1
|
Kimmel SD, Samet JH, Cheng DM, Vetrova M, Idrisov B, Rossi SL, Rateau L, Astone K, Michals A, Sisson E, Blokhina E, Milet-Carty N, Bovell-Ammon BJ, Gnatienko N, Truong V, Krupitsky E, Lunze K. Stigma and other correlates of sharing injection equipment among people with HIV in St. Petersburg, Russia. Glob Public Health 2024; 19:2296009. [PMID: 38158724 PMCID: PMC10764055 DOI: 10.1080/17441692.2023.2296009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
Stigma that people with HIV who inject drugs experience negatively impacts HIV and substance use care, but stigma's association with sharing injection equipment is not known. This is a cross-sectional analysis of data from two studies of people with HIV reporting drug injection (N = 319) in St. Petersburg, Russia (September 2018-December 2020). We used logistic regression to examine associations between HIV stigma and substance use stigma scores (categorised into quartiles) and past 30-day equipment sharing, adjusting for demographic and clinical characteristics. Secondary analyses examined associations of arrest history and social support with sharing equipment. Almost half (48.6%) of participants reported sharing injection equipment. Among groups who did and did not share, mean HIV stigma (2.3 vs 2.2) and substance use stigma (32 vs 31) scores were similar. Adjusted analyses detected no significant associations between HIV stigma quartiles (global p-value = 0.85) or substance use stigma quartiles (global p-value = 0.51) and sharing equipment. Neither arrest history nor social support were significantly associated with sharing equipment. In this cohort, sharing injection equipment was common and did not vary based on stigma, arrest history, or social support. To reduce equipment sharing, investments in sterile injection equipment access in Russia should be prioritised over interventions to address stigma.
Collapse
Affiliation(s)
- Simeon D Kimmel
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
- Section of Infectious Diseases, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Jeffrey H Samet
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Marina Vetrova
- Institute of Pharmacology, Pavlov University, St. Petersburg, Russia
| | - Bulat Idrisov
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Sarah L Rossi
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Lindsey Rateau
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Kristina Astone
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Amy Michals
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Emily Sisson
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Elena Blokhina
- Institute of Pharmacology, Pavlov University, St. Petersburg, Russia
| | - Natasha Milet-Carty
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Benjamin J Bovell-Ammon
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
- The Miriam Hospital, Lifespan, Providence, Rhode Island, USA
| | - Natalia Gnatienko
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Ve Truong
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Evgeny Krupitsky
- Institute of Pharmacology, Pavlov University, St. Petersburg, Russia
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Karsten Lunze
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| |
Collapse
|
2
|
Leung J, Peacock A, Colledge S, Grebely J, Cunningham EB, Hickman M, Vickerman P, Stone J, Trickey A, Dumchev K, Lynskey M, Hines L, Griffiths P, Mattick RP, Degenhardt L, Larney S. A Global Meta-analysis of the Prevalence of HIV, Hepatitis C Virus, and Hepatitis B Virus Among People Who Inject Drugs-Do Gender-Based Differences Vary by Country-Level Indicators? J Infect Dis 2020; 220:78-90. [PMID: 30726973 DOI: 10.1093/infdis/jiz058] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/05/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women-specific factors exist that increases vulnerability to drug-related harms from injection drug use, including blood-borne viruses (BBVs), but gender-based differences in BBV prevalence have not been systematically examined. METHODS We conducted meta-analyses to estimate country, regional, and global prevalence of serologically confirmed human immunodeficiency virus (HIV), hepatitis C virus (HCV; based on detection of anti-HCV antibody), and hepatitis B virus (HBV; based on detection of HBV surface antigen) in people who inject drugs (PWID), by gender. Gender-based differences in the BBV prevalence (calculated as the risk among women relative to the risk among men) were regressed on country-level prevalence and inequality measures (Gender inequality index, Human development index, Gini coefficient, and high, low or middle income of the country). RESULTS Gender-based differences varied by countries and regions. HIV prevalence was higher among women than men in sub-Saharan Africa (relative risk [RR], 2.8; 95% confidence interval [CI], 1.8-4.4) and South Asia (RR, 1.7; 95% CI, 1.1-2.7); anti-HCV was lower among women in the Middle East and North Africa (RR, 0.6; 95% CI, .5-.7) and East and Southeast Asia (RR, 0.8; 95% CI, .7-.9). Gender-based differences varied with country-levels of the BBV prevalence in the general population, human development, and income distribution. CONCLUSION HIV was more prevalent in women who inject drugs as compared to their male counterparts in some countries, but there is variation between and within regions. In countries where women are at higher risks, there is a need to develop gender-sensitive harm-reduction services for the particularly marginalized population of women who inject drugs.
