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PubMedDate not supplied

Admissions of injection drug users to drug abuse treatment following HIV counseling and testing.

The outcomes of counseling and testing programs related to human immunodeficiency virus (HIV) infection and risk of infection among injection drug users (IDUs) are not well known or understood. A counseling and testing outcome of potential public health importance is attaining admission to drug abuse treatment by those IDUs who are either infected or who are at high risk of becoming infected. The authors investigated factors related to admission to drug abuse treatment among 519 IDUs who received HIV counseling and testing from September 1987 through December 1990 at a men's prison and at community-based testing sites in Worcester, MA. By June 1991, 123 of the 519 IDUs (24 percent) had been admitted to treatment. Variables associated with their admission included a long history of drug injection, frequent recent drug injection, cleaning injection equipment using bleach, prior drug treatment, and a positive HIV test result. Logistic regression analyses, controlling for effects of recruitment site, year, sex, and area of residence, generally confirmed the associations. IDUs in the study population who were HIV-infected sought treatment or were admitted to treatment more frequently than those who were not infected. The results indicate that access to drug abuse treatment should be facilitated for high-risk IDUs and for those who have begun to inject drugs recently.

Adolescent↗
PubMed1992

HIV infection in intravenous drug users entering drug treatment, United States, 1988 to 1989. The Field Services Branch of the Centers for Disease Control.

BACKGROUND: Intravenous drug use has played a key role in the human immunodeficiency virus (HIV) epidemic. Standardized surveillance of HIV infection among intravenous drug users (IVDUs) is needed to determine HIV prevalence rates, to monitor changes in prevalence over time, and to describe behaviors associated with HIV infection. METHODS: In 1987, the Centers for Disease Control began collaborating with state and local health departments to conduct a national program of HIV seroprevalence surveys in a variety of populations and settings. This program includes unlinked HIV seroprevalence surveys in IVDUs entering sentinel drug treatment programs. RESULTS: From April 1988 through December 1989, annual studies were completed in 59 drug treatment centers in 33 US cities. Center-specific seroprevalence rates ranged from 0% to 48.2%, with a median of 4.6%. HIV seroprevalence rates varied widely by geographic area, with rates highest in the Northeast, intermediate in the Middle Atlantic cities of Baltimore and Washington, DC, and lower in other parts of the country. Median rates were 15.6% among African Americans, 3.2% among Hispanics, and 3.3% among Whites. CONCLUSIONS: Intravenous drug use is likely to remain an important factor in HIV transmission. This study supports the need to develop or expand programs to prevent the further introduction and spread of HIV among IVDUs and to prevent HIV transmission to their sexual partners.

Adult↗
PubMed2000

Prevention of HIV infection in street-recruited injection drug users. The Collaborative Injection Drug User Study (CIDUS).

BACKGROUND: Injection drug users (IDUs) and their sex partners account for an increasing proportion of new AIDS and HIV cases in the United States, but public debate and policy regarding the effectiveness of various HIV prevention programs for them must cite data from other countries, from non-street-recruited IDUs already in treatment, or other programs, and from infection rates for pathogens other than HIV. METHODS: Participants were recruited from the street at six sites (Baltimore [Maryland], New York [two sites], Chicago [Illinois], San Jose [California], Los Angeles [California], and at a state women's correctional facility [Connecticut]), interviewed with a standard questionnaire, and located and reinterviewed at one or more follow-up visits (mean, 7.8 months later). HIV serostatus and participation in various programs and behaviors that could reduce HIV infection risk were determined at each visit. RESULTS: In all, 3773 participants were recruited from the street, and 2306 (61%) were located and interviewed subsequently. Of 3562 initial serum specimens, 520 (14.6%) were HIV-seropositive; at subsequent assessment, 19 people, all from the East Coast and Chicago, had acquired HIV. Not using previously used needles was substantially protective against HIV acquisition (relative risk [RR], 0.29; 95% confidence interval [CI], 0.11-0.80 ) and, in a multivariate model, was significantly associated with use of needle and syringe exchange programs (adjusted odds ratio [ORadj], 2.08; 95% CI, 1.15-3.85). Similarly, reduction of injection frequency was very protective against seroconversion (RR, 0.33; 95% CI, 0.14-0.80), and this behavior was strongly associated with participation in drug treatment programs (ORadj, 3.54; 95% CI, 2.50-5.00). In a separate analysis, only 37.5% of study-participants had sufficient new needles to meet their monthly demand. CONCLUSIONS: In this large multicity study of IDUs in the United States, several HIV prevention strategies appeared to be individually and partially effective; these results indicate the continued need for, and substantial gaps in, effective approaches to preventing HIV infection in drug users.

