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Biomedical subjects

W Loxley

Publications and source records attributed to W Loxley.

16 recordsLinked to original sources
PubMed2000

Doing the possible: harm reduction, injecting drug use and blood borne viral infections in Australia.

Most surveys show that, other than among men who inject drugs and have a history of homosexual contact, the prevalence of HIV infection among injecting drug users (IDUs) in Australia is about 2%. Rates of needle sharing have also declined greatly in the last decade, although the high prevalence and incidence of hepatitis C infection suggest that existing strategies have not yet brought this epidemic under control. Harm reduction has been the major Australian approach to the reduction of blood borne viral infections (BBVIs) in IDUs. Harm reduction strategies include needle distribution schemes, drug substitution therapies and education about safe administration practices. Importantly, with IDUs as with gay men, the infected and affected communities have been brought into partnership with health educators, researchers and policy makers. This paper will review Australia's approach to the prevention of BBVI in IDUs and the effectiveness of current strategies. I will argue that while HIV/AIDS among heterosexual IDUs appears to have been successfully prevented, international experiences of rapidly emerging epidemics demonstrate there is little room for complacency. Moreover, reducing the incidence of hepatitis C and hepatitis B among IDUs remains a major challenge.

Journal Article↗
PubMed2000

Citizens who inject drugs: the 'Fitpack' study.

Most injecting drug users have never been in drug treatment yet much research is done on samples with high treatment rates drawn from agency and peer recruited populations. This study accessed drug injectors with little or no prior drug treatment, described their characteristics, BBVI risk behaviours and feedback on services. Its results challenge some stereotypes about citizens who inject drugs. A sample of 511 'hidden' drug injectors, of whom only 28.7% had any specialist drug treatment agency contact, completed a questionnaire which was distributed with 'Fitpack' needle packs sold through community pharmacies in WA. The mean age of respondents was 26.2 years, 43.4% were women, 44.3% were living with their sexual partner, 41.7% were parents, and 46.4% were employed, mostly in full time work. In the previous month 61.2% had injected less frequently than daily. The study accessed a diverse group of drug injectors not typically seen in agency and peer recruited research. They provided useful feedback about how harm reduction strategies among injectors can be improved. However, they also reported higher rates of injecting and sharing than found previously in traditionally recruited samples of injectors which suggests there is no room for complacency regarding the potential for blood-borne viral infection (BBVI) transmission in this group.

Journal Article↗
PubMed1997

Protecting the interests of participants in research into illicit drug use: two case studies.

This paper addresses the conflict between the ethical and legal responsibilities of researchers engaged in illicit drug use research. Fundamentally, the primary ethical responsibility is to protect research subjects from any harm which may come to them as a consequence of having taken part in the research. Legal responsibilities, however, might lie in assisting police with their enquiries into the conduct of an individual who is a research subject, and allowing research data to be searched and possibly used in evidence against the individual. There is no Western Australian legislation which protects research, nor Australian legislation which can be applied to most studies. Using two case studies, we give examples of the conflict and suggest that legislation may be the most effective way to overcome it. However, we also raise a number of issues which would need to be considered before solutions are enacted.

Australia↗
PubMed1995

Friends and lovers: needle sharing in young people in Western Australia.

The Youth AIDS and Drugs (YAD) Study is a study of young people who inject drugs, and their risk of the transmission of HIV through needle sharing and/or unsafe sex. One hundred and five people, aged less than 21, 75% of whom were current or recent injectors, undertook in-depth interviews which were tape recorded, transcribed and analysed qualitatively. This paper focuses on the ways in which the young people in the group attempted to manage the risk of needle sharing. Needle sharing in the study group was not common behaviour. Almost all injectors employed one of four major Risk Management Strategies some of which included the possibility of sharing unbleached needles with a friend or a lover. These strategies were strongly related to beliefs that such friends and lovers were well enough known by the individual for there to be very little risk. The implications of these findings for health promotion with young people who inject drugs in Perth, a city of low IDU seroprevalence, are outlined.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Changes in drug use and HIV/AIDS risk-taking 1989-90.

The Australian National AIDS and Injecting Drug Use Study was designed to monitor the risk behaviour of Australian injecting drug users (IDUs) in a number of major cities, and to estimate the seroprevalence of those interviewed. Differences in risk behaviour found across 2 years in Perth are reported. One hundred and ninety-six Perth IDUs were interviewed in 1989, and 150 in 1990 using the same survey questionnaire, with a small cohort of 38 respondents being followed up across the 2 years.Significant injecting differences between 1989 and 1990 in both the cohort and independent samples were found. In general, these amounted to a greater likelihood that a new needle and syringe would be used on each injecting occasion, and a greater use of bleach in 1990 than in 1989. The most common response of respondents who said they had changed their drug use behaviour in 1990 was to report ceasing to share needles, while the most common response in 1989 was reduced sharing. There was an increased use of condoms for vaginal intercourse with all partners in both studies across the 2 years. Seropositivity for all new cases across the 2 years was 1.75%. It is apparent that there has been a significant shift in risky behaviour in the direction of greater safety across the 2 years. There is also objective corroborative evidence in increased demand for sterile injecting equipment sold through pharmacists, although there is no evidence that drug use increased significantly during the same period. It is concluded that the availability of sterile needles and syringes should be maintained and improved and that emphasis should be placed on encouraging safer sexual behaviour among IDUs.

Journal Article↗
PubMed1995

Hepatitis C and young drug users: are they about to join the epidemic?