Collapse
Affiliation(s)
- Janni Leung
- National Drug and Alcohol Research Centre, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, Australia
| | | | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Australia
| | | | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol
| | - Jack Stone
- Population Health Science, Bristol Medical School, University of Bristol, Bristol
| | - Adam Trickey
- Population Health Science, Bristol Medical School, University of Bristol, Bristol
| | | | - Michael Lynskey
- National Addiction Centre, King's College London, London, United Kingdom
| | - Lindsey Hines
- Population Health Science, Bristol Medical School, University of Bristol, Bristol
| | - Paul Griffiths
- European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
| | | | | | - Sarah Larney
- National Drug and Alcohol Research Centre, Australia
| |
Collapse
|
3
|
Park JN, Footer KH, Decker MR, Tomko C, Allen ST, Galai N, Sherman SG. Interpersonal and structural factors associated with receptive syringe-sharing among a prospective cohort of female sex workers who inject drugs. Addiction 2019; 114:1204-1213. [PMID: 30694587 PMCID: PMC6548574 DOI: 10.1111/add.14567] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/20/2018] [Accepted: 01/21/2019] [Indexed: 02/02/2023]
Abstract
AIMS To determine the interpersonal and structural factors associated with receptive syringe sharing (RSS) among female sex workers who inject drugs (FSW-IDU), a group at high risk of HIV/hepatitis C virus (HCV) acquisition. DESIGN Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study, a prospective cohort study. SETTING Baltimore, MD, USA PARTICIPANTS: One hundred and eighty FSW-IDU; mean age = 33 years, 77.1% white and 62.9% in a relationship/married. MEASUREMENTS Surveys were conducted between April 2016 and February 2018. The main outcome was recent RSS (past 3 months). In addition to socio-demographic characteristics and drug use behaviors, we assessed factors at the interpersonal level, including injection practices, intimate partner and client drug use and exposure to violence. Structural-level factors included methods of syringe access. FINDINGS Nearly all FSW-IDU used heroin (97.1%) or crack cocaine (89.7%). Recent RSS was reported by 18.3%. Syringes were accessed from needle exchange programs (64.6%), pharmacies (29.7%), street sellers (30.3%) or personal networks (29.1%). Some FSW-IDU had clients or intimate partners who injected drugs (26.3 and 26.9%, respectively). Longitudinal factors independently associated with RSS in the multi-level mixed-effects model were recent client violence [adjusted odds ratio (aOR) = 2.17, 95% confidence interval (CI) = 1.09-4.33], having an intimate partner who injected drugs (aOR = 2.18, 95% CI = 0.98-4.85), being injected by others (aOR = 4.95, 95% CI = 2.42-10.10) and obtaining syringes from a street seller (aOR = 1.88, 95% CI = 0.94-3.78) or from a member of their personal network (aOR = 4.43, 95% CI = 2.21-8.90). CONCLUSIONS Client violence, intimate partner injection drug use, being injected by others and obtaining syringes from personal connections appear to increase parenteral HIV/HCV risk among female sex workers who inject drugs.
Collapse
Affiliation(s)
- Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205, USA,Corresponding author
| | - Katherine H.A. Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
| | - Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205, USA,Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205, USA
| |
Collapse
|
4
|
Campeau L, Blouin K, Leclerc P, Alary M, Morissette C, Blanchette C, Serhir B, Roy E. Impact of sex work on risk behaviours and their association with HIV positivity among people who inject drugs in Eastern Central Canada: cross-sectional results from an open cohort study. BMJ Open 2018; 8:e019388. [PMID: 29391367 PMCID: PMC5829837 DOI: 10.1136/bmjopen-2017-019388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objectives of this study were: (1) to examine the correlates of HIV positivity among participants who injected drugs and engaged in sex work (PWID-SWs) in the SurvUDI network between 2004 and 2016, after stratification by sex, and (2) to compare these correlates with those of sexually active participants who did not engage in sex work (PWID non-SWs). DESIGN AND SETTING This biobehavioural survey is an open cohort of services where participants who had injected in the past 6 months were recruited mainly through harm reduction programmes in Eastern Central Canada. PARTICIPANTS Data from 5476 participants (9223 visits in total; 785 not included in multivariate analyses due to missing values) were included. METHODS Participants completed an interviewer-administered questionnaire and provided saliva samples for anti-HIV antibody testing. Generalised estimating equations taking into account multiple participations were used. RESULTS Baseline HIV prevalence was higher among SWs compared with non-SWs (women: 13.0% vs 7.7%; P<0.001, and men: 17.4% vs 10.8%; P<0.001). PWID-SWs were particularly susceptible to HIV infection as a result of higher levels of vulnerability factors and injection risk behaviours. They also presented different risk-taking patterns than their non-SWs counterparts, as shown by differences in correlates of HIV positivity. Additionally, the importance of sex work for HIV infection varies according to gender, as suggested by a large proportion of injection risk behaviours associated with HIV among women and, conversely, a stronger association between sexual behaviours and HIV positivity observed among men. CONCLUSION These results suggest that sex work has an impact on the risk of HIV acquisition and that risk behaviours vary according to gender. Public health practitioners should take those specificities into account when designing HIV prevention interventions aimed at PWIDs.
