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PubMed2005

Homelessness and HIV risk behaviors among drug injectors in Puerto Rico.

This report examines associations between homelessness and HIV risk behaviors among injection drug users (IDUs) in Puerto Rico. The study sample consisted of 557 IDUs who were not in treatment, recruited in inner-city neighborhoods of the North Metro Health Care Region. Subjects were categorized into three groups by residential status (last 30 days): housed, transitionally housed (living with friends, family, or others but considering themselves homeless), and on-the-street homeless (living on the street or in a shelter). Multiple logistic regression models were fitted to assess effects of residential status on each HIV risk behavior after adjusting for sociodemographic and drug-use related covariates. Transitionally housed and on-the-street homeless subjects made up 16% of the total sample. On-the-street homeless IDUs were more likely to test positive for HIV than were transitionally housed and housed IDUs. In the adjusted analysis, on-the-street homeless subjects were significantly more likely to share needles, share rinse water, and practice back loading than the other two groups. Sexual risk behaviors (last 30 days) were not significantly associated with residential status after adjustment. Findings from this study present an added challenge to drug treatment and HIV prevention and treatment programs, to provide services that can address the additional needs of drug users suffering the stressors of homelessness.

Adult↗
PubMed1996

Prevalence and risk behaviours for HIV infection among inmates of a provincial prison in Quebec City.

OBJECTIVE: To assess HIV prevalence and related risk factors among inmates at the Quebec Detention Centre (QDC). DESIGN: Cross-sectional prevalence study. METHODS: Inmates incarcerated at the QDC in September 1994 were asked to participate in an anonymous survey concerning HIV infection. Volunteers answered a questionnaire and provided a saliva sample during a meeting with an interviewer. RESULTS: The overall participation rate was 95% (618 out of 651). HIV prevalence was 2% (11 out of 499) in men. All HIV-infected men were injecting drug users (IDU) with an HIV prevalence of 9% (11 out of 129) in this group. HIV prevalence was 14% (9/63) among male IDU admitting previous needle-sharing and 3% (two out of 66) among the other IDU (odds ratio, 5.3; P = 0.028). Twelve male inmates admitted injecting drugs during imprisonment, of whom 11 shared needles and three were HIV-positive. HIV prevalence in men reporting sexual intercourse with men prior to incarceration was 10% (five out of 52). Nine of the 119 women were HIV-infected (8%), seven of whom were IDU (prevalence of 16% in female IDU). One of the two non-IDU had sexual contacts with male IDU, and the other with men who had sex with men. Tattooing was not associated with HIV infection in either men or women. CONCLUSIONS: Prisoners constitute a group at high risk of HIV infection mainly because of the high proportion of them who are IDU. Imprisonment offers a good opportunity to provide education and preventive programs to this specific group that might otherwise be difficult to reach.

Female↗
PubMed1996

The use of anabolic-androgenic steroids by Canadian students.

OBJECTIVE: To assess the prevalence of use of anabolic-androgenic steroids and other presumed performance-enhancing drugs and the associated knowledge, attitudes, and behavior of school-aged Canadians. DESIGN: A national survey was conducted using a self-report questionnaire distributed randomly to schools within each of five Canadian regions. SETTING: Canada. SUBJECTS: The subjects were 16,119 Canadian students, in the sixth grade and above, from 107 schools drawn randomly from five Canadian regions. MAIN OUTCOME MEASUREMENTS: The number of students reporting the use of anabolic-androgenic steroids and other performance-enhancing drugs in the year before the survey, the nature of such drug-taking activities, and the attitudes underlying the decision to take anabolic-androgenic steroids. RESULTS: More than 83,000 young Canadians (2.8% of the respondents) are estimated to have used anabolic-androgenic steroids in the year before the survey. Of those taking such drugs, 29.4% reported that they injected them; of the latter group, 29.2% reported sharing needles in the course of injecting anabolic-androgenic steroids. Significant numbers of respondents reported using other substances (caffeine, 27%; extra protein, 27%; alcohol, 8.6%; painkillers, 9%; stimulants, 3.1%; "doping methods," 2.3%; beta-blockers, 1%) in attempts to improve sport performance. CONCLUSIONS: The use of anabolic-androgenic steroids is more widespread than may have been assumed and is often accompanied by high-risk needle-sharing. Anabolic-androgenic steroid use is often intended to alter body build as opposed to accentuating sport performance. Many young Canadians use a variety of other substances in attempts to improve sport performance. Drug-taking of this kind represents a special challenge for educators, health professionals, and sport authorities.

