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PubMedDate not supplied

[The results of sentinel epidemiological surveillance on the level of HIV prevalence among injection narcotic abusers in the city of Poltava].

The sentinel epidemiological surveillance on the level of spread of HIV infection among injecting drug users in Poltava, taking part in the program of harm reduction, was carried out. The results of the surveillance revealed that the level of HIV infection among drug users was 37.8%, the level of HIV infection among females being higher than that among males. These data indicate that the level of HIV infection rises with the increase of age and the time of drug consumption. Still in the age group of 30 years and older and among drug addicts using drugs for 7 years and longer the lowest level of HIV infection was noted.

Adolescent↗

PubMedDate not supplied

[An analysis of the situation with injection narcotic usage in the city of Voronezh during the development of the HIV infection epidemic in Russia].

The medico-demographic situation in Voronezh, characterized by a decrease in the birth rate, a rise in the mortality rate, the prevalence of pensioners (38%) in the structure of the population, is presented. The negative influence of the deterioration of socio-economic conditions on the social health of the population, especially on the situation with drug addiction, is pointed out. The extent of the misuse of narcotic and toxic substances among adolescents essentially increased. The rapid assessment of the situation with the intravenous use of drugs in Voronezh was carried out, following the WHO methodology. The conclusion was made concerning the necessity of complex sociological monitoring with a view to obtaining more reliable data on the number of drug addicts. The calculation of the supposed number of users in Voronezh among persons aged 15-30 years, made by three modules of assessment, revealed this number reached 61,374 persons, i.e. every fifth or sixth young person used some narcotic substances. The necessity of taking drastic measures on the primary prophylaxis of HIV infection among injecting drug users by creating conditions for the realization of the programs "Harm Reduction" and "Equal Helps Equal" which proved to be effective in other regions of the Russian Federation.

Adolescent↗

PubMedDate not supplied

[The UNAIDS strategy in the prevention of HIV/AIDS in the countries of Eastern Europe].

Grounds for the necessity of the formation of effective approaches to the prevention of HIV epidemic with a view to counteract the rapid spread of infection in East European countries are presented. Attention is specially drawn to fact that the epidemic will not be limited by drug users, but will quickly cross the boundaries of this group. The development of preventive measures must be based on the use of the world experience. New effective approaches to work with vulnerable groups (the strategy of harm reduction, work in communities, consultations, etc.) must be widely used. The program of actions of the UNAIDS European Section, stipulating the strengthening and extension of the potential of the countries in the region for the effective counteraction to the epidemic, is formulated. As priority areas, activities covering vulnerable groups and with young people have been determined. The strategy of UNAIDS is realized through 20 UN theme groups on HIV/AIDS in the countries of Eastern Europe. Special attention is drawn to the creation of methodological networks. The creation of a unified strategic plan for counteraction the epidemic of HIV/AIDS is regarded by UNAIDS as its perspective for the future.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[A strategy for the control of HIV infection and viral hepatitides against the background of the narcotic abuse epidemic].

The presence of the epidemic of drug addiction in the Russian Federation is stated: for the recent 10 years the number of drug addicts increased 3.5-fold. The questioning of several thousand drug addicts has revealed that 60% of them have hepatitis B, 80% have hepatitis C, 10% have syphilis. The strategy of controlling HIV infection among drug addicts is proposed. It includes, in the first place, the prevention of the secondary infection from HIV-infected addicts; in the second place, the detection of HIV-infected persons in groups of drug addicts, difficult to establish contacts with; in the third place, the primary prophylaxis within the program "Harm reduction" in the most susceptible groups of drug addicts. The thesis that the prevention of HIV infection must become the prevention of drug addiction by rendering multi-stage assistance to HIV-infected persons, including mainly drug addicts, is substantiated.

Adolescent↗

PubMedDate not supplied

[The effect of a syringe-exchange program on a decrease in the risk of HIV infection among intravenous narcotic abusers in the city of Rostov-on-Don].

