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PubMed1989

Survey of AIDS knowledge and behavior changes among Massachusetts adults.

In October 1987, 1,323 Massachusetts residents were randomly interviewed by telephone to explore their exposure to AIDS educational efforts, levels of knowledge about AIDS, and whether that knowledge modified their behavior. Gay/bisexual males, iv drug users and heterosexual respondents were compared as were blacks, Hispanics, and whites. While 81% of respondents had read or heard mass media stories about AIDS, in the previous week, only 5% had ever been counseled about AIDS by a physician. Over 97% of black (N = 152) and white respondents (N = 1,057), as well as gay/bisexual males (N = 21) and iv drug users (N = 33) were aware that HIV can be transmitted by homosexual or heterosexual intercourse and by sharing needles when injecting drugs. However, 9% of the 55 Hispanics interviewed were unaware of male homosexual transmission, and 7% did not know about heterosexual transmission or the risks of needle sharing. Twenty percent of Hispanics, compared with 9% of other respondents, did not know HIV can be transmitted sexually by someone who appears healthy. Fifty-two percent of gay/bisexual males, 27% of iv drug users, and 21% of those who had multiple heterosexual partners in recent years reported adopting abstinence, monogamous relations, or condom use to avoid HIV exposure. Those who continued risky behavior were just as knowledgeable about HIV transmission, but they were less likely to report that they worry a great deal about getting AIDS, 14% vs 32%. The results indicate that new strategies and resources are needed to educate Hispanics. Physicians need to counsel more persons about HIV transmission and further efforts are needed to translate knowledge about HIV transmission into behavior change to avoid the virus.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Minority women and sexual choice in the age of AIDS.

As rates of HIV infection among women continue to rise, health education efforts promoting safer sexual practices have increasingly targeted the female population. However, the wisdom of these efforts is often questioned on the grounds that women, particularly disadvantaged, minority women, lack the necessary power in their relationships with men to influence the course of sexual decision-making. Using a qualitative, focus group methodology, the present study explored the bases of sexual decision-making among groups of high risk black and hispanic women. Sixteen focus groups were conducted with a total of 134 women recruited from drug treatment centers and community agencies in three Northern New Jersey cities. Three groups each were conducted with black and hispanic IV drug users and HIV positive women and 2 groups each with sex partners of IV drug users. Findings suggest that minority women often retain substantial power vis a vis their male partners with respect to sexual decision-making. Factors relating to perceptions of risk are frequently more salient barriers to the practice of safer sex in this population.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Target groups for preventing AIDS among intravenous drug users: 2. The "hard" data studies.

Studies were reviewed with respect to three different target groups for preventing AIDS among intravenous (IV) drug users by (a) providing drug abuse treatment for those who want to stop injecting drugs, (b) providing "safer" injection for those who are likely to continue injecting, and (c) preventing drug injection among those who are at high risk for beginning to inject. The studies reviewed were limited to those that include "hard" data: validated self-reports, seroprevalence outcomes, or self-reports of behavior that is the opposed to any of the demand characteristics generated by the research setting. For two groups of current IV drug users--those entering drug treatment and those continuing to inject--these hard data studies show rapidly induced AIDS risk reduction but suggest a need for large-scale change maintained over long time periods. In terms of preventing initial injection, alternative forms of intense drug use have emerged but have not supplanted drug injection, and basic knowledge of AIDS does not appear to deter initial drug injection.

Acquired Immunodeficiency Syndrome↗
PubMed1990

AIDS prevention for intravenous drug users in the community: street-based education and risk behavior.

Conducted a study of behavior change associated with a street-based AIDS education project targeted to intravenous (IV) drug users in San Francisco. Two cross-sections were sampled from drug detoxification clinics and street locations in 1986 (n = 438) and 1987 (n = 623). Significant increases were reported in the percentage of IV drug users who used bleach to decontaminate syringes, who did not share needles in past year, and in condom use. A significant reduction in an index of the number of needle-sharing partners was reported. Respondents ranked treatment program as most important source of AIDS information prior to implementation of the program, and ranked outreach workers as most important after implementation. Findings suggest that this community-based outreach program had at least some impact on knowledge about AIDS and may have led to reductions in behaviors known to transmit HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Increasing prevalence of HTLV-III infection in intravenous drug users in Liguria, Italy.

