HIV Risk Behavior Among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa

Sexual behavior experience of former injecting drug users infected with HIV in Bali, Indonesia

Injecting Drug Users (IDUs) have become a serious concern in public health due to their potential in HIV transmission. This study aims to describe the sexual behavior experience of former IDUs infected with HIV in Bali, Indonesia. A qualitative study with a phenomenology approach was conducted using purposive sampling. Five former IDUs infected with HIV were selected and analyzed using a thematic analysis. The finding showed two themes; (1) knowledge related to drugs and HIV/AIDS, and (2) risky sexual behavior which consisted of sex with many close friends and using local prostitutes, sex after a drug party or after using drugs, preference for vaginal sex, engaging in sex despite having a known HIV positive status, and not using condoms frequently. This finding can be used to recommend that nurses and other health care providers work collaboratively and comprehensively in preventing the new cases of HIV caused by the risky sexual behavior of the IDUs.

Methamphetamine use, health and criminal justice system outcomes: A systematic review

ISSUES

Methamphetamine use is a problem for health and criminal justice systems (CJS) worldwide. Methamphetamine is used at higher rates in CJS-involved populations than the general community. This systematic review synthesises the evidence for health and CJS outcomes post-CJS contact for people reporting pre-CJS methamphetamine use.

APPROACH

Academic databases were searched to identify peer-reviewed original studies using a longitudinal design that investigated associations between pre-CJS methamphetamine use and health and criminal justice outcomes after CJS contact. Identified studies were screened in two stages: title and abstract, then full-text. Data from the included studies were extracted and analysed. Results are reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

KEY FINDINGS

Nine studies met the inclusion criteria: five investigated health and four investigated CJS outcomes. Pre-CJS methamphetamine use was associated with subsequent hospitalisation for drug-induced psychosis, increased risk of recidivism and higher crime costs after CJS contact. Pre-CJS methamphetamine use was not associated with subsequent hospitalisation for non-drug induced psychosis or post-release mortality.

IMPLICATIONS

Current evidence suggests that pre-CJS contact methamphetamine use increases the risk of subsequent drug-induced psychosis and recidivism. There is a need for more longitudinal research that measures mediators and moderators of health and criminal justice outcomes after CJS contact, to inform targeted prevention.

CONCLUSION

Methamphetamine use is a major problem that is contributing to serious mental illness and recidivism among CJS-involved populations. Prioritising treatment during CJS contact is recommended. Further research to identify key opportunities during health service and CJS contact for intervention is needed.

Drug use and risk behaviour profile, and the prevalence of HIV, hepatitis C and hepatitis B among people with methamphetamine use in Iran

BACKGROUND

Stimulants substances use, particularly methamphetamine use, is increasing globally, including in Iran. This study assessed the drug use and risk behaviour profile, and prevalence of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) among a large population using methamphetamine as their primary drug in Iran.

METHODS

This cross-sectional study was conducted in eight provinces of Iran. Individuals using methamphetamine for ≥3 months during the past three years, with no life-time history of injecting opioid drugs were enrolled. Drug use and risk behaviour data were collected through interviews. Blood samples were tested for HIV antibodies (HIV Ab), HCV antibodies (HCV Ab), and HBV surface antigen (HBs Ag).

RESULT

Among 567 participated, 84% were men and mean age was 36 years. Smoking with pipe was the most common method of methamphetamine use (53%), while 13% had a history of injecting methamphetamine, among whom 30% shared needles or syringes. Among those having sex during intoxication phase (n = 270), 48% never used condom. The prevalence of HIV Ab, HCV Ab and HBs Ag was 6.7% (95%CI: 4.7-9.1), 19.4% (95%CI: 16.2-22.9) and 1.4% (95%CI: 0.6-2.7), respectively. Age ≥ 30 years (adjusted OR [aOR]: 2.10, 95%CI: 1.18-3.76), lower education (high school vs. tertiary education, aOR: 13.95, 95%CI: 1.90-102.60), and injecting methamphetamine (aOR: 1.92, 95%CI 1.10-3.35) were significantly associated with HCV exposure. No factor was found associated with HIV infection. Among those reporting no potential injecting or sexual risk factors, 19.8% and 6.8% have HCV Ab positive and HIV Ab positive, respectively.