Collapse
Affiliation(s)
- Laurence Campeau
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
- École de santé publique, Université de Montréal, Montréal, Québec, Canada
| | - Karine Blouin
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
| | - Pascale Leclerc
- École de santé publique, Université de Montréal, Montréal, Québec, Canada
- Direction régionale de Santé Publique - CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Michel Alary
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Quebec – Université Laval, Québec City, Quebec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada
| | - Carole Morissette
- Direction régionale de Santé Publique - CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Caty Blanchette
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Quebec – Université Laval, Québec City, Quebec, Canada
| | - Bouchra Serhir
- Sérologie, Virologie et biologie moléculaire, Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne de Bellevue, Québec, Canada
| | - Elise Roy
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke - Campus de Longueuil, Longueuil, Québec, Canada
| |
Collapse
|
5
|
Sex Work as an Emerging Risk Factor for Human Immunodeficiency Virus Seroconversion Among People who Inject Drugs in the SurvUDI Network. Sex Transm Dis 2017; 43:648-55. [PMID: 27631361 DOI: 10.1097/olq.0000000000000504] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent analyses have shown an emerging positive association between sex work and human immunodeficiency virus (HIV) incidence among people who inject drugs (PWIDs) in the SurvUDI network. METHODS Participants who had injected in the past 6 months were recruited across the Province of Quebec and in the city of Ottawa, mainly in harm reduction programs. They completed a questionnaire and provided gingival exudate for HIV antibody testing. The associations with HIV seroconversion were tested with a Cox proportional hazard model using time-dependent covariables including the main variable of interest, sexual activity (sex work; no sex work; sexually inactive). The final model included significant variables and confounders of the associations with sexual activity. RESULTS Seventy-two HIV seroconversions were observed during 5239.2 person-years (py) of follow-up (incidence rates: total = 1.4/100 py; 95% confidence interval [CI], 1.1-1.7; sex work = 2.5/100 py; 95% CI, 1.5-3.6; no sex work = 0.8/100 py; 95% CI, 0.5-1.2; sexually inactive = 1.8/100 py; 95% CI, 1.1-2.5). In the final multivariate model, HIV incidence was significantly associated with sexual activity (sex work: adjusted hazard ratio [AHR], 2.19; 95% CI, 1.13-4.25; sexually inactive: AHR, 1.62; 95% CI, 0.92-2.88), and injection with a needle/syringe used by someone else (AHR, 2.84; 95% CI, 1.73-4.66). CONCLUSIONS Sex work is independently associated with HIV incidence among PWIDs. At the other end of the spectrum of sexual activity, sexually inactive PWIDs have a higher HIV incidence rate, likely due to more profound dependence leading to increased vulnerabilities, which may include mental illness, poverty, and social exclusion. Further studies are needed to understand whether the association between sex work and HIV is related to sexual transmission or other vulnerability factors.
Collapse
|
6
|
Global Epidemiology of HIV Among Women and Girls Who Use or Inject Drugs: Current Knowledge and Limitations of Existing Data. J Acquir Immune Defic Syndr 2015; 69 Suppl 2:S100-9. [PMID: 25978476 DOI: 10.1097/qai.0000000000000623] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women and girls who use and inject drugs are a critical population at risk of HIV. In this article, we review data on the epidemiology of drug use and injection among women globally and HIV prevalence among women and girls who use and inject drugs. RESULTS Women and girls comprise one-third of people who use and inject drugs globally. There is substantial variation in HIV prevalence in this population, between and within countries. There is a pronounced lack of data examining HIV risk among particularly vulnerable subpopulations of women who use and inject drugs, including women who have sex with women, transgender women, racial and ethnic minority women, and young women. Women who use and inject drugs experience stigma and discrimination that affect access to services, and high levels of sexual risk exposures. CONCLUSIONS There are significant gaps in our understanding of the epidemiology of drug use and injecting among women and girls and HIV risk and prevalence in this population. Women are frequently underrepresented in studies of drug use and HIV risk and prevalence among people who inject drugs, limiting our understanding of possible sex differences in this population. Most research originates from developed countries and may not be generalizable to other settings. A great deal of work is needed to improve understanding of HIV among particularly vulnerable subpopulations, such as transgender women who use drugs. Better data are critical to efforts to advocate for the needs of women and girls who use and inject drugs.
Collapse
|
7
|
Wirtz AL, Peryshkina A, Mogilniy V, Beyrer C, Decker MR. Current and recent drug use intensifies sexual and structural HIV risk outcomes among female sex workers in the Russian Federation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:755-63. [PMID: 26003930 DOI: 10.1016/j.drugpo.2015.04.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/22/2015] [Accepted: 04/16/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Female sex workers (FSW) and people who inject drugs (PWID) are at high risk for HIV infection, with FSW-PWID at even greater risk. HIV-related research often focuses on the primary mode of transmission - sexual or parenteral transmission for FSW and PWID, respectively - with less known on how sex work and injection drug use (IDU) are collectively associated with the risk environment experienced by sex workers. We investigated this relationship among FSW in three Russian cities. METHODS In 2011, FSWs (N=754) in Tomsk, Krasnoyarsk, and Kazan were recruited via respondent-driven sampling and completed a survey and rapid HIV screening. Multivariable models evaluated the role of injection history (classified as active: last 6 months, former: prior to last 6 months, and never) with a set of sexual and structural HIV risk outcomes. RESULTS IDU was common: 11% actively injected drugs and 11% were former injectors. HIV infection was most prevalent among active injectors (AOR: 6.7; 95% CI: 2.4-18.9) and former injectors (AOR:4.5; 95%CI: 1.7-11.6), compared to non-injectors. Some 6-8% of non-injecting FSWs reported recent physical or sexual client violence and 23% police extortion. Compared to these non-injectors, active injecting was associated with unprotected anal sex (AOR: 2.8, 95%CI: 1.2-6.4), client violence (AOR: 7.3, 95%CI: 2.1-24.7), and police extortion (AOR: 3.0 95%CI: 1.5-5.9%). Self-reported sexual and structural risk outcomes were also more prevalent among active compared to former injectors; however, few differences existed between former and non-injectors. CONCLUSIONS FSW experience sexual, structural, and HIV risk outcomes and these risks are amplified for actively injecting FSWs. FSW who stopped injecting drugs demonstrated risk profiles closer to those of sex workers who had no history of injection. HIV prevention programs and outreach can provide opportunities to include harm reduction interventions and linkage to treatment for FSW to move FSWs towards lower risk environments.
