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Biomedical subjects

A Wodak

Publications and source records attributed to A Wodak.

At least 91 records · Page 5Linked to original sources
PubMed1993

HIV infection among injecting drug users in Asia: an evolving public health crisis.

Injecting drug use is being reported from an increasing number of Asian and other Third World countries. HIV continues to spread globally among and from populations of injecting drug users (IDUs), although the rate of spread appears to have slowed down recently in some industrialized countries. Asia produces two-thirds of the world's supply of opium. In recent years the rapid development of new illicit drug trade routes in efforts to evade detection by law enforcement authorities has exposed new populations in Asia to drug injecting and, thus, the risk of HIV infection. Epidemic spread of HIV has recently commenced in some Asian countries among injecting drug users, and others are at substantial risk of an HIV epidemic among their IDU populations. The speed of spread and the consequences of HIV infection among IDUs in Asian and other Third World countries are even more profound than in western countries. Asian countries attempting to control this component of the epidemic often have greater difficulty than industrialized countries because of their proximity to drug producing areas, scarcity of resources and a greater likelihood of pragmatic policies conflicting with traditional values. Vigorous efforts are urgently required at both a national and international level to raise awareness of the consequences of an uncontrolled epidemic of HIV among IDUs in Asian and other countries, and to support the implementation of policies which are likely to reduce the spread of HIV.

Asia↗
PubMed1993

Changes in equipment sharing in injecting drug users in Sydney 1989-1990.

We investigated levels of equipment sharing in injecting drug users in Sydney, Australia, in two consecutive samples recruited in a non-treatment setting using similar methodology in 1989 (n = 1,245) and 1990 (n = 550). Comparison between the two waves of the study indicated that there were consistent and major reductions in percentage of time used equipment was re-used, and number of people from whom used equipment had been accepted. There was a corresponding significant and major increase in use of sterile injection equipment, obtained more frequently in the second sample from needle and syringe exchanges. The proportion of respondents reporting they had never shared equipment rose significantly. These data suggest that there is a continuing increase in the adoption of safer injecting practices and utilisation of needle and syringe exchanges over time in response to the threat of HIV transmission in injecting drug users.

Journal Article↗
PubMed1993

HIV prevalence among IDUs in Australia: a methodological review.

A review was carried out of Australian studies which have measured the prevalence of HIV infection among injecting drug users (IDUs). The review considered published studies which had reported on serologically-determined HIV prevalence. There were five studies reported from specialized sexually-transmissible disease of HIV clinics, five studies reported from health services aimed at IDUs, three studies reported from other health services and one multi-centre behavioural study. The main findings from the studies were that HIV prevalence in IDUs has been low in Australia, apart from in male IDUs who also had homosexual contact. HIV prevalence ranged from 20 to 24% in male IDUs reporting homosexual contact and from 0 to 5% in other IDUs.The studies, while reflecting a range of research methodologies, are subject to a number of limitations. Most of the studies did not provide detailed analyses of HIV prevalence by age and sex or behavioural factors, and several studies used sampling frames which were not clearly defined. There is little available information on temporal trends in seroprevalence and geographical comparisons are rendered difficult by differences in the study methodology. Adoption of standardized, continuing seroprevalence surveys on IDUs would provide a better means of monitoring the occurrence of HIV infection in this group, which has been a key determinant of the course of the HIV epidemic in a number of Western countries.

Journal Article↗
PubMed1993

Evaluation of a cognitive-behavioural intervention for HIV prevention among injecting drug users.