CONCLUSION

High prevalence of injecting and sexual risk behaviours, HIV infection and HCV exposure were found among individuals using methamphetamine as their primary drug, demonstrating them as an emerging population at risk of HIV and HCV in Iran. Targeted screening and harm reduction programs for this population are required.

High Prevalence of Inconsistent Condom Use With Regular Female Sex Partners Among Heterosexual Male Sexually Transmitted Disease Patients in Southern China

This study was to investigate the prevalence of and factors associated with inconsistent condom use with regular female sex partners (RPs) among heterosexual male STD patients (MSTDPs) in China. We interviewed 413 MSTDPs who had had sex with at least one RP and had received a diagnosis within the past week to six months. The prevalence of inconsistent condom use with RPs was 42.9% since STD diagnosis. Associated factors included perceptions related to condom use, regret about the decision of having unprotected sex with RP, and perceived personal partners' responsibility of using condoms.

Understanding HIV Risk Behaviors Among Young Men in South Africa: A Syndemic Approach

Young men in South Africa experience several adverse socio-structural and psychosocial factors that may contribute HIV risk behaviors. This study applied a syndemic framework to explore whether these syndemic factors are interconnected and work in synergy to increase HIV risk behaviors. Five syndemic factors were assessed including: binge drinking, polydrug use, depressive symptoms, violence and food insecurity on two HIV risk behaviors: multiple sex partners and transactional sex. Participants were (N = 1233) young men aged 18-29 years from a township in Cape Town, South Africa. Bivariate logistic regression analysis demonstrated that many of the syndemic factors were related to one another. Pairwise interactions (on an additive scale) among the syndemic factors revealed significant positive interactions between binge drinking and violence on greater odds of reporting multiple sex partners (aOR = 5.10, 95% CI 3.10, 8.29; p = < .001) compared to reporting neither factor. Also, food insecurity and violence (aOR = 2.89, 95% CI 1.63, 5.11; p = < .001) as well as food insecurity and polydrug use (aOR = 2.73, 95% CI 1.54, 4.84; p = < .001) were significantly associated with greater odds of transactional sex compared to reporting neither factor. Our findings highlight a synergistic relationship between some adverse socio-structural and psychosocial factors on HIV risk behaviors. HIV prevention programs that address multiple syndemic factors simultaneously may achieve greater impact on HIV risk reduction.

Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users

Background

Substance use is increasingly becoming prevalent on the African continent, fueling the spread of HIV infection. Although socio-demographic factors influence substance consumption and risk of HIV infection, the association of these factors with HIV infection is poorly understood among substance users on the African continent. The objective of the study was to assess socio-demographic and sexual practices that are associated with HIV infection among injection drug users (IDUs), non-IDUs, and non-drug users (DUs) at an urban setting of coastal Kenya.

Methods

A cross-sectional descriptive study was conducted among 451 adults comprising HIV-infected and -uninfected IDUs (n = 157 and 39); non-IDUs (n = 17 and 48); and non-DUs (n = 55 and 135); respectively at coastal, Kenya. Respondent driven sampling, snowball and makeshift methods were used to enroll IDUs and non-IDUs. Convenience and purposive sampling were used to enroll non-DUs from the hospital’s voluntary HIV testing unit. Participant assisted questionnaire was used in collecting socio-demographic data and sexual practices.

Results

Binary logistic regression analysis indicated that higher likelihood of HIV infection was associated with sex for police protection (OR, 9.526; 95% CI, 1.156-78.528; P = 0.036) and history of sexually transmitted infection (OR, 5.117; 95% CI, 1.924-13.485; P = 0.001) in IDUs; divorced, separated or widowed marital status (OR, 6.315; 95% CI, 1.334-29.898; P = 0.020) in non-IDUs; and unemployment (OR, 2.724; 95% CI, 1.049-7.070; P = 0.040) in non-drug users. However, never married (single) marital status (OR, 0.140; 95% CI, 0.030-0.649; P = 0.012) was associated with lower odds for HIV infection in non-drug users.

Conclusion

Altogether, these results suggest that socio-demographic and sexual risk factors for HIV transmission differ with drug use status, suggesting targeted preventive measures for drug users.