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Morris MD, Neilands TB, Andrew E, Maher L, Page KA, Hahn JA. Development and validation of a novel scale for measuring interpersonal factors underlying injection drug using behaviours among injecting partnerships. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:54-62. [PMID: 28804051 DOI: 10.1016/j.drugpo.2017.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND People who inject drugs with sexual partners or close friends have high rates of syringe/ancillary equipment sharing and HIV and hepatitis C virus (HCV) infection. Although evidence suggests that interpersonal factors underlie these higher risk profiles, there is no quantitative measure of how interpersonal factors operate within injecting relationships. We aimed to develop and validate a quantitative scale to assess levels of injecting drug-related interpersonal factors associated with risky injecting behaviours within injecting partnerships. METHODS We conducted qualitative interviews with 45 people who inject drugs (PWID) who reported having injecting partners to inform item development, and tested these items in a quantitative study of 140 PWID from San Francisco, USA, to assess internal reliability (Cronbach's alpha) and validity (convergent, and discriminant validity). RESULTS With results from the qualitative interview data, we developed the Interpersonal Dynamics in Injecting Partnerships (IDIP) scale with 54 final items for 5 subscales of injecting-related interpersonal factors. Exploratory factor analysis revealed 5 factors ("trust", "power", "risk perception", "intimacy", and "cooperation") with eigenvalues of 14.32, 6.18, 3.55, 2.46, and 2.14, explaining 57% of the variance, and indicating good internal reliability (alpha: 0.92-0.68). Strong convergent validity was observed in bivariate logistic regression models where higher levels of trust, intimacy, and cooperation within partnerships were positively associated with partners sharing needles and injecting equipment, whereas higher levels of power and risk perception were negatively associated with partners sharing needles and injecting equipment. CONCLUSIONS These findings offer strong evidence that the IDIP scale provides a psychometrically sound measure of injecting drug-related interpersonal dynamics. This measurement tool has the potential to facilitate additional investigations into the individual and collective impact of trust, intimacy, power, cooperation, and risk perception on injection drug using behaviours and engagement in HIV and HCV testing and treatment among PWID in a variety of settings.
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Affiliation(s)
- Meghan D Morris
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA.
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, UCSF, San Francisco, CA USA
| | - Erin Andrew
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Lisa Maher
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kimberly A Page
- Department of Internal Medicine, University of New Mexico Health Center, Albuquerque, NM, USA
| | - Judith A Hahn
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA; Department of Medicine, UCSF, San Francisco, CA, USA
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Grau LE, Zhan W, Heimer R. Prevention knowledge, risk behaviours and seroprevalence among nonurban injectors of southwest Connecticut. Drug Alcohol Rev 2016; 35:628-36. [PMID: 27073014 DOI: 10.1111/dar.12396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/21/2016] [Accepted: 01/31/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Little is known about injection-associated risk behaviours, knowledge and seroprevalence of viral infections among people who inject drugs (PWID) in nonurban locales in the US. Harm reduction services are more available in urban locales. The present study examined a cohort of active PWID residing in non urban areas of Connecticut to investigate how primarily injecting in urban or non urban areas was associated with injection-associated risk behaviours, knowledge and prevalence of blood-borne viruses. DESIGN AND METHODS We described the sample and performed bivariate and multivariable analyses on injection-associated risk behaviours, HIV/hepatitis/overdose knowledge and baseline serological data to identify differences between individuals who injected primarily in nonurban locales and those who did not. RESULTS Harm reduction knowledge and use of harm reduction services were poor in both groups. Those injecting most often in urban settings were 1.88 (1.19, 2.98 95% confidence interval) times more likely to engage in at least one injection-associated risk behaviour than their nonurban counterpart. Seroprevalence rates (23.6% for hepatitis B virus, 39.2% for hepatitis C virus, and 1.1% for HIV) were no different between the two groups. DISCUSSION AND CONCLUSIONS The data provided little evidence that the benefits of urban harm reduction programs, such as syringe exchange, risk reduction interventions and education programs have penetrated into this nonurban population, even among those who injected in urban locales where such programs exist. Harm reduction interventions for nonurban communities of PWID are needed to reduce HIV and hepatitis B and C transmission. [Grau LB, Zhan W, Heimer R. Prevention knowledge, risk behaviours and seroprevalence among nonurban injectors of southwest Connecticut. Drug Alcohol Rev 2016;35:628-636].
