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PubMed1989

Introduction of HIV infection among intravenous drug abusers in low prevalence areas.

To explore the introduction of human immunodeficiency virus (HIV) infection into intravenous drug abusing populations, risk behaviors of 1,154 intravenous drug abusers (IVDAs) in four U.S. cities with low prevalence of IVDA/HIV infection (0.9-13.0%) were examined. Seropositive subjects (N = 54) were compared with demographically matched seronegative controls regarding drug use practices, homosexual contact, blood transfusions, risk behaviors while traveling or living in high prevalence areas, and acquaintance with persons with AIDS. With the exception of needle sharing with homosexual/bisexual males, no differences in risk behaviors were found between seropositive subjects and matched seronegatives. Seropositives were substantially more likely than matched seronegatives to report having shared a needle with a homosexual or bisexual male, suggesting that needle sharing between homosexual/bisexual IVDAs and heterosexual IVDAs may be an important means by which HIV is introduced among heterosexual IVDAs in low prevalence areas.

Adult↗
PubMed1992

Behavioral characteristics of seroconverted intravenous drug users.

A total of 440 participants (218 in 1987 and 222 in 1988) were recruited from methadone maintenance clinics in New York City. After obtaining informed consent, a standardized questionnaire was administered. Also, sera were collected and tested for HIV antibody. The overall HIV infection rate was 60% in 1987 and 52% in 1988. In 1987 and 1988, respectively, 19 of 23 and 23 of 40 participants who admitted to a previous HIV seronegative result were found to test HIV seropositive. The behavioral factors which differentiated suspected seroconverters from participants who remained seronegative were frequencies of sharing needles (p < .01), sharing cookers (p < .02), and use of shooting galleries (p < .05) during the last 5 years. Needle-sharing behaviors continue to be associated with HIV seroconversion among IVDUs. More effective education to stop needle sharing among IVDUs is needed.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Differentiated risk behaviour for HIV and hepatitis among injecting drug users (IDUs).

Needle sharing is a risk factor for contracting blood-borne infections among injecting drug users (IDUs). We explored the relation of socio-financial, physical and mental health factors (ASI) to risk behaviour (Qr23) for contracting blood-borne infections among IDUs (Addiction Severity Index and Questionnaire for risk behaviour). 42 HIV negative IDUs were studied prospectively. The median age was 42.5 (range 18-61) y, 28 of 42 (67%) were males and median duration of injecting was 19.0 (range 0-43) y. HCV and HBV antibodies were found in 37 (88%) and 31 (71%) participants, respectively. Poly drug use was reported by 23 (55%) participants; amphetamine by 10 (24%) and heroin by 9 (21%). From the ASI data we were unable to find any statistically significant factor that was associated with needle sharing (n = 26/42, 61%) or sharing drug mixture/filter (n = 25/42, 59%). 19 (73%) of 26 participants who shared needles also shared drug mixture/filter. Of these 26 IDUs, 7 shared needles with partners, 11 with acquaintances, 3 with strangers and 5 with all categories. In conclusion, the study group showed differentiated risk behaviours for blood-borne infections with regard to various persons and to whom they were exposed. This suggests that IDUs may benefit from individualized counselling regarding risks for infections with HIV, HCV and HBV.

Adolescent↗
PubMed1998

Changing behavioural pattern of drug users in Hong Kong 1991-1995.