Collapse
Affiliation(s)
- Andrea L Wirtz
- Johns Hopkins Medical Institute, Department of Emergency Medicine, Baltimore, USA; Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA.
| | | | | | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA
| | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA; Johns Hopkins Bloomberg School of Public Health, Department of Population, Family & Reproductive Health, Baltimore, USA
| |
Collapse
|
8
|
Corsi KF, Dvoryak S, Garver-Apgar C, Davis JM, Brewster JT, Lisovska O, Booth RE. Gender differences between predictors of HIV status among PWID in Ukraine. Drug Alcohol Depend 2014; 138:103-8. [PMID: 24613219 PMCID: PMC4002293 DOI: 10.1016/j.drugalcdep.2014.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The HIV epidemic in Ukraine is among the largest in Europe. While traditionally the epidemic has spread through injection risk behavior, sexual transmission is becoming more common. Previous research has found that women in Ukraine have higher rates of HIV and engage in more HIV risk behavior than men. This study extended that work by identifying risk factors that differentially predict men and women's HIV status among people who inject drugs (PWID) in Ukraine. METHODS From July 2010 to July 2013, 2480 sexually active PWID with unknown HIV status were recruited from three cities in Ukraine through street outreach. The average age was 31 years old. RESULTS Women, who made up twenty-eight percent of the sample, had higher safe sex self-efficacy (p<.01) and HIV knowledge (p<.001) than men, but scored higher on both the risky injection (p<.001) and risky sex (p<.001) composite scores than men. Risky sex behaviors were associated with women's HIV status more than men's. We also report results identifying predictors of risky injection and sex behaviors. CONCLUSIONS Gender-specific interventions could address problem of HIV risk among women who inject drugs in a country with a growing HIV epidemic. Our findings suggest specific ways in which intervention efforts might focus on groups and individuals who are at the highest risk of contracting HIV (or who are already HIV positive) to halt the spread of HIV in Ukraine.
Collapse
Affiliation(s)
- K F Corsi
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States.
| | - S Dvoryak
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | - C Garver-Apgar
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
| | - J M Davis
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
| | - J T Brewster
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
| | - O Lisovska
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | - R E Booth
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
| |
Collapse
|
9
|
Decker MR, Wirtz AL, Moguilnyi V, Peryshkina A, Ostrovskaya M, Nikita M, Kuznetzova J, Beyrer C. Female sex workers in three cities in Russia: HIV prevalence, risk factors and experience with targeted HIV prevention. AIDS Behav 2014; 18:562-72. [PMID: 23929034 DOI: 10.1007/s10461-013-0577-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Within Eastern Europe/Central Asia's expanding HIV epidemic, relatively little is known about female sex workers (FSWs). Using mixed methods, we report on sex work context, HIV prevalence and contextual risk factors, and exposure to FSW-targeted prevention services among FSWs in Kazan, Krasnoyarsk, and Tomsk, Russia. Following a qualitative phase, FSWs (n = 754) were recruited via respondent-driven sampling for a cross-sectional survey with HIV screening in 2011. HIV was prevalent (3.9 %). In adjusted analyses, significant risk factors included injection drug use (IDU; AOR 5.85, 95 % CI 2.47, 14.43), client-perpetrated physical violence (AOR 2.52, 95 % CI 1.41, 4.51), and client-perpetrated sexual violence (vaginal AOR 3.77, 95 % CI 1.73, 8.22; anal AOR 4.80, 95 % CI 1.89, 12.19). FSW-targeted programming (reported by 75 %) was described as highly valuable, providing free, anonymous, and non-stigmatizing care. Findings confirm FSWs as a core HIV risk population in Russia, and demonstrate the need to support FSW-oriented HIV services. Such efforts should address violence against FSWs.
Collapse
Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., E4142, Baltimore, MD, 21205, USA,
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Jozaghi E, Carleton R. The identification of subtypes among injection drug users: HIV and hepatitis C differences as indicated with the theory of planned behaviour. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2013.866987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
11
|
Czerwinski M, McNutt LA, DeHovitz JA, Zielinski A, Rosinska M. Refining HIV risk: the modifying effects of youth, gender and education among people who inject drugs in Poland. PLoS One 2013; 8:e68018. [PMID: 23935852 PMCID: PMC3720710 DOI: 10.1371/journal.pone.0068018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/24/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine specific factors placing young (aged <30) women who inject drugs at higher risk for HIV, and to establish the need for targeted interventions within this population. METHODS A national cross-sectional sero-survey was conducted in 2004-2005 in six regions in Poland. A snowball sample of ever-injectors was recruited from drug treatment facilities and the surrounding community. Log-binomial regression was used to estimate adjusted prevalence ratios (PRs). RESULTS A total of 491 injection drug users younger than 30 were recruited, of whom 159 were women and 332 were men. The prevalence of HIV was 16.4% and 9.6% among women and men, respectively. In multivariate analysis, young female injectors whose education terminated at the primary level were more likely to be HIV-positive compared to males with a similar level of education (PR = 3.34, 95% CI = 1.86-6.00) and more highly educated women (PR = 4.16, 95% CI = 2.21-7.82). CONCLUSIONS This study confirms an elevated risk of HIV among under-educated young women. Suggestions for specific interventions to reduce HIV transmission are presented. Additional research is needed to quantify the differential distribution of risk behaviors which amplify their likelihood of transmission.
Collapse
Affiliation(s)
- Michal Czerwinski
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
| | | | | | | | | |
Collapse
|
12
|
Urada LA, Raj A, Cheng DM, Quinn E, Bridden C, Blokhina EA, Krupitsky E, Samet JH. History of intimate partner violence is associated with sex work but not sexually transmitted infection among HIV-positive female drinkers in Russia. Int J STD AIDS 2013; 24:287-92. [PMID: 23970660 DOI: 10.1177/0956462412472809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper assesses the associations between intimate partner violence (IPV) and sexually transmitted infections (STIs) and sexual risks among HIV-positive female drinkers in St Petersburg, Russia. Survey and STI data were analysed from 285 women in HERMITAGE, a secondary prevention study of HIV-positive heavy drinkers. Logistic and Poisson regression analyses assessed associations of IPV with STI and risky sex. Most women (78%) experienced IPV and 19% were STI positive; 15% sold sex. IPV was not significantly associated with STI, but was with selling sex (adjusted odds ratio = 3.56, 95% confidence interval = 1.02-12.43). In conclusion, IPV is common and associated with sex trade involvement among Russian HIV-positive female drinkers.
