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HIV/AIDS prevalence and behaviour in drug users and pregnant women in Kashgar Prefecture: case report.

Second Generation sub-population HIV Surveillance was undertaken in Kashgar City and Shache County, Xinjiang, Peoples Republic of China between December 2003 and January 2004, targeting injecting and mixed method drug users and pregnant and postnatal women. The study aimed to determine the extent to which the epidemic is shifting from a concentrated stage to a more generalised epidemic. One hundred and forty two (142) exclusively injecting drug users (66) and mixed method drug users (injecting and non-injecting-76) participated in this survey. Eight hundred and two (802) pregnant and postnatal women participated in the survey. In Kashgar City and Shache County the serum prevalence of HIV amongst injecting drug users was 56.06%, for mixed method drug users 48.68% and 0.38% in pregnant women. In Shache County HIV infection rates were significantly lower in drug user groups and amongst pregnant and post-natal women, at 2.22% and 0% respectively. The behavioral survey indicated that 15% of injecting drug users have shared needles (however sero prevalence and knowledge in relation to access to clean needles and syringes suggests that this may not reflect the actual situation). Knowledge of prevention of transmission strategies (not sharing needles and condom utilisation) is similar between both groups at 60-70%. However it appears that this knowledge has not significantly impacted on behavior such as needle sharing and condom utilisation. In Kashgar City and Shache County there have been very few interventions to support HIV/AIDS prevention, care and control. The results from this survey will inform future directions and the development and implementation of targeted interventions including targeted information dissemination and harm reduction strategies. This survey was funded by the Xinjiang HIV/AIDS Prevention and Care Project, a bilateral project jointly implemented by the Government of the People's Republic of China and the Government of Australia.

Journal Article↗

Needle exchange programs and drug infection behavior.

This study examines how drug injection and needle sharing propensities respond when a needle exchange program (NEP) is introduced into a city. I analyze 1989-1995 Drug Use Forecasting data on adult male arrestees from 24 large U.S. cities, in nine of which NEPs opened during the sample period. After controlling for cocaine and heroin prices, AIDS prevalence, fixed effects for cities and years and city-specific time trends, the model indicates that the presence of a NEP is associated with declines of 13 percent in drug injection and 20 percent in needle sharing among drug injectors.

Adult↗

[Qualitative study of drug-using and sexual behaviors of drug users in Guangxi].

OBJECTIVE: To understand where and how drug-using and sexual behaviors occurred among drug users. METHODS: Twenty-five drug users were recruited from detoxification centers and communities. In-depth interview was used to collect information about drug-using and sexual behaviors. Each subject was interviewed separately and privately for about 2 - 3 hours. RESULTS: Most drug users shifted from oral taking drugs to injecting drugs in order to reduce economic burden and look for "high feeling". Reasons for not injecting among few drug users included 'perceiving information on harm of injection', 'over-dose death' or 'infection with HIV'. Most drug users knew that HIV transmit through sharing needles or having sexual intercourse without using a condom. However, needles were shared at night when drug or needles were scarce. Promiscuous sexual relationship was common among drug users. Most female drug users had engaged in prostitution but few used condoms. CONCLUSION: High-risk drug injecting behaviors and high-risk sexual behaviors were prevalent among drug users despite knowledge on HIV transmission and prevention. Thus, education alone would not work unless specific intervention programs are taken.

Adolescent↗

Racial/ethnic differences in HIV-1 seroprevalence and risky behaviors among intravenous drug users in a multisite study.