Anti-HTLV III prevalence has been investigated in serum samples of 638 intravenous drug users collected over May 1981 - March 1985 and stored at -20 degrees C. Separately, in a prospective way, we have studied 68 IV drug abusers (53 Genoese and 15 of Sanremo area) of whom we have collected, at least, one serum specimen for each year, starting with 1981. We have also tested for anti-HTLV III presence serum samples of: 91 subjects of Hospital staff (Infectious Diseases Department and Laboratory workers); 32 workers in Therapeutic Communities for drug users and 24 family contacts of anti-HTLV III positive drug users. And then serum samples of two groups of general population collected for other seroepidemiological investigations in 1982 (256 subjects) and 1984 (538 subjects) were tested. No IV drug user was positive in 1981 whilst from 1982 up to 1984 there was a strong rising of the prevalence of anti-HTLV III positive subjects: 2, 22, and 39 per cent, respectively. The prevalence remained about 40% in the first months of 1985. The investigations carried out also show that HTLV III spread in Sanremo area slightly before than in Genoa and neighbourhood. No subject positive for anti-HTLV III has been detected among the Hospital staff and in workers of Therapeutic communities who have more probability to get in contact with infected subjects or their blood, as well as in the general population. A positive case has been discovered in a family contact (the wife of a positive for anti-HTLV III IV drug user). Some epidemiological and public health questions linked to the situation observed, at present, in Liguria, are discussed.

Antibodies, Viral↗
PubMed1992

Intravenous injection of household bleach.

The widespread use of household bleach (5.25% sodium hypochlorite) as a disinfectant by IV drug users may cause an increase in the number of IV injections of this substance. We report the case of a 31-year-old man who injected less than 1 mL of bleach and then experienced transient left-sided chest pain and vomiting. The patient did not have any serious complications. This report is similar to the only other reported case in the medical literature of an IV injection of a small amount of bleach. Based on these two reports, household bleach appears to be safe when used as a disinfectant by IV drug users, but more studies are needed.

Adult↗
PubMedDate not supplied

Designing an AIDS information campaign to reach intravenous drug users and sex partners.

Intravenous drug users are currently the second largest group to have developed the acquired immunodeficiency syndrome in the United States and Europe. Clearly, health communication plays an important role in the development of AIDS prevention programs directed at IV drug users. However, few public information campaigns have been developed to reach IV drug users or their sexual partners. In a recent campaign directed at these groups, the selection of messages to be used was based both on theory and on research into multi-media public information campaigns. The attempt was made to communicate basic facts about AIDS etiology and prevention. This included information that needle sharing and unprotected sex could spread the human immunodeficiency virus (HIV) that causes AIDS, while bleaching needles and using condoms properly could reduce the risk of infection. A step-by-step diagram on how to bleach needles was provided. Posters, pamphlets, billboards, and out-reach workers were used to spread the word in inner-city neighbors, and coverage of the campaign was sought in the news media. Strategies incorporating practical and theory-based suggestions for future campaigns on IV drug use and AIDS are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Antibodies to Bartonella species in inner-city intravenous drug users in Baltimore, Md.

BACKGROUND: Bartonella quintana has recently been associated with homeless alcoholic men. Both B quintana and Bartonella henselae have been shown to be opportunistic pathogens of people with acquired immunodeficiency syndrome. The reservoirs and modes of transmission of these infections are incompletely known. OBJECTIVES: To examine serum samples that were taken from inner-city intravenous (IV) drug users for antibodies to Bartonella organisms to determine whether there is an urban transmission cycle for Bartonella species and to examine the demographic and behavioral characteristics of IV drug users to identify possible risk factors for infection with any of these agents. MATERIALS AND METHODS: A serologic survey was conducted, using a convenience sample of serum specimens collected during a study of IV drug use and human immunodeficiency virus infection among 630 inner-city residents in Baltimore, Md. A detailed questionnaire was administered at the initial collection of serum, and additional serum collections and questionnaire updates were made at 6-month intervals. The most recent available serum sample was tested for Bartonella antibody titer by using the indirect immunofluorescent antibody test with 3 antigens: Bartonella elizabethae, B henselae, and B quintana. Univariate and multivariate analyses of selected potential demographic and behavioral risk factors were conducted. RESULTS: Antibodies to Bartonella were highly prevalent in this group; more than 37% of all samples reacted with at least 1 antigen. Overall seroprevalence of antibodies to B elizabethae, B henselae, and B quintana was 33%, 11%, and 10%, respectively. Current IV drug use, frequency of injection, and seronegative human immunodeficiency virus status were significantly associated with Bartonella antibody presence, but these associations varied by analysis. There was a significant inverse association of antibody prevalence to B henselae and B quintana by using CD4+ cell counts among human immunodeficiency virus-seropositive individuals. CONCLUSIONS: Intravenous drug users have an elevated prevalence of antibodies to Bartonella organisms and may be at significant risk of becoming infected. Current IV drug use, high frequency of injection, and seronegative human immunodeficiency virus status are significant risk factors for an increased prevalence of Bartonella antibodies. The current natural histories of Bartonella species are rapidly changing, and mechanisms of transmission remain unknown.