The necessity and effectiveness of introducing the program of the exchange of syringes for intravenous drug users as a preventive and antiepidemic measure are discussed. Preventive and antiepidemic measures within the concept of harm reduction are described. The comparative analysis of materials obtained as a result of two sociological questionings, carried out in 1997-1998 among the representatives of the community (random nonrepeating choice) and in the middle of 1999 among the participants of the program revealed that the participants of the program had statistically significant changes in risky behavior patterns during the use of injection drugs.

Adolescent↗

PubMedDate not supplied

[The joint work of NGOs and UNAIDS in realizing a project for the prevention of HIV/AIDS among people using narcotics by injection in a region with relatively low rates of HIV infection spread].

In recent years the Ukraine has become the epicenter of AIDS in Eastern Europe, though there are still regions with a relatively low number of HIV-infected persons, such as Vinnitsa Province. After the comprehensive study of the factors contributing to the spread of HIV infection in groups of risk the realistic evaluation of the epidemiological danger could be made and the preventive work could be carried out with the help of collaboration between a non-governmental organization (NGO) and the UN Theme Group on the Problems of HIV/AIDS. The successful work of the Public Congress "Stalist" one of such NGO, in Vinnitsa in 1998-1999, carried out with the financial and methodological support of UNAIDS in the Ukraine, created conditions for the introduction of such components of the strategy of harm reduction as information and educational work, as well as the exchange of syringes and needles, which showed a high degree of efficiency in controlling the spread of HIV/AIDS.

Adolescent↗

PubMedDate not supplied

[Regional government policy in the area of preventing the spread of HIV infection and drug abuse among youth].

In 1993 the Youth Social Service, aimed at the creation of favorable conditions for the development of young people, the realization of their rights, the preservation of their individuality, their self determination and self expression, the support of their innovative activities, was created in Kiev. The work on the prevention of the spread if HIV infection and injection drug use should be considered only in the aspect of the involvement of young people in the work on the prevention of negative phenomena. The prerequisite for these programs was the tendency to an increase in the number of manifestations of negative phenomena among young people in Kiev. One of the most complicated programs was the program "Harm Reduction" among injecting drug users. The main prospect in the realization of this program was the involvement of a large number of volunteers and training by the method "Per Education".

Adolescent↗

PubMedDate not supplied

[The prevention of HIV/AIDS among injection narcotics users in the city of Odessa].

Since August 1996 the realization of the first Ukrainian Project "HIV/AIDS Preventive Maintenance among Injecting Drug Users", based on the strategy of harm reduction, has been started in Odessa with a view to the effective counteraction to the spread of HIV/AIDS among injecting drug users (IDU). The project is being realized with the advisory and financial support of UNAIDS, UNICEF and USAID. The basic organization for the realization of the Project is the Public Movement "Faith, Hope, Love". The Project is aimed at decreasing the rate of the spread of HIV infection in cases of the non-medical use of narcotic drugs by the elaboration and adoption of measures conductive to changes in hazardous behavior. The realization of the project includes the following stages: the rapid evaluation of the situation with the injecting use of drugs in Odessa, the elaboration and adoption of preventive measures.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[The prevention of HIV/AIDS among injection drug abusers and women in the sex business in the city of Kharkiv].

A steady increase of the number of persons with drug addiction has been noted both on Kharkov and Kharkov Province. Since 1996 a considerable number of HIV-infected persons has been detected among injecting drug users (80-82% of them infected parenterally). Rapid evaluation, carried out in 1997 within the project "Harm Reduction", served as the basis for the creation of the Charity Fund "Scarlet Ribbon" collaborating with the UNAIDS Representation in the Ukraine and other international organizations. The information and educational activity of the Fund among injecting drug users is presented. The necessity of organizing additional stationary and mobile exchange stations of the syringe is pointed out.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[We rely on the common sense of young people].