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Affiliation(s)
- Lauretta E Grau
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.
| | - Weihai Zhan
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.,Department of Children and Families, Hartford, USA
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
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Intimate injection partnerships are at elevated risk of high-risk injecting: a multi-level longitudinal study of HCV-serodiscordant injection partnerships in San Francisco, CA. PLoS One 2014; 9:e109282. [PMID: 25286346 PMCID: PMC4186818 DOI: 10.1371/journal.pone.0109282] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 09/10/2014] [Indexed: 12/13/2022] Open
Abstract
Background It is increasingly recognized that the risk for HIV and hepatitis C (HCV) transmission among people who inject drugs (PWID), such as syringe sharing, occurs in the context of relationships between (at least) two people. Evidence suggests that the risk associated with injection behavior varies with injection partner types. Methods We utilized longitudinal dyad-level data from a study of young PWID from San Francisco (2006 to 2013) to investigate the relationship-level factors influencing high-risk injecting within HCV-serodiscordant injection partners (i.e., individuals who injected together ≥5 times in the prior month). Utilizing data from 70 HCV-serodiscordant injection partnerships, we used generalized linear models to examine relationship-level predictors (i.e., partnership composition, partnership closeness, and partnership dynamics) of: (1) receptive syringe sharing (RSS); and (2) receptive cooker use (RCU), as reported by the HCV-negative injection partner. Results As reported by the “at-risk” HCV-negative injection partner, receptive syringe sharing (RSS) and receptive cooker use (RCU) were 19% and 33% at enrollment, and 11% and 12% over all visits (total follow-up time 55 person-years) resulting in 13 new HCV-infections (incidence rate: 23.8/100 person-years). Person-level factors, injection partnership composition, and partnership dynamics were not significantly associated with either RSS or RCU. Instead, intimate injection partnerships (those who lived together and were also in a sexual relationship) were independently associated with a 5-times greater risk of both RSS and a 7-times greater risk of RCU when compared to injecting only partnerships. Conclusion Our findings suggest a positive, and amplified effect of relationship factors on injecting drug risk behaviors among young PWID injection partnerships. The majority of interventions to reduce injection drug use related harms focus on individual-based education to increase drug use knowledge. Our findings support the need to expand harm reduction strategies to relationship-based messaging and interventions.
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Rácz J, Csák R, Lisznyai S. Transition from “old” injected drugs to mephedrone in an urban micro segregate in Budapest, Hungary: a qualitative analysis. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.895872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jones L, Atkinson A, Bates G, McCoy E, Porcellato L, Beynon C, McVeigh J, Bellis MA. Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: systematic review of qualitative research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:204-11. [PMID: 24332457 DOI: 10.1016/j.drugpo.2013.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 10/30/2013] [Accepted: 11/11/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many developed countries are facing a major challenge to improve identification of individuals acutely and chronically infected with hepatitis C virus (HCV) infection. We explored the views and experiences of people who inject drugs (PWID) in relation to HCV testing, and diagnosis through a review and synthesis of qualitative research. METHODS Based on the thematic synthesis of qualitative research. Searches were conducted in 14 databases and supplemented by reference checking, hand searching of selected journals, and searches of relevant websites. Studies of any qualitative design that examined the views and experiences of, and attitudes towards, HCV testing and diagnosis among PWID or practitioners involved in their care were included. Key themes and sub-themes were systematically coded according to the meaning and content of the findings of each study which proceeded to the preparation of a narrative account of the synthesis. RESULTS 28 qualitative studies were identified. We identified a number of overarching descriptive themes in the literature, finding overall that PWID hold complex and differing views and experiences of testing and diagnosis. Three major themes emerged: missed opportunities for the provision of information and knowledge; shifting priorities between HCV testing and other needs; and testing as unexpected and routine. Evidence of missed opportunities for the provision of knowledge and information about HCV were clear, contributing to delays in seeking testing and providing a context to poor experiences of diagnosis. Influenced by the nature of their personal circumstances, perceptions of the risk associated with HCV and the prioritisation of other needs acted both to encourage and discourage the uptake of HCV testing. Undergoing HCV testing as part of routine health assessment, and an unawareness of being testing was common. An unexpected positive diagnosis exacerbated anxiety and confusion. CONCLUSION This review has identified that there are modifiable factors that affect the uptake of HCV testing and experiences of HCV diagnosis among PWID. Intervention development should focus on addressing these factors. There is a need for further research that engages PWID from a diverse range of populations to identify interventions, strategies and approaches that they consider valuable.
