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Biomedical subjects

N Crofts

Publications and source records attributed to N Crofts.

At least 73 records · Page 4Linked to original sources
PubMed1996

Hepatitis C transmission through tattooing: a case report.

We report the case of a prisoner for whom tattooing was the likely source of hepatitis C virus (HCV) infection. Many of the tattoos were carried out within prison using equipment that was multiply shared with other prisoners with limited access to means of disinfection. This case supports previous reports that prison is a risk factor for HCV infection and that HCV can be transmitted through tattooing. Use of unsterilised equipment for tattooing within prison must be a high-risk activity, given the high prevalence of HCV infection among those incarcerated. Harm reduction approaches are required to diminish risk in this environment.

Adult↗
PubMed1996

A profile of HIV testing in Victoria to the end of 1993. Victorian Collaborative Group on HIV and AIDS Surveillance (VCGHAS).

Examination of testing patterns for human immunodeficiency virus (HIV) in a population is important because it affects interpretation of surveillance data on new HIV diagnoses and can guide the targeting and evaluation of campaigns to encourage appropriate antibody testing. This report describes a relatively inexpensive mechanism of collecting information on who is being tested for HIV in Victoria (other than at the Blood Bank). The annual number of HIV tests performed in Victoria increased steadily throughout the 1980s but the rate of increase slowed in the early 1990s. By 1993, women accounted for almost half of HIV tests, although they made up only 8 per cent of positive tests. There were marked differences in the volume of testing and testing profiles of different laboratories. The information available on personal risk category and the reasons for HIV tests show that many people of low risk are tested, although conclusions are limited by inadequate information elicited or provided by many requesting doctors. For better information on what is occurring with respect to HIV testing, the fundamental requirement is better compliance from requesting doctors in supplying basic information on who they test and why.

AIDS Serodiagnosis↗
PubMed1996

HIV in the mentally ill.

OBJECTIVE: To review the published literature in relation to prevalence of HIV infection and risk behaviours for HIV among the mentally ill to assist in the development of appropriate strategies for public health policy, surveillance and clinical management of HIV and HIV risk in these groups. METHOD: A search of published literature was carried out using 'Medline', in association with following up appropriate papers cited in the references of journals identified. RESULTS: The North American literature shows an increased risk of HIV infection in psychiatric patients receiving treatment in both inpatient or community settings. HIV infection is associated with a number of risk behaviours, particularly male homosexual sex and injecting drug use, and being the sexual partner of a person with a history of these. Impulsivity, high levels of sexual activity during acute exacerbations of psychiatric illness, poor skills at negotiating safe sex, homelessness and drug abuse are all risk behaviours common among those affected by some mental illnesses. The mentally ill also have a comparatively poorer knowledge of HIV/AIDS. There is a dearth of published Australian data addressing the question of HIV seroprevalence or risk in the mentally ill. Although there has been development and implementation of HIV risk-reduction programs overseas, the development and evaluation of any programs in Australia has not been published. CONCLUSIONS: Arguably, Australia has developed a comprehensive program of national surveillance for HIV infection and has been relatively successful in its response to the HIV epidemic, with the high rates of infection in the early to mid-1980s substantially reduced to around 600 new diagnoses per year. However, while risk behaviours which exposed those infected with the virus are recorded, underlying conditions which predispose them to these behaviours are not. Nevertheless, there is HIV infection amongst mentally ill and intellectually disabled people in Australia. Examination of the North American experience reveals opportunities to prevent a high rate of HIV infection in those with mental illness in Australia. Such a program would require adequate risk behaviour assessment, appropriate diagnostic testing and management, and development of specific educational interventions which are properly evaluated to ensure their effectiveness.

Adolescent↗
PubMed1995

Ascertaining exposure categories of HIV-infected individuals with previously unrecorded risk data.

