[Risk behaviours among intravenous drug users under methadone treatment]

Factores asociados a la práctica de compartir jeringuillas usadas entre usuarios de droga por vía parenteral reclutados en la calle

BACKGROUND AND OBJECTIVE

To estimate the prevalence of risk behaviors related to drug use and to identify factors associated with of accepting and passing on used syringes among intravenous drug users (IDU) recruited in Barcelona city and other surrounding areas in 2004.

SUBJECTS AND METHOD

A cross-sectional study of IDU recruited from the streets by ex-IDU interviewers. A standardized and anonymous questionnaire which explored behaviors in the previous 6 months was used. Saliva samples were collected to determine human immunodeficiency virus (HIV) prevalence. Logistic regression models were used to identify determinants of accepting and passing on used syringes.

RESULTS

Of the 300 participants, 17.7% and 13.3% accepted and passed on used syringes, respectively. 74.8% practiced front-backloading (to prepare the drug solution in a syringe and then divide it up into other syringes) and 77.9% shared other equipment. The prevalence of HIV was 57.7%. The predictors of accepting used syringes were using more than 4 drugs (odds ratio [OR] = 5.6), having a positive hepatitis C virus status (OR = 7.3), practising front/backloading (OR = 12.6) and having an IDU steady partner (OR = 2.9); and with passing on used syringes were practicing front/backloading (OR = 4.9), having an IDU steady partner (OR = 5.8), and having sexual risk behaviors with casual partners (OR = 4.0). Starting to inject drugs older than 15 years of age was a protective factor (OR = 0.2).

CONCLUSIONS

The prevalence of risk behaviors related to drug use remains high, especially indirect sharing, just as the prevalence of HIV and hepatitis C virus. Prevention programs should be targeted to IDU, especially to young IDU, polydrug users and those who have an IDU steady partner.

[Non-occupational post-exposure HIV prophylaxis. Knowledge and practices among physicians and groups with risk behavior]

BACKGROUND AND OBJECTIVE

Although occupational post-exposure HIV prophylaxis is widely admitted and used, the non-occupational post-exposure prophylaxis (NONOPEP) is controversial. Prevention of mother-to-child HIV transmission, experimental studies in animal models and retrospective studies in health workers, along with biological plausibility, would justify the use of NONOPEP in certain circumstances. Our objectives were: 1) To review the existence of recommendations; 2) To describe the attitudes, knowledge and practices of the professionals involved in the attention of non-occupational exposures to HIV; 3) To describe the attitudes and knowledge on such a prophylaxis by people with risk behaviours (homosexual men and intravenous drug users (IDU)); and 4) To describe the NONOPEP-related responses of telephone services of public attention on AIDS.

SUBJECTS AND METHOD

Descriptive study by means of a survey of each defined target population between September 1999 and July 2000, using self-administered questionnaires and personal interviews. Structured and simulated interviews were used to survey the telephone services.

RESULTS

To date, no official recommendations exist. 84% (97/116) of consulted doctors have taken care of some of non-occupational accidental exposure to HIV over the last six months. 77% (75/97) have prescribed NONOPEP, and 76% of doctors prescribing NONOPEP (57/75) have used the 1998 CDC recommendations for occupational exposures. Most frequent observed cases were related to needle sticks in the street and preservative breakage. The assessment of certain risk factors and therapeutic performance in cases of intermediate risk showed discrepancies among doctors. 41% (103/252) among homosexuals and 2% (3/160) among IDU on treatment know the NONOPEP. 15% (15/98) and 98% (70/118) respectively would take less prevention to avoid HIV infection if they took the NONOPEP. It was mentioned the possibility of NONOPEP in 20% (12/59) of calls to the information telephone services on AIDS.

CONCLUSIONS

HIV risk accidents susceptible of NONOPEP are relatively frequent. Without forgetting the greater importance of primary prevention, it is advisable to reach and agreement on homogeneous recommendations. It is also advisable to draw up a surveillance system to evaluate the application and eventually the effectiveness of these recommendations.

[Differential health and toxicological features of drug-dependents in treatment and in active consumption]

OBJECTIVES

To describe and compare the demographic and health characteristics and drug use patterns in a group of drug dependent individuals who were actively using drugs versus those in different types of treatment. To analyze the interventions used with the different groups.

DESIGN

Descriptive study.

SETTING

Users at the Association for Aid to Drug Dependent Persons (Asociación de Ayuda al Drogodependiente, ACLAD) in the city of Valladolid in northwestern Spain.

PATIENTS

1224 drug dependent persons.

MEASURES

We reviewed the medical records for a 30-month period for users who were seen at a treatment center and who were participating in a damage reduction program. We recorded demographic, drug use and clinical variables and compared changes.

RESULTS

We studied 1224 patients in all. One-third had human immunodeficiency virus infection, 63% had markers for previous hepatitis A infection, 48% had markers for hepatitis B, and 68.5% for hepatitis C. The Mantoux test was positive in 39.1%. We found differences in the prevalence of infections between active drug users and users in treatment, between drug dependent persons receiving different types of treatment, and between different periods of study.

CONCLUSIONS

There were clear differences in demographic and health characteristics and drug use patterns between users. Those who were not in rehabilitation were in worse health, and were studied in less detail that other groups of drug users. During follow-up we noted a slight improvement in their health conditions, along with a tendency toward improved primary care interventions.