Collapse
Affiliation(s)
- L A Urada
- Division of Global Public Health, Department of Medicine, University of California - San Diego School of Medicine, San Diego, CA 92093-0507, USA.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Vasquez C, Lioznov D, Nikolaenko S, Yatsishin S, Lesnikova D, Cox D, Pankovich J, Rosenes R, Wobeser W, Cooper, on behalf of the St. Peters C. Gender disparities in HIV risk behavior and access to health care in St. Petersburg, Russia. AIDS Patient Care STDS 2013; 27:304-10. [PMID: 23651108 DOI: 10.1089/apc.2013.0019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Over 40,000 HIV-infected individuals live in St Petersburg, Russia. Population characteristics and barriers to care are largely undefined. 152 consecutive patients receiving HIV care at two sites completed a questionnaire in Spring 2011. Rates of chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, alcohol use, and rates of antiretroviral uptake were similar by gender. Males reported a higher history of injection drug use (80.3% vs. 48.7%; p<0.01) and tuberculosis infection (18.8% vs. 1.6%; p<0.01). Females were more likely to have had a child (63.3% vs. 31.5%; p<0.01) and be currently raising that child within their residence (49.3% vs. 15.3%; p<0.01). Unprotected sex (60.5% vs. 17.8%; p<0.01) and a history of sexually transmitted infection (37.7% vs. 20.3%; p=0.03) were more common in females. Females utilized social services more frequently (34.2% vs. 11.9%; p<0.01). There is a heavy burden of concurrent infectious disease, substance use and abuse, mental health illness, and need for social service support in this population. Important differences exist between genders in service uptake and utilization. Further evaluation of these differences may help inform the allocation of limited resources in this high HIV prevalence region of Russia.
Collapse
Affiliation(s)
| | | | | | - Sergey Yatsishin
- St. Petersburg Branch of Russian Red Cross, St. Petersburg, Russia
| | - Darya Lesnikova
- St. Petersburg Branch of Russian Red Cross, St. Petersburg, Russia
| | - David Cox
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Jim Pankovich
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Ron Rosenes
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- CTN Community Advisory Committee, Toronto, Ontario, Canada
| | - Wendy Wobeser
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- Queen's University, Kingston, Ontario, Canada
| | | |
Collapse
|
14
|
Fazito E, Cuchi P, Mahy M, Brown T. Analysis of duration of risk behaviour for key populations: a literature review. Sex Transm Infect 2013; 88 Suppl 2:i24-32. [PMID: 23172343 PMCID: PMC3512397 DOI: 10.1136/sextrans-2012-050647] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The objective of this paper is to review literature in order to calculate regional estimates of the average duration of time individuals maintain a specific high-risk behaviour. Methods The review targeted the key populations of female sex workers (FSW), male clients of female sex workers (MCFSW), people who inject drugs (injecting drug users (IDU)) and high-risk men who have sex with men (MSM). To be included in the review the study had to provide information on (1) the time a person spent at risk until death or cessation of the risk behaviour, (2) the percentage of the sample who initiated the risk behaviour in less than a year or (3) the mean or median duration of the behaviour from a representative sample. Results 49 papers were found for the FSW population describing the period of time FSW stay in sex work to be between 2.9 years (Asia) and 12 years (Latin America). Eight papers were found for MCFSW showing the duration of the risk behaviour in this category varying from 4.6 years in Africa to 32 years in Asia. 86 papers were reviewed for the population of IDU showing that the average time a person injects illegal drugs varies from 5.6 years (Africa) to 21 years (South America). No information was found for duration of high-risk behaviour among MSM; instead, the definitions found in the literature for high- and low-risk behaviour among MSM were described. Conclusions There is high variability of estimates of duration of high-risk behaviours at regional level. More research is needed to inform models and prevention programmes on the average duration of time individuals maintain a specific high-risk behaviour.
Collapse
Affiliation(s)
- Erika Fazito
- University of Brasília, 26 Chemin Colladon, 1209 Genève, Suisse, Brasília, Brazil.
| | | | | | | |
Collapse
|
15
|
Platt L, Jolley E, Rhodes T, Hope V, Latypov A, Reynolds L, Wilson D. Factors mediating HIV risk among female sex workers in Europe: a systematic review and ecological analysis. BMJ Open 2013; 3:bmjopen-2013-002836. [PMID: 23883879 PMCID: PMC3731729 DOI: 10.1136/bmjopen-2013-002836] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We reviewed the epidemiology of HIV and selected sexually transmitted infections (STIs) among female sex workers (FSWs) in WHO-defined Europe. There were three objectives: (1) to assess the prevalence of HIV and STIs (chlamydia, syphilis and gonorrhoea); (2) to describe structural and individual-level risk factors associated with prevalence and (3) to examine the relationship between structural-level factors and national estimates of HIV prevalence among FSWs. DESIGN A systematic search of published and unpublished literature measuring HIV/STIs and risk factors among FSWs, identified through electronic databases published since 2005. 'Best' estimates of HIV prevalence were calculated from the systematic review to provide national level estimates of HIV. Associations between HIV prevalence and selected structural-level indicators were assessed using linear regression models. STUDIES REVIEWED Of the 1993 papers identified in the search, 73 peer-reviewed and grey literature documents were identified as meeting our criteria of which 63 papers provided unique estimates of HIV and STI prevalence and nine reported multivariate risk factors for HIV/STI among FSWs. RESULTS HIV in Europe remains low among FSWs who do not inject drugs (<1%), but STIs are high, particularly syphilis in the East and gonorrhoea. FSWs experience high levels of violence and structural risk factors associated with HIV, including lack of access to services and working on the street. Linear regression models showed HIV among FSWs to link with injecting drug use and imprisonment. CONCLUSIONS Findings show that HIV prevention interventions should be nested inside strategies that address the social welfare of sex workers, highlighting in turn the need to target the social determinants of health and inequality, including regarding access to services, experience of violence and migration. Future epidemiological and intervention studies of HIV among vulnerable populations need to better systematically delineate how microenvironmental and macroenvironmental factors combine to increase or reduce HIV/STI risk.