AIMS: To analyse the temporal changes in demography and drug-taking behaviours of a cohort of drug users in Hong Kong. DESIGN: An analysis of records of clients over a 5-year period. SETTING: Shek Kwu Chau Treatment and Rehabilitation Centre, a large residential service offering voluntary rehabilitation programmes for male drug users in Hong Kong. MEASUREMENTS: The following parameters were analysed for all admissions between 1991 and 1995: duration of drug-taking, route(s) of drug administration, type of drugs abused, practice of injection and needle-sharing, time since last needle-sharing, and expenditure on drugs. FINDINGS: A total of 10,353 admissions were recorded in the 5-year period from 1991 to 1995, of whom 2853 (27.6%) were new admissions. The mean age was 36 years. There was a significant increase in new admission in those between the age of 13 and 19. Almost all clients were heroin users. The needle-sharing rates fell from over 20% in 1991 to < 5% in 1995. Needle-sharing was more common in younger clients. The decline in the rate of needle-sharing was especially significant in those between the age of 20 and 39. CONCLUSION: The proportion of young drug users in the study population in Hong Kong has risen over the 5-year period. The prevalence of high-risk drug-taking behaviours had declined, which might have contributed to the low HIV rates in the community.

Adolescent↗
PubMed2000

Drug injectors and the cleaning of needles and syringes.

When people share needles and syringes they risk transmitting human immunodeficiency virus (HIV) and other infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). Cleaning needles and syringes can help to reduce, although not eliminate, these risks. This article begins by engaging with some of the literature on the cleaning of needles and syringes. Drawing on qualitative research conducted with drug injectors in England, the article then goes on to explore drug injectors' perceptions and experiences of cleaning needles and syringes inside and outside prison. The article concludes by highlighting the implications for future research and policy making. Ultimately there should be a stronger policy response to reduce the risks associated with sharing needles and syringes inside prison, which should include the piloting of prison needle and syringe exchange schemes.

HIV Infections↗
PubMed1997

Infection with human immunodeficiency virus and hepatitis viruses in Chinese drug addicts.

The prevalence of antibody against hepatitis C virus (anti-HCV) and five hepatitis B virus markers (HBVM) was measured in 176 Chinese drug addicts, of whom 23 were AIDS patients. Of 176 drug addicts, 147 were members of ethnic minorities while 29 were Han, the majority ethnic group. The total prevalence rates of anti-HCV and HBVM were 35.8% and 50.6% respectively, significantly different (P < 0.01). Anti-HCV and HBVM were together found in 22.7%. Similar prevalence rates were found among the different ethnic groups. Among the ethnic minorities, there was a significantly higher prevalence rate of anti-HCV in intravenous drug addicts (IVDA, 51.1%) than in oral drug addicts (20.3%). Furthermore, the prevalence of anti-HCV was significantly higher in needle-sharing abusers (60.4%) than in non-needle sharing ones (37.1%, P < 0.05). The prevalence of HBVM was also significantly higher in needle-sharing abusers (69.8%) than in non-needle sharing ones (34.3%). Prevalence of HBsAg was significantly higher in drug abusers with AIDS (47.8%) than in IVDA only (16.1%). The anti-HCV positive rates among ethnic minority people were: for the Yi people 69.2%, the Hui 55.6%, the Bai 53.9%, the Dai 26.8% and the Wa 23.1%. No obvious difference was identified for HBVM. The prevalence rates of HCV, HBV and HCV + HBV in IVDA showed no significant difference (P > 0.05) between the two regions. HIV, HCV and HBV infections may promote each other and be related to needle-sharing behaviour in drug abuse and to different subcultures and living habits.

Adolescent↗
PubMed1990

Exposure factors for HIV-1 infection among heterosexual drug abusers in New Jersey treatment programs.

In a cross-sectional study of 926 subjects from 10 drug treatment programs conducted in 1984 in New Jersey, the seroprevalence of human immunodeficiency virus (HIV) was 35% overall; 30% in whites, 33% in hispanics, and 46% in blacks (p = 0.01 for comparison of blacks to non-blacks). Univariate analysis showed the seroprevalence of HIV was not associated with age or gender, but did correlate with frequency of cocaine or heroin injection (p trend less than 0.001); frequency of needle sharing (p trend = 0.007); and inversely with levels of education (p = 0.05). The prevalence of HIV was also inversely related to the distance of the treatment center from lower Manhattan; being highest for distances of less than 5 miles from lower Manhattan and lowest for distances of 80 miles, with intermediate rates for the intervening distances (p trend less than 0.001). In multivariate analyses, HIV seropositivity was consistently associated with the frequency of needle sharing (p = 0.02) and less than 12 years (high school level) of education (p = 0.02), but not with black race. However, blacks who shared needles less than once a month had a relative risk of 3.2 (95% CI 1.2, 7.7) while non-blacks who shared less than once a month had a relative risk of only 0.9 (95% CI 0.3, 2.4). The risk in non-blacks increased to more than twofold with more frequent needle sharing. When the analysis was stratified by gender and adjusted for needle sharing and geography, a significant twofold increased risk was observed for female (but not male) subjects who had two or more heterosexual partners compared with those who had one partner.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team.

