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Biomedical subjects

A Wodak

Publications and source records attributed to A Wodak.

At least 73 records · Page 4Linked to original sources
PubMed1994

Drug use and HIV risk-taking behaviour among injecting drug users not currently in treatment in Sydney, Australia.

This study investigated the drug use patterns and HIV risk-taking behaviour of 200 injecting drug users (IDU) not currently in treatment in Sydney, Australia. Although there was low HIV seroprevalence, unsafe injecting and sexual practices were common. Variables that were predictive of injecting risk-taking were higher level of heroin use, sexual relationship with an IDU and greater polydrug use. Two variables were predictive of sexual risk-taking: higher level of hallucinogen use and sexual relationship with an IDU. Female subjects were significantly more likely to have an IDU sexual partner. A higher level of cannabis use was associated with greater polydrug use and a higher level of amphetamine use was associated with greater use of opiates other than heroin. The findings are discussed in terms of the need for interventions aimed towards reducing sexual risk-taking among users of hallucinogens and towards reducing injecting and sexual risk-taking among IDU and their sexual partners. The potential difficulty in producing behaviour change among polydrug users is highlighted.

Adolescent↗
PubMed1994

Controlled evaluation of a brief intervention for HIV prevention among injecting drug users not in treatment.

This study evaluated the effectiveness of a brief intervention (BI), a one-session motivational interview, in reducing HIV risk-taking behaviour among injecting drug users (IDU) not enrolled in any form of treatment for drug dependence. IDU were randomly assigned to either BI or a non-intervention control condition (NIC). One hundred and twenty-one subjects were successfully contacted for a 3-month follow-up and 88 subjects were followed up at 6 months. There were significant reductions for the sample as a whole for injecting risk-taking subscale scores on the HIV Risk-taking Behaviour Scale between pre-treatment and follow-up. There was no significant change in sexual risk-taking behaviour. There were no significant differences between groups on any measure at 3- and 6-month follow-up. There are a number of possible reasons why the sample as a whole showed significant improvements from initial to follow-up assessments. It is possible that, having had their attention directed to their risk-taking behaviour, subjects attempted to reduce their injecting risk-taking behaviour. If this is the case and subjects in the NIC condition can be considered as having received a BI, this suggests that BIs involving a personal risk assessment are effective in reducing risk behaviours associated with injecting. However, this suggestion could only be confirmed by comparison with a non-assessment control group.

Adolescent↗
PubMed1994

Predictors of unsafe injecting drug use.

This paper reports on the incidence of unsafe injecting and the factors which influence this practice in a sample of 1245 Sydney injecting drug users (IDUs). Using a needle and syringe after someone else at some time in the last six months was reported in 41.6% of the sample. Taking into account those who claimed always to clean used needles with virucidal methods, 32.9% had placed themselves at risk of HIV infection from shared needles in the six months prior to interview.Seven factors were predictive of unsafe behaviour. These were (a) the amount spent per week on drugs, (b) the number of times a single needle was used prior to disposal, (c) having shared with a person who is now HIV infected, (d) having a regular sexual partner, (e) the proportion of times high, stoned or drunk when injecting, (f) being part of a group that injects together and (g) having been in prison.

Journal Article↗
PubMed1994

Explanations for sharing injection equipment in injecting drug users and barriers to safer drug use.

We examined the explanations given by a sample of 1245 injecting drug users in Sydney, Australia for accepting used injection equipment. Factor analysis of these reasons revealed three dimensions of sharing: not caring when withdrawing or intoxicated, unavailability of equipment, and not seeing it as high risk or ease of injecting. The most common reasons given were difficulty in obtaining sterile equipment (73% of cases), the dangers not seeming so important when in withdrawal (40%) and sharing being something done with friends or lovers (31%). Most common reasons for not sharing were related to health issues (91% citing AIDS and 67% hepatitis). These data suggest that interventions target provision of sterile equipment, and education which highlights risk situations such as intoxication and withdrawal.

Adult↗
PubMed1994

Predictors of HIV status among injecting drug users and health promotion.