This study investigated what some high-risk youth in Perth knew about, believed about and did about hepatitis C, and the extent to which they had been exposed to the virus, by surveying 234 12-to-20-year-old users of injectable drugs. About half of the respondents (108) gave a blood sample for anonymous hepatitis C virus antibody testing. All respondents had used at least one illicit drug other than marijuana in the previous 12 months and most (75 per cent) reported injecting drugs at least once in the past 12 months. The study group was obtained through drug treatment agencies and interviewer networks. Although more than 80 per cent of the study group had heard of hepatitis C, only 50 per cent considered the infection to be a serious problem. Eighty per cent of respondents were at risk of infection from unsafe injecting practices, and their relevant knowledge of hepatitis C was at best, barely adequate. Of those tested, 5.5 per cent were seropositive. A pool of infection, albeit small, already exists among this group of users of illicit drugs. Given the low average duration of illicit drug use among this group (less than 2 years) and the fact that many of the users are part of a hidden population that will probably never be in treatment, that there is any infection present is of concern. Appropriate, well-aimed education and peer outreach programs are desperately needed if the transmission of hepatitis C among young users of injectable drugs is to be kept to a minimum.

Adolescent↗
PubMed1994

A bridge too near? Injecting drug users' sexual behaviour.

One-hundred-and-fifty injecting drug users were interviewed about their sexual behaviour, and types of sexual relationships and partners in the past year. The aims of the study were to assess the extent of changes in sexual HIV-risk behaviour patterns and to understand aspects of respondents' sexual relationships, as well as HIV/AIDS knowledge. We found few changes in sexual behaviour. The ability to assess personal HIV-risk varied widely across the sample and intoxication during sexual activity was widely reported. Whilst the use of condoms was infrequent, young respondents were more likely to use condoms, but have more sexual partners, hence a likely erosion of any net gain may have occurred. Over half of the respondents were in sexually monogamous relationships and there were no significant gender-related differences in respect of regular partners' IDU-status. Estimated rates of seroprevalence in Perth are low and with the effectiveness of deterrence dependent on visible negative outcomes, it may be difficult to ensure safer-sex messages are heeded. These concerns are raised and facilitation of safer-sex among IDUs are discussed. Further areas of research are recommended.

Adolescent↗
PubMed1992

Coffee shops and clinics: the give and take of doing HIV/AIDS research with injecting drug users.

We discuss recruiting and interviewing injecting drug users and using research as health promotion in the context of collecting information related to human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) from a convenience sample of 200 injecting drug users, half in treatment and half not, in 1989 and 1990 in Perth, Western Australia. A variety of recruiting methods were used including advertising, referral by agency staff, 'snowballing' and approaches to personal contacts and others known to inject by the interviewer. Snowballing and personal contacts were the most successful means of recruiting those not in treatment, while advertising was comparatively unsuccessful with this group because of the importance of establishing the credibility of the study and the interviewer among injecting drug users before they will volunteer to be involved. The promotion of behavioural risk reduction among respondents during the interview is detailed. We argue that the traditionally rigid separation between research and intervention is inappropriate in the HIV/AIDS context. When lives are potentially at stake, any contact with injecting drug users, especially those not in treatment (where may receive HIV/AIDS education), must be used as an HIV/AIDS prevention opportunity, and the interview is an ideal opportunity. The employment of research as community intervention is also discussed.

HIV Infections↗
PubMed1992

Drinkers and their driving: compliance with drinking-driving legislation in four Australian states.

This study replicates work in Norway and the United States in investigating the extent to which Australian drivers attempt to comply with drinking-driving legislation. In a four-state survey of 1,133 drinkers, it was found that people were aware of the need to control their alcohol input before driving, and derived estimates of blood alcohol after a recent away-from-home drinking occasion demonstrated that the amount people drank was influenced by whether or not they were driving. Drivers reported drinking less than nondrivers and were also those who usually consumed less alcohol. These findings were also true of people with different levels of normal consumption. Although these results are encouraging, it is suggested that there is need for further modification of sanctions, and that the community needs more information about the alcohol content of drinks and drink sizes if people are to moderate effectively their drinking before driving.

Accidents, Traffic↗
PubMed1992

Young people, alcohol, and driving in two Australian states.

Road traffic accidents are the single largest cause of death in Australia among people aged 15-24. The proposition that a broadly based deterrence measure, such as random breath testing (RBT), would be sufficient to change the behavior of young drivers was tested in a comparison of young drivers in New South Wales (NSW), which has had RBT for 6 years, with young drivers in Western Australia (WA), where there was no RBT. The results demonstrated that NSW young drivers were less likely to drink and drive and more likely to believe their peers would disapprove of drink-driving than were their counterparts in WA. It was concluded that RBT had altered the drink-driving behavior and possibly the beliefs about drink-driving of young people in NSW.

Accidents, Traffic↗
PubMed1991

Age and injecting drug use in Perth, Western Australia: the Australian national AIDS and injecting drug use study.

Young injecting drug users (IDUs) in Australia are a group about whom little is known. It is suggested, however, that their drug using behaviours and life styles put them at particular risk for HIV/AIDS. Data collected in Perth from 195 respondents in the Australian National AIDS and Injecting Drug Use Study was analyzed with emphasis on the distinctions between young and older injecting drug users. It was found that, relative to those aged 23 or over, IDUs under 23 used more stimulants and LSD and fewer opiates and benzodiazepines; were more likely to inject all or most of their drugs; were less likely to have been in treatment; had more sex partners; were less likely to have changed their drug taking behaviour because of AIDS; were less likely to use alone; shared needles less frequently but shared at least some of the time; and had less knowledge of AIDS and were more pessimistic about the long term outcomes of AIDS. Such characteristics need to be taken into account if effective intervention and prevention strategies for this group are planned.

Acquired Immunodeficiency Syndrome↗