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Affiliation(s)
- L Jones
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
| | - A Atkinson
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - G Bates
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - E McCoy
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - L Porcellato
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - C Beynon
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - J McVeigh
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - M A Bellis
- Public Health Wales, Haydn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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Abstract
Since there is little evidence about gay community norms across the world, we reviewed published literature in this area and discuss implications for prevention and research. Eight databases were searched for articles and 16 were considered suitable for analysis. All used quantitative methodology and seven were based on a published theoretical framework. The most common theory employed by four out of the seven papers was the Theory of Reasoned Action. All papers reviewed examined norms on condom use but norms on other risk reduction practices were not explored in these papers. Seven (44 %) studies found those men who perceived strong social support from their peers, were less likely to engage in unprotected anal intercourse. This finding suggests that social support from partners and community members plays a role in shaping safe sex norms. Better understanding of norms may help to redress HIV behaviour change programmes, particularly at the time when HIV diagnoses rates are increasing in most gay communities across the world.
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Gyarmathy VA, Neaigus A. The association between social marginalisation and the injecting of alcohol amongst IDUs in Budapest, Hungary. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:393-7. [PMID: 21764285 DOI: 10.1016/j.drugpo.2011.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 03/21/2011] [Accepted: 05/05/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Alcohol injecting may cause intense irritation, serious vein damage, and additional risks. What little is known about alcohol injecting points to the potential role of social marginalisation. METHODS Injecting drug users (N=215) were recruited between October 2005 and December 2006 in Budapest, Hungary from non-treatment settings. Multivariate logistic regression models identified correlates of lifetime alcohol injecting. RESULTS About a quarter (23%) reported ever injecting alcohol-only 3% reported injecting alcohol in the past 30 days. In multivariate analysis, six variables were statistically significantly associated with ever injecting alcohol: male gender, being homeless, ever sharing cookers or filters and injecting mostly in public places showed a positive association, whilst Roma ethnicity and working at least part time showed a negative association. CONCLUSIONS Our study suggests that alcohol injecting is more of a rare event than a so far undiscovered research and prevention priority. Still, providers of harm reduction services should be aware that alcohol injecting happens, albeit rarely, especially amongst socially marginalised IDUs, who should be counselled about the risks of and discouraged from alcohol injecting.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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Gyarmathy VA, Li N, Tobin KE, Hoffman IF, Sokolov N, Levchenko J, Batluk J, Kozlov AA, Kozlov AP, Latkin CA. Unprotected sex in heterosexual partnerships of injecting drug users in st. Petersburg, Russia. AIDS Behav 2011; 15:58-64. [PMID: 20532604 DOI: 10.1007/s10461-010-9721-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined the association of individual demographic and behavioral attributes, partnership (dyad) and social network characteristics with unprotected sex in the heterosexual dyads of IDUs in St. Petersburg, Russia. Of the individual-level characteristics female gender and younger age; and of the dyad-level characteristics sharing injecting equipment, social exposure to the sex partner ("hanging out with" or seeing each other daily), and both partners self-reporting being HIV infected were associated with unprotected sex. Although self-reported HIV discordant couples were less likely to engage in unprotected sex, it was reported in over half of self-reported HIV discordant relationships. This study highlights the intertwining of sexual risk and injecting risk, and the importance of sero-sorting based on perceived HIV status among IDU sexual partnerships in St. Petersburg, Russia. A combination of social network and dyad interventions may be appropriate for this population of IDUs, especially for IDUs who are both injecting and sex partners, supported by free and confidential rapid HIV testing and counseling services to provide a comprehensive response to the wide-spread HIV epidemic among IDUs in St. Petersburg.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Cais do Sodré, 1249-289 Lisbon, Portugal.