Adolescent↗
PubMed1991

HIV seroprevalence among patients admitted to two psychiatric hospitals.

OBJECTIVE: The authors determined the seroprevalence of HIV-1 among patients admitted to two psychiatric hospitals in New York City. METHOD: Patients consecutively admitted to an acute psychiatric unit in Manhattan and a large state hospital in Queens were anonymously tested for HIV-1 antibodies from December 1989 through July 1990. Test results were linked to age, gender, ethnicity, and two risk behaviors: male homosexual activity and injection drug use. RESULTS: Blood was obtained from 83.0% of the eligible patients. The prevalence of HIV was 5.5% (25 of 451). Black patients accounted for 38.0% of the patients tested and 76.0% of positive results (N = 19), a rate of 11.1% for this group. The rate of seropositivity was comparable in women and men. Clinicians had charted risk behavior for nine (36.0%) of the 25 HIV-positive patients. Infection control records suggested that clinicians were aware of seven (28.0%) of the positive cases. CONCLUSIONS: One in every 18 patients admitted to two public psychiatric hospitals in New York City was HIV positive. Clinical staff largely failed to identify HIV-positive patients. Ethnicity and a history of homosexual activity among men or use of injected drugs were strongly associated with seropositivity. This pattern of infection may be linked to needle sharing and/or sexual activity with partners who have shared needles. Future research should clarify how psychiatric illness affects risk-taking behavior, focus on improving detection by clinicians, and identify effective prevention strategies in this population.

Adolescent↗
PubMed1999

Survey of risk behaviour and HIV prevalence in an English prison.

An anonymous, voluntary, linked cohort study was undertaken to determine the prevalence of HIV infection and identify risk factors for the spread of infection in an English prison. Three hundred and seventy-eight (68%) of the inmates participated. The HIV point prevalence was 0.26%. Injecting drug use (IDU) was the most significant HIV risk factor within 20% admitting IDU at any time, of whom 58% injected whilst in prison. Of those injecting in prison 73% shared needles. Two inmates admitted having sex with a male partner in prison. This study demonstrates that the potential exists in this setting for an outbreak of blood-borne virus infection; hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infection. Injecting drug use and needle sharing represent the greatest risk.

Adult↗
PubMed2002

Characteristics and predictors of HIV risk behaviors among injection-drug-using men and women in St. Petersburg, Russia.

The purpose of this study was to establish the prevalence of high-risk sexual behaviors and drug-using behaviors in a large community sample of male and female injection drug users (IDUs) in St. Petersburg, Russia. This investigation used a data collection plan that systematically recruited a drug user sample from venues where IDUs were known to congregate and could be accessed. Surveys were completed by 239 IDUs (males = 139, females = 100), aged 13-25. Participants averaged 44 injections (range = 0-240) in the past 30 days, with heroin (70%) and heroin plus other drugs (20%) the most frequently used. Participants' mean age of first drug injecting was 17.6 years, 41% of participants regularly shared needles, most had multiple sexual partners (mean = 9.3 partners in the past 3 months), and 70% reported engaging in vaginal intercourse without condoms. Stepwise logistic regression showed that high-risk sexual behavior was predicted by being female, young, using heroin several times a month, and less negative attitudes toward using condoms. Effective HIV prevention efforts for IDUs in Russia must be tailored to their age, gender, drug use, and condom attitudes. These programs will also have to address the dual risk factors, unique to IDUs, of risky sexual behaviors and needle sharing. Without a rapid intervention response, Russia's HIV/AIDS crisis will soon turn catastrophic.

Adolescent↗
PubMed1994

HIV vaccine trials: will intravenous drug users enroll?