Adult↗
PubMed1995

Prevalence of hepatitis B virus markers among drug-dependent patients in Jeddah Saudi Arabia.

The purpose of this study was to determine the prevalence of HBV markers--hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs) and antibody to hepatitis B core antigen (anti-HBc) among drug-dependent patients in Jeddah, Saudi Arabia. Over a period of four months, all the patients admitted for drug dependence were tested for these HBV markers. There were 349 patients altogether of which 281 (80.5%) were intravenous drug users. 44 were positive for HBsAg, 171 were positive for anti-HBs and 187 were positive for anti-HBc, giving an overall prevalence of 12.6%, 49.0% and 53.6%, respectively. The prevalence of each marker was higher among the IV drug users. The high prevalence of the markers indicate that HBV is highly endemic among drug-dependent patients in this city, especially among the IV drug users and that almost half of all the patients have developed some immunity to the virus. Many of the drug-dependent HBsAg carriers also possess HBeAg. The persistence of these two antigens makes them highly infectious and predisposes them to chronic liver diseases and hepatocellular carcinoma. There is a need for more public education and needle and syringe exchange schemes to control the spread of the virus and prevent future complications.

Biomarkers↗
PubMed1999

Hepatitis C virus infection among short-term intravenous drug users in southern Taiwan.

The purpose of this study was to determine the correlation between the prevalence of hepatitis C virus (HCV) infection with duration of drug use and other risk factors among drug users. This survey covered 899 male drug users from Kaohsiung Narcotic Abstention Institute and Kaohsiung prison. The prevalence of positive anti-HCV was 67.2% among intravenous drug users (IVDU) and 14.7% among non-intravenous drug users (non-IVDU). Among intravenous (IV) drug users, age and duration of drug use were independently related to HCV seropositivity. Seroprevalence rate for HCV in the IVDU group increased with increasing duration of injection use within the first seven years of drug use. However, the steepest trajectory in seroprevalence of HCV infection occurred within the first four months. Due to the high rate of HCV infection among drug users, investigation of risk behaviors should be routine in such a group. A high frequency of HCV infection was also found among short-term injectors, which indicated that early risk reduction intervention was an important measure in moderating HCV infection.

Adolescent↗
PubMed1993

Asymptomatic oral Candida albicans carriage in HIV-infection: frequency and predisposing factors.

Many studies have focused on the epidemiology and pathogenesis of oral candidiasis in HIV infection. Little is known on the incidence and predisposing factors of asymptomatic oral candida carriage in this setting, obviously an important issue in view of prophylaxis. To address this question, 261 consecutive HIV-infected individuals without clinical evidence of candidiasis were investigated. C. albicans was isolated from cultured oral cavity swabs of 63 subjects (24%). Colonization was significantly more frequent in IV drug users, CDC groups IV, and in subjects with lymphocytopenia, CD4+ cell depletion, or elevated beta-2 microglobulin. These data further suggest that oral candidiasis occurs in HIV infection as a result of C. albicans overgrowth and raise the question of primary antifungal prophylaxis in subjects with low CD4 counts and asymptomatic oral Candida carriage.

AIDS-Related Opportunistic Infections↗
PubMed1992

I.v. versus non-i.v. drug use and selected patient variables related to AIDS risk behaviors.