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9
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Gyarmathy VA, Neaigus A, Li N, Ujhelyi E, Caplinskiene I, Caplinskas S, Latkin CA. Infection disclosure in the injecting dyads of Hungarian and Lithuanian injecting drug users who self-reported being infected with hepatitis C virus or human immunodeficiency virus. ACTA ACUST UNITED AC 2010; 43:32-42. [PMID: 20840002 DOI: 10.3109/00365548.2010.513064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to assess the prevalence and correlates of disclosure to network members of being hepatitis C virus (HCV)- or human immunodeficiency virus (HIV)-infected among injecting dyads of infected injection drug users (IDUs) in Budapest, Hungary and Vilnius, Lithuania,. Multivariate generalized estimating equations (GEE) were used to assess associations. Very strong infection disclosure norms exist in Hungary, and HCV disclosure was associated with using drugs and having sex within the dyad. Non-ethnic Russian IDUs in Lithuania were more likely to disclose HCV infection to non-Roma, emotionally close and HCV-infected network members, and to those with whom they shared cookers, filters, drug solutions or rinse water or got used syringes from, and if they had fewer non-IDU or IDU network members. Ethnic Russian Lithuanian IDUs were more likely to disclose HCV if they had higher disclosure attitude and knowledge scores, 'trusted' network members, and had lower non-injecting network density and higher injecting network density. HIV-infected Lithuanian IDUs were more likely to disclose to 'trusted' network members. Disclosure norms matched disclosure behaviour in Hungary, while disclosure in Lithuania to 'trusted' network members suggests possible stigmatization. Ongoing free and confidential HCV/HIV testing services for IDUs are needed to emphasize and strengthen disclosure norms, and to decrease stigma.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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Gyarmathy VA, Rácz J. [Social networks, risk dyads, and their role in the epidemiology and prevention of drug related infectious diseases]. Orv Hetil 2010; 151:1289-94. [PMID: 20656668 DOI: 10.1556/oh.2010.28860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the case of risk behaviors where infection transmission occurs through social relationships (e.g. via sharing drugs and injecting equipment, or through sexual relations), prevention should follow (among others) the path of the social network. Previous studies have shown that sharing of injecting equipment is more likely to occur in larger and denser networks and that more popular individuals are more likely to engage in risk behaviors, become infected or transmit infection. Primary targets of social network interventions are central individuals, and information diffuses from them to the more peripheral members of the network. The most effective preventions are those where social network interventions targeting high-risk, central individuals are complemented by concurrent individual counseling and/or dyad interventions. Injecting drug users in Hungary would also benefit from such a multifaceted prevention approach aiming to reduce risky injecting behavior. This population needs prevention, in whatever form available, to prevent the deterioration of the current HCV and HIV epidemiological situation in Hungary and the development of an HIV epidemic that will eventually spread over to the general population.
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Affiliation(s)
- V Anna Gyarmathy
- Európai Kábítószer- és Kábítószerfüggoség-megfigyelo Központ (EMCDDA), Lisszabon Portugália.
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Hopwood M, Nakamura T, Treloar C. Disclosing hepatitis C infection within everyday contexts: implications for accessing support and healthcare. J Health Psychol 2010; 15:811-8. [PMID: 20656767 DOI: 10.1177/1359105310370499] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this paper the authors quantify hepatitis C disclosure outcomes across social contexts and identify the factors associated with widespread disclosure of infection. In a cross-sectional survey of people with hepatitis C (N = 504) more than half reported receiving a bad reaction from someone following disclosure. Unauthorized disclosure occurred, and many participants had been pressured into disclosing their infection. The factors associated with widespread disclosure were: education level; knowing other people with hepatitis C; feeling fatigued; receiving disclosure advice; and experiencing unauthorized disclosure. Bad reactions following disclosure are common and may impede health-seeking behaviour including uptake of hepatitis C treatment.
