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PubMed2002

HIV and injection drug use in Latin America.

OBJECTIVE: This paper presents HIV/AIDS-related data on injection drug use (IDU) and drug use trends in Latin America, and policy issues and strategies developed to face the HIV epidemic. METHODS: Serosurveillance data on HIV/AIDS and IDU in Latin America were compiled. Key experts were consulted in Argentina, Brazil, Colombia and Mexico. Published and grey literature was reviewed. An overview and information on selected countries is discussed in order to analyse different responses. RESULTS: IDU AIDS cases are driving the epidemiological trend in the Southern Cone at 34.3%, followed by Brazil at 20.2%, Latin Caribbean 2.8%, Central America 0.9%, Mexico 0.6%, and the Andean area 0.2%. Available prevalence data are absent or scarce with the exception of Argentina and Brazil. Even with evidence of HIV transmission occurring in IDU, there is a notorious lack of studies in most other countries. In 1984-2000 only four out of 21 Latin American countries had reported prevalence studies. CONCLUSION: For countries that have already initiated harm-reduction programmes (HRP) the great challenge is to ensure that these activities are sustained. In other countries, IDU as a high-risk factor is currently of less importance. However, an increase in the frequency of IDU has been detected, and HIV prevalence is expected to increase. It is therefore necessary to implement HRP to encourage and help drug users to adopt safer methods, such as access to equipment and sterile materials, cleaning materials and information about safe sex, as well as counselling, support groups and medical assistance.

Cocaine-Related Disorders↗

PubMed1998

Rates of and risk factors for trichomoniasis among pregnant inmates in New York City.

BACKGROUND: Trichomonas vaginalis is a common pathogen that is associated with adverse pregnancy outcomes and may serve as a cofactor in human immunodeficiency virus (HIV) transmission. GOAL: To define the epidemiology of trichomoniasis in a population of newly incarcerated pregnant women in New York City. STUDY DESIGN: Prospective study of 213 pregnant prisoners attending prenatal clinic. Patients participated in an interview regarding sexual and drug-related behaviors, and underwent direct culture for T. vaginalis in addition to routine testing for syphilis, gonorrhea, and chlamydia. RESULTS: The prevalence of trichomoniasis was 46.9%. On univariate analysis, there was a significant association between trichomoniasis and older age, crack use, prostitution, known HIV infection, and positive serological test for syphilis. Multivariate analysis showed a significant association of trichomoniasis with crack use and positive serological test for syphilis. CONCLUSION: Trichomoniasis is highly prevalent in pregnant prisoners in New York City. The extent of disease observed may justify a formal program of testing and treatment and emphasizes the urgent need for harm reduction education and expanded HIV counseling and testing services in this high-risk population.

Adolescent↗

PubMed2001

Stigmatized drug use, sexual partner concurrency, and other sex risk network and behavior characteristics of 18- to 24-year-old youth in a high-risk neighborhood.

BACKGROUND: Sex risks and drug use are related. This relation in youth is described. GOAL: To determine how stigmatized drug use is related to sexual risk behaviors and network characteristics among youth. STUDY DESIGN: In-person interviews were conducted with both a probability household sample (n = 363) and a targeted, street-recruited sample of cocaine, heroin, crack, or injected drug users (n - 165) comprising 18- to 24-year-olds in an inner city neighborhood. Drug use in the preceding 12 months was scaled hierarchically, lowest to highest social stigma, as none, marijuana, noninjected cocaine, noninjected heroin, crack, and injected drugs. RESULTS: Users of the more stigmatized drugs had more sex partners. They were more likely to report a history of concurrent sex partners, sex with someone who also had engaged in sex with a network member, commercial sex work, and unprotected sex. Findings showed crack use and drug injection to be associated more strongly with increased sex risk among women than among men. CONCLUSIONS: Young users of the more stigmatized drugs are at much greater network and behavior risk for sexually transmitted diseases. Drug use prevention, harm reduction interventions, or both may lower this risk.

Adolescent↗

PubMed1999

Survival of HIV-1 in syringes.