OBJECTIVES: To improve the quality of surveillance data for HIV in Victoria by following up all cases with an unknown exposure category; and to determine whether those with no exposure category included cases of transmission other than via the conventionally recognised routes. METHODS: The Victorian HIV database records data on all people diagnosed with HIV in Victoria, including information on route of exposure to the virus. We identified all HIV diagnoses to which no exposure category had been attributed and, with the permission of the State Minister for Health, obtained access to namecoded testing records. Exposure categories, where possible, were obtained directly from these records. Otherwise, cases were checked against the namecoded AIDS database and, if necessary, an intensive process of call-back to laboratories, diagnosing doctors and HIV treatment centres was undertaken. RESULTS: The database initially contained records for 289 people with unknown exposure categories (9.1% of Victorian people with HIV infection). We identified exposure categories for 155 of these people. CONCLUSIONS: Exposure categories for those cases previously without data were similar to those for cases where exposure category was known. No instances of HIV transmission by previously unrecognised means were detected.

Data Collection↗
PubMed1995

Spread of bloodborne viruses among Australian prison entrants.

OBJECTIVES: To assess spread of bloodborne viruses among prison entrants in Victoria, Australia. DESIGN: Voluntary confidential testing of all prison entrants for markers of exposure to bloodborne viruses with collection of minimal data on demography and risk factors over 12 months. SETTING: Her Majesty's Prisons, Pentridge and Fairlea, Victoria, Australia. SUBJECTS: 3429 male and 198 female prison entrants (> 99% of all prison entrants); 344 entered prison and were tested more than once. MAIN OUTCOME MEASURES: Prevalence and incidence of antibodies to HIV, hepatitis B, and hepatitis C viruses, and minimal data on risk factors. RESULTS: 1562 (46%) gave a history of use of injected drugs, 1171 (33%) had antibody to hepatitis B core antigen, 1418 (39%) were anti-hepatitis C positive including 914 (64%) of the men who injected drugs, 91 (2.5%) were positive for hepatitis B surface antigen, and 17 (0.47%) were positive for antibody to HIV. Incidence rates for infection with hepatitis B and C virus were 12.6 and 18.3 per 100 person years, respectively; in men who injected drugs and were aged less than 30 years (29% of all prison entrants) these were 21 and 41 per 100 person years. Seroconversion to hepatitis B or C was associated with young age and shorter stay in prison. Only 5% of those who were not immune to hepatitis B reported hepatitis B immunisation. CONCLUSIONS: Hepatitis B and C are spreading rapidly through some populations of injecting drug users in Victoria, particularly among men aged less than 30 years at risk of imprisonment in whom rates of spread are extreme; this group constitutes a sizeable at risk population for spread of HIV. This spread is occurring in a context of integrated harm reduction measures outside prisons for prevention of viral spread but few programmes within or on transition from prisons; it poses an urgent challenge to these programmes.

Adult↗
PubMed1995

Seroepidemiology of hepatitis E in selected Australian populations.

The presence of hepatitis E virus-specific antibodies (anti-HEV) was determined in selected Australian groups. Anti-HEV was detected initially using a recombinant antigen-based enzyme immunoassay (EIA). It was found that 1 of 279 (0.4%) blood donors, 14 of 182 (7.7%) Indochinese refugees, 2 of 89 (2.2%) sera submitted for amoebic serology (generally people who had visited developing countries), 1 of 13 (7.7%) patients with non-A, non-B hepatitis, none of 7 (0%) patients with fulminant non-A, non-B hepatitis, and none of 33 (0%) control sera were repeatedly reactive by the HEV EIA. The positive sera were subjected to further testing using a supplemental immunoblot. Preliminary data suggest that while potentially large numbers of people infected with HEV are entering Australia, no compulsive evidence was found in these particular groups for endemic HEV infection in Australia. This is the first seroepidemiological survey of HEV in Australia.

Adult↗
PubMed1995

Determinants of HIV risk among men who have homosexual sex and inject drugs.