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Affiliation(s)
- Max Hopwood
- National Centre in HIV Social Research, University of New South Wales, Sydney, Australia.
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Gyarmathy VA, Li N, Tobin KE, Hoffman IF, Sokolov N, Levchenko J, Batluk J, Kozlov AA, Kozlov AP, Latkin CA. Injecting equipment sharing in Russian drug injecting dyads. AIDS Behav 2010; 14:141-51. [PMID: 19214731 PMCID: PMC2818991 DOI: 10.1007/s10461-008-9518-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
Abstract
In this study, we investigated how individual attributes, dyad characteristics and social network characteristics may influence engaging in receptive syringe sharing, distributive syringe sharing and sharing cookers in injecting partnerships of IDUs in St Petersburg, Russia. We found that all three levels were associated with injecting equipment sharing, and that dyad characteristics were modified by characteristics of the social network. Self-reported HIV discordance and male gender concordance played a role in the risk of equipment sharing. Dyad interventions may not be sufficient to reduce injecting risk in IDU partnerships, but a combination of dyad and network interventions that target both IDU partnerships and the entire IDU population may be more appropriate to address injecting risk among IDUs.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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Gyarmathy VA, Neaigus A, Li N, Ujhelyi E, Caplinskiene I, Caplinskas S, Latkin CA. Liquid Drugs and High Dead Space Syringes May Keep HIV and HCV Prevalence High – A Comparison of Hungary and Lithuania. Eur Addict Res 2010; 16:220-8. [PMID: 20798543 PMCID: PMC2969108 DOI: 10.1159/000320287] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despitevery similar political, drug policy and HIV prevention backgrounds, HIV and HCV prevalence is considerably different in Hungary (low HIV and moderate HCV prevalence) and Lithuania (high HCV and moderate HIV prevalence). Wecompared the drug use profile of Hungarian (n = 215) and Lithuanian (n = 300) injecting drug users (IDUs). Overall, compared with IDUs in Hungary, IDUs in Lithuania often injected opiates purchased in liquid form ('shirka'), used and shared 2-piece syringes (vs. 1-piece syringes) disproportionately more often, were less likely to acquire their syringes from legal sources and had significantly more experience with injected and less experience with non-injected drugs. It may not be liquid drugs per se that contribute to a higher prevalence of HCV and/or HIV, but it is probably factors associated with the injecting of liquid drugs, such as the wide-spread use and sharing of potentially contaminated 2-piece syringes acquired often from non-legal sources, and syringe-mediated drug sharing with 2-piece syringes. Scaling up substitution therapy, especially heroin replacement, combined with reducing the supply of liquid drugs may decrease the prevalence of high-risk injecting behaviours related to the injecting of liquid drugs and drug injecting-related infections among IDUs in Lithuania.
