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PubMed2003

Needle sharing with known and diagnosed human immunodeficiency virus-infected injecting drug users.

The annual number of reported cases of human immunodeficiency virus (HIV) infection among injecting drug users (IDUs) in Sweden has been about 20 for more than 5 y, but in 2001 36 new cases were reported. Risk behaviour for contracting HIV infection was studied in 21 of 24 identified and evaluable IDUs with diagnosed HIV infection in the metropolitan area of Stockholm in 2001 and in 23 of 30 evaluable consecutive controls. HIV status was associated with general needle sharing (p = 0.04) and needle sharing with an HIV-positive individual (p = 0.0001), despite extensive information on possible transmission routes for HIV. These results indicate that efforts for reducing transmission of HIV should focus on HIV-negative and HIV-positive individuals with risk behaviour.

Adolescent↗

PubMed1992

A model-based estimate of HIV infectivity via needle sharing.

Critical to understanding the spread of the human immunodeficiency virus via needle sharing among drug users is the infectivity, i.e., the conditional probability of infection given injection with a shared, contaminated syringe. A simple mathematical model was constructed that relates infectivity to the prevalence of infection in needles used by drug users, the mean shared injection frequency among drug users, the probability that a needle is disinfected prior to use, and the mean AIDS incubation time. Three of these parameters have been estimated using data from the New Haven, Connecticut legal needle exchange program. Using the polymerase chain reaction to test for the presence of HIV proviral DNA in a sample of returned needles, we determined that 67.5% were HIV positive. We were able to estimate shared injection rates and disinfection rates from surveys of drug users enrolled in the needle exchange and our syringe tracking system. Current estimates of the mean AIDS incubation time are available in the literature. Our model implies that the probability of infection per injection with a contaminated syringe equals 0.0067, which is slightly higher than the transmission probabilities of 1/300 to 1/200 estimated from needlestick studies, and a factor of 3 higher than estimates of the probability of HIV transmission per vaginal sex act from a infected man to an uninfected woman.

HIV Infections↗

PubMed1989

Determinants of needle sharing among intravenous drug users.

Data from 110 IV-drug abusing persons in methadone maintenance were analyzed to determine the correlates of needle sharing. Sharing was directly related to peer group behavior, attitudes conducive to sharing, economic motivation to share, not owning injection equipment, and fatalism about developing AIDS. Sharers were aware of their AIDS risk. Indicated measures to reduce needle sharing would be positive peer support groups to help resist pressures to share, legal and free access to fresh injection equipment, education on the utility of risk reduction, and increased treatment options for IV cocaine users.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Social determinants predict needle-sharing behaviour among injection drug users in Vancouver, Canada.

Despite the fact that needle exchange was introduced in Vancouver as early as 1988, needle sharing remains common. An analysis was conducted to identify determinants of borrowing used needles among subjects participating in a case-control study. IDUs had a documented HIV seroconversion after 1 January, 1994 (n = 89), or repeatedly tested HIV-seronegative after this date (n = 192). Interviewer-administered questionnaires focused on drug use, sexual behaviours, source of needles and depression. Subjects were asked if they had "ever been forced to have sex" as a child, youth or adult. Logistic regression identified determinants of borrowing needles. After controlling for HIV serostatus, factors independently associated with borrowing were injecting > 4 times/day, polydrug use, and ever experiencing non-consensual sex (AOR = 3.4, 95% CI: 1.8, 6.5). Depression was associated with borrowing, although not independently so. Homosexual activity was independently associated with borrowing among males, whereas living with a sexual partner was an independent predictor for females. Access or barriers to clean needle use were not associated with borrowing. Social determinants, particularly a history of sexual abuse, are among the most significant predictors of needle borrowing among Vancouver's IDUs. Early identification of these factors should be a component of HIV prevention programmes.

Adult↗

PubMed2005

Needle sharing and sex-related risk behaviours among drug users in Shenzhen, a city in Guangdong, southern China.

Intravenous drug users (IDUs) are at high risk of contracting HIV, but there is a geographic bias in such research efforts in China. The aim was to study the pattern of needle sharing and sex-related risk behaviours among drug users in southern China. About 260 drug users in a detoxification centre completed an anonymous questionnaire (response rate=87.3%). The results show that needle sharing among IDUs was prevalent (60.6% and 45.3% for male and female IDUs, respectively); the sharers were often friends, spouses, and acquaintances. Few IDUs sterilized the used needles properly. Commercial sex behaviours (males: 44%; females: 60%) as well as multiple partnership (males: 60%; females: 53%) were also prevalent among all male and female drug users studied. Inconsistent condom use with commercial sex partners, spouses, and regular sex partners was also very common. Yet, few of all drug users studied perceived the susceptibility of contracting HIV (11%) or sexually transmitted diseases (24%) in the future. A better HIV-related knowledge level was associated with lower levels of risk behaviours. It is concluded that harm reduction programmes are urgently warranted in China.