We performed a study to determine the duration of survival of HIV-1 in syringes typically used by injectors of illicit drugs (IDUs). We describe the effectiveness of a microculture assay in detecting viable virus in volumes of blood typical of those commonly found inside used syringes. Using this assay and modeling the worse-case situation for syringe sharing, we have recovered viable, proliferating HIV-1 from syringes that have been maintained at room temperature for periods in excess of 4 weeks. The percentage of syringes with viable virus varied with the volume of residual blood and the titer of HIV-1 in the blood. These experiments provide a scientific basis for needle exchange schemes, harm reduction, and other interventions among IDUs that support the nonsharing and removal of used syringes from circulation.

Acquired Immunodeficiency Syndrome↗

PubMed1999

HIV seroprevalence and risk factors among clients of female and male prostitutes.

OBJECTIVES: To document the HIV and STD infection rates among clients of female (CFP) and clients of male prostitutes (CMP) and to identify the risk factors for HIV among CFP and CMP. METHODS: Structured interviews were conducted with 82 CMP and 69 CFP in 1990 and 1991 in Atlanta, Georgia, U.S.A. Blood samples were tested for HIV, syphilis, and hepatitis B. RESULTS: The HIV-positive rate was 36.6% among CMP and 2.9% among CFP. Syphilis seromarkers were found in 15.9% of CMP and 10.1% of CFP; hepatitis B seromarkers were identified in 58.0% of CMP and 24.6% of CFP. Key risk factors for HIV among CMP included serologic history of syphilis, serologic history of hepatitis B, receptive anal sex with a male prostitute, ever injecting drugs, ever using crack cocaine, and little education. CFP had no significant risk factors for HIV in the logistic analysis. CONCLUSIONS: Several studies have focused on risk factors for HIV among female and male prostitutes; however, research on their clients has been limited. Although HIV infection rates among CFP are relatively low, their infection rate for syphilis and hepatitis warrants serious health education efforts. Even more critical are harm-reduction programs targeting CMP. Generic health and HIV risk reduction messages on heterosexual transmission might be insufficient.

Crack Cocaine↗

PubMed2001

Can HIV-1-contaminated syringes be disinfected? Implications for transmission among injection drug users.

Bleaching of syringes has been advocated to prevent HIV-1 transmission among injection drug users (IDUs). Bleach is frequently distributed by needle exchange, outreach, and educational programs targeting IDUs. We applied a sensitive HIV-1 microculture assay to determine the effectiveness of bleach in disinfecting syringes contaminated with HIV-1. This study demonstrates that in a laboratory environment designed to replicate injection behaviors, undiluted bleach is highly effective in reducing the viability of HIV-1 even after minimal contact time. However, it did not reduce the HIV-1 recovery to zero. Furthermore, three washes with water were nearly as effective as a single rinse with undiluted bleach in reducing the likelihood that contaminated syringes harbored viable HIV-1. Given the reality that IDUs share syringes and may not have access to a new, sterile syringe for each injection, the results suggest that they should be encouraged through harm reduction interventions to clean their syringes, preferably with undiluted bleach.

Disinfectants↗

PubMed2002

Continuing HIV transmission among injection drug users in Eastern Central Canada: the SurvUDI Study, 1995 to 2000.

OBJECTIVE: To document HIV prevalence/incidence trends from 1995-2000 and associated risk factors among injection drug users (IDUs) in Eastern Central Canada as an indication of harm reduction strategy effectiveness. METHODS: Nonnominal cross-sectional data (one-time participants) and longitudinal data (repeat participants) were collected using convenience sampling. Participants provided informed consent for face-to-face interviews focused on injection drug use and sexual practices during the previous 6 months; oral fluid samples were taken for HIV testing by enzyme immunoassay. Unique encrypted codes for initially HIV-negative repeat participants permitted incidence rate calculations. RESULTS: In all, 6387 IDUs (median age, 31 years; range, 13-67; males, 73.5%) participated on 9724 occasions. HIV prevalence ranged from 4.7% (95% confidence interval [CI], 2.9-6.5) in semiurban areas to 20.1% (95% CI, 17.6-22.7) in Ottawa, Ontario. HIV incidence was 6.0 (95%CI, 4.5-7.6) per 100 person-years (py) in Montréal, Québec, 3.2 (95% CI, 2.2-4.2) per 100 py in Québec City and 7.0 (95% CI, 4.1-9.8) per 100 py in Ottawa/Hull. Reusing other IDUs' needles was reported by 38.4%. In multivariate logistic regression, IDUs injecting for 6 or more years were more likely to be HIV positive, particularly if cocaine was the predominant drug injected. Multivariate Cox regression revealed higher HIV incidence among those who predominantly injected cocaine, reused others' needles, had injected 6 years or more, injected with strangers, or were men reporting commercial sex work. CONCLUSIONS: These results reveal a volatile situation of continuing HIV transmission among IDUs in Eastern Central Canada.