Recent studies have reported on the utility of audio computer-assisted self-interviewing (ACASI) in surveys of human immunodeficiency virus (HIV) risk behaviors that involve a single assessment. This paper reports the results of a test of ACASI within a longitudinal study of HIV risk behavior and infection. Study participants (gay men (n = 1,974) and injection drug users (n = 903)) were randomly assigned to either ACASI or interviewer-administered assessment at their second follow-up visit 12 months after baseline. Significantly more of the sexually active gay men assessed via ACASI reported having sexual partners who were HIV antibody positive (odds ratio = 1.36, 95% confidence interval: 1.08, 1.72), and a higher proportion reported unprotected receptive anal intercourse. Among injection drug users (IDUs), our hypothesis was partially supported. Significantly more IDUs assessed via ACASI reported using a needle after another person without cleaning it (odds ratio = 2.40, 95% confidence interval: 1.34, 4.30). ACASI-assessed IDUs reported similar rates of needle sharing and needle exchange use but a lower frequency of injection. Participants reported few problems using ACASI, and it was well accepted among members of both risk groups. Sixty percent of the participants felt that the ACASI elicited more honest responses than did interviewer-administered questionnaires. Together, these data are consistent with prior research findings and suggest that ACASI can enhance the quality of behavioral assessment and provide an acceptable method for collecting self-reports of HIV risk behavior in longitudinal studies and clinical trials of prevention interventions.

Adolescent↗
PubMed1994

Transitions between routes of administration of regular amphetamine users.

A sample of 301 regular amphetamine users was interviewed regarding transitions between routes of administration of amphetamines. Use of amphetamines by injecting was widespread, with two-thirds (67%) of subjects having injected the drug during the preceding 6 months. Needle-sharing was common, with 41% of injectors having shared a needle in the month preceding interview. A transition to regular amphetamine injecting from other routes of administration was reported by 40% of subjects, with males being twice as likely to report such a transition. The median number of such transitions was one. The main reasons given by subjects for the transition to injecting were liking the "rush" from injecting, and seeing it as a more economical and a healthier way to use. A small proportion of subjects (9%) reported a transition away from injecting amphetamines, with a median of one such transition. The most common reason given for abandoning injecting was concern about vascular damage. Interventions to encourage safer use of amphetamines need to address the misconceptions that injecting is more economical and more healthy, and to emphasize the vascular problems associated with injecting.

Adolescent↗
PubMed2003

Attitudes toward HIV treatments influence unsafe sexual and injection practices among injecting drug users.