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Affiliation(s)
- V. Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal,Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA,*V. Anna Gyarmathy, European Monitoring Centre for Drugs and Drug Addiction, Cais do Sodré, PT–1249-289 Lisbon (Portugal), Tel. +351 21 121 0200, Fax +351 21 358 4441, E-Mail
| | - Alan Neaigus
- Mailman School of Public Health, Columbia University, New York, N.Y., USA
| | - Nan Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA
| | | | - Irma Caplinskiene
- Centre for Communicable Diseases and AIDS, Social Policy Faculty, Vilnius, Lithuania,M. Romerius University, Social Policy Faculty, Vilnius, Lithuania
| | - Saulius Caplinskas
- Centre for Communicable Diseases and AIDS, Social Policy Faculty, Vilnius, Lithuania,M. Romerius University, Social Policy Faculty, Vilnius, Lithuania
| | - Carl A. Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA
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Gyarmathy VA, Li N, Tobin KE, Hoffman IF, Sokolov N, Levchenko J, Batluk J, Kozlov AA, Kozlov AP, Latkin CA. Correlates of unsafe equipment sharing among injecting drug users in St. Petersburg, Russia. Eur Addict Res 2009; 15:163-70. [PMID: 19506377 PMCID: PMC2794890 DOI: 10.1159/000220344] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIMS To assess among injecting drug users (IDUs) in St. Petersburg, Russia, the urban environment, social norms and individual correlates of unsafe injecting. METHODS Between December 2004 and January 2007, 446 IDUs were interviewed in St. Petersburg, Russia. RESULTS Prevalence of HCV was 96% and HIV 44%. 17% reported receptive syringe sharing after an HIV-infected IDU, 49% distributive syringe sharing, 76% sharing cookers, 73% sharing filters and 71% syringe-mediated drug sharing when not all syringes were new. Urban environmental characteristics correlated with sharing cookers and syringe-mediated sharing, and social norms correlated with receptive and distributive syringe sharing and sharing cookers. Individual correlates included cleaning used syringes (all 5 dependent variables) and self-report of HIV infection (receptive and distributive syringe sharing). CONCLUSION HIV status disclosure is an unreliable but frequently used HIV prevention method among IDUs in St. Petersburg, who reported alarmingly high levels of injecting equipment sharing. Voluntary counseling and testing should be widely available for this population. Ethnography is needed to assess the effectiveness of the syringe cleaning process. Prevention interventions need to be ongoing among IDUs in St. Petersburg, and should incorporate urban environmental factors and social norms, which may involve peer education and social network interventions.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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De P, Cox J, Boivin JF, Platt RW, Jolly AM, Alexander PE. HIV and HCV discordant injecting partners and their association to drug equipment sharing. ACTA ACUST UNITED AC 2009; 41:206-14. [PMID: 19172434 DOI: 10.1080/00365540902721376] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Our objective was to examine the association between HIV and HCV discordant infection status and the sharing of drug equipment by injection drug users (IDUs). IDUs were recruited from syringe exchange and methadone treatment programmes in Montreal, Canada. Characteristics of participants and their injecting partners were elicited using a structured questionnaire. Among 159 participants and 245 injecting partners, sharing of syringes and drug preparation equipment did not differ between concordant or discordant partners, although HIV-positive subjects did not share with HIV-negative injectors. Sharing of syringes was positively associated with discordant HIV status (OR=1.85) and negatively with discordant HCV status (OR=0.65), but both results were not statistically significant. Sharing of drug preparation equipment was positively associated with both discordant HIV (OR=1.61) and HCV (OR=1.18) status, but both results were non-significant. Factors such as large injecting networks, frequent mutual injections, younger age, and male gender were stronger predictors of equipment sharing. In conclusion, IDUs do not appear to discriminate drug equipment sharing partners based at least on their HCV infection status. The results warrant greater screening to raise awareness of infection status, post-test counselling to promote status disclosure among partners, and skill-building to avoid equipment sharing between discordant partners.
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Affiliation(s)
- Prithwish De
- Departments of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
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Gyarmathy VA, Neaigus A. The relationship of sexual dyad and personal network characteristics and individual attributes to unprotected sex among young injecting drug users. AIDS Behav 2009; 13:196-206. [PMID: 17690975 PMCID: PMC2651987 DOI: 10.1007/s10461-007-9285-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 07/16/2007] [Indexed: 10/23/2022]
Abstract
We examine in the heterosexual partnerships (dyads) of IDUs the correlates of engaging in unprotected sex on three levels: individual attributes, social network characteristics, and dyad characteristics. Unprotected sex was significantly less likely to occur in dyads where the participant injected daily or had high safe-sex attitude scores, and in dyads where both members encouraged each other to use condoms. Unprotected sex was significantly more likely to occur in dyads that smoked crack together, shared needles with each other, and where the participant knew that the sex partner had concurrent sex partners. In the sexual dyads of IDUs there is a combined risk of unsafe injecting and unsafe sex. Both injecting and sexual risk, and their combination need to be addressed in interventions that target the sexual partnerships of IDUs. Such interventions should also aim to reduce injected and non-injected crack and other stimulant use associated with high-risk sex.