Adult↗
PubMed2004

Prevention myths and HIV risk reduction by active drug users.

Drug injectors and crack users (526) in South Florida responded to a survey questionnaire that was designed to examine belief in the effectiveness of various strategies, other than condom use, employed to reduce personal risk of contracting HIV during sexual acts. Each strategy was believed to be effective by at least one quarter of the study participants. Factor analysis was used to group these strategies. Subsequent multivariate analysis indicated that the participants who believed in the effectiveness of HIV prevention strategies other than condom use were also less likely to report using condoms. These findings highlight the need for prevention interventions to elicit prevention myths and the full range of risk reduction strategies practiced.

Adult↗
PubMed2006

Invasive group A streptococcal infection in injecting drug users and non-drug users in a single UK city.

OBJECTIVES: Injecting drug users (IDU) represent an increasing proportion of patients with invasive group A streptococcal (GAS) disease. Our aims were to characterise the clinical presentation and strains causing GAS bacteremia in IDU from a single UK city (Brighton and Hove), and to compare this patient group with non-drug users (non-DU) with GAS bacteremia. METHODS: Consecutive GAS blood culture isolates from twenty-two IDU and twenty-two non-DU presenting to the city hospital were studied. Clinical features, strain emm typing and superantigen toxin genotyping were investigated. RESULTS: GAS invasive disease presented differently in IDU compared to non-DU with a predominance of injection site abscesses and lower mortality in IDU. GAS strains from IDU were predominantly emm82 and emm83 types, which are uncommon in the UK and emm82 strains appeared clonal. The non-DU GAS strains demonstrated a broader range of emm types including most frequently emm1 and emm89. There was no major difference in superantigen gene profile between the isolate groups. CONCLUSION: The distinct presentation of invasive GAS disease in IDU compared with non-DU was associated with distinct emm types, a predominance of abscesses, and low mortality, although the small numbers preclude definitive conclusions. Further study is required to establish if these findings reflect strain differences or epidemiological differences in colonisation patterns and injecting practice.

Adolescent↗
PubMed1988

Prevalence and risk factors of HIV infections among drug users and drug-using prostitutes in Amsterdam.

In December 1985 we started a study to determine the prevalence and risk factors of HIV infection among drug users and drug-using prostitutes in Amsterdam. Recruitment took place at methadone posts (not drug-free; i.e. a low-threshold programme on which some drug users continue to use hard drugs, but at a lower level) and the weekly evening sexually transmitted diseases (STD) clinic for drug-addicted prostitutes. Three hundred and ten drug users have so far been tested and interviewed. Eighty-one per cent reported intravenous drug use; 83% of the 166 females and 15% of the 144 men reported prostitution. Female prostitutes practised mainly vaginal and orogenital intercourse and reported frequent use of condoms (89% of vaginal and 64% of orogenital contact). Male prostitutes practised mainly orogenital and manual contact. At entry 88 of the 310 (28%) were HIV-antibody-seropositive; 85 of these 88 were intravenous drug users and three were male homosexuals. HIV-antigen was detected in two seropositive and one seronegative intravenous drug-user. Antibodies to HTLV-I were found in four out of 308. Risk factors independently associated with HIV-antibody seropositivity among intravenous drug users were: frequency of borrowing used needle or syringe, date of first intravenous drug use, recent intravenous drug use, time living in Amsterdam and German nationality. Of medical history data, an attack of herpes zoster in the previous 5 years had the greatest value in the prediction of the presence of HIV antibodies (relative risk 20.90; 95% confidence interval 2.41-167.27).(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1998

HIV knowledge, beliefs and sexual behavior of male heterosexual drug users and non-drug users attending an HIV testing clinic in Israel.

UNLABELLED: The aim of the study was to compare HIV-related knowledge, beliefs in self-control and sexual behavior of non-drug using and drug using heterosexual men. All individuals attending an HIV testing site during a two-month period were asked to complete a questionnaire anonymously. Data for 49 drug users (DU), most of them non-injectors, were compared to that of 94 non-drug using (non-DU) men with similar education levels (high school or less). Sexual behavior items refer to previous six months. FINDINGS: HIV-related knowledge was reported correctly by the majority of men in both groups, but the DU showed significantly more misconceptions (p < 0.01). Consistent but statistically insignificant lower levels of self-control were reported by the DU. Type of sexual relations and the number of regular sexual partners were not different between the groups: 55% of the DU and 67% of the non-DU were not monogamous. DU had either none or many casual partners (three or more), significantly different from the non-DU. The proportion of DU who never used condoms (65%) was higher as compared to non-DU men (43%, p < 0.05). However, when controlling for type of partnership, this difference was sustained only among monogamous men (82% of DU vs. 42% of non-DU never used condoms, p < 0.05). Condom use was significantly associated with age, HIV knowledge and sexual partnership in the DU. The greater deficiencies in HIV-related knowledge, and the prevalence of risk behaviors among DU require intensive individual and group counselling, specifically adapted for the needs and the culture of drug users in Israel and incorporated with social-influence-orientated change processes.

