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PubMed1996

Migrant injecting users: characteristics of Italian drug users living in Amsterdam.

The aim of the study was to compare the behavior of Italian injecting drug users (IDUs) in Amsterdam with Italian IDUs who moved abroad but returned with those who never moved. The Italian IDUs in Amsterdam showed a pattern of drug use very similar to the Dutch IDUs. They also reported a high prevalence of needle borrowing, needle lending, and HIV-1 infection. One out of three Italian IDUs in Amsterdam reported nondrug using occasional sexual partners, but condom use was always reported. This study shows that Italian IDUs in Amsterdam are a marginalized population with a high risk of HIV transmission.

Adult↗

PubMed1991

Suboptimal response to hepatitis B vaccine in drug users.

Fifty-five drug users institutionalized in a community for drug detoxification were vaccinated against hepatitis B virus (HBV) with a recombinant yeast-derived vaccine (Engerix B, Smith Kline Biologicals, Belgium). At 0, 1, and 6 months, 20 micrograms of vaccine was given in the deltoid to these patients, of whom 17 had no serum HBV markers, 15 had only the antibody to core antigen (anti-HBc), and 23 had anti-HBc and antibody to the surface antigen (anti-HBs) values lower than the allegedly "protective" value of 10 mIU/mL. Forty-one healthy controls were vaccinated in parallel. At month 7 (ie, 1 month after the third dose of vaccine), in 76% (13/17) of drug users with no HBV markers, 6% (1/15) of those with isolated anti-HBc, and 69% (16/23) of those with anti-HBc and nonprotective anti-HBs, protective anti-HBs titers (greater than or equal to 10 mIU/mL) developed, compared with 97% (40/41) of controls. At month 24, these rates fell to 43% for drug users with no HBV marker, 0% for those with anti-HBc, 31% for those with anti-HBc and anti-HBs, and 86% for controls. The drug users who did not respond to vaccination were more likely to be those with evidence of prior HBV infection and anergy to skin tests. This indicates that unresponsiveness to hepatitis B vaccine in drug users may be due to altered immunity.

Adult↗

PubMed2006

A bridge over troubled waters: factors associated with non-injection drug users having injection drug-using sex partners.

OBJECTIVES: To examine factors associated with noninjectors having 1 or more injection drug users as sex partners. METHODS: We collected data as a part of the Self-Help in Eliminating Life Threatening Diseases study, a network-oriented experimental HIV prevention intervention. All eligible participants were administered a detailed face-to-face interview on their sociodemographic background, patterns of drug use, HIV prevention and risk behaviors, and social networks. The sample for these analyses consisted of 863 noninjectors, 97 of whom had 1 or more injection drug-using sex partners. RESULTS: Among the factors associated with an increased odds of having 1 or more injecting sex partners were long-term unemployment, increasing proportion of women in network (among male noninjectors), increasing number of recent sex partners (among former injectors), increasing number of injecting non-sex partners in the network, and increasing network size above 15. CONCLUSIONS: There are specific network characteristics associated with noninjectors having injecting sex partners.

Adult↗

PubMedDate not supplied

Demystifying the injection drug user: willingness to participate in traditional drug treatment services among participants in a needle exchange program.

Injection drug users have been vilified in our culture as being wild-eyed and willing to do anything for the next hit. These individuals are typically seen as being unemployed, uneducated and completely disinterested in making any changes in their lives. Sixty-one participants in a syringe exchange program in Cleveland, Ohio were interviewed using the NIDA Risk Behavior Assessment. Fifty (81%) of the respondents were either in an abstinence-based program or reported a willingness to participate in such a program. Importantly, although the sample consisted of long-term daily users of injection drugs (m=19.95 years), the majority of the sample was employed (69%) and were high school graduates (51%). The results of this study suggest that injection drug users are willing to make changes in their use-related behaviors, involvement in a needle exchange program does not preclude involvement in abstinence-based programming, and needle exchange services may serve as an important component in a continuum of care when coupled with traditional abstinence-based services.

Adult↗

PubMed1980

The HIT clinical profile of psychedelic drug users.