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Affiliation(s)
- V Anna Gyarmathy
- National Development and Research Institutes, Inc., 71 W 23rd St., 8th Floor, New York, NY 10010, USA.
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Gyarmathy VA, Neaigus A, Mitchell MM, Ujhelyi E. The association of syringe type and syringe cleaning with HCV infection among IDUs in Budapest, Hungary. Drug Alcohol Depend 2009; 100:240-7. [PMID: 19058925 PMCID: PMC2628960 DOI: 10.1016/j.drugalcdep.2008.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 09/25/2008] [Accepted: 10/12/2008] [Indexed: 11/24/2022]
Abstract
We assessed whether syringe type, syringe cleaning and distributive syringe sharing were associated with self-reported and laboratory-confirmed HCV infection among Hungarian IDUs. Injecting drug users (N=215) were recruited from non-treatment settings in Budapest, Hungary between October 2005 and December 2006. Multivariate logistic regression models identified correlates of self-report of being HCV infected and testing positive for HCV. While 37% tested positive for HCV, 14% of the total (39% of those who tested positive) self-reported being HCV infected. Using any two-piece syringes was significantly associated with self-reported HCV infection, while distributive syringe sharing was not associated with self-report of being HCV infected. Engaging in receptive sharing of only one-piece syringes but always cleaning before reuse was not associated with testing HCV positive, while any receptive sharing of only one-piece syringes and not always cleaning before reuse was significantly associated with testing HCV positive. Sharing cookers and squirting drugs from one syringe into another syringe were not associated with testing HCV positive. The high percent of those HCV infected who did not know they were infected highlights the need to provide better access to confidential testing and counseling services. Counseling should emphasize secondary prevention of HCV among HCV infected IDUs. Our findings also indicate that syringe type and syringe cleaning practices may play a role in HCV transmission. Ethnographic research should identify the reasons why IDUs may use two-piece syringes and suggest means to reduce their use. Thorough cleaning of one-piece syringes when sterile syringes are unavailable may be an efficient way to reduce the risk of HCV infection.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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Volf V, Marx D, Pliskova L, Sümegh L, Celko A. Retraction to: A survey of hepatitis B and C prevalence amongst the homeless community of Prague. Eur J Public Health 2007; 18:44-7. [PMID: 17613558 DOI: 10.1093/eurpub/ckm072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Viral hepatitis B (VHB) and C (VHC) are a major health concern worldwide, with 170 million people chronically infected and at risk of liver cancer, cirrhosis or liver failure. Since no vaccination is available against VHC it is important to understand how to prevent future infection. The modes of transmission include intravenous drug use (IDU), blood products, tattooing and, to a lesser extent, sexual intercourse. Homelessness is a risk factor of VHB and VHC because of the environments and behaviours associated with homeless communities such as poor hygiene, nutrition and high levels of IDU. The aim of this project was to determine the prevalence of VHB and VHC and its risk factors amongst homeless community of Prague, Czech Republic. PATIENTS AND METHODS Ninety-eight individuals of the Prague homeless community were interviewed and tested for VHB and VHC infection markers. RESULTS The prevalence of both VHB and VHC was 26.5%. The major risk factors in this population were past and present IDU, young age and sharing the paraphernalia used by intravenous drug users (e.g. spoons, foils and filters). CONCLUSION With the exception of age, all these risk factors could all be targeted in order to combat the major public health concern that VHB and VHC poses to the homeless community of Prague.
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Affiliation(s)
- Vladimír Volf
- Department of Paediatrics and Adolescent Medicine, Charles University 3rd Medical Faculty, Prague, Czech Republic.