AIDS Serodiagnosis↗

PubMed2003

HIV prevalence and risks among injection and noninjection drug users in northern Thailand: need for comprehensive HIV prevention programs.

The authors sought to determine sociodemographic and sexual and drug use risk factors for HIV infection among drug users in northern Thailand adjacent to the Golden Triangle. The authors enrolled patients admitted for inpatient drug detoxification at one treatment center in northern Thailand and studied HIV risks and prevalence using an interviewer-administered questionnaire and serum collection with HIV pretest and posttest counseling. Between February 1, 1999 and January 31, 2000, 1865 patients admitted for opiate and methamphetamine dependence completed study procedures. Overall HIV prevalence was 10.3%: 30.0% among 513 injection drug users (IDUs) and 2.8% among non-IDUs (OR = 14.8, 95% CI: 10.2, 21.6). HIV seroprevalence was 2.4% among exclusive methamphetamine users (98% of whom are non-IDUs) and 3.4% among opium smokers. Injection drug use was the dominant risk factor in multivariate models. Although Thailand is widely recognized as having a successful national response to the heterosexual HIV epidemic, seroprevalence in IDUs remains high. Despite a sharp increase of non-IDUs admitted to the drug treatment center, HIV infection and risks remained high among IDUs in northern Thailand. HIV prevention campaigns need to focus on IDUs and to implement harm reduction strategies to reduce transmission to IDUs and further contain the HIV epidemic in Thailand.

Adolescent↗

PubMed2005

Prevalence of and factors associated with HIV-1 infection among drug users visiting treatment centers in Tehran, Iran.

OBJECTIVES: This study was conducted to identify the prevalence of and potential risk factors for HIV-1 infection among drug users visiting drug treatment centers in Tehran, Iran. DESIGN: Cross-sectional quantitative study. METHODS: Between October 2003 and May 2004, drug users who visited three public drug treatment centers in Tehran were interviewed and information about their sociodemographics, drug use characteristics, incarceration history, sexual history, and HIV/AIDS knowledge and risk perception were collected. Specimens of oral mucosal transudate were then collected from participants to be tested for HIV-1 antibodies. Logistic regression analysis was conducted on the association between the demographic and behavioral factors with HIV-1 infection. RESULTS: Overall, 611 (588 male and 23 female) drug users participated in the study. Among male injectors with HIV-1 prevalence of 15.2%, a history of shared injection inside prison [adjusted odds ratio (OR), 12.37; 95% confidence interval (CI), 2.94-51.97] was the main factor associated with HIV-1 infection. Among those who reported no history of injecting drug use, HIV-1 prevalence was 5.4%, and lack of condom use during sex was significantly associated with the infection (adjusted OR, 3.42; 95% CI, 1.25-9.36). CONCLUSIONS: HIV-1 infection is already prevalent among drug users in Tehran, Iran and shared injection inside prison has been revealed to be a particular risk factor for HIV-1 infection among injecting drug users. Harm reduction programs which have been started in Iran should be urgently expanded particularly in correctional settings and strengthened by condom use promotion to prevent sexual acquisition or transmission of HIV-1 among drug users.

Adult↗

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

Hepatitis C virus infection, substance use and mental illness among homeless youth: a review.

OBJECTIVES: Homeless youth are at a high risk of substance abuse, mental illness and blood-borne infections, such as hepatitis C. In this paper, we review the implications of these conditions, discuss the unique challenges faced by homeless youth, and explore potential strategies for harm reduction and intervention in this vulnerable population. RESULTS: Interventions that combine youth-centered, service-based care, street outreach, case management, and motivational interviewing with integrated health services such as hepatitis A/B vaccination, and mental health and substance abuse programmes, are presented as innovative approaches to address the healthcare needs of homeless youth. CONCLUSION: Recommendations for age-appropriate interventions and further research are made.