Differences in human immunodeficiency virus type 1 (HIV-1) seroprevalence and patterns of drug-use and sexual behaviors were examined among Hispanic, black, and white intravenous drug users recruited at multiple sites in Worcester, Massachusetts. A total of 1,092 (786 males, 306 females) intravenous drug users were interviewed, and HIV-1 antibody test results were available for 874 (80.0%). After adjustment for demographic differences, black males were significantly less likely to report risky drug-use behaviors (ever sharing needles and recently visiting shooting galleries) compared with white males. In contrast, Hispanic males were significantly more likely to report recent risky drug-use behaviors (sharing needles in New York City, daily needle-sharing, and visiting shooting galleries). Both groups were less likely to report risky sexual behaviors compared with whites. The odds ratios for HIV-1 seropositivity remained significantly greater than 1 for Hispanics compared with whites (odds ratio = 4.5) and maintained marginal significance for blacks compared with whites (odds ratio = 2.1) when adjusted for risky behaviors and demographic variables. The different patterns of drug-use and sexual behaviors by race/ethnicity indicate the need for interventions targeted to specific populations.

AIDS Serodiagnosis↗

Hepatitis C prevalence and needle/syringe sharing behaviours in recent onset injecting drug users.

AIM: To investigate the prevalence of hepatitis C antibody (anti-HCV) in injecting drug users (IDU), particularly amongst those of recent onset beginning since the advent of the needle-exchange programme. Secondly this study sought information on needle-sharing practices. METHODS: The records of injecting drug users over 2 years from January 1992 were examined for anti-HCV results and needle-sharing reports on initial assessment at the Wellington drug dependency clinic. RESULTS: Amongst 110 injecting drug users 92 (84%) were tested for anti-HCV, and 71 (77%) were positive. There was a significant (p = 0.02) association between the reported duration of intravenous drug misuse and the proportion of injecting drug users who were positive for anti-HCV. Of those injecting drug users who had reported use of less than 4 years, since the introduction of the New Zealand needle exchange programme, 53% were positive for anti-HCV. Needle-sharing was frequently reported to have ever occurred in 74% of these patients at some time, and in 64% of those who reported use of less than 4 years. These differences were not significant. However, in the period before presenting 67% had not shared over the last 3 months and 57% had not shared over the previous 1 year, which are improvements on previous studies of needle-sharing, considered to be the most important mode of transmission for blood-borne viruses in injecting drug users. CONCLUSIONS: These results suggest considerable potential for HIV infection rates among injecting drug users in New Zealand to increase from the current low level. There needs to be continuing emphasis on public health programmes to eradicate needle-sharing, and to promote safe injecting techniques for injecting drug users.

Adult↗

Risk factors for HIV infection among drug injectors in southern Thailand.

BACKGROUND: To determine HIV sero-prevalence and risk factors for HIV infection among injecting drug users (IDU) in southern Thailand. METHODS: Using a cross-sectional HIV sero-prevalence and behavioral survey, 272 active IDU were interviewed about background, life-style, drug use patterns, and sexual behaviors at six drug-treatment clinics in southern Thailand. RESULTS: Ninety-one percent reported lifetime needle sharing; 96% had tried HIV risk-reduction by either stopping/decreasing visits to sex workers and/or stopping/decreasing needle sharing. Only 5% knew that bleaching needles could reduce transmission risks. Overall, 51% tested HIV-positive (43% ethnic Thai vs. 64% ethnic Malay). HIV seropositivity among ethnic Thai was independently correlated with past history of needle sharing (OR 6.95; 1.89-25.58), injecting immediately at drug onset (OR 2.53; 1.25-5.13), and starting first injection at younger age (OR 2.61; 1.31-5.22). Injecting immediately at drug onset (OR 4.32; 1.23-15.14) and not carrying new needles (OR 4.47; 1.27-15.69) were risk factors among minority ethnic Malay. CONCLUSION: A high rate of HIV infection persists among southern-Thai IDU. HIV-infected individuals may act as a bridge of HIV transmission to their sex partners. AIDS prevention efforts should more intensely focus on minority ethnic Malays, discouraging needle sharing and increasing protected sex with regular sexual partners.

Adult↗

[Determinants associated wtih the presence of risk behaviors in HIV infected patients].