A sample of 206 drug users volunteered for a survey questionnaire of AIDS-related risk behaviors. The Risk Behavior Inventory (RBI) was used to elicit self-report information on risk behaviors including drug use, needle use, and sexual practices. Non-IV cocaine users reported less risk behaviors than patients involved in IV drug use. Nevertheless, non-IV users remained substantially at risk for HIV exposure because of sexual practices and sexual interaction with IV drug users. Multiple regression analysis indicated that method of drug administration (IV vs non-IV) was the major contributor of accountable variance in risk behaviors, while other patient variables, such as age, gender, educational level, employment, and marital status, did not contribute significantly to the explained variance.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Retrospective study of 594 HIV-1 seropositive patients seen in 8 hospitals of western Paris].

This multicenter retrospective study concerns 594 cases of HIV-1 positive patients. The majority were asymptomatic. Some had Aids-related complex and some had AIDS. They were all seen in seven hospitals of the western outskirts of Paris and in one Paris hospital between 1983 and 1988. There was a predominance of homosexuals and of cases of AIDS in the center of Paris. Intravenous (IV) drug users and asymptomatic cases were more numerous in the city outskirts, a reflection of the populations at risk around each hospital. The proportion of cases of AIDS was lower among IV drug users than among homosexuals or bisexuals probably due to the fact that the viral infection was discovered at an earlier stage in a population contaminated at a later date or to the tendency to ask for the test "systematically" in drug addicts. 22% of the cases were women with a sex ratio of 3.5. HIV infection was attributed to use of intravenous drugs in 51% and to heterosexual transmission in 18% of the women. But the incidence of heterosexual transmission increased significantly, essentially in women. Overall, the incidence of infection by the HIV 1 has decreased since 1986. A number of recent publications seem to indicate the same tendency. But this fundamental observation remains to be validated by further studies. The yearly incidence of AIDS increases. The 5 year calculated actuarial rate of probability of remaining asymptomatic decreased to 40% in 385 initially asymptomatic patients.

Adult↗
PubMed1992

High school students' knowledge of HIV/AIDS and perceived risk of currently having AIDS.

Factors associated with AIDS knowledge and perceived risk of currently having HIV infection among adolescents were examined. A modified version of the Centers for Disease Control's Health Risk Survey was administered to 11th and 12th grade students (N = 2,483) in homerooms from nine schools in one southeastern community. Knowledge was based on cumulative responses to 12 questions. Many adolescents incorrectly answered seven questions. Based on multivariate analysis of variance, lower AIDS knowledge was associated with no prior school-based AIDS education (p less than or equal to 0.0001), previous IV drug use (p less than or equal to 0.0001), male gender (p less than or equal to 0.0001), and being Black or "other" ethnic group (p less than or equal to 0.0001). Based on interaction effects, Hispanics not receiving AIDS education in school (p less than or equal to 0.0001) and Black and "other" ethnic group IV drug users (p less than or equal to 0.0011) had a lower AIDS knowledge. When controlling for AIDS knowledge level (p less than or equal to 0.0001), higher perceived risk of current infection with HIV was associated with previous IV drug use (p less than or equal to 0.0001) and male gender (p less than or equal to 0.0001). However, previous IV drug users who never received AIDS education (p less than or equal to 0.0001) or were from Black or "other" ethnic group (p less than or equal to 0.008) had higher perceived risks of presently having HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1987

The response of state agencies to AIDS, addiction, and alcoholism.

State agencies have been profoundly impacted by the AIDS epidemic. In the absence of a vaccine that would prevent AIDS or of medicines that would cure it, the primary strategies of such agencies have focused on reducing the spread of AIDS by promoting cessation of high risk behaviors and thus preventing or slowing its transmission. Recent research indicates that the primary route of AIDS transmission into the general heterosexual population is by intravenous (IV) drug abusers, who directly account for about 17% of AIDS cases nationwide. Reducing the spread of AIDS within this group would not only reduce the overall toll of the disease but should limit its spread to the population at large. Infection by the human immunodeficiency virus (HIV) can be minimized by reducing or eliminating certain high-risk activities. In the IV drug using community, the primary intervention strategies include: educating IV drug users about the hazards of AIDS and sharing of needles; enrolling them in treatment programs to reduce drug use; promoting the use of new or sterilized syringes and needles among those who will not abstain from drug use; and discouraging high-risk sexual activity among those who are already infected by HIV. The State of California has already increased the number of treatment slots for IV drug users and, through the Department of Alcohol and Drug Programs, is scaling up its educational, prevention, and intervention activities, particularly those related to safe sex, promoting the cessation of IV drug use, and improving equipment hygiene by those who continue use.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Prevalence of anti-HCV and risk factors for hepatitis C virus infection in healthy pregnant women.