OBJECTIVES: The purpose of this study was to assess the willingness of intravenous drug users to participate in a preventive human immunodeficiency virus (HIV) vaccine efficacy trial. METHODS: Of the 347 intravenous drug users in methadone treatment who were approached for participation, 257 completed a battery of self-administered questionnaires assessing risk behaviors, interest in vaccine trials, and other vaccine-related information. Data from 16 known seropositives and 1 inconsistent responder were dropped from analyses (n = 240). RESULTS: Fifty-two percent of the subjects expressed a willingness to be one of the first individuals to participate in a preventive HIV vaccine efficacy trial. Subjects who had recently shared needles or works and subjects who trusted the government to ensure vaccine safety were both twice as likely to report interest in participation. Twenty-two percent of subjects reported that they would increase needle sharing if vaccinated. Thirty percent did not know what a vaccine was. CONCLUSIONS: These findings suggest that some in-treatment intravenous drug users would volunteer for a preventive HIV vaccine efficacy trial. Education and counseling will be required to ensure that subjects fully understand the trial's purposes, methods, risks and benefits.

AIDS Vaccines↗
PubMed1990

Risk behaviors and perceptions of AIDS among street injection drug users.

Standardized survey interviews (n = 325) and guided in-depth interviews (n = 22) were conducted with injection drug users (IDUs) in Long Beach, California, to document drug usage and injection patterns, sexual practices, perceived risk of HIV infection, sources of health information, and knowledge and attitudes about AIDS. Most IDUs reported sharing needles (87.9%), and a large minority reported regular sterilization of needles/syringes (40.3%). Lower rates of needle sharing were reported among cocaine users than among heroin and speedball users. HIV seroprevalence was 5.7 percent (11/194). Sexually active female (60.7%) and male (20.5%) IDUs reported exchanging sex for money or drugs. Overall, 48.3 percent of IDUs reported having made changes in their injection practices and one-third reported modifying their sexual behavior in order to avoid HIV infection. Differences in drug use, sexual practices, and drug treatment history were found with regard to gender, ethnicity, age, and type of drug injected. Implications of findings for the development of AIDS risk-reduction programs are presented.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Effect of psychological factors on risk behavior of human immunodeficiency virus (HIV) infection among intravenous drug users (IVDUs).

The effect of psychological factors on drug and sexual behaviors in relation to HIV infection was investigated among 262 IVDUs in methadone clinics in New York City. Among female IVDUs, the HIV positive subjects reported larger numbers of sex partners than those subjects who were HIV negative, and those who had larger numbers of sex partners were more likely to be depressed. The IVDUs who had larger numbers of needle-sharing partners at shooting galleries were more likely to be HIV positive. Intervention programs should focus on IVDUs who are sexually active females, sharing needles at galleries, still using heroin and cocaine, and who began using heroin at an early age.

Adolescent↗
PubMed1991

HIV infection and AIDS risk behaviors among intravenous drug users entering methadone treatment in selected U.S. cities.

To assess trends in HIV infection and AIDS risk behaviors among intravenous drug users (IVDUs), a series of nonblinded point-prevalence surveys was conducted with admissions to methadone treatment in seven areas, including New York City; Trenton and Asbury Park, New Jersey; Baltimore; Chicago; San Antonio, Texas; and Los Angeles County between February and December 1987 (n = 713), January and June 1988 (n = 1,089), July and December 1988 (n = 932), and January and June 1989 (n = 1,110). Over the 2-year period, significant changes in HIV seropositivity levels were found in only one of the seven cities (Chicago, with levels increasing from 8.4 to 14.7%). High levels of AIDS risk behaviors (frequency of injection, needle sharing, needle cleaning, and use of shooting galleries) were found in all cities. Comparisons of trends in recent risk behaviors (past year) within cities suggest that relatively little reduction in AIDS risk behaviors had occurred during the study.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Drug users' AIDS-related knowledge, attitudes, and behaviors before and after AIDS education sessions.

The investigators interviewed 100 drug users in a detoxification facility before and after they received information about acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV). The drug users already had a considerable amount of information about AIDS and HIV transmission modes before they received the information. However, 79 percent of them reported never having used condoms. Fifty percent of intravenous drug users acknowledged having shared needles during the previous year. Subjects exhibited psychological denial in appraising the riskiness of their personal sexual and needle-sharing behaviors, which they rated as less risky than those activities in general. Following their participation in an AIDS and HIV education program, their knowledge concerning modes of transmission and disease progression increased. Subjects became more aware of their personal risk for HIV infection, and their faith in condom effectiveness and their intent to use them increased. Intravenous drug users reported increased determination to stop their drug use. The results suggest that AIDS education efforts can be useful in programs to help prevent HIV transmission among drug users.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Prevalence patterns and genotypes of GB virus C/hepatitis G virus among imprisoned intravenous drug users.