Adult↗
PubMed2000

Sex related HIV risk behaviors: differential risks among injection drug users, crack smokers, and injection drug users who smoke crack.

This study was designed to assess differences in sex-related risk behaviors between drug injectors who did not smoke crack cocaine, crack smokers who did not inject drugs, and drug users who both injected drugs and smoked crack. Current drug users (i.e. used within the past 30 days) from 22 cities were recruited and assessed. The sample (n = 26,982) included 28% who injected only, 42% who smoked crack only, and 30% who both injected and smoked crack. Results showed that active drug users were at risk of HIV infection through sexual transmission: in the 30 day period prior to their interview, 28% reported sex with two or more individuals, 23% had an IDU sex partner, and 24% had exchanged sex for drugs or money. In addition, more than 80% did not use a condom during sex. Crack only smokers and crack smoking injectors were more likely than injectors only to report multiple sex partners and exchanging sex. Because of these high risk behaviors, condom use was of particular importance. The number of days of alcohol use and having an IDU sex partner were independently associated with not using a condom. Crack smoking injectors reported the highest average number of days of alcohol consumption and were the most likely to have had an IDU sex partner.

Adult↗
PubMed1995

Seroepidemiology of hepatitis B virus in a population of injecting drug users. Association with drug injection patterns.

To investigate the epidemiology of hepatitis B virus (HBV) infection among injecting drug users, the authors assessed the prevalence of HBV seromarkers among 2,558 injecting drug users recruited through street outreach in Baltimore, Maryland, in 1988-1989. Eighty percent of the drug users had at least one HBV seromarker. HBV seropositivity was associated with increasing age, duration of injecting drug use, African-American ethnicity, injecting drugs at least once daily, and sharing needles or visiting "shooting galleries" during the previous 11 years, but not with high-risk sexual behaviors or a history of sexually transmitted disease. This finding is possibly due to the relative inefficiency of sexual transmission as compared with parenteral transmission in injecting drug users. In addition, HBV seropositivity was strongly associated with seropositivity for hepatitis C virus and human immunodeficiency virus. The authors conclude that HBV transmission among injecting drug users occurs primarily through the sharing of contaminated drug injecting equipment rather than through sexual relations, and that efforts to prevent HBV infection must target injecting drug users early in their injecting careers.

Adult↗
PubMed2000

Problem gambling and comorbid psychiatric and substance use disorders among drug users recruited from drug treatment and community settings.

Little is known about gambling rates of drug users recruited from drug treatment compared with those recruited from the community. We use the Diagnostic Interview Schedule (DIS) to provide lifetime prevalence estimates of problem gambling (i.e., at least one gambling problem) and DSM-III-R pathological gambling (i.e., at least four gambling problems) and describe the association between gambling and psychiatric disorders for drug users recruited from drug treatment settings (n = 512) and from the community (n = 478). We also report the relative risk of being a recreational and problem gambler in this sample. The sample was first interviewed in 1989-90 as a part of two NIDA-funded St. Louis-based studies. The prevalence of problem gambling in the overall sample was 22% and the prevalence of pathological gambling was 11%. There were no statistically significant differences in problem and pathological gambling rates for subjects recruited from drug treatment and those recruited from the community. The conditional prevalence rates, that is, the rate of problem and pathological gambling only among gamblers were 27% and 13.5%, respectively. Major findings indicate that problem gambling was associated with Antisocial Personality Disorder (ASPD), even after controlling for recruitment source and socio-demographic characteristics. In fact, when examining the temporal order of these disorders, we found that pathological gambling was always secondary to ASPD, occurring on average 11.4 years after the onset of ASPD. Problem gamblers, compared with everyone else, were more likely to be male, African-American, recruited from drug treatment, have ASPD and be dependent on illicit drugs. Multinomial logistic regression analysis predicted the relative risk of being a recreational and problem gambler (compared with a nongambler) in this sample according to socio-demographics, ASPD, and dependence on illicit drugs. Results imply that screening for gambling problems will need to be broad-based among drug users.

Journal Article↗
PubMed1993

HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack.