Men with histories of both homosexual contact and injecting drug use (IDU) are at increased risk of HIV infection over men who have only one such risk. Despite this, their special needs and circumstances have been neglected by AIDS prevention programmes. A survey of a wide spectrum of homosexual male IDUs was carried out in Melbourne and Sydney in 1993 to inform the development of specific policy and programmes for HIV prevention in these subcultures. Of 169 men, self-reported HIV prevalence was 27%. Decreasing compliance with safe sex guidelines (as measured by numbers of casual partners, participation in anal intercourse and use of condoms) was associated with HIV seropositivity, increased age, and increased participation in sex work; having a regular male partner was not protective against unsafe sexual behaviour, no matter the length of the relationship. A substantial proportion (15%) reported inconsistent condom use during anal sex with more than two partners in the preceding month: they were slightly more likely to be engaging in sex work, less 'stable' and more likely to be HIV infected. Sexual risk was not strongly associated with unsafe injecting, which was in general safe. Men who both have homosexual sex and inject drugs are groups at high risk of HIV, more from unsafe sex than from shared injecting equipment; men who believed themselves to be HIV infected were continuing to have sex in such a way that would allow transmission. These are clearly groups in need of priority targeted interventions.

Adolescent↗
PubMed1995

Declining risk for HIV among injecting drug users in Kathmandu, Nepal: the impact of a harm-reduction programme.

OBJECTIVE: To measure changes in self-reported risk behaviour for HIV infections and HIV seroprevalence among injecting drug user (IDU) clients of an outreach harm-reduction programme in Kathmandu, Nepal. METHODS: The Lifesaving and Lifegiving Society (LALS) of Kathmandu began providing sterile injecting equipment and education to Nepalese IDU in 1991. A sample of these IDU were interviewed and tested for HIV each year from 1991 through 1994. RESULTS: Indicators of unsafe injecting fell, as knowledge of HIV rose more in 1994 for those who had been in touch with LALS for longer. Indicators of unsafe sex did not change. HIV seroprevalence remained low, 1.6% in 1991 and 0% in 1994. CONCLUSION: We conclude that programmes for the prevention of HIV spread among IDU are possible and effective in Asia, and are urgently needed.

Adult↗
PubMed1994

Blood-borne virus infections among Australian injecting drug users: implications for spread of HIV.

To describe the epidemiology of infection with hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among injecting drug users (IDUs) in Australia, in relation to the potential for further spread of HIV in IDUs, a cross-sectional analysis was performed on data from a sample of injecting drug users, correlating markers of exposure to blood-borne viruses with sex, age, sexual orientation, primary current drug injected and duration of injecting in rural and metropolitan Victoria, Australia. The subjects were currently active IDUs from a wide spectrum of age, sex, sexual orientation, geographical location and social background, contacted and recruited through their social networks and from community agencies and prisons by trained peer workers who interviewed and collected blood from them in the field. Sera were tested for antibody to HIV, HCV and hepatitis B core antigen (HBcAg), for hepatitis B surface antigen (HBsAg), and for HCV RNA using reverse transcription and polymerase chain reaction (RT-PCR). At entry to the study, 4.5% (14/311) had antibody to HIV, 47% (146/308) to HBcAg and 68% (206/303) to HCV. Prevalence of HBsAg was 1.8% overall (5/282), and 50% (84/168) were positive for HCV RNA. By multivariate analysis, HIV seropositivity was strongly associated with a history of homosexual contact in males and with exposure to HBV but not to HCV. Those who reported their current primary injected drug to be amphetamines were at greater and continuing risk of HIV infection than were current heroin injectors, while the reverse applied for HCV.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

The pattern of diagnosed HIV infection in Australia, 1984-1992.