Two consecutive samples one year apart of injecting drug users (n = 754 and n = 345) were collected in Sydney, Australia and analysed for predictors of Human Immunodeficiency Virus (HIV) prevalence. Data indicated that similar variables were associated with HIV infection in both waves of the study. Risks for HIV infection included number of injections in last typical using month, acceptance of used injecting equipment from other injecting drug users (IDUs) who were known to be infected either before or after the sharing occurred, having sex with people known to be infected with HIV, and sexual orientation. It was not possible to determine whether sexual or equipment sharing with known HIV infected people preceded or followed HIV infection. These data confirm that predictors of HIV prevalence in Sydney are similar to those found in overseas studies and that sexual orientation appears to be the most powerful predictor. These data suggest both that sexual contact is an important route of infection in IDUs, and that sexual risks for HIV infection in IDUs need to be emphasised.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Predictors of intoxicated sex in injecting drug users.

Transmission of HIV by sexual contact as well as through sharing of contaminated injection equipment is a source of viral spread from injecting drug users (IDUs). We report on an analysis of data from 1,245 IDUs interviewed in Sydney, Australia in which half of the respondents reported being intoxicated during sex for more than half of their sexual encounters. The most common drugs on which people were intoxicated during sex were heroin, cannabis and alcohol. Predictors of having sex when intoxicated were a lower likelihood of having been in treatment, higher number of sexual partners, sharing injection equipment with more people and more recently, being intoxicated when injecting, and not being a sex worker. The data indicate that having sex while intoxicated is common in these IDUs and that sex under the influence of drugs is part of a more general lifestyle of spending a greater time intoxicated. Targeting of those IDUs who spend a significant amount of time intoxicated and their recruitment into treatment may thus reduce both risky sexual behaviour and risky injecting behaviour.

Adult↗
PubMed1994

Managing illicit drug use. A practical guide.

Illicit drug use is spreading, especially in the developing world, but has begun to stabilise in most developed countries. The phenomenon of illicit drug use is still poorly understood, with responses in most countries influenced largely by cultural factors. A range of psychosocial and pharmacotherapeutic treatments is available; of these, methadone maintenance treatment for heroin dependence has the most evidence of benefit. A large body of literature--including some well designed studies--indicates that methadone reduces heroin use, mortality, criminal activity and risk of human immunodeficiency virus (HIV) infection. Methadone is more likely to be effective if higher doses, longer durations of treatment and more realistic goals are set. However, research findings which would improve outcomes considerably are often not implemented. Methadone maintenance programmes, which attract and retain more illicit drug users than other treatment modalities, are now being made more available in many countries in recognition of their therapeutic effectiveness and utility in reducing the spread of HIV infection among people injecting heroin. HIV infection is now recognised in many countries to be the most serious complication of illicit drug use for both individual drug injectors and their communities. Levo-alpha-acetylmethadol (LAAM) has similar properties to methadone but a longer half-life. This suggests a number of clinical benefits which would also reduce the cost of treatment. However, LAAM has not been approved by regulatory authorities for routine use despite positive findings in some studies. Buprenorphine has shown some promise in the management of heroin dependence but is still undergoing evaluation. It is, however, unlikely to ever be used widely for the management of illicit drug users. Naltrexone may have some advantages for special populations. Pharmacotherapeutic treatment for cocaine and amphetamine users is still at a developmental stage.

Buprenorphine↗
PubMed1994

A comparison of HIV risk between women and men who inject drugs.

Although there is growing evidence of differences between women and men who inject drugs (IDUs) in terms of level of risk for HIV infection, very little research has been conducted specifically addressing the risk practices of women IDUs. This study formed part of a national study of HIV infection risks in IDUs and the purpose of the present analysis was an exploration of gender differences in HIV risk practices, focusing on the HIV risk practices of IDU women. 1,245 IDUs from the inner city area of Sydney took part in this study. Of these, 908 were men and 331 were women. Notable results were that female respondents were more likely to report sharing needles, they injected heroin more times in a typical using month and were more likely to have shared with someone they later found out was HIV seropositive. Female respondents also reported more sexual partners than men, were more likely to engage in prostitution, and were more likely to have sexual partners who were themselves IDUs. The results provide support for the proposition that women who inject drugs may be at greater risk of HIV infection through both their drug taking and their sexual practices. Further research is needed to explore the reasons underlying the risk practices of women who inject drugs and an understanding of these factors needs to be incorporated into HIV risk-reduction and drug harm-reduction policies and programs.

Adolescent↗
PubMed1993

The prescription of methadone for opiate dependence in Australia, 1985-1991.