Forty-three psychedelic drug users and 39 non-drug users matched by age, sex, and amount of education, were given the Holtzman Inkblot Technique (HIT). Scores were plotted on the HIT Clinical Profile Sheet. Psychedelic drug users scored significantly higher on Movement, Human Abstract, Color, Hostility, Pathognomic Verbalization, and Sex. Cluster analysis of HIT variables showed that reality contact was adequate for both groups. Drug users were shown to be more actively imaginative, to demonstrate a greater capacity for empathy, to fantasize more, and are more likely to act-out their feelings and possess more unconscious hostility. Although drug users gave a greater number of deviant responses, profile analysis contraindicates evidence of psychopathology. In general, the drug users were significantly more inner-directed than the non-users. It was found that plotting mean scores on the HIT Clinical Profile Sheet without statistical analyses does not accurately reflect the degree of differences between groups of subjects.

Adolescent↗

PubMed1987

AIDS and self-organization among intravenous drug users.

Gays and intravenous (i.v.) drug users are the two largest risk groups for AIDS. Gays, unlike drug users, have formed many organizations to deal with AIDS. Data are presented indicating that gay individuals have more risk-reducing behavioral changes than have i.v. drug users. It is also shown that i.v. drug users are more likely to protect themselves if their acquaintances do so. It is suggested that collective self-organization can lead to peer support for risk reduction and that this can help i.v. drug users to reduce their risks on an ongoing basis. Difficulties that face i.v. drug users' attempts to organize collectively and examples of i.v. drug user collective organization to deal with AIDS and other problems are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Knowledge of HIV serostatus and preventive behaviour among European injecting drug users: second study. European Community Study Group on HIV in Injecting Drug Users.

The objective of the study was to analyse the effect of knowledge of HIV serostatus on behaviours preventing the acquisition or transmission of HIV among European IDU, and to compare results with a previous similar study conducted 3 years before. Data were gathered in 1992-1993 during a retrospective multicentre cross-sectional study of IDU recruited in 11 European countries, in specialized centers and on the street. We compared, between groups with different HIV serological status (IDU who knew well before their HIV-positive serological status, IDU who knew their HIV-negative serostatus and IDU who did not know before their serological status), the respective proportions of IDU who reported that, during the six months prior to interview, (1) always used condoms, (2) never gave their used injecting equipment to other IDU, (3) always injected drugs safely. We only included IDU who had known their serological status for at least six months prior to interview. Results were compared to the similar survey conducted in 1990. From 2171 IDU recruited, data of 1334 IDU were included in the analysis. Compared with IDU who did not know their HIV serostatus, only IDU knowing their HIV-positive serostatus used condoms significantly more often (37% compared to 15%, rate ratio (RR): 2.4; 95% confidence interval (CI): 1.8-2.3) and never gave their used injecting equipment to other IDU (69% compared to 53%, RR: 1.3; 95% CI: 1.2-1.4). In comparison with the 1990 study, only condom use significantly improved and only for IDU who knew their HIV-negative serostatus (13% compared to 9%, RR: 1.6; 95% CI: 1.1-2.3). This study confirms among European IDU the relation between knowing own HIV serological status to preventive behaviours. However, there were only minor improvements between 1990 and 1992-1993, indicating that prevention of HIV transmission among IDU must be reinforced.

Adult↗

PubMed1990

The criminality of new drug users in Glasgow.

The drug use and crime of 210 teenage licit and illicit drug users were examined. Over 90% of the sample, including non-users, soft drug users, opioid users and injectors, were obtained via the same 'snowball' of friends and acquaintances. None had been injecting for more than 2 years. It was found that the frequency of use of all licit and illict drugs and the frequency of all crimes were intercorrelated. However, even many of the opioid injectors in this sample were not near-daily users and 'addiction' did not explain the results of regression equations predicting crime and drug use; crime explained drug use more than drug use explained crime and drug use was not a major unique predictor of theft. The criminal drug-using teenagers in this sample were better regarded as 'delinquents' than as 'drug-abusers' or 'drug addicts'. Delinquent behaviour of all kinds appeared to be increased by prior criminal experience, having delinquent friends and lack of conventional social support (notably including having spent time in care). Implications of these findings for theories of delinquency and the practice of treatment and prevention are discussed.

Adolescent↗

PubMed1994

Risk factors for HIV infection among drug users in Yunnan province, China: association with intravenous drug use and protective effect of boiling reusable needles and syringes.