OBJECTIVE: To evaluate the effectiveness of relapse prevention (RP) and brief intervention (BI) in reducing HIV risk-taking behaviours among injecting drug users (IDU) enrolled in methadone programmes. The hypotheses tested were: (1) that a six-session RP programme would be more effective in reducing HIV risk-taking behaviours than a one-session BI and a non-intervention control condition (C); and (2) that BI would be more effective in reducing HIV risk-taking behaviours than C. DESIGN: Clients of methadone programmes were randomly assigned to either RP, BI, or C. Follow-up occurred 6 months after pre-intervention assessment and was conducted by independent research assistants who were not aware of subjects' group allocations. SETTING: Confidential assessment interviews and interventions generally took place at the methadone unit treating the subject. PARTICIPANTS: Ninety-five IDU enrolled in methadone programmes. Study entry criteria were: injection of any drug in the 6 months before the day of pre-intervention assessment; literacy in English; agreement to HIV-antibody testing for research purposes; and no known diagnosis of a serious mental illness. Eighty subjects were contacted successfully for a 6-month follow-up. INTERVENTIONS: The RP intervention was a six-session programme. Each 60-90 min session was conducted individually. The BI was a one-session motivational interview lasting 60-90 min, accompanied by a self-help booklet. MAIN OUTCOME MEASURES: All subjects were administered the Drug Use Scale and HIV Risk-Taking Behaviour Scale of the Opiate Treatment Index and consented to the collection of a capillary blood sample for HIV-antibody testing at pre-intervention assessment and follow-up. At follow-up, the Highest HIV Risk-Taking Behaviour Scale, collateral reports from subjects' sexual partners pertaining to the previous month and urinalysis results for the month before follow-up were collected. RESULTS: Compliance with interventions was good. Correspondence of self-reports with urinalysis and collateral reports was satisfactory. There were no significant differences between groups in risk-taking behaviours during the month before follow-up. However, there was evidence of a lower rate of needle-risk behaviour (sharing and cleaning) during the heaviest risk-taking month since pre-intervention assessment in the group given RP. There were no indications that BI was of greater benefit than the usual methadone treatment and neither intervention appeared to reduce sexual risk behaviour. CONCLUSIONS: The results are cautiously interpreted as showing that individual RP programmes decrease the level of needle-risk behaviour during relapse episodes, but further research is required to replicate this finding.

Adolescent↗
PubMed1993

The effects of methadone on immune function among injecting drug users: a review.

Methadone maintenance therapy is advocated as a major preventive strategy for the spread of the human immunodeficiency virus (HIV) and other blood-borne infectious agents among injecting drug users (IDUs) because of its effects in decreasing the frequency of injecting and presumably sharing of equipment. As an opioid agonist, methadone may share the direct and indirect immunoregulatory effects of other opioids, and thus affect susceptibility to, and the natural history of, HIV infection. Available evidence pertaining to methadone and immune function is reviewed. The long-term immunosuppression observed in heroin injectors on present (incomplete) evidence appears to be caused by factors associated with a drug-using lifestyle rather than by a direct action of heroin. Although data are conflicting, it is most likely that methadone does not significantly impair immune function and is safe for HIV-infected IDUs, possibly even allowing some improvement of immune function to occur. The increasing reliance placed on methadone maintenance to control the epidemic of HIV infection in IDUs requires that remaining uncertainties regarding methadone and immune function are clarified urgently.

Antibody Formation↗
PubMed1993

Patterns of drug use and risk-taking among injecting amphetamine and opioid drug users in Sydney, Australia.

Data are presented on the patterns of drug use and HIV risk-taking of daily amphetamine and opioid injectors among 1245 injecting drug users who were interviewed in Sydney in 1989. About one-third of the sample had injected amphetamines during a typical month of injecting, and 12% were using amphetamines on a daily basis. Daily amphetamine injectors were younger, less well educated, and less likely to have engaged in drug treatment, but they were no more likely than daily opioid users to have shared injection equipment or to have engaged in other behaviour likely to transmit HIV. Although there seemed to be no special cause for concern about HIV risk-taking among amphetamine injectors, there was nonetheless a high prevalence of sharing injecting equipment, with over half of daily amphetamine and heroin injectors having shared in the past several months. In addition, approximately a third of amphetamine injectors were injecting on a daily basis, a pattern of use which increases the risk of developing a severe dependence syndrome, and of experiencing an amphetamine-induced psychosis.

Adolescent↗
PubMed1993

Strategies for the prevention of HIV infection among and from injecting drug users.