BACKGROUND: Determinants associated with risk behaviours are evaluated in a known HIV-infected population not belonging to the great metropolitan nuclei. PATIENTS AND METHODS: 110 unselected HIV+ patients were interviewed, including 77 variables. Their association with sharing needles, and unprotected sex is analysed. RESULTS: Sharing needles was associated to: low academic achievement (p = 0.045), no children (p = 0.045), any physical limitation (p = 0.004), previous admission to detoxification unit (p = 0.014), and depression. With unprotected sex were associated: low academic achievement (p = 0.005), lesser time of HIV infection (p = 0.009), no family support (p = 0.005), and scanty information about HIV transmission (p = 0.018). CONCLUSIONS: A cohort of HIV-infected subjects who persist with risk practices is remaining. Some easily recognizable variables may be useful for their early recognition.

Adult↗

Imprisonment: a risk factor for HIV infection counteracting education and prevention programmes for intravenous drug users.

OBJECTIVES: To examine changes of risk behaviour and its determinants as well as risk factors for HIV infection in intravenous drug users (IVDU) with particular attention to imprisonment and its risk patterns. SETTING: In 1993 a multisite cross-sectional study was carried out by standardized questionnaires and blood/saliva samples in which 612 IVDU from Berlin were enrolled. RESULTS: Multifactorial analysis revealed that the most important risk factor for HIV infection was needle-sharing in prison. In total, 353 IVDU (58%) reported reduced risk behaviour; changes related more to injection behaviour than sexual practices (91 versus 68%). Important determinants for needle-sharing during the last 6 months were intravenous drug use in prison, duration of drug-taking history, and knowledge of a negative HIV test. The most frequently reported reasons for current needle-sharing were having shared needles with only one regular partner (45%) and imprisonment (26%). CONCLUSION: Information campaigns and other prevention measures appear to have produced risk awareness in IVDU, and as a consequence, a reduction in risk behaviour. The situation in prisons (no sterile injecting equipment, no effective disinfectants), however, is counteractive to prevention measures implemented outside prisons. An important task for future strategies should be to enable IVDU to avoid HIV transmission while in prisons.

Adult↗

Risk factors for HIV-1 seropositivity in drug users under 30 years old in Haiphong, Vietnam.

AIMS: To assess the prevalence of HIV infection among young drug users in Haiphong and, secondarily, to document the current patterns of drug use and sexual behavior in them. Design, setting and participants. A cross-sectional survey of drug users 15-30 years old, identified from police lists and by the snowballing method between March 15 and May 30, 1999, was conducted in Haiphong City. MEASUREMENTS: Subjects (n = 520: 514 males and six females) were interviewed and donated blood specimens for HIV-1 antibody testing. FINDINGS: Mean age of the subjects was 25 years (range 15-30 years). The prevalence of HIV among injecting drug users (IDUs) was 74% and among drug users not reporting injecting was 46% (92/201). Sixty-one per cent (319) reported injecting drugs. Among injectors, 72% used heroin, and 68% had shared needles. Factors related to the presence of HIV antibody among IDUs were sharing needles (OR: 4.12) and injecting more than 31 times per month (OR: 2.37). Extramarital sex within the last 6 months was reported by 44% of single and 24% of married IDUs. CONCLUSION: The high HIV-1 prevalence in drug users and their frequent sexual mixing with the non-drug-using population suggests that preventive interventions for reduction of high-risk drug taking and sexual activities are urgently needed in these populations. Interventions through public sexually transmitted infection (STI) clinics are unlikely to have much impact, as only 16% of IDUs with an STI attended a public STI clinic.

Adolescent↗

Short tandem repeat methodology for genotypic identification of single-person versus multi-person use of syringes.