An RT-PCR assay using primers from the 5'-UTR of the GBV-C/HGV genome was used to detect viremia, and a serological assay was used to detect past exposure to GBV-C/HGV, in sera from 106 imprisoned Greek intravenous drug users. High seroprevalence rates indicative of the parenteral route of transmission of the virus were found (32.1% for GBV-C RNA and 46.2% for anti-GBV-C E2). These rates were nonetheless lower in comparison to the corresponding rates of HCV infection markers (64.2% for HCV RNA and 77.4% for anti-HCV). Statistically significant univariate associations were observed between GBV-C-RNA positivity and younger age (P=0.006) and HCV-RNA positivity (P=0.024), as well as with higher serum alanine aminotransferase levels (P< 0.001); this latter association was shown to be independent of coinfection with HCV and of age by a multiple logistic regression model. Apparently, GBV-C/HGV had spread readily by needle-sharing in prison, while causing acute subclinical hepatitis in infected inmates. Phylogenetic analysis of the partial 5'-UTR of the GBV-C/HGV genome from 16 seropositive individuals, which delineated their grouping within genotype 2, also revealed a close genetic relationship between two sets of sequences from 4 drug addicts, 3 of whom admitted to sharing needles while imprisoned.

5' Untranslated Regions↗
PubMed2001

Potential for hepatitis C transmission among non-needle/syringe sharing Sheffield drug injectors through the sharing of drug preparation paraphernalia.

This study aimed to investigate possible means by which hepatitis C virus (HCV) might be transmitted between drug injecting individuals without the sharing of needles and syringes. A questionnaire-based survey of 143 (out of 287) attendees was conducted at an Infectious Diseases Unit-based HCV clinic. Those patients (all of whom were positive for antibodies to HCV) who asked about risk activities and those that admitted to a history of recreational drug injecting were questioned in detail about their past and current drug preparation practices. Ten per cent denied any history of needle and/or syringe sharing and had no other apparent source of their HCV infection, but instead admitted to having shared drug preparation eqiupment. The existence among drug injectors of such practices with the potential to transmit blood borne viruses is important as it may explain how HCV, which is capable of being spread via very small quantities of blood, can be passed between drug injecting individuals who might otherwise never come into contact with another drug injector's blood. Clinical and public health messages regarding the prevention of the spread of HCV may need to be revised and strengthened.

Communicable Disease Control↗
PubMed2000

Alcohol use patterns predict high-risk HIV behaviors among active injection drug users.

The purpose of this study was to determine if alcohol use is independently associated with needle-sharing behavior. Participants were 196 active injection drug users recruited into the Providence, Rhode Island Needle Exchange program between July 1997 and March 1998. All subjects were administered a 45-minute questionnaire that included questions on quantity/frequency of alcohol use and the alcohol abuse section of the Structured Clinical Interview for DSM-III-R (SCID; Spitzer, Williams, Gibbon, & First, 1992). Drug risk behaviors, including needle sharing were assessed using the HIV Risk Assessment Battery (RAB; Navaline et al., 1994). Of 196 IDUs, 60% had used alcohol in the last month. Twenty-eight percent met criteria from the Diagnostic and Statistical Manual for Mental Disorders, 3rd ed., rev. (DSM-III-R; American Psychiatric Association, 1987) for alcohol abuse over the last 6 months. One half of IDUs had shared needles in the last 6 months. Increasing levels of alcohol ingestion were associated with greater RAB drug risk scores and greater needle sharing. Using multiple logistic regression, high-level "at-risk" alcohol use (odds ratio [OR], 2.5) and alcohol abuse (OR, 2.3) were significantly associated with needle sharing when controlling for other demographic and behavioral factors previously found to be associated with sharing. The results of this study showed that prevalence of alcohol abuse is high in this population and is associated with needle sharing. HIV prevention effects in needle exchange programs should address alcohol use.