Despite a substantial reduction in the level of high-risk behaviours among injecting drug users (IDUs) documented in an impressive number of studies from many countries, human immunodeficiency virus (HIV) infection continues to spread among and from this population, reflecting the high baseline levels of these risk behaviours before the epidemic. In many countries, the control of HIV spread among IDUs is critical to efforts to control the epidemic in the population as a whole. Although the evaluation of individual or multiple strategies is problematic, there is accumulating evidence and increasing confidence that the course of the epidemic can be altered by implementing some or all of a range of strategies. Authorities mindful of their public health responsibilities should estimate the risk of spread of HIV among and from IDU populations in their jurisdiction and plan their response accordingly by selecting prevention measures that are appropriate for local conditions and by vigilantly monitoring developments.

AIDS Serodiagnosis↗
PubMed1993

A comparison of drug use and HIV infection risk behavior between injecting drug users currently in treatment, previously in treatment, and never in treatment.

We compared three groups of injecting drug users in a large cross-sectional study on HIV/AIDS and risk behaviors in Sydney, Australia, to determine what differences existed between those who had never been in treatment (n = 458), had previously been in treatment (n = 387), and were currently in treatment (n = 367). Drug use for those currently in treatment was assessed during the last typical using month before treatment. Those previously and currently in treatment were similar in terms of drug use patterns and HIV risk-related injecting behaviors. Those never in treatment were younger, had a lower level of HIV risk-related injecting behaviors, and reported lower drug use and less involvement in the drug subculture. There was little difference between the three groups on HIV risk-related sexual behaviors. These data suggest that those never in treatment are less dysfunctional and possibly less involved in drug-using careers, whereas there appears to be a close relationship between being previously and currently in treatment.

Adult↗
PubMed1992

Benzodiazepine use and HIV risk-taking behaviour among injecting drug users.

This paper examines the prevalence of benzodiazepine use, and its relationship to other drug use and HIV risk-taking among a sample of 1245 injecting drug users (IDU). Approximately a third (36.6%) of the sample had used benzodiazepines during their last typical month of injecting. Benzodiazepine users had injected more frequently, injected more heroin and amphetamines, and had more poly-drug use than other IDU. They also had higher levels of HIV risk-taking, having shared injecting equipment more frequently and with more people. There were no differences between groups in number of sexual partners or condom use, although benzodiazepine users were more likely to have been paid for sex. The demographic and drug use variables indicate that benzodiazepine users are a more dysfunctional subgroup of IDU who require particular attention in HIV interventions.

Adult↗
PubMed1992

Drug use and HIV risk-taking behaviour among clients in methadone maintenance treatment.

Current drug use and HIV risk-taking behaviour of a sample of 95 methadone maintenance clients was investigated. Subjects had been on their current programme for an average of 70.9 weeks with a mean daily dose of methadone of 65.6 mg. Two-thirds had injected heroin, and 82% had injected a street drug in the month prior to interview. Over 20% of subjects had shared a needle in the month before interview, all with only one other person. Subjects who had injected cocaine in the month before interview had significantly higher levels of injecting risk-taking behaviour than those subjects who had injected but not used cocaine. Condom use among subjects was low, particularly in regular relationships. While knowledge concerning HIV was high among subjects, there was no relation between level of knowledge and actual behaviour. It is concluded that knowledge alone is not sufficient to ensure behaviour change.

Adolescent↗
PubMed1992

Differences across sexual orientation on HIV risk behaviours in injecting drug users.

Injecting drug users (IDUs) play a disproportionate role in the spread of HIV given their injecting and sexual contacts, and thereby act as conduits between these risk groups. We investigated differences in risk behaviour and HIV seroprevalence in a Sydney sample of 1,245 IDUs. Significant differences were observed across sexual orientation in HIV serostatus for males, with homosexual men having the highest HIV seroprevalence rate (35%), bisexual men intermediate (12%) and heterosexual men lowest (3%). Sexual HIV risk behaviours were lowest for homosexual men, intermediate for bisexual men, and highest for heterosexual men in the case of condom use: however, for numbers of partners, seroprevalence, and anal sex the trends were reversed. There were no differences across sexual orientation for either sex for injecting drug risk behaviours. Both male and female respondents reported having more than 50% of sexual contacts while under the influence of drugs. This study suggests that risk reduction in the sexual domain has not generalized to the injecting risk domain regardless of sexual orientation, and demonstrates that sexual risk behaviours in IDUs are lowest in homosexual, intermediate in bisexual, and highest in heterosexual IDU men.

Adult↗