondents, sexual and drug-using risks began in the early teens and were associated with leaving school prematurely. CONCLUSIONS: Respondents were vulnerable to exposure to blood-borne viruses from an early age, posing a challenge for health education programs. An opportunity exists for harm minimization and prevention of spread of blood-borne viruses within the first year of injection drug use in this population.

Adolescent↗

A computer model of the spread of hepatitis C virus among injecting drug users.

A number of behavioural and clinical parameters influence the transmission of an infectious agent through direct contact between two individuals. The behavioural parameters encountered in such situations are also likely to exhibit an enormous amount of variability. With the spread of hepatitis C among injecting drug users, the parameters associated with injecting behaviour play an important role in the modelling of the transmission process. Computer simulation modelling is an ideal approach to deal with a large number of parameters as well as high levels of variability without excessive simplification. The simulation model presented in this paper is tested on data from a cohort of injecting drug users and the results obtained are very encouraging from a public health perspective. The model clearly indicates that the rate at which HCV spreads through a population of injecting drug users is extremely sensitive to the interaction rate and to the probability of infection through a single contact with an infective. At the same time it shows that rate of spread is not very sensitive to initial prevalence, which is very encouraging from a public health perspective.

Computer Simulation↗

Assessment of long-term outcomes of hepatitis C virus infection in a cohort of patients with acute hepatitis in 1971-1975: results of a pilot study.

BACKGROUND: To examine the long-term effects of hepatitis C virus (HCV) infection in a cohort of patients admitted to Fairfield Hospital with hepatitis from 1971 to 1975. The availability of stored sera from this time enabled testing to identify those who were anti-HCV positive on admission. METHODS: Sixteen per cent (n = 230) of the cohort tested positive for HCV antibody (anti-HCV). The 'unexposed' group was selected from those who were anti-HCV negative. Systematic approaches were used to locate the cohort and health outcomes assessed by a study specific questionnaire and clinical review with repeat serology and liver function tests. RESULTS: Complete follow up has been achieved on a subset of 35 HCV-seropositive and 70 seronegative individuals. The seropositive group was significantly more likely to have given a history of injecting drug use, the presumed route of infection. The seropositive group was also more likely to have elevated serum alanine aminotransferase levels, but only two (6%) were known to have progressed to cirrhosis. DISCUSSION: The anti-HCV-positive individuals followed up to date are at increased risk of liver-related pathology, but few had progressed to cirrhotic liver disease. This differs from findings of transfusion-related studies and suggests, within the limitations of the study, that the natural history of community acquired HCV may be more benign.

Acute Disease↗

Risk factors for hepatitis C transmission in the Victorian population: a telephone survey.

OBJECTIVE: To measure knowledge and prevalences of risk factors for hepatitis C infection in the Victorian community. METHOD: Telephone survey of 757 Victorian householders aged 15+ years, March 1996. RESULTS: An estimated 2.2% of Victorians have injected illicit drugs; 4.8% have tattoos and 49.6% have skin piercings; 11.4% received a blood transfusion before screening for HCV was introduced; 10.9% have had a test for HCV antibody. A majority of respondents perceived sexual contact and receipt of a transfusion to be risks for HCV transmission. CONCLUSIONS: Risk factors associated with the spread of HCV are widespread in the Victorian community; however, the most important risk factor--injecting drug use--has low prevalence. Considerable uncertainty exists about risk factors for hepatitis C. IMPLICATIONS: A very small percentage of Victorians are injecting drug users and therefore at highest risk of hepatitis C infection, therefore transmission control programs can be efficiently focused on this group. The Victorian community needs to be better educated about risk factors for hepatitis C, in particular that transfusions and blood donations are safe.

Adolescent↗

Tuberculosis infection and homelessness in Melbourne, Australia, 1995-1996.

OBJECTIVE: To describe tuberculosis infection among persons experiencing homelessness in inner Melbourne, Australia. DESIGN: Homeless people were surveyed during late 1995 and early 1996. In stage one of the study 284 homeless people from crisis and long-term accommodation sites were recruited by means of stratified, systematic, random sampling. In stage two a convenience sample of 100 homeless people from squats and the streets were recruited. Participants completed a questionnaire and Mantoux testing was performed. RESULTS: A past history of tuberculosis was reported by 3%. Thirty-seven per cent had a Mantoux > or =10 mm; 21% > or =15 mm; and 11% > or =20 mm. A Mantoux > or =15 mm was independently associated with being aged > or =40 years, coming from the accommodated sample, overseas birth, and a past history of tuberculosis. Using logistic regression modelling, a Mantoux > or =15 mm was predicted by being aged > or =40 years, overseas birth, and past history of tuberculosis. CONCLUSION: Mantoux test results suggest that this group of homeless people had a high prevalence of infection with the tubercle bacillus. Many aspects of the physical and social circumstances of homeless people predispose to reactivation and have the potential to enhance rapid spread should latent infection become active disease.

Adolescent↗