Collapse
Affiliation(s)
- Lucy Platt
- Centre for Research on Drugs and Health Behaviour, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Jolley
- Centre for Research on Drugs and Health Behaviour, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Vivian Hope
- Centre for Research on Drugs and Health Behaviour, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Alisher Latypov
- The Central Asia Program, Institute for European, Russian, and Eurasian Studies, George Washington University, Washington DC, USA
- Global Health Research Centre of Central Asia, Columbia University, New York, USA
| | - Lucy Reynolds
- Centre for Research on Drugs and Health Behaviour, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Wilson
- Global HIV/AIDS Programme, World Bank, Washington DC, USA
| |
Collapse
|
16
|
HIV Prevention and Rehabilitation Models for Women Who Inject Drugs in Russia and Ukraine. Adv Prev Med 2012; 2012:316871. [PMID: 23304535 PMCID: PMC3529453 DOI: 10.1155/2012/316871] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 11/17/2022] Open
Abstract
Women who inject drugs require gender-specific approaches to drug rehabilitation, modification of risk behaviors, and psychosocial adaptation. Improved outcomes have been demonstrated when the specific needs of women's subpopulations have been addressed. Special services for women include prenatal care, child care, women-only programs, supplemental workshops on women-focused topics, mental health services, and comprehensive programs that include several of the above components. To address the special needs of women injecting drug user (IDU) subpopulations, such as HIV-positive pregnant women and women with young children, recently released female prisoners, and street-involved girls and young women, HealthRight International and its local partners in Russia and Ukraine have developed innovative service models. This paper presents each of these models and discusses their effectiveness and implementation challenges specific to local contexts in Russia and Ukraine.
Collapse
|
17
|
Jolley E, Rhodes T, Platt L, Hope V, Latypov A, Donoghoe M, Wilson D. HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy. BMJ Open 2012; 2:e001465. [PMID: 23087014 PMCID: PMC3488708 DOI: 10.1136/bmjopen-2012-001465] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 09/06/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES HIV among people who inject drugs (PWID) is a major public health concern in Eastern and Central Europe and Central Asia. HIV transmission in this group is growing and over 27 000 HIV cases were diagnosed among PWID in 2010 alone. The objective of this systematic review was to examine risk factors associated with HIV prevalence among PWID in Central and Eastern Europe and Central Asia and to describe the response to HIV in this population and the policy environments in which they live. DESIGN A systematic review of peer-reviewed and grey literature addressing HIV prevalence and risk factors for HIV prevalence among PWID and a synthesis of key resources describing the response to HIV in this population. We used a comprehensive search strategy across multiple electronic databases to collect original research papers addressing HIV prevalence and risk factors among PWID since 2005. We summarised the extent of key harm reduction interventions, and using a simple index of 'enabling' environment described the policy environments in which they are implemented. STUDIES REVIEWED Of the 5644 research papers identified from electronic databases and 40 documents collected from our grey literature search, 70 documents provided unique estimates of HIV and 14 provided multivariate risk factors for HIV among PWID. RESULTS HIV prevalence varies widely, with generally low or medium (<5%) prevalence in Central Europe and high (>10%) prevalence in Eastern Europe. We found evidence for a number of structural factors associated with HIV including gender, socio-economic position and contact with law enforcement agencies. CONCLUSIONS The HIV epidemic among PWID in the region is varied, with the greatest burden generally in Eastern Europe. Data suggest that the current response to HIV among PWID is insufficient, and hindered by multiple environmental barriers including restricted access to services and unsupportive policy or social environments.
Collapse
Affiliation(s)
- Emma Jolley
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Platt
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
| | - Vivian Hope
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Infections, Health Protection Agency, London, UK
| | - Alisher Latypov
- Eurasian Harm Reduction Network, Vilnius, Lithuania
- Global Health Research Center of Central Asia, Columbia University, New York, New York, USA
| | - Martin Donoghoe
- Division of Communicable Diseases, Health Security and Environment, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - David Wilson
- Global HIV/AIDS Programme, World Bank, Washington DC, USA
| |
Collapse
|
18
|
Des Jarlais DC, Feelemyer JP, Modi SN, Arasteh K, Hagan H. Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas. Drug Alcohol Depend 2012; 124:95-107. [PMID: 22257753 PMCID: PMC3353009 DOI: 10.1016/j.drugalcdep.2011.12.020] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There are multiple reasons why females who inject drugs may be more likely to become infected with HIV than males who inject drugs. Where this is the case, special HIV prevention programs for females would be needed. DESIGN International systematic review and meta-analysis of studies across 14 countries. METHODS Countries with high seroprevalence (>20%) HIV epidemics among persons who inject drugs (PWID) were identified from the Reference Group to the UN on HIV and Injecting Drug Use. Systematic literature reviews collected data on HIV prevalence by gender for these countries. Non-parametric and parametric tests along with meta-analytic techniques examined heterogeneity and differences in odds ratios (OR) across studies. RESULTS Data were abstracted from 117 studies in 14 countries; total sample size N = 128,745. The mean weighted OR for HIV prevalence among females to males was 1.18 [95% CI 1.10-1.26], with high heterogeneity among studies (I(2)= 70.7%). There was a Gaussian distribution of the log ORs across studies in the sample. CONCLUSION There was a significantly higher HIV prevalence among females compared to males who inject drugs in high seroprevalence settings, but the effect size is extremely modest. The high level of heterogeneity and the Gaussian distribution suggest multiple causes of differences in HIV prevalence between females and males, with a specific difference determined by local factors. Greater understanding of factors that may protect females from HIV infection may provide insights into more effective HIV prevention for both females and males who inject drugs.