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Rácz J, Gyarmathy VA, Neaigus A, Ujhelyi E. Injecting equipment sharing and perception of HIV and hepatitis risk among injecting drug users in Budapest. AIDS Care 2007; 19:59-66. [PMID: 17129858 PMCID: PMC2597713 DOI: 10.1080/09540120600722742] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In central European states, rates of HIV among injection drug users (IDUs) have been low although Hepatitis C (HCV) infection is widespread. The goal of our study was to assess HIV infection, risk perceptions and injecting equipment sharing among IDUs in Budapest, Hungary. Altogether 150 IDUs were interviewed (121 structured interviews between 1999 and 2000 and 29 ethnographic interviews between 2003 and 2004). The majority of them injected heroin (52% and 79%) and many injected amphetamines (51% and 35%). One person tested positive for HIV. Two thirds (68%) shared injecting equipment (syringes, cookers and filters). Some participants said they shared syringes because they were not carrying them for fear of police harassment and that they reused filters as a backup drug supply. In multivariate analysis, sharing of injecting equipment was associated with higher perceived susceptibility to HIV/AIDS, lower self-efficacy for sterile equipment use, higher motivation to comply with peer pressure to use dirty injecting equipment and with having a criminal record. The high levels of injecting risk-behaviors found in this study are a cause for serious concern. Interventions for HIV-prevention need to address not only sharing syringes but also sharing and reusing of other injecting equipment and drug filters.
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Affiliation(s)
- József Rácz
- Psychiatric Research Institute, Hungarian Academy of Sciences, Budapest, Hungary Victor Hugo utca 18-22, 1132 Budapest, Hungary, Telephone: (+36 20) 925-6568, Fax: (+36 1) 239-4740. E-mail:
- Blue Point Drug Counseling and Outpatient Treatment Center, Budapest, Hungary Balázs Béla utca 21, 1094 Budapest, Hungary, Telephone/fax: (+361) 2157833 E-mail:
| | - V. Anna Gyarmathy
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 624 N. Broadway, Suite 393 Baltimore, MD 21205 (410) 955-0422
- National Development and Research Institutes, Inc., New York, NY, USA 71 W 23rd St, 8th Floor New York, NY 10010 (212) 845-4480
| | - Alan Neaigus
- National Development and Research Institutes, Inc., New York, NY, USA 71 W 23rd St, 8th Floor New York, NY 10010 (212) 845-4480
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Eszter Ujhelyi
- Immunological Laboratory, Szent László Hospital, Budapest, Hungary Gyáli út 5-7, 1097 Budapest, Hungary Telephone: (+361) 2159073 E-mail:
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Gyarmathy VA, Neaigus A. The Effect of Personal Network Exposure on Injecting Equipment Sharing among IDUs in Budapest, Hungary. CONNECTIONS (TORONTO, ONT.) 2006; 27:25-38. [PMID: 34629605 PMCID: PMC8496454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Until the mid-1990s, the prevalence and incidence of HIV infection was uniformly low in countries across the Central and Eastern European region. In the past decade, however, this has changed dramatically, with a rapid increase in HIV infections in the region, especially in Eastern Europe where 41% of new HIV infection cases were among injecting drug users (IDUs) and as much as 66% of IDUs are infected with HIV in certain regions. While Russia, the largest country in Eastern Europe, has the fastest growing HIV rates in the world, the situation is different in Central Europe. For example, Hungary has low levels of HIV infection - estimated less than 1% of IDUs. Understanding the role of network factors in the spread and prevention of HIV could not only enable us to keep the HIV rates low among IDUs in countries like Hungary, but also provide a means for the effective prevention of other blood-borne and sexually transmitted infections (STIs) that share similar routes of transmission as HIV. Rogers' diffusion of innovations theory may help explain why HIV rates among IDUs are low in Hungary. Valente's related exposure or contagion model postulates that the more individuals within a social network adopt an innovation or a practice, the greater the probability of an individual is to adopt this innovation or practice. Personal network exposure (PNE), measured both within egocentric and sociocentric networks quantifies the extent to which a person is exposed to risk through their social network. The aim of this analysis was to assess the association of PNE and other correlates with injecting equipment sharing among IDUs in Budapest, Hungary.
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Affiliation(s)
| | - Alan Neaigus
- NDRI and Columbia University, Mailman School of Public Health
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