OBJECTIVE: To describe the rates and patterns of prescription of methadone for opiate dependence in Australia from 1985 to 1991. DESIGN: Data on the numbers of Australians prescribed methadone in States and Territories were used to calculate prevalence rates of prescription of methadone. RESULTS: In 1985, Queensland had the highest rate of prescription of methadone. After the establishment of the National Campaign Against Drug Abuse, rates increased in most jurisdictions. Assessment procedures and prescribing practices, such as private prescription of methadone, appear to have markedly affected rates of prescription in some States. CONCLUSION: Large differences in rates of methadone prescription have occurred in Australian States and Territories. There are inadequate data to explain how rates of prescription are related to the prevalence of opiate use. Investigations of prevalence of injecting opiate use, demand for treatment and clinic practices are needed to explain these patterns fully.

Adolescent↗
PubMed1993

HIV infection in drug and alcohol practice.

The injecting of illicit drugs frequently involves the sharing of injection equipment and a risk of HIV transmission. Injecting drug use at any time since 1980 should be considered a high-risk activity and users should be advised to have HIV testing. Recognition of this important lifestyle clue is more likely to occur if the doctor has evolved a practical approach to the possibility of illicit drug use.

Alcohol Drinking↗
PubMed1993

Injecting drug users and HIV/AIDS: risk behaviours and risk perception.

This paper reports on the incidence of risk taking behaviours, and the relationship between risk perception and risk behaviours in a sample of 1245 Sydney injecting drug users (IDUs). Almost all respondents reported engaging in behaviours that placed them at risk of HIV infection: 32.9% through unsafe injecting, 84.4% because of unsafe sexual behaviour and 89.2% because of either injecting or sexual behaviour. Injecting and sexual behaviour were poorly correlated. This study also found that risk perception is unrelated to injecting or sexual behaviours, previous history of sexually transmitted diseases, a range of demographic characteristics including age and gender, and the number of times tested for HIV. Social policy and prevention programs should aim to change unsafe injecting and sexual behaviours directly, rather than attempting to achieve change indirectly by changing risk perception.

AIDS Serodiagnosis↗
PubMed1993

Preventing the spread of HIV among Australian injecting drug users.

Control of HIV infection among and from injecting drug users is critical for the long-term control of HIV infection in Australia. There is now consistent and strong evidence that the prevalence of HIV infection among Australian injecting drug users is still low. Recent evidence suggests that Australian injecting drug users are reducing injecting behaviour associated with HIV infection. Australian adopted harm reduction policies early and implemented a comprehensive range of programmes vigorously. These were designed to reduce the spread of HIV infection in this population. The most plausible explanation for the low prevalence of HIV infection in Australia is the adoption and implementation of these policies and programmes, although it is unrealistic to expect that this can be proved in a definitive way. Control of HIV infection in Australian injecting drug users represents one of the major public health triumphs in this country in the past decade and probably reduced the present cumulative number of AIDS cases by 1200, AIDS deaths by 800 and expenditure on AIDS by at least $60 million. However, recent international experience in this area is alarming. The prevalence of HIV infection in injecting drug users in Australia will probably rise in the future. Complacency, failure to implement HIV prevention in prisons (including especially bleach distribution), continued emphasis on supply reduction drug policy and a failure to foster a research capability will ensure that this happens sooner rather than later.

Australia↗
PubMed1993

Significant relationships and social supports of injecting drug users and their implications for HIV/AIDS services.

Strong social support networks have been associated with positive outcomes for health and well-being throughout the life-cycle. This paper investigates the structural and functional nature of social support networks of 100 injecting drug users (IDUs) in Sydney and the implications for HIV/AIDS services. Using a modified ISEL respondents saw support in terms of its tangibility of people and support, in terms of an appraisal of having friends, and as a self-esteem measure. We found the majority of respondents 'hung around' with other IDUs, lived with other IDUs, and were satisfied with the support they received from their friends. Friends appeared to be a more important source of social support than biological families and if respondents were to become HIV infected they would be more open about their status with friends than family. Where family was involved in support it was likely to be provided by mothers and siblings who were also the family members who knew about the respondent's drug use. There was no relationship between numbers of supports and satisfaction of support, suggesting quality and quantity of support were independent. Non-social supports were conceptualized primarily in terms of medical services.

Acquired Immunodeficiency Syndrome↗