Collapse
Affiliation(s)
- Don C Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York City 10038, USA.
| | | | | | | | | |
Collapse
|
19
|
Thorne C, Semenenko I, Malyuta R. Prevention of mother-to-child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000-10. Addiction 2012; 107:118-28. [PMID: 21819473 PMCID: PMC3272221 DOI: 10.1111/j.1360-0443.2011.03609.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/20/2011] [Accepted: 08/02/2011] [Indexed: 12/01/2022]
Abstract
AIMS To compare clinical status, mother-to-child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV-infected injecting drug users (IDUs) and non-IDUs. DESIGN AND SETTING Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000-10. PARTICIPANTS Pregnant HIV-infected women, identified before/during pregnancy or intrapartum, and their live-born infants (n = 6200); 1028 women followed post-partum. MEASUREMENTS Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW). FINDINGS Of 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P < 0.01). Among women with undiagnosed HIV at conception, 20% of IDUs were diagnosed intrapartum versus 4% of non-IDUs (P < 0.01). At enrolment, 14% of IDUs had severe/advanced HIV symptoms versus 6% of non-IDUs (P < 0.001). IDUs had higher rates of PTD and LBW infants than non-IDUs, respectively, 16% versus 7% and 22% versus 10% (P < 0.001). IDUs were more likely to receive no neonatal or intrapartum PMTCT prophylaxis compared with non-IDUs (OR 2.81, p < 0.001). MTCT rates were 10.8% in IDUs versus 5.9% in non-IDUs; IDUs had increased MTCT risk (adjusted odds ratio 1.32, P = 0.049). Fewer IDUs with treatment indications received HAART compared with non-IDUs (58% versus 68%, P = 0.03). CONCLUSIONS Pregnant human immunodeficiency virus-infected injecting drug users in Ukraine have worse clinical status, poorer access to prevention of mother-to-child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother-to-child transmission than non-injecting drug user women.
Collapse
MESH Headings
- Adult
- Analgesics, Opioid
- Anti-Retroviral Agents/therapeutic use
- Antiretroviral Therapy, Highly Active/statistics & numerical data
- CD4 Lymphocyte Count
- Female
- HIV Infections/drug therapy
- HIV Infections/epidemiology
- HIV Infections/prevention & control
- HIV Infections/transmission
- Health Status
- Healthcare Disparities
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infectious Disease Transmission, Vertical/prevention & control
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Male
- Post-Exposure Prophylaxis/methods
- Post-Exposure Prophylaxis/statistics & numerical data
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/prevention & control
- Pregnancy Outcome
- Prospective Studies
- Risk Factors
- Substance Abuse, Intravenous/epidemiology
- Ukraine/epidemiology
- Young Adult
Collapse
Affiliation(s)
- Claire Thorne
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, UK.
| | | | | |
Collapse
|
20
|
Abdala N, Kershaw T, Krasnoselskikh TV, Kozlov AP. Contraception use and unplanned pregnancies among injection drug-using women in St Petersburg, Russia. ACTA ACUST UNITED AC 2011; 37:158-64. [PMID: 21493618 DOI: 10.1136/jfprhc-2011-0079] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This cross-sectional study estimated the prevalence of contraceptive methods and investigated whether abortion rates influence contraceptive behaviour among injection drug-using (IDU) women in St Petersburg, Russia. METHODOLOGY A self-administered questionnaire of behaviour in the last 3 months was applied to a convenient sample of IDU women. RESULTS Of 80 sexually active participants, 67% had had an abortion. No participant reported using hormonal contraceptives or intrauterine devices (IUDs). The only valid method of contraception used was condoms, which was reported by half of the participants. Consistent condom use was reported by 22% of participants and was no more likely among those who had an abortion. Condom use was significantly associated with having multiple or casual sex partners [prevalence ratio (PR) 1.75, 95% (confidence interval) CI 1.11-2.78, p = 0.01], having an IDU sex partner (PR 0.55, 95% CI 0.36-0.85, p = 0.029) and with a negative attitude toward condoms (PR 0.53, 95% CI 0.33-0.84, p = 0.01). Abortions were less likely among those who had multiple or casual sex partners (PR 0.69, 95% CI 0.49-0.97, p = 0.03). CONCLUSIONS Despite the high prevalence of abortions among IDU women, none reported the use of hormonal contraception or IUDs. Having had an abortion was not associated with greater likelihood of using condoms. Participants mostly used condoms with casual or multiple sex partners, suggesting that condoms were used mainly to prevent HIV/sexually transmitted infection transmission and not to prevent pregnancy. Programmes to prevent unwanted pregnancies and reduce abortion-related health risks among this understudied vulnerable group are needed.