OBJECTIVE: To develop laboratory methods to differentiate between single- versus multi-person use of syringes by injection drug users. METHODS: Forensic short tandem repeat (STR) genetic analysis was undertaken to cross-validate a test panel of trace blood contents from syringes representing single- versus multi-person syringe use. Laboratory-simulated scenarios of needle sharing generated 34 syringe washes that were blinded for evaluation. Polymerase chain reaction was used to amplify the polymorphic STR locus D6S502 from blood trace contents in used syringes. Alleles were sized and quantified using a commercial gene sequencer. A statistical algorithm was developed to determine the number of alleles present in the amplified DNA fragments. Syringes with more than two expected alleles were considered to represent multi-person syringe use. Sensitivity, specificity and the kappa coefficient were calculated. RESULTS: Allelic matrix-based analysis of alleles from the single STR successfully characterized single-use (n = 12) and multiple-use (n = 22) syringes with 68% sensitivity and 100% specificity upon re-analysis. The extent of agreement over and above chance (kappa = 0.6; P < 0.0001) indicated good agreement for differentiating single- versus multi-person syringe use. CONCLUSIONS: These findings suggest that improved genotypic STR analysis of syringe material could be an adjunct to methods for validating self-reported needle sharing, conducting behavioral surveillance of needle-sharing behaviors, and evaluating interventions such as needle-exchange programs. Assays based on multiple STR loci will undoubtedly improve upon the promising results obtained from laboratory simulations of needle sharing.

Alleles↗

Sexual behaviors of intravenous drug users in treatment.

Sexual behaviors of a group of 313 intravenous drug users (IVDUs) (225 men, 88 women) were assessed by a structured interview at the start of an AIDS prevention project. Although the majority were celibate or monogamous during the prior year (men 52.5%, women 64.3%), many IVDUs had multiple sexual partners in that time, including 19.6% of men and 7.2% of women reporting five or more. Married male and female IVDUs were more likely to have multiple sexual partners than married people in general population samples. Only 38.5% of male and 35.4% of female IVDUs ever used condoms during the previous 5 years. Percentage of sexual encounters in which condoms were used correlated significantly with the number of partners for women (r = 0.37, p less than 0.01), but not for men (r = 0.03, ns). Use of intravenous drugs in the prior year, sharing of needles, use of stimulants, exchange of sex for money or drugs, and combining sexual events with drug use were all associated with greater numbers of sexual partners. A subset of male IVDUs engages in the dual-risk behaviors of needle sharing and unprotected intercourse with multiple partners. This group could act as a highly efficient vector for human immunodeficiency virus transmission and should become a focus of intensive preventive intervention.

Acquired Immunodeficiency Syndrome↗

Mode of acquiring AIDS and nurses' intention to provide care.

The intention of 322 staff nurses to provide care to male patients who acquired AIDS either through sexual activity with males, sexual activity with females, sharing needles, or a blood transfusion was examined. For each mode of acquiring AIDS, respondents indicated their intent to perform 11 care-giving behaviors, whether they were comfortable performing the behaviors, and if they felt in danger by performing the behaviors. No statistically significant differences related to mode of acquiring AIDS were found in nurses' intention to provide care. Comfort was the only significant predictor of intent to provide care.

Acquired Immunodeficiency Syndrome↗

Prevalence of hepatitis C, HIV, and risk behaviors for blood-borne infections: a population-based survey of the adult population of T'bilisi, Republic of Georgia.

Injection drug use and associated hepatitis C virus (HCV) and HIV infections are on the rise in Russia and the republics of the former Soviet Union. While small targeted studies have found widespread drug use and disease among at-risk populations, there have been few attempts to comprehensively evaluate the extent of these epidemics in general post-Soviet societies. We conducted a two-stage cluster randomized survey of the entire adult population of T'bilisi, Republic of Georgia and assessed the burden of HCV, HIV, and risk behaviors for blood-borne infections in 2,000 study participants. Of the 2,000 surveyed individuals, 162 (8.1%) had injected illicit drugs during their lifetimes. Of the individuals who had injected illicit drugs, 138 (85.2%) reported sharing needles with injection partners. HCV was found in 134 (6.7%) of the total surveyed population, but in 114 (70.4%) of those who had injected illicit drugs. We found HIV in only three (0.2%) individuals, all of whom had injected illicit drugs. Injection drug use and high-risk injection practices are very common in Georgia and may be harbingers of a large burden of HCV-associated liver diseases and a potentially serious HIV epidemic in the years to come.

Adult↗

Absence of prolonged immunosilent infection with human immunodeficiency virus in individuals with high-risk behaviors.