Adolescent↗

PubMed1995

Methadone maintenance and the likelihood of risky needle-sharing.

Survey data were used to study the association of methadone maintenance and needle-sharing. An ordinal scale of HIV risk was derived from the number of persons from whom subjects reported accepting a used needle and syringe in the 6 months prior to interview. The odds of respondents in methadone maintenance being in the higher risk group were half those of daily heroin users not in treatment for all three transitions in a four-level ordinal scale of risk (OR 0.55, 95% CL 0.33 to 0.90, ordinal logistic regression). This association disappeared when methadone patients who had not injected in the month prior to interview were excluded from the analysis. Subjects' knowledge concerning HIV and AIDS had no measurable association with the outcome. It is concluded that methadone maintenance reduces heroin addicts' risk of infection with HIV by reducing the likelihood of their injecting drugs rather than by changing their injecting behavior.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Needle sharing among intravenous drug abusers: future directions.

In summary, the conference focused on one means of HIV transmission among intravenous drug abusers: exposure through the sharing of drug injection equipment. The participants emphasized the urgency of the AIDS epidemic among intravenous drug abusers. A massive effort is needed now to prevent further spread of the disease. The prevention of AIDS requires a multipronged approach to reach intravenous drug abusers, with various motivations for behavior change: Communities across the United States should quickly implement programs to educate addicts regarding their risk for AIDS and how they may reduce their risk. Aggressive outreach is a key educational tool. Drug abuse treatment is an important means of combating the AIDS epidemic among intravenous drug abusers who wish to quit using drugs and are willing to enter treatment. Resources need to be expanded so that drug abuse treatment is readily available. Since a substantial number of intravenous drug abusers will continue to inject drugs, an effective AIDS prevention strategy must encourage these individuals not to share injection equipment and must provide clear and explicit information on how they can clean their injection equipment to decrease the likelihood of HIV transmission if they continue to share. Public policies that restrict the availability of needles and thereby encourage needle sharing should be reexamined. As part of this reexamination, research should be conducted to determine the effectiveness of needle exchange programs that provide intravenous drug abusers with sterile needles in exchange for used needles.

Acquired Immunodeficiency Syndrome↗

PubMed1998

The relative importance of factors which influence order of injecting with a shared needle and syringe.

Injecting drug users (IDUs) in Adelaide, South Australia, rated the likelihood of first use of a shared needle and syringe by persons who have characteristics which have previously been suggested as influencing order of injecting. This enabled the relative importance of these factors to be assessed. It was found that those who supply their own drug and injecting equipment have the greatest likelihood of using first, but it is also somewhat advantageous if one is able to promote one's needs, has recently been tested for HIV or is at home when the opportunity to inject arises. Older IDUs and regular users may be slightly advantaged, as may those who inject others and those who were denied first use the last time sharing occurred. A model for predicting order of use is proposed.

Adolescent↗

PubMedDate not supplied

Notification of the sex and needle-sharing partners of individuals with human immunodeficiency virus in rural South Carolina: 30-month experience.

The authors conducted a confidential and voluntary partner notification program to identify and educate the sex and needle-sharing partners of individuals with the human immunodeficiency virus (HIV) in a rural health district in South Carolina. During the first 30 months, of 485 named contacts, 290 (60%) were residents of the health district and were contacted and offered testing. Of the 290 contacted, 280 (97%)--53 women and 227 men; age range 14-74 years--accepted counseling and testing and 49 (18%) were HIV-antibody positive. Only 3 of the 49 (6%) had been previously tested. All HIV-infected individuals received appropriate physician, laboratory, and public health referrals. During the study, the mean number of sex partners per 6-month period decreased from 5.6 to 1.1 (80% reduction) for HIV-antibody positive persons and from 4.0 to 2.0 (50% reduction) for HIV-antibody negative persons. The authors conclude that in a rural setting, partner notification of HIV exposure can accurately target education and testing and can produce positive behavior change.