The principles of the primary prophylaxis, analogous to the program "Harm Reduction", are presented. The basis for placing this work on broad footing was the rapid assessment of the situation with the use of narcotic drugs in the city (the number of users exceeded 10,000 per 238,000 inhabitants) with a tendency towards a sharp decrease of the age of the users (9-13 years). The experience of work on the training of medical personnel, directly contacting with blood and thus considered to be a risk group, taking into account risky professional behavior (potentially dangerous), was accumulated. The training activities among students of medical schools proved to be effective. They became the best volunteers and leaders among young people. Adolescents aged 14-18 years were enlisted as volunteers: they worked in different places usually attended by young people and invited drug addicts to the anonymous examination room. The role of local mass media in educating the public on of the problems of the prevention of HIV infection is discussed. As a result, the activation of the youth movement in support of the program "Anti-AIDS" and an increase in the number of people in target groups coming to the anonymous examination room are noted.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Public health and hepatitis C.

This paper reviews key public health aspects related to surveillance, transmission and primary prevention of hepatitis C. Hepatitis C is now a reportable disease in all Canadian provinces and territories. Although prevalence in Canada is estimated at under 1%, that associated with injection drug use (IDU) approaches 90%. The epidemiology of new HCV infections in Canada is now primarily defined by IDU behaviour, with annual incidence rates among new drug injectors exceeding 25%. HCV is less efficiently transmitted through other routes of exposure. An effective vaccine against HCV remains elusive. Some jurisdictions offer hepatitis A and hepatitis B vaccine to HCV-infected persons. An array of harm reduction strategies targeting IDU has been implemented but underdeployed across Canada, and has been ineffective to date in controlling the HCV epidemic. Public policy alternatives, such as legalization and regulation of injection drugs, are being debated. Improved HCV preventive strategies are urgently required and need careful evaluation.

Canada↗

PubMed2000

Effectiveness of HIV prevention interventions in developing countries.

OBJECTIVE: To review the effectiveness of projects and programs in developing countries that aim to reduce sexual transmission of HIV infection or transmission related to injection drug use. DESIGN: We identified 34 published studies undertaken in 18 developing countries that met rigorous inclusion criteria. These criteria included the length of follow-up, use of statistical analysis, the inclusion of a comparison group, and type of outcomes measured. RESULTS: We found that behavioral change interventions are effective when targeted to populations at high risk, particularly female sex workers and their clients. Few studies have evaluated harm reduction interventions in injecting drug users (IDUs). Evidence on the effectiveness of voluntary counseling and testing programs was promising, and VCT was most effective when directed at discordant couples. Treatment of sexually transmitted diseases (STD) appears highly effective in reducing HIV/STD transmission, particularly in the earlier stages of the epidemic. CONCLUSIONS: This review demonstrates that HIV prevention interventions can be effective in changing risk behaviors and preventing transmission in low and middle-income countries. When the appropriate mix of interventions is applied, they can lead to significant reductions in the prevalence of HIV at the national level. Additional research is needed to identify effective interventions, particularly in men who have sex with men, youth, IDUs and HIV-infected persons. Structural and environmental interventions show great promise, although more evaluation is needed.

Developing Countries↗

PubMedDate not supplied

Syringe exchanges: a public health response to problem drug use.

This paper presents the findings of the first ever Irish follow-up study to establish the effectiveness of syringe exchanges as a harm reduction strategy in the context of public health. The study was conducted in collaboration with 370 injecting drug users who attended the Merchant's Quay Project's Health Promotion Unit between May 1st 1997 and October 31st 1998. Data was collected from respondents by means of a structured interview at first visit and three-months after initial contact. Evidence from the study demonstrates that syringe exchanges play an important contributing role in significantly reducing the numbers reporting both the use of heroin as a primary drug (n=41; McNemar x2=10.1;p<0.01), and its frequency of use (n=70; McNemar x2=4.13;p<0.05) at follow-up. Moreover, there were significant reductions in the reported borrowing (n=60; McNemar x2=10.1;p<0.01) and lending (n=42: McNemar x2=7.9;p<0.01) of used injecting equipment. There was however no significant change in the reported sharing of injecting paraphernalia or in levels of reported condom use. The results of this study illustrate that low threshold services such as the Health Promotion Unit have the ability to attract injecting drug users not in contact with other drug treatment services. Furthermore, this type of service has been shown to be effective in maintaining contact with injecting drug users and promoting safer drug use among attendees. Even though the distribution of sterile injecting equipment reduces the situational sharing, this is hampered by the limited availability of sterile injecting equipment in Dublin. There is a need to continue to develop strategies to prevent HIV and hepatitis C transmission. One such approach would be to develop effective outreach as a means of reaching greater numbers of drug users earlier in their injecting histories. Other areas for future HIV and HCV prevention include discouraging the transition from smoking to injecting, and among those who inject, encouraging further reductions in sharing, sustaining risk reduction over time, and encouraging the adoption of safer sexual behaviour.