OBJECTIVE: To describe the pattern of newly diagnosed HIV infection in Australia, between 1984 and 1992. METHODS: State and Territory health authorities reported cases of newly diagnosed HIV infection to the national HIV surveillance centre. Information sought on each case included the State or Territory of diagnosis, the case identifying number, the sex, date of birth and postcode of residence of the person with newly diagnosed HIV infection, the source of exposure to HIV and the date of specimen collection for the diagnosis of infection. RESULTS: By the end of December 1992, a total of 16,765 cases of newly diagnosed HIV infection had been reported in Australia. The annual number of cases declined between 1985 and 1992. Most diagnoses were among males, and exposure to HIV was attributed to male homosexual contact for more than 80% of cases for which information on exposure to HIV was available. Cases of HIV infection attributed to heterosexual contact represented an increasing proportion of the annual number of diagnoses over the period 1985-1992, among both men and women. CONCLUSION: National surveillance for newly diagnosed HIV infection has complemented national surveillance for diagnoses of AIDS as a key mechanism for monitoring the course of the HIV epidemic in Australia. The pattern of newly diagnosed HIV infection was similar to the pattern of AIDS diagnoses, with the overwhelming majority of diagnoses of infection being in adult males whose exposure to HIV was attributed to homosexual contact. Limitations of HIV surveillance include the lack of information on HIV testing patterns, incomplete information on HIV exposure histories and duplication of reported diagnoses.

Adolescent↗
PubMed1994

Surveillance for sexually transmissible diseases in Victoria, 1983 to 1992.

Surveillance systems have been developed in Victoria to determine trends in sexually transmissible diseases (STDs). Notifications to the Health Department (including laboratory notification since May 1990) have been supplemented by data about strains of Neisseria gonorrhoeae and cultures for Chlamydia trachomatis processed by the Microbiological Diagnostic Unit, enhanced laboratory surveillance of syphilis, and data on genital herpes and genital warts from the Melbourne Sexual Health Centre. During the period under review the incidence of gonorrhoea declined, rapidly at first, and then more slowly. For women, this trend has continued, while gonorrhoea acquired abroad by men has become relatively more important. Since 1988, gonorrhoea in homosexual men has increased, and rectal isolates have increased concurrently, raising concerns about HIV risk behaviour. Cases of syphilis are likely to be ascertained through STD, antenatal and refugee screening, rather than because of symptoms or contact tracing. Chlamydia is a the most common notifiable STD, despite underreporting and underdiagnosis. In 1991, 832 cases were notified, increasing to 1377 in 1992. In 1992, of the 73 cases (65 per cent of notifications) where the doctor identified a risk, 15 per cent was attributed to homosexual contact, and 27.4 per cent to heterosexual exposure. Limitations in the data include inadequate standard case definitions for many STDs, changes in the statutory requirement for notifications in 1990, underreporting, changes in diagnostic and screening patterns, and lack of detailed demographic data. Education of general practitioners is needed to improve diagnosis and notification of chlamydia.

Adult↗
PubMed1994

A national surveillance system for newly acquired HIV infection in Australia. National HIV Surveillance Committee.

OBJECTIVES: The purpose of this study was to describe the establishment of a national surveillance system for newly acquired human immunodeficiency virus (HIV) infection and present the first 3 years' results. METHODS: All new cases of diagnosed HIV infection were reported to the national HIV surveillance center through state and territory health authorities. Information sought on each case included evidence of whether the infection had been newly acquired, defined by the diagnosis of HIV seroconversion illness or by the report of a negative or indeterminate HIV antibody test result occurring within the 12 months prior to diagnosis of infection. RESULTS: Of 3602 reported cases of HIV infection in adults and adolescents newly diagnosed in Australia between 1991 and 1993, 11.4% were identified as newly acquired. The majority (85%) of cases of newly diagnosed HIV infection occurred among men who reported homosexual contact, and 15% of these cases were identified as newly acquired. Average age at diagnosis was 31 years for cases of newly acquired infection and 34 years for other cases. CONCLUSIONS: Surveillance for newly acquired HIV infection has been established at a national level in Australia and provides valuable information for planning primary HIV prevention programs.

AIDS Serodiagnosis↗