OBJECTIVE: To determine if HIV treatment-related attitudes are associated with unprotected sex and needle sharing among HIV-seropositive and -seronegative injecting drug users (IDU) in Baltimore, Maryland. DESIGN AND METHODS: IDU participating in a cohort study seen between December 2000 and July 2001 completed an interviewer-administered questionnaire on attitudes toward HIV treatment and risk behaviors (593 HIV-seronegative, 338 HIV-seropositive), including: perceived HIV transmissibility through unprotected sex and needle sharing, and safer sex and injection fatigue. Logistic regression was used to examine the role of attitudinal factors on needle sharing and unsafe sex. RESULTS: Almost two-thirds of sexually active participants engaged in unprotected sex and approximately half of those injecting drugs shared needles. Among HIV-seropositive IDU, perception of reduced HIV transmissibility through unprotected sex was significantly associated with unprotected sex [adjusted odds ratio (AOR), 3.33; 95% confidence interval (CI), 1.05-10.55). Safer injection fatigue was independently associated with needle sharing among HIV-seropositive IDU (AOR, 6.55; 95% CI, 1.69-25.39). Among HIV-seronegative IDU, safer sex fatigue and safer injection fatigue were independently associated with unprotected sex (AOR, 3.12; 95% CI, 1.17-8.35) and needle sharing (AOR, 5.15; 95% CI, 2.33-11.37), respectively. CONCLUSION: Among HIV-seropositive IDU, perceiving that HIV treatments reduce HIV transmission was significantly associated with unprotected sex. Risk reduction fatigue was strongly associated with unsafe sexual and injection behaviors among HIV-seronegative individuals. HIV prevention interventions must consider the unintended impact of HIV treatments on attitudes and risk behaviors among IDU.

Adult↗
PubMed1993

Trends in self-reported HIV risk behavior: injection drug users in Los Angeles.

This article reviews trends in HIV risk behaviors across serial samples of Los Angeles injection drug users interviewed between 1987 and 1991. All indicators are based on self-reported behavior during the year before the interview. Findings show persistent drug-related risk behaviors. No decrease has occurred in needle sharing with strangers/acquaintances or at shooting galleries. No increase has occurred in self-reported avoidance of needle sharing for as long as 1 year. The only exception to this pattern is a significant increase in bleach use among injection drug users who share needles. Findings are mixed regarding sex-related risk behaviors. Drug users have not reduced their yearly number of sex partners, but condom use has become more prevalent among nonmonogamous drug users. We conclude that preventive education will need to adopt new strategies for addressing persistent risk behaviors while at the same time reinforcing favorable trends that have already begun.

Adult↗
PubMed1995

Practice of drug abuse among inmates of a drug rehabilitation centre in Hong Kong.

Sharing of contaminated injection equipment accounts for the rapid spread of the human immunodeficiency virus (HIV) among injecting drug users (IDUs). The profile of drug addiction practice among inmates of the Shek Kwu Chau Drug Rehabilitation Centre in Hong Kong was studied. Registers on all the new admissions to the Centre during a two-year period between 1990 and 1992 were reviewed. Of the 3129 drug users studied, 68.7% were aged between 21 and 40; 84.8% were IDUs and heroin was the commonest drug of addition. Nearly 70% of the IDUs had never shared injection equipment with others. There were significantly more young addicts (< or = 30 years old) who had shared needles compared with the older ones (31.2% vs 26.8%, P < 0.05). Those with addiction time > 6 months were more likely to have shared needles than the new ones. Only 19% of the drug users accepted HIV testing at their first admission. Factors speculated for the low needle-sharing rates among IDUs in Hong Kong and the low HIV prevalence in the IDU population are discussed. It is of utmost importance to monitor continuously such a high-risk behaviour pattern so as to design appropriate intervention strategies to stop the transmission of HIV.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Unsafe injection practices in a cohort of injection drug users in Vancouver: could safer injecting rooms help?