Adult↗
PubMed1991

Intravenous drug users and AIDS: risk behaviors.

Risk-taking behaviors were studied in this assessment of 345 intravenous drug users from Baltimore, El Paso, and Denver. Over 50% reported injecting drugs daily and 70% shared needles with others, averaging 6.3 partners. In addition, 86% had shared a "cooker" and nearly 50% injected in a "shooting gallery." More than half of the males sampled had two or more sex partners, including 18% with five or more. Females averaged 19 sex partners in the preceding 6 months, with 22% reporting sex with five or more. Two-thirds of the total sample never used a condom, while only 6% always used this form of protection. On the other end of this risk continuum were those subjects who did not share needles or always cleaned their needles with an effective agent, had no sexual relations or always used a condom. Subjects following such practices could be considered low risk if they adopted safe behaviors in other associated areas of their lives. However, in an analysis of total risk, it was found that only 14 subjects (4%) practiced safe needle use and safe sex. Despite these findings, some encouraging results were seen. In an analysis of risk according to location, Baltimore subjects were significantly less at risk according to number of needle-sharing partners, borrowing needles, sharing a "cooker," injection in a "shooting gallery," cleaning needles, use of disinfectants, number of sexual partners, and use of condoms than either their cohorts in El Paso or Denver. Street outreach to modity risk behaviors among IVDUs began in Baltimore approximately 2 years prior to funding in El Paso and Denver. These results suggest that there may be a potential to moderate risk through intervention.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Prevalence of opioid analgesic injection among rural nonmedical opioid analgesic users.

OBJECTIVE: The purpose of this study was to examine the prevalence and correlates of opioid analgesic injection (OAI) in a cohort of rural opioid analgesic users. METHODS: Cross-sectional study of 184 participants from rural Appalachian Kentucky. RESULTS: The majority of participants were male (54.9%), white (98.4%) and the median age was 30 years (interquartile range: 24-37). The self-reported lifetime prevalence of injection drug use (IDU) was 44.3%, with 35.3% of respondents reporting injection of oral opioid analgesic formulations. The prevalence of self-reported hepatitis C (HCV) was 14.8%, significantly greater than those not injecting opioid analgesics (1.7%) (p<0.001). Receptive needle sharing, distributive needle sharing and sharing of other injection paraphernalia was reported by 10.5%, 26.3%, and 42.1% of those currently injecting, respectively. CONCLUSIONS: Opioid analgesic injection was more prevalent in this rural population than has been found in previous reports. This study suggests a rising problem with injecting among rural opioid users, a problem more typically associated with urban drug users. Educating injectors of opioid analgesics on safe needle practices is necessary in order to curb the transmission of HIV, HCV, and other infectious diseases. Further study on the longitudinal course of opioid analgesic injection in this population appears warranted.

Adult↗
PubMed2004

HIV risk behaviors and alcohol intoxication among injection drug users in Puerto Rico.

This paper reports results of an analysis of the association between alcohol intoxication and injection and sexual HIV risk behaviors among 557 Hispanic heroin and cocaine injectors, not in treatment, who were recruited in poor communities in Puerto Rico. Subjects were part of a longitudinal prevention-intervention study aimed at reducing drug use and HIV risk behaviors. Participants reported a high prevalence of co-occurring conditions, particularly symptoms of severe depression (52%) and severe anxiety (37%), measured by Beck's Depression Index and Beck's Anxiety Index, respectively. Alcohol intoxication during the last 30 days was reported by 18% of participants. Associations were found between alcohol intoxication and both injection and sexual risk behaviors. In the bivariate analysis, subjects reporting alcohol intoxication were more likely to inject three or more times per day, pool money to buy drugs, share needles, and share cotton. They were also significantly more likely to have a casual or paying sex partner and to have unprotected sex with these partners. After adjustment, sharing needles and cotton, having sex with a paying partner or casual partner, and exchanging sex for money or drugs were significantly related to alcohol intoxication. HIV prevention programs, to be effective, must address alcohol intoxication and its relation to injection and sexual risk behaviors as a central issue in HIV prevention among drug injectors.

Adolescent↗