OBJECTIVES: This study was designed to assess and compare sex risk behaviors for human immunodeficiency virus (HIV) transmission of three drug user groups: injectors who do not smoke crack, crack smokers who do not inject, and injectors who also smoke crack. METHODS: Sexual risk behaviors for HIV were assessed among 246 drug users from Denver, Miami, and San Francisco. Respondents were classified into the three drug groups based on self-report and verified through urinalysis and physical inspection. RESULTS: An increased risk for HIV through sexual transmission was associated with crack cocaine use, particularly among those who also injected. Crack smoking injectors were more likely to report sex with an injector, exchanging sex for drugs and/or money, drug use before or during sex, and unprotected sexual intercourse. They also injected more than injectors only, smoked crack as often as smokers only, and reported higher overall frequencies of drug use. CONCLUSIONS: These findings, together with the higher rates of gonorrhea and syphilis reported by smokers and injectors/smokers, are indicators of the risk crack poses for the heterosexual transmission of HIV.

Adult↗
PubMed2000

Cue-induced cocaine craving: neuroanatomical specificity for drug users and drug stimuli.

OBJECTIVE: Cocaine-related cues have been hypothesized to perpetuate drug abuse by inducing a craving response that prompts drug-seeking behavior. However, the mechanisms, underlying neuroanatomy, and specificity of this neuroanatomy are not yet fully understood. METHOD: To address these issues, experienced cocaine users (N=17) and comparison subjects (N=14) underwent functional magnetic resonance imaging while viewing three separate films that portrayed 1 ) individuals smoking crack cocaine, 2) outdoor nature scenes, and 3) explicit sexual content. Candidate craving sites were identified as those that showed significant activation in the cocaine users when viewing the cocaine film. These sites were then required to show significantly greater activation when contrasted with comparison subjects viewing the cocaine film (population specificity) and cocaine users viewing the nature film (content specificity). RESULTS: Brain regions that satisfied these criteria were largely left lateralized and included the frontal lobe (medial and middle frontal gyri, bilateral inferior frontal gyrus), parietal lobe (bilateral inferior parietal lobule), insula, and limbic lobe (anterior and posterior cingulate gyrus). Of the 13 regions identified as putative craving sites, just three (anterior cingulate, right inferior parietal lobule, and the caudate/lateral dorsal nucleus) showed significantly greater activation during the cocaine film than during the sex film in the cocaine users, which suggests that cocaine cues activated similar neuroanatomical substrates as naturally evocative stimuli in the cocaine users. Finally, contrary to the effects of the cocaine film, cocaine users showed a smaller response than the comparison subjects to the sex film. CONCLUSIONS: These data suggest that cocaine craving is not associated with a dedicated and unique neuroanatomical circuitry; instead, unique to the cocaine user is the ability of learned, drug-related cues to produce brain activation comparable to that seen with nondrug evocative stimuli in healthy comparison subjects.

Adult↗
PubMed2003

Hepatitis C-related discrimination among heroin users in Sydney: drug user or hepatitis C discrimination?

The hepatitis C virus (HCV) is a common infection among injecting drug users. There are currently few available data on the extent (or prevalence) of HCV-related discrimination. This study examined perceived discrimination among a sample of heroin users and sought to determine whether the discrimination was attributed to their drug user or HCV status. Heroin users were recruited through needle and syringe programmes and methadone clinics in Sydney and were asked about discrimination in the preceding 12 months. Four hundred and one heroin users were recruited, of whom 59% reported being HCV-positive. Discrimination was reported by 22% of the 237 IDUs who reported being HCV-positive, with 17% reporting that the discrimination occurred in the preceding 12 months. Sixty-seven incidents were reported, of which half were perceived to be due to their drug user status, 15% of these incidents were due to HCV status and 25% due to a combination of both. Twenty-five incidents occurred in a health-care setting, of which 13 resulted in the service being withheld. HCV is a serious public health concern, and if IDU are to be encouraged into drug treatment it is essential that service providers are perceived to be non-discriminatory. In managing IDU patients, health care workers need to be cognizant of the impact that their attitude has on treatment outcome.

Adolescent↗
PubMed2006

Patterns of drug use and associated harms among rural injecting drug users: comparisons with metropolitan injecting drug users.