Adolescent↗

PubMed2004

Approaches to brief intervention for hazardous drinking in young people.

This article represents the proceedings of a symposium at the 2002 joint conference of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism in San Francisco. The chair was John B. Saunders. The focus of the symposium was on brief intervention approaches for hazardous drinking among young people. The presentations were (1) Evidence for the effectiveness of brief intervention as an approach to reducing hazardous alcohol use, by John B. Saunders; (2) College student hazardous drinking in New Zealand, the USA, UK, and Australia: implications for research, policy, and intervention, by Kypros Kypri; (3) Applications of motivational feedback on the college campus, by Scott T. Walters; (4) A population based individualized alcohol harm reduction feedback intervention: preliminary results from the college-based alcohol risk reduction (CBARR) trial, by Robert G. Laforge; and (5) Brief interventions: conclusions and future directions, by Mary E. Larimer.

Adolescent↗

PubMed2004

Is smokeless tobacco a risk factor for coronary heart disease? A systematic review of epidemiological studies.

BACKGROUND: There is on-going debate about the wisdom of substituting smokeless tobacco products for cigarette smoking as a 'harm reduction' strategy. It is generally believed that health risks associated with smokeless tobacco use (ST) are lower than those with cigarette smoking. However, the population attributable risk of smoking is higher for cardiovascular diseases than for any cancers, and few studies or reviews have considered the cardiovascular outcomes of ST use. A systematic review was therefore carried out to highlight the gaps in the evidence base. METHODS: Electronic databases were searched, supplemented by screening reference lists, smoking-related websites, and contacting experts. Analytical observational studies of ST use (cohorts, case-control, cross-sectional studies) were included if they reported on cardiovascular disease (CVD) outcomes, or risk factors. Data extraction covered control of confounding, selection of cases and controls, sample size, clear definitions and measurements of the health outcome and ST use. One or two independent reviewers carried out selection, extraction and quality assessments. RESULTS: A narrative review was carried out. Very few studies were identified; only three from Sweden consider CVD outcomes and these are discrepant. There may be a modest association between use of Swedish snuff (snus) and cardiovascular disease (e.g., relative risk=1.4, 95% confidence interval 1.2-1.6) in one prospective cohort study. Several other studies have considered associations between ST use and intermediate outcomes (CVD risk factors). CONCLUSIONS: There may be an association between ST use and cardiovascular disease. However, further rigorous studies with adequate sample sizes are required.

Cardiovascular Diseases↗

PubMed2005

Adolescent substance use: brief interventions by emergency care providers.

Use of tobacco, alcohol and other drugs plays a major role in adolescent morbidity and mortality. When under the influence of alcohol or other drugs, adolescents are at increased risk for injuries, unprotected sex, or interpersonal violence. Alcohol and other drugs are major factors in adolescent deaths, contributing to motor vehicle crashes, homicides, and suicides. Adolescents tend to have shorter substance use histories therefore they often experience emergency/acute care health treatment resulting from substance use related trauma and/or overdose. Substance use screening of adolescents who present to an Emergency Department (ED) is vitally important. The CRAFFT is a valid and reliable screening tool that was developed for use with adolescents. If an adolescent screens positive, then the next step is to determine their stage of use and readiness for change in preparation for doing a brief intervention. Helping patients to recognize the potential relation between their substance use and health related consequences, may motivate them to decrease their use for harm reduction. Motivational interviewing is an effective, evidence-based approach to helping people change their high risk behavior.

Adolescent↗

PubMed2004

Prevention with HIV-seropositive men who have sex with men: lessons from the Seropositive Urban Men's Study (SUMS) and the Seropositive Urban Men's Intervention Trial (SUMIT).