HIV Infections↗

PubMed2000

[Risks incurred by first-injection intravenous drug users] [In Process Citation]

Aims. - The objectives of the study were to describe the circumstances surrounding the intiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. Design.- In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. Participants.- Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. Findings. - The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72% and 74% of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83% and 85% of cases. Conclusion. - Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.

Journal Article↗

PubMedDate not supplied

Video-assisted thoracic surgery--state of the art.

Video-assisted thoracic surgery (VATS) is one of the main medical revolutions of the past decade. For its satisfactory performance, the following prerequisites are essential: (1) knowledge and experience in thoracic surgery; (2) team of experienced anesthesiologists; (3) preoperative assessment of respiratory function; (4) adequate postoperative care; and (5) instruments specially designed for thoracoscopic surgery. VATS is routinely performed under general anesthesia with double lumen endotracheal intubation for separate control of each lung. Insufflation of carbon dioxide must not exceed 1-3 mm Hg. Too high pressure may cause harmful reduction of venous return and mediastinal shift with impairment of ventilation. Presence of adhesions should be determined by finger exploration of the pleural cavity. Operative ports should be placed carefully, avoiding damage to the intercostal nerves and vessels. The video technique can be used with efficiency for the following indications: pneumothorax, resection of pulmonary nodules, biopsies of lung, pleura and mediastinal structures, resection of mediastinal tumors, management of empyema, and hemostasis and closure of lacerations after trauma. Indications for esophageal procedures include esophagomyotomy for achalasia and resections of benign lesions. Repair of perforated esophagus is a matter of controversy, but in early stages it can be done thoracoscopically. Although video-pericardioscopy has been performed by some surgeons, this procedure can be done easier and faster using the direct approach without the video equipment. There are differences of opinion with regard to major pulmonary and esophageal resections for cancer. The apparent advantage of diminished pain is offset by inadequate resection, spread of malignant cells and potential damage to the resected specimen with loss of important information concerning pathology. Complications of VATS are few, and include prolonged air leak, dysrhythmia, respiratory failure, bleeding and infection. Due to progress over the past several years, VATS has become an inseparable part of thoracic surgery and should be included in the basic training of every thoracic surgeon.

Humans↗

PubMed2000

[Risks incurred by the first intravenous drug injection].

AIMS: The objectives of the study were to describe the circumstances surrounding the initiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. DESIGN: In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. PARTICIPANTS: Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. FINDINGS: The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72 % and 74 % of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83 % and 85 % of cases. CONCLUSION: Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.

Adolescent↗

PubMed2001

Drug use and social circumstances: a study among different target groups in northwest Bangladesh.

The use of illicit drugs has become an increasingly serious problem among various sections of the Bangladesh population. However, there has been almost no research on the use of illicit drugs by Bangladeshi people. This paper examines drug use patterns and the social circumstances within which drug-taking behaviour took place among a sample of different target groups. The study incorporated a semi-structured qualitative interview and a structured quantitative questionnaire. Demographic and drug use information was collected from a total of 154 drug users. Approximately three-quarters of the subjects reported that they had used alcohol and ganja in the month prior to being interviewed. The findings revealed interesting differences between the groups. For example, the student group was found to use phensidyl syrup (67%) more often than those of other groups and did not differ significantly in the use of ganja. The use of heroin and sedatives was widespread, with nearly one-third of subjects (40%) reporting having injected these drugs. The majority (41%) of most recent drug use occurred in conjunction with a group of people. Drug use was associated with frustration, peer pressure, family problems and curiosity. Peer education programs are likely to be the most effective harm reduction approach among new drug users. The implications of these findings are discussed.

Adolescent↗

PubMed2001

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↗