BACKGROUND: In several European countries safer injecting rooms have reduced the public disorder and health-related problems of injection drug use. We explored factors associated with needle-sharing practices that could potentially be alleviated by the availability of safer injecting rooms in Canada. METHODS: The Vancouver Injection Drug User Study is a prospective cohort study of injection drug users (IDUs) that began in 1996. The analyses reported here were restricted to the 776 participants who reported actively injecting drugs in the 6 months before the most recent follow-up visit, during the period January 1999 to October 2000. Needle sharing was defined as either borrowing or lending a used needle in the 6-month period before the interview. RESULTS: Overall, 214 (27.6%) of the participants reported sharing needles during the 6 months before follow-up; 106 (13.7%) injected drugs in public, and 581 (74.9%) reported injecting alone at least once. Variables independently associated with needle sharing in a multivariate analysis included difficulty getting sterile needles (adjusted odds ratio [OR] 2.7, 95% confidence interval [CI] 1.8-4.1), requiring help to inject drugs (adjusted OR 2.0, 95% CI 1.4-2.8), needle reuse (adjusted OR 1.8, 95% CI 1.3-2.6), frequent cocaine injection (adjusted OR 1.6, 95% CI 1.1-2.3) and frequent heroin injection (adjusted OR 1.5, 95% CI 1.04-2.1). Conversely, HIV-positive participants were less likely to share needles (adjusted OR 0.5, 95% CI 0.4-0.8), although 20.2% of the HIV-positive IDUs still reported sharing needles. INTERPRETATION: Despite the availability of a large needle-exchange program and targeted law enforcement efforts in Vancouver, needle sharing remains an alarmingly common practice in our cohort. We identified a number of risk behaviours--difficulty getting sterile needles, needle sharing and reuse, injection of drugs in public and injecting alone (one of the main contributing causes of overdose)--that may be alleviated by the establishment of supervised safer injecting rooms.

British Columbia↗
PubMed1994

HIV risk-taking behaviour among amphetamine users in Sydney, Australia.

A survey was undertaken of needle-sharing and sexually risky behaviour among 231 Australian amphetamine users, half of whom usually injected amphetamine. The prevalence of risky needle use and sexual behaviour was similar to that observed in recent Australian surveys of opioid injectors. About a third of those who had ever injected had shared needles, and the variables that best predicted frequency of sharing needles were having an injecting drug user as a partner, having experienced symptoms of dependence on amphetamines, and having sought medical treatment for an amphetamine related problem. Regular condom use with either regular or causal partners was low; only the minority employed in the sex industry regularly used condoms. Sexual risk-taking was not related to needle-sharing or amphetamine use. Although Australian amphetamine and opioid users have reduced their risks of transmitting HIV, there remains a substantial minority of both types of drug injector who continue to place themselves and others at risk by sharing needles and engaging in unsafe sexual behaviour.

Adult↗
PubMed2003

The impact of needle-exchange programs on the spread of HIV among injection drug users: a simulation study.

OBJECTIVE: To determine the impact of the implementation of a needle-exchange program (NEP) on the spread of human immunodeficiency virus (HIV) in an injection drug user (IDU) community. We conducted a Monte Carlo simulation study of a theoretical population of 10000 IDUs. The population was followed monthly from 1984 to 2000. HIV was assumed to be transmitted only by needle sharing. The NEP was introduced in 1989 and evaluated over a period of 11 years. The impacts of the proportion of the population attending the NEP, the risk level of IDUs attending the NEP, the reduction in needle-sharing frequency, and the number of new needle-sharing partners acquired at the NEP on prevalence and incidence of HIV were determined. Increasing the proportion of the population who always attend the NEP and eliminating needle-sharing incidents among IDUs who always attended the NEP were the most effective ways of reducing the spread of HIV. Attracting high-risk users instead of lower risk users to the NEP also reduced the spread of HIV, but to a lesser extent. NEPs are effective at reducing the spread of HIV; even under the worst case scenario of low risk users more likely to attend the NEP, one additional partner per month as a result of attending the NEP, and poor NEP attendance, the estimated prevalence was still less than that from the scenario without an NEP. Under our model, NEPs were shown to reduce the spread of HIV significantly. Efforts should be focused on getting as many IDUs as possible to become regular NEP attenders and stop sharing needles rather than partially reducing the frequency of sharing by a larger number of IDUs.

British Columbia↗
PubMed2001

Changes in HIV-1 incidence in heroin users in Guangxi Province, China.