SUMMARY: Men who have sex with men (MSM) are disproportionately affected by HIV, and HIV-seropositive (HIV-positive) MSM are an especially important group for prevention efforts. This article describes findings from the Seropositive Urban Men's Study (SUMS, N = 456) and the Seropositive Urban Men's Intervention Trial (SUMIT, N = 1168). These studies were conducted from 1996 to 2002 with racially diverse samples from New York and San Francisco. Patterns of sexual behavior often reflected an understanding of the relative risks of specific sexual practices and were generally consistent with harm reduction strategies to reduce the risk of HIV transmission to uninfected partners. Some men, however, continued to engage in behaviors that placed themselves and their partners at risk for exposure to HIV and other sexually transmitted infections. Correlates of unprotected sex included self-efficacy, personal responsibility, substance use, mental health, and contextual influences. Disclosure of HIV status was a difficult issue for many HIV-positive MSM. Most participants had disclosed to their main partner, but they disclosed to less than half of their non-main partners before first sex. The interest of HIV-positive MSM in prevention efforts, the design of the SUMIT intervention trial, and implications for future research and programmatic efforts are discussed.

HIV Infections↗

PubMed2006

HIV voluntary counseling and testing and HIV incidence in male injecting drug users in northern Thailand: evidence of an urgent need for HIV prevention.

HIV voluntary counseling and testing (VCT), an important strategy for HIV prevention and care, has been available in all government hospitals in Thailand since 1992. We assessed factors associated with HIV testing, its uptake, and estimates of HIV incidence after HIV testing among male northern Thai injecting drug users (IDUs) admitted for inpatient drug treatment. Participants were interviewed about risk behaviors and HIV testing history before VCT was provided as part of the study. Of 825 IDUs who participated, 36% reported a prior HIV test. Factors associated with prior HIV testing in multiple logistic regression analysis included higher education and having >1 lifetime sex partner. Needle sharing was not associated with prior HIV testing. Of the 298 men with a prior test, 80% reported a negative result on their last prior HIV test, of whom 28% tested positive in our study, leading to an estimated incidence rate of 10.2 per 100 person-years. Fifty-nine percent of the IDUs who reported a prior HIV test stated that they did not receive pre- and/or posttest counseling. HIV incidence among IDUs remains high despite having VCT. Extending HIV prevention and harm reduction programs is urgently needed for IDUs in the region.

AIDS Serodiagnosis↗

PubMed2006

High prevalence of HIV infection associated with incarceration among community-based injecting drug users in Tehran, Iran.

OBJECTIVES: To determine the prevalence and correlates of HIV-1 infection among community-based injecting drug users (IDUs) in Tehran, Iran. METHODS: In October 2004, 213 IDUs were recruited from a drop-in center and its neighboring parks and streets in Tehran. Participants were interviewed using a structured questionnaire regarding their sociodemographics and HIV risk characteristics, and specimens of oral mucosal transudate were collected and tested for HIV-1 antibodies. Data were analyzed using chi and multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The prevalence of HIV-1 infection was 23.2% (48 of 207) among male injecting drug users. In the multivariable analysis, a history of shared drug injection inside prison (OR, 2.45; 95% CI, 1.01-5.97) and that of multiple incarcerations (OR, 3.13; 95% CI, 1.08-9.09) were associated with significantly higher prevalence of HIV-1 infection. CONCLUSIONS: The prevalence of HIV-1 infection has reached an alarming level among IDUs in Tehran, with incarceration-related exposures revealed to be the main correlates of HIV-1 infection. Urgent and comprehensive harm reduction programs for drug users in prison and those in the community in Tehran are of prime importance to prevent further transmission of HIV infection.

Adolescent↗

PubMed1989

Dutch policy on the management of drug-related problems.

It is argued that the drug abuse problem should not be primarily seen as a problem of police and justice. It is essentially a manner of health. The Dutch acknowledge that the international repressive, prohibitive approach leads to unintentional negative side-effects, both for the individual and for society. They try to avoid a situation in which consumers of cannabis suffer more damage from the criminal proceedings than from the use of the drug itself. They opt rather for a realistic and practical approach to the drug problem than for a moralistic and over-dramatized one. The Dutch alternative is the normalization of the drug problem, as a pragmatic compromise between two extreme options: an intensified war on drugs and legalization. The implications of the normalization approach for the prevention and treatment policies are discussed: AIDS-prevention, harm reduction instead of detoxification and de-mystification. It is suggested that the policy of normalization is rather successful and does not produce an increase of drug use.

Drug and Narcotic Control↗