OBJECTIVES: To characterize the prevalence and correlates of HIV infection among drug users in southwestern China. METHODS: Drug users in Longdao village, Yunnan Province underwent standardized interview and voluntary HIV serologic testing in a cross-sectional study. Analyses of potential risk and protective factors were stratified by method of drug use. RESULTS: Of 182 participants, 79 (43%) were HIV-1-seropositive. HIV seropositivity was found in 51 (80%) of the 64 intravenous drug users (IVDU) and 28 (24%) of the 118 who acknowledged use of drugs only by smoking [odds ratio (OR), 12.6; 95% confidence interval (CI), 5.7-28.5]. Among IVDU, reported sterilization of reusable injection equipment by boiling before intravenous drug use was associated with significant protection (adjusted OR, 0.16; 95% CI, 0.03-0.87). This protective association was also significant among the subset of IVDU who shared reusable injection equipment. CONCLUSIONS: HIV infection among drug users in Yunnan Province was highly correlated with intravenous drug use. The protective effect of sterilization of reusable injection equipment by boiling could be easily integrated into health education programs among IVDU in China and other rural Asian settings where reusable injection equipment is used.

Adult↗

PubMedDate not supplied

Drug sharing and HIV transmission risks: the practice of frontloading in the Dutch injecting drug user population.

Injecting drug users may now be the largest group at risk for contracting HIV, mainly through the sharing of drug injection equipment (including lending, borrowing, and renting). This article presents the results of an ongoing ethnographic study into the drug-taking rituals of heroin addicts. A possible additional route of HIV contamination is presented, namely the ritual sharing of drugs through a practice termed "frontloading," which is embedded in a broader pattern of the sharing of resources among addicts. It is hypothesized that in the Netherlands this practice may be responsible for a substantial proportion of HIV spread among injecting drug users.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Risk Factors and predictors of human immunodeficiency virus infection among injection drug users.

BACKGROUND/AIM: Injection drug users (IDUs) have a high risk of acquiring an infection with the human immunodeficiency virus (HIV). To improve counseling and prevention, a better understanding of risk factors and predictors for an infection must be gained. This retrospective study has the aim to determine the risk factors for acquisition of HIV infection other than sharing of needles/syringes. METHODS: The study population consisted of all patients admitted to the detoxification unit between 1991 and 1996 who met ICD-10 criteria for opioid dependency, who reported to share needles, and who agreed to have an antibody test. Possible risk factors were assessed by interview. Cross tables based on bivariate logistic regression were constructed to estimate the relative odds. Multiple logistic regression modeling procedures were used to adjust possible confounding factors. RESULTS: A total of 1,049 out of 1,656 patients admitted were included into the study. 4.8% of the patients were HIV-1 seropositive. The prevalence was higher among older patients and among patients living with a significant other substance drug user with substance dependency, after a longer duration of drug use, and after coinfection with hepatitis B virus and/or hepatitis C virus (HCV). Using multiple logistic regression analyses and including all individually significant risk factors, we found only coinfection with HCV to remain significant. 92% of the HIV-infected patients were also HCV infected. In the group younger than 23 years of age, a total of 53.5% of the IDUs were still seronegative for HIV, hepatitis A and B virus, and HCV. CONCLUSIONS: Despite the high rate of HCV coinfection (92%) in HIV-infected patients, we found more than 50% of IDUs younger than 23 years to be neither infected with HCV nor with HIV. Early prevention strategies against infectious diseases should especially focus on young IDUs.

Adult↗

PubMedDate not supplied

Clinical management of HIV disease in intravenous drug-users.

Intravenous drug-users comprise a major group of HIV-infected individuals in the developed world and, whilst progression of HIV disease in them appears little different from other risk groups, their medical presentations may be altered by continuing drug use. Drug-users are particularly susceptible to bacterial infections irrespective of their HIV status; they may present with symptoms directly caused by their drugs, which can be difficult to differentiate from non-drug-related causes and may closely resemble symptoms directly attributable to HIV. In addition, the life style associated with drug use can make compliance difficult, but in clinics combining HIV care and methadone prescribing these problems can be overcome.

Female↗

PubMed2000

Continuation of high-risk behavior by HIV-positive drug users. Treatment implications.