Adolescent↗

PubMed1990

Hepatitis B: transmission by sexual contact and needle sharing.

In the Western world most cases of hepatitis B virus (HBV) infection are acquired through sexual intercourse and through needle sharing by intravenous drug users (IVDU). The major risk factors for HBV infection in homosexual men include the number of sex partners and receptive anal intercourse. In heterosexuals, this risk also rises with an increasing number of sex partners. IVDU consistently show the highest HBV infection rates in Europe and North America, presently accounting for 25 to 50% of all hepatitis B cases. Infection with the human immunodeficiency virus affects the course of HBV infection as well as the immunological response to hepatitis B vaccines. Thus, in the industrialized world, interventions against HBV infection should primarily be targeted to homosexual men, heterosexuals with multiple partners, and IVDU.

HIV Infections↗

PubMed1997

Characterisation of an epidemic of hepatitis A virus involving intravenous drug abusers--infection by needle sharing?

An epidemic of hepatitis A virus (HAV) among intravenous drug abusers in Oslo involved 144 serologically confirmed cases. Another 26 patients (non-drug abusers), of whom 14 were derived from a single nosocomial outbreak, were associated with the epidemic. Sequencing of the VP1/P2A junction revealed that viruses associated with the epidemic were completely identical, whereas other HAV samples collected during the same period differed by up to 10%. HAV was detected in the serum of 48 of 100 patients by a nested PCR. Viremia was observed as early as 25 days before the onset of clinical hepatitis, and up to 30 days after. The large number of patients within the drug abuser group, and the few secondary cases, raised the question of whether the virus could be transmitted by the use of needles. To establish whether viral contamination of drugs did contribute appreciably to maintaining the epidemic, we examined heroin and amphetamine confiscated during the period, using immunomagnetic separation coupled to nested PCR, but failed to detect any virus. Antibodies against hepatitis B virus and hepatitis C virus were common among the HAV infected drug abusers (43% and 81%, respectively), suggesting widespread sharing of needles. This observation and the large number of patients with a demonstrable viremia suggest that needle sharing may contribute to the dissemination of HAV.

Amphetamine↗

PubMed2006

Beyond needle sharing: meta-analyses of social context risk behaviors of injection drug users attending needle exchange programs.

This study gathered data from U.S. and international needle exchange programs (NEPs). Of particular interest were outcome measures of dependent variables related to behaviors within social contexts of injection drug users (IDUs), an area not well understood. Thirty-one studies, with a total of 86 separate measures of 36 dependent variables were included. Because combining all results into a single meta-analysis would be inappropriate, dependent variables were placed into five categories for five separate meta-analyses: risky contexts, injection frequency, sharing drug paraphernalia, drug preparation, and syringe use. NEP attendance was inversely related to declines in all categorical behaviors except for "risky context." NEP attenders are slightly more likely to be in a risky circumstance when injecting drugs than non-attenders. While injection frequency declined only slightly among NEP attenders, that result may be interpreted as a positive outcome, given the often-stated criticism that providing clean needles encourages increased drug use. NEP use was weakly associated with a decrease in the sharing of drug paraphernalia. Clean needles alone do not appear to be sufficient motivation to motivate major changes in contextual risk behaviors analyzed herein. Research is needed to assess the impact of interpersonal IDU relationships with other stakeholders (clinic employees, van drivers, medical personnel, nutritionists, sexual partners, etc.) on IDU drug-using behaviors at many levels.

Female↗

PubMed2002

The general mixing of addicts and needles in a variable-infectivity needle-sharing environment.

In this paper we develop and analyse a model for the spread of HIV/AIDS amongst a population of injecting drug users. The model we discuss focuses on the transmission of HIV through the sharing of contaminated drug injection equipment and in particular we examine the mixing of addicts and needles when the AIDS incubation period is divided into three distinct infectious stages. The impact of this assumption is to greatly increase the complexity of the HIV transmission mechanism. We begin the paper with a brief literature review followed by the derivation of a model which incorporates three classes of infectious addicts and three classes of infectious needles and where a general probability structure is used to represent the interaction of addicts and needles of varying levels of infectivity. We find that if the basic reproductive number is less than or equal to unity then there exists a globally stable disease free equilibrium. The model possesses an endemic equilibrium solution if the basic reproductive number exceeds unity. We then conduct a brief simulation study of our model. We find that the spread of disease is heavily influenced by the way addicts and needles of different levels of infectivity interact.

Computer Simulation↗

PubMed1992