OBJECTIVE: Given the harms associated with injecting drug use to both individuals and community and the paucity of such data from rural areas, the study aimed to compare: patterns of drug use, harms, and service access and utilisation among rural and metropolitan injecting drug users (IDU). DESIGN: Cross-sectional survey, using interviewer-administered structured questionnaire. PARTICIPANTS: One hundred and sixty-four rural and 96 metropolitan IDU from seven different New South Wales Area Health Services, recruited through needle and syringe programs (NSPs), snowballing techniques and advertisement. RESULTS: Age, gender, education and employment were similar for rural and metropolitan participants. Both samples reported use of a range of drugs, but rural participants were less likely than metropolitan participants to report daily heroin use (2% vs 10%), but more likely to report having injected morphine (50% vs 21%) in the last six months. Similar proportions reported using a needle/syringe after another person. Rural participants were less likely to report use of NSPs (36% vs 80%) and reported a number of barriers to NSP access and also to drug treatment services. Rural participants reported a significantly longer period of time between blood-borne virus testing. CONCLUSION: Samples of rural IDU are similar to metropolitan, although report some differences in patterns of drug use. Service provision, including access to new injecting equipment, blood-borne virus testing and drug treatment was found to cause considerable problems for rural IDU. These issues warrant further consideration.

Adolescent↗
PubMedDate not supplied

Barriers to condom use and needle cleaning among impoverished minority female injection drug users and partners of injection drug users.

This study was undertaken to describe sexual behaviors and drug use and other factors that inhibit condom use and needle cleaning among impoverished women who are injection drug users (IDUs) or sexual partners of IDUs. This study also investigated whether risky sexual behavior or barriers to risk reduction differ with ethnicity and level of acculturation. Survey instruments to assess drug and sexual activity were administered to 378 African American and Latina women recruited primarily from homeless shelters and drug recovery programs. The most commonly cited barriers to condom use were belief that partners did not have acquired immunodeficiency syndrome (AIDS), lack of knowledge about where to get and how to use condoms, and discomfort discussing condom use with partners. African American women were more likely to report having multiple partners and unprotected sex, and more likely to report barriers in using, discussing, and obtaining condoms. Latina women were more likely to report partners' dislike of condoms. African American and highly acculturated Latina women were more likely to be IDUs than less acculturated Latina women. The most pervasive barriers for needle cleaning were not having personal needles, being high and not interested in needle cleaning, and not having disinfectant available. In a multiple logistic regression analysis for engaging in unprotected sex and cleaning needles, not ethnic or acculturation differences were found after controlling for selected demographic characteristics and risk factors. The data indicate a need to increase the supply of free or low cost condoms, to provide easily accessible sites for obtaining condoms, to supply clean needles,and to focus counseling for women on negotiating condom use with partners and the skillful and correct placement of the condom.

Adolescent↗
PubMed1998

Drug users' views of drug service providers.

In Britain, there are a wide range of agencies providing many types of service to drug users. Such provision, it is argued, should be monitored and evaluated in the same way as provision to other client groups. To this end, the paper focuses on one aspect of drug service evaluation; users' views of service providers. Semi-structured qualitative interviews were conducted with 124 illicit drug users in rural, urban and inner city areas of Scotland and the respondents' comments were analysed inductively using the software package, Winmax. The study revealed three main findings. First, there was a high level of consensus amongst users regarding desired and undesired provider characteristics; and these characteristics held regardless of agency type. Secondly, users simultaneously retained different expectations of the different agencies and did not consider these agencies to be interchangeable. Thirdly, gender differences in attitudes to, and use, the different providers were apparent. The paper concludes that it is necessary to recognize the fundamental role that process factors, particularly providers' attitudes, play in terms of drug users' overall perception and evaluation of services. Additionally, although agencies should aim to provide a broad range of flexible forms of assistance, providers are not interchangeable and the continued development of a flexible mixture of interactive drug services and providers is recommended. Finally, drug users do not provide the definitive statement about the value of drug service provision. Nevertheless, their views and experiences are an important aspect of service evaluation and consequently deserve careful attention from policy, practice and research.

Journal Article↗
PubMed1989

Risk behaviours for HIV infection among injecting drug users attending a drug dependency clinic.

To study a range of possible risk factors for HIV among injecting drug user patients attending a clinic in London were interviewed from November 1986 to November 1987. Serum samples were tested for viral markers. Of 116 patients, 101 had shared injecting equipment, 75 on the first occasion of injecting and 76 during the past year. Seventy said that sharing was because equipment was not available. In the past year 102 had been sexually active, a third having two to 20 partners; a quarter of the women had exchanged sexual intercourse for money. The four patients who were positive for antibody to HIV antigen had shared equipment or had intercourse with drug users from areas with a high prevalence of HIV. Eleven patients had injected drugs while in prison. Despite a low prevalence of HIV infection this infection remains a threat to drug users in London; strenuous efforts are still needed to prevent its further transmission.

Acquired Immunodeficiency Syndrome↗