PURPOSE: The presence in some individuals of a prolonged phase of infection with human immunodeficiency virus type 1 (HIV-1) before seroconversion remains controversial. This study was undertaken to determine with a sensitive in vitro amplification technique, the polymerase chain reaction (PCR), whether seronegative individuals with high-risk behaviors could harbor HIV-1 sequences in their peripheral blood mononuclear cells (PBMCs) and remain seronegative for more than 6 months. PATIENTS AND METHODS: Seronegative individuals who engaged in unprotected anogenital intercourse with HIV-1-infected partners or with more than 10 individuals per year, and seronegative individuals who shared needles with seropositive partners, were recruited prospectively over 18 months. HIV-1 DNA and RNA sequences were detected in PBMCs of these individuals with three PCR assays using SK38/SK39, SK145/SK431, and SK68/SK69. Seronegative but PCR-positive patients were also evaluated with p24 antigen capture assay, radioimmunoprecipitation assay, and Western blot. The latter patients were followed prospectively to reproduce PCR-positive results and monitor serologic responses. RESULTS: Sixty-one men and 18 women, with an average age of 34.1 +/- 7.6 years, were recruited: 56 were homosexual men, 18 were heterosexual women, and 5 were heterosexual men. Amplification reactions for HIV-1 of 104 PBMC specimens from 79 patients with negative or indeterminate serologies revealed that 4 patients (5.1%) were positive with PCR for HIV-1 DNA and RNA at the time of enrollment. Positive amplification reactions could not be reproduced in prospective samples for one patient. The analysis of a variable human genomic locus in this patient's PBMCs demonstrated that the first PCR-positive sample and following PCR-negative samples originated from different patients, suggesting a specimen mix-up. Two of the three PCR-positive seronegative patients had symptoms suggestive of acute retroviral disease. Sera from all three patients contained p24 antigen. Two patients seroconverted within 1 month whereas one patient could not be followed prospectively. CONCLUSION: Prolonged infection with HIV-1 without seroconversion was not found in our population of patients at very high risk for HIV-1 infection. All PCR-positive patients seroconverted in less than 1 month.

Adult↗

Patterns of illicit drug use of prisoners in police custody in London, UK.

AIMS AND METHODS: The aims of the study were to explore the current characteristics of drug misusers seen in police custody and identify trends or changes that have taken place in the last decade. A prospective, anonymised, structured questionnaire survey was undertaken of consenting consecutive, self-admitted illicit drug users seen by forensic physicians in police custody within the Metropolitan Police Service in London, UK in 2003. RESULTS: 30% of detainees were dependent on heroin or crack cocaine. Drug users (n=113) were studied in 2003. 95.4% completed the questionnaire. 82% were male, 18% female. Mean age was 28.5 y (range 18-49). 80% were unemployed; significant mental health issues (e.g., schizophrenia) were present in 18%; 15% had alcohol dependence; heroin was the most frequently used drug (93%); crack cocaine -- 87%; mean daily cost of drugs -- heroin GBP 76 (range 20-240), crack GBP 81 (range 20-300). >50% users inject crack and heroin simultaneously. 56% used the intravenous route; 25% had shared needles; 100% had accessible sources of clean needles; 6.4% were hepatitis B positive; 42% were aware of hepatitis prophylaxis; hepatitis C positive -- 20.2%; 3.6% were HIV positive. Mean length of time of drug use was 7.5 y (range 1 month -- 20 years); 82% had served a previous prison sentence; 54% had used drugs in prison; 11% had used needles in prison; 3% of users stated they had started using in prison. 38% had been on rehabilitation programs; 11% had been on Drug Treatment and Testing; Orders (DTTO); 32% had used the services of Drug Arrest Referral Teams in police stations; 10% were in contact with Drug Teams at the time of assessment. CONCLUSIONS: In the last decade, there appears to be a substantial increase in the prevalence of drug use in this population -- particularly of crack cocaine. Treatment interventions are either not readily available, or not followed through. In very general terms, the illicit drug use problem appears to have significantly worsened in the population seen in police custody in London, UK, in the last decade although there is evidence that health education and harm reduction messages appear to have had some positive effects.