Guangxi Province, China recently experienced an outbreak of HIV-1 infection among heroin users. We studied HIV-1 incidence rates and associated risk factors for HIV-1 infection among heroin users residing in Pingxiang City. A total of 318 heroin users were followed from February 1998 through January 1999 (median follow-up: 8.1 months). Of these, 130 were prospectively followed from January through September 1999 (median follow-up: 8.3 months). HIV-1 and hepatitis C virus (HCV) incidence rates for each period were calculated. A generalized estimating equation approach was implemented to identify independent risk factors associated with HIV-1 infection across both periods. Among 318 study participants, 97.2% were men. The median age was 22 years. Approximately 60% reported sharing needles. HIV-1 prevalence at baseline was 15.4%. During the first follow-up period, HIV-1 incidence was 2.38 per 100 person years (py), and HCV incidence was 26.8 per 100 py. During the second follow-up period, HIV-1 incidence was 6.86 per 100 py, and HCV incidence was 28.9 per 100 py. After controlling for age and other factors, HCV seropositivity, history of sexually transmitted diseases, and sharing needles were independently associated with HIV-1 infection. These data suggest that HIV-1 incidence was rising over time in Pingxiang City, Guangxi Province. The high incidence of HCV heightens the importance of enhanced prevention programs to reduce injection and needle sharing among heroin users.

Adult↗
PubMed2005

Correlates of unsafe syringe acquisition and disposal among injection drug users in Baltimore, Maryland.

Because multi-person syringe use is the most common vehicle for HIV and hepatitis C virus transmission among injection drug users (IDUs), safe sources of sterile syringes and safe methods of disposal are necessary to curb these epidemics. We examined syringe acquisition and disposal in a cohort of IDUs in Baltimore. Between January 1, 1998 and December 31, 2001, 1034 participants reported on syringe acquisition at 3492 visits, and 953 reported on disposal at 2569 visits. Participants were 69.9% male, 93.9% African-American, and median age was 44. Syringes were acquired exclusively from unsafe sources at 32.3% of visits, while exclusively unsafe disposal was reported at 59.3% of visits. Significant correlates of unsafe acquisition were: attending shooting galleries, anonymous sex, sharing needles, smoking crack, and emergency room visits. Significant correlates of unsafe disposal were: injecting speedball, no methadone treatment, acquiring safely, and frequent injection. Having a primary source of medical care was associated with safe acquisition, but unsafe disposal. IDUs continue to acquire safely but dispose unsafely, especially among those with a primary source of care; this suggests that messages about safe disposal are not being disseminated as widely as those about acquisition. These data suggest the need for a more active program involving pharmacists, an expanded syringe access program, and better efforts to enhance safe disposal.

Adolescent↗
PubMed1996

Injection drug use and risk of HIV transmission among homeless men with mental illness.

OBJECTIVE: The high seroprevalence of HIV that has been reported among homeless individuals with mental illness indicates an urgent need to examine HIV risk behavior in this population. METHOD: Injection drug use and sexual behavior were assessed in comprehensive interviews with 218 homeless mentally ill men in a New York City shelter. First, the proportion of men who had injected drugs was established. Then, among those who had injected drugs, the injection drug use behaviors associated with HIV transmission (i.e., whether they had ever engaged in high-risk behaviors and had ever engaged in risk-reduction behaviors) and their current sexual risk behaviors were examined. RESULTS: Fifty (23%) of the 218 men had injected drugs. Among these 50, the great majority had engaged in high-risk behaviors, including sharing needles (66%) and using shooting galleries (64%). Few had engaged in risk-reduction behaviors, such as cleaning needles with bleach (22%) and using a needle exchange program (2%). In the past 6 months alone, the majority of the injection drug users had had unprotected sex with women (48%) or with men (10%). CONCLUSIONS: This study documents a high lifetime prevalence of injection drug use in a group of homeless men with mental illness. The men who had injected drugs reported injection drug use and sexual behaviors with high risk of HIV transmission and gave scant evidence of risk-reduction behaviors. These individuals may fall between service systems and may be difficult to reach but, nonetheless, must be included in efforts to prevent transmission of HIV infection.

Adult↗