The prevalence of anti-HCV antibodies and the risk factors for HCV infection were assessed in 5,672 pregnant women living in North Italy. All reactive sera were confirmed by RIBA-2 test. Anti-HCV positive pregnant women together with an anti-HCV negative control group, were interviewed by standardised questionnaire to identify "known" or "potential" risk factors for HCV infection. The anti-HCV prevalence was 0.7% (40/5,672), higher than that observed among blood donors in the same geographical area (0.2%). The RIBA-2 assay was positive in 60% (24/40) of cases, indeterminate in 10% (4/40) and negative in 30% (12/40). As for "known" risk factors, considering RIBA-2 positivity, intravenous drug use was by far the main risk factor for HCV infection, resulting in a significantly higher risk than in the control group (50% versus 5.9% [O. R. 15.8, CI 5.4-45.5]). The ten RIBA-2 positive women without histories of transfusion or IV drug use had a significantly higher frequency of "sexual contacts with IV drug users" compared to controls (50% vs 4.9% [O. R. 19.0, CI 3.6-94.0]). In conclusion, our study provides evidence that in our geographical area the anti-HCV antibody prevalence is higher in pregnant women than in blood donors and that IV drug use and sexual contacts with IV drug users represent the most important risk factors for HCV infection among young women in North Italy.

Adult↗
PubMed1996

[Zidovudine-resistant HIV strains in intravenous drug users and homosexual men in Amsterdam].

OBJECTIVE: To investigate the spread of HIV strains resistant to antiviral drugs prescribed in the Netherlands. DESIGN: Descriptive. SETTING: Amsterdam. METHOD: In several cohorts of homosexual men and intravenous drug users being followed in Amsterdam, in cases of newly acquired HIV infections in the period 1992-1995 HIV RNA was isolated from serum. The nucleic acid sequence encoding the first 250 amino acids of the HIV reverse transcriptase was determined in order to detect mutations conferring resistance to reverse transcriptase inhibitors. RESULTS: Among participants of the Amsterdam cohort studies, 12 new HIV infections of homosexual men and 23 of IV drug users were observed. In the group of homosexual men the first infection by a zidovudine-resistant HIV was observed in 1995. In the group of IV drug users the first infection by a zidovudine-resistant strain was noticed in 1993 with two more infections in 1995. The mutations regarded positions 41, 67, 70 and 215 of the HIV reverse transcriptase. No HIV strains resistant to didanosine, deoxycytidine, lamuvidine or nevirapine were found in untreated persons with an acute infection. CONCLUSION: As zidovudine is a vital part of the latest and most efficacious combination therapies of HIV infection, testing for zidovudine-resistance prior to treatment is recommended.

Cohort Studies↗
PubMed1990

[HIV epidemic: a study among physicians in Vaud].

A two-phase survey was conducted in the Canton of Vaud among the 1006 registered private practitioners (response rate 98%). The first phase aimed at determining the proportion of these physicians involved in the care of HIV+ persons. The results showed that 43% of the practitioners had been consulted by HIV+ patients. In the second phase, all institutions (hospitals, prisons and IV-drug user rehabilitation and testing centers) and a representative sample of the physicians with HIV+ patients were asked about the transmission category of their HIV+ patients. A mathematical method was used to estimate the true number of known HIV+ individuals by December 1988. Approximately 60% of the HIV+ persons had been seen exclusively by the private practitioners. IV-drug users represented 57% of all HIV+ persons compared to only 27% of the AIDS cases registered in 1988, suggesting that an important change in the transmission categories of AIDS cases is to be expected in the near future. These observations underscore the evolving nature of the HIV epidemic on the one hand, and the crucial role of the private practitioners in the prevention of the HIV infection on the other. This also points to the need for methods specifically designed to monitor HIV and AIDS epidemics respectively.

Acquired Immunodeficiency Syndrome↗