Adolescent↗

Lay injection practices among migrant farmworkers in the age of AIDS: evolution of a biomedical folk practice.

The practice of injecting vitamins and antibiotics by lay people is common among Hispanic migrant farmworkers in the U.S.A. This practice has recent roots in the Latin American cultures from which these farmworkers originate, but it presents a public health concern in its new context because of the high prevalence of HIV infection among this disenfrachised population. Reasons for use of lay injections include cultural beliefs about the superiority of injections over oral forms of medications, perceived irrelevance of a professional diagnostician in prescribing empirical treatment, and a multitude of barriers to access to Western medicine. Although HIV educational materials directed at migrant farmworkers do not address the issue of sharing needles for these types of injections, some farmworkers indicated they had already modified their injection techniques in response to simple directives from physicians in their home country. In contrast to other folk treatment practices that have been resistant to change mediated solely through the provision of information, lay injection is such a new development that considerable experimentation and incorporation of new knowledge are still actively shaping its use. In this process, physicians are seen as legitimate sources of information about the use of Western pharmaceuticals; they should use this role to discourage unsafe injection practices. Efforts to extinguish the practice of lay injection entirely are less likely to meet with success so long as other means of accessing Western medicine are limited.

Adolescent↗

Regional differences in injecting practices and other substance use-related behaviour among entrants into opioid maintenance pharmacotherapy treatment in New South Wales, Australia.

BACKGROUND: Investigations of injecting drug users (IDUs) have been conducted largely in urban areas. Those studies that compare rural and urban IDUs often utilise small and possibly unrepresentative samples. AIM: To investigate regional differences in the characteristics of IDUs. METHODS: The study compared the demographic, drug use-related, and treatment characteristics of 1045 urban, 213 regional, and 254 rural opioid maintenance pharmacotherapy (OMP) treatment entrants recruited as part of a feasibility study into the implementation of a state-based treatment outcome monitoring system. RESULTS: Participants from regional and rural New South Wales (NSW) were significantly more likely to report sharing of needles and other injection equipment and higher non-opioid drug use and polydrug use than their urban counterparts. In addition, they were more likely to be living with dependent children, to be unemployed, and to be experiencing greater psychological problems than their urban counterparts. Needle sharing also was independently associated with being younger, female, having been arrested, or having non-opioid drugs of concern. CONCLUSIONS: Reasons for the higher rates of blood-borne virus (BBV) transmission risk-related behaviour among rural and regional IDUs should be investigated further and considered when planning for the targeted provision of harm reduction activities.

Adolescent↗

Tattooing and body piercing among adolescent detainees: relationship to alcohol and other drug use.

PURPOSE: The purpose of this preliminary study was to document self-reported tattooing and body piercing behavior among a sample of 860 adolescent detainees. Additionally, the study examined the relationship of alcohol and drug use to tattooing and body piercing--an often overlooked HIV risk behavior. METHODS: Adolescents (N = 860) participating in a substance use and HIV risk reduction intervention were surveyed upon entrance to a Youth Development Campus (YDC). RESULTS: Twenty-nine percent of the sample (N = 245) had at least one tattoo, and more than half (69%) had at least one body piercing. Fifteen percent had two or more tattoos, while 28% had three or more piercings. Although a small percentage of the youth reported knowingly sharing needles for tattoos or piercings (2% and 1.5%, respectively), 21% had tattoos that had been administered unprofessionally and 20% had unprofessionally administered piercings. Marijuana and alcohol were the highest reported substances used in this sample, 62% and 54%, respectively. Alcohol, marijuana, antidepressants, and sedatives were significant correlates of having tattoos. Alcohol was found to be a marginally significant (P = .052) correlate of body piercing. CONCLUSION: The popularity of tattooing and piercing and the risk involved with these activities make them an HIV risk behavior worthy of address. Risk reduction messages to youth should consistently address these behaviors and focus on them as they relate to substance use.

Adolescent↗