Drug users who are positive for the human immunodeficiency virus (HIV) represent a major vector of HIV transmission, yet relatively little is known about their continued drug- and sex-related HIV-risk behavior, which may impede the development of effective risk-reduction interventions. In this study, 50 HIV-seropositive injection drug users entering methadone maintenance treatment completed a comprehensive risk assessment battery, including self-report of HIV-risk behavior since learning HIV serostatus, and measures of risk-reduction information, motivation, and behavioral skills. We found that a disconcertingly high proportion of patients (66%) reported having engaged in HIV-risk behavior since learning their HIV-seropositive status. Level of HIV-related knowledge did not predict high-risk behavior. Drug-related risk behavior was predicted by psychiatric severity and poor behavioral skills. Sex-related risk was predicted by low levels of motivation and poor behavioral skills. Implications of these findings for treatment are discussed.

Adult↗

PubMed1997

Immunoresponse to hepatitis B vaccination and adherence campaign among injecting drug users.

Fifty injecting drug users (IDUs) were recruited to evaluate the efficacy of an hepatitis B virus (HBV) vaccination campaign to be carried out in a Public centre for Drug Users (PCDU). The vaccination schedule was successfully performed in most patients, who showed a great interest in this problem. After three doses of vaccine the seroconversion rate, with antibodies against HBV, proved similar to the one obtained in another group of healthy men of same age, while the antibody titres against HBV were lower after the second and third dose of vaccine. Vaccination campaigns for IDUs could lead to successful results in terms of compliance and efficacy, but they need to be closely monitored considering the IDUs relatively low antibody response.

Adult↗

PubMed1990

The practical business of treatment--13. Providing health care for drug users?

The majority of drug users neglect their health and have limited access to primary and preventative health care services. A health care team was developed in an attempt to provide health care for drug users, to prevent the spread of HIV and provide health education to the drug users. The health problems were related to injecting drugs, comprising abscesses, peripheral neuropathy and poor peripheral circulation. A high level of past infection with hepatitis B virus was noted, indicating the need for hepatitis B vaccination for drug users.

England↗

PubMed1992

Mad, bad and dangerous to know: dimensions and measurement of attitudes toward injecting drug users.

Attitudes toward injecting drug users were assessed using a 53-item questionnaire which was administered to 143 workers at a drug and alcohol research unit and an AIDS treatment facility. Factor analysis revealed three interpretable dimensions: intravenous drug use as a matter of both public concern and personal inadequacy; intravenous drug users as criminals who should be removed from society; and social avoidance of, and personal distaste for, intravenous drug users. The scale and subscales had good test-retest reliability and internal consistency. Its potential use as a measure of attitudes toward injecting drug users for both treatment research and AIDS research is discussed.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Challenges facing health professionals caring for HIV-infected drug users.

Although injection drug use accounts for only 5% to 10% of cumulative HIV infections globally, it is a more efficient way of spreading HIV than sexual intercourse. HIV epidemics among injection drug users (IDUs) have a potential for rapid spread of the virus within the IDU community and outward into the general population. Effective interventions addressing this mode of HIV transmission are needed because part of a comprehensive strategy to curb the spread of HIV infection. IDUs, often marginalized, pose serious health challenges that can no longer be overlooked. Health care providers need to familiarize themselves with these challenges in order to meet the needs of this disenfranchised population. Providers need to have a clear understanding of targeted behavior and their patients' environmental context. Efforts must be made to foster healthy behavior among IDUs to assist them in managing their infection effectively and become productive members of society. This paper reviews these challenges and outlines selected models that may assist health care providers in fostering behavior changes among HIV-positive injection drug users.

Anti-Retroviral Agents↗

PubMed2001

Predicting condom use with casual and steady sex partners among drug users.

In many Western societies, drug users are accountable for heterosexual transmission of HIV. Although various studies have shown that safe sex is not a common practice among drug users, we still have little understanding of the factors that determine their use of condoms in their sexual relationships with steady or casual partners. The objective of this study is to gain more insight into the determinants of drug users' condom use with steady and casual sex partners. In a study conducted among 103 Dutch drug users, the participants indicated their intentions, vulnerability, attitude, personal norms, subjective norms, descriptive norms, self-efficacy and response efficacy regarding condom use with steady and casual partners. The results showed that some drug users had borrowed used syringes and that most drug users practise unsafe sex, especially with steady partners. Most drug users were hardly motivated to start using condoms. The study further showed that antecedents of condom use differ with regard to steady sex partners and casual sex partners. Self-efficacy and subjective norms were predictors of intentions to use condoms with steady partners; intention to use condoms with casual partners was only predicted by self-efficacy. These differences should be taken into account when designing AIDS prevention interventions to encourage use of condoms.

Adult↗