Collapse
Affiliation(s)
- Nadia Abdala
- Yale School of Public Health, New Haven, CT 06520-8034, USA.
| | | | | | | |
Collapse
|
21
|
Gu J, Lau JT, Chen H, Tsui H, Ling W. Prevalence and factors related to syringe sharing behaviours among female injecting drug users who are also sex workers in China. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:26-33. [DOI: 10.1016/j.drugpo.2010.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 06/02/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
|
22
|
Hottes TS, Bruneau J, Daniel M. Gender-specific situational correlates of syringe sharing during a single injection episode. AIDS Behav 2011; 15:75-85. [PMID: 19224359 DOI: 10.1007/s10461-009-9530-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
Abstract
Factors associated with syringe sharing differ between women and men; however, it is uncertain whether these hold within the setting of a single injection episode. A questionnaire eliciting information about the last injection episode with others present was administered to participants in a cohort of Montréal injection drug users (IDUs). Logistic regression was used to identify correlates of syringe sharing and to test potential gender differences in relation to syringe sharing. Data from 467 participants revealed significant differences between men and women with regard to situational factors; however, the relationships between situational factors and syringe sharing did not vary according to gender. In multivariate models including both genders, syringe sharing was associated with various attributes of other IDUs who were present as well as alcohol use during that specific episode. These results highlight the relevance of situational factors in injection drug use activity, regardless of gender.
Collapse
|
23
|
Štulhofer A, Baćak V, Drglin T, Puljiz M, Miklin M. Female sex work and HIV risks in Croatia. AIDS Care 2009; 21:1439-46. [DOI: 10.1080/09540120902862592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Aleksandar Štulhofer
- a Department of Sociology, Faculty of Humanities and Social Sciences , University of Zagreb , Croatia
| | - Valerio Baćak
- a Department of Sociology, Faculty of Humanities and Social Sciences , University of Zagreb , Croatia
| | - Tihana Drglin
- a Department of Sociology, Faculty of Humanities and Social Sciences , University of Zagreb , Croatia
| | - Mario Puljiz
- b Non-governmental organization “Help” , Split , Croatia
| | - Marko Miklin
- c Non-governmental organization “Let” , Zagreb , Croatia
| |
Collapse
|
24
|
Raj A, Cheng DM, Krupitsky EM, Levenson S, Egorova VY, Meli S, Zvartau EE, Samet JH. Binge drinking and unsafe sex: a study of narcology hospital patients from St. Petersburg, Russia. Subst Abus 2009; 30:213-22. [PMID: 19591057 DOI: 10.1080/08897070903040923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to assess the association between binge alcohol use and unprotected sex in Russian substance users. Participants (N = 181) were narcology hospital patients assessed on demographics, alcohol use, risky sex, and sexually transmitted disease/human immunodeficiency virus (STD/HIV) diagnoses. Adjusted generalized estimating equations (GEEs) logistic regression analysis examined the association between binge drinking and same-day unprotected sex across each of the past 30 days, per participant (N = 5430 observations). Participants were age 18 to 55 years, 75% male, and 64% binge drinking. Sex trade was reported by 27%; history of STDs by 43%; and HIV by 15%. One fourth of daily observations included sex; 88% of these involved unprotected sex. Binge drinking was not associated with same-day unprotected sex (adjusted odds ratio [OR(adj)] = 1.0, 95% confidence interval [CI] = 0.7-1.4, chi(2)(1, N = 5219) = 0.01, ns). Findings document substantial HIV/STD risk and prevalence among Russian narcology patients, but no link between binge drinking and unprotected sex in this population, possibly due to very low rates of condom use generally.
Collapse
Affiliation(s)
- A Raj
- Department of Social Behavioral Sciences, Boston University of Public Health, Boston, Massachusetts 02118, USA.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Lau JT, Gu J, Zhang L, Cheng F, Zhang Y, Zhang J, Wang N, Lan Y. Comparing prevalence of HIV-related behaviors among female injecting drug users (IDU) whose regular sexual partner was or was not IDU in Sichuan and Yunnan Provinces, China. AIDS Care 2009; 21:909-17. [DOI: 10.1080/09540120802612790] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Joseph T.F. Lau
- a Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
| | - Jing Gu
- a Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , China
| | - Linglin Zhang
- b Sichuan Provincial Center for Disease Control and Prevention , Chengdu , China
| | - Feng Cheng
- c China Country Office of Family Health International , Beijing , China
| | - Yun Zhang
- d Management office of China-UK HIV/AIDS Prevention and Care Project , Beijing , China
| | - Jianxin Zhang
- e School of Public Health , Sichuan University , Chengdu , China
| | - Ning Wang
- f National Center for AIDS/STDs Control and Prevention , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Yajia Lan
- e School of Public Health , Sichuan University , Chengdu , China
| |
Collapse
|
26
|
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.
Collapse
Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Platt L, Sutton AJ, Vickerman P, Koshkina E, Maximova S, Latishevskaya N, Hickman M, Bonell C, Parry J, Rhodes T. Measuring risk of HIV and HCV among injecting drug users in the Russian Federation. Eur J Public Health 2009; 19:428-33. [DOI: 10.1093/eurpub/ckp041] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Correlates of any condom use among Russian narcology patients reporting recent unprotected sex. AIDS Behav 2009; 13:310-7. [PMID: 18401698 DOI: 10.1007/s10461-008-9383-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to assess whether HIV/sexually transmitted infection (STI) risk factors: risky sex (multiple sex partners and sex trade involvement), past HIV or STI diagnosis and substance use (at risk drinking and injection drug use) are associated with the outcome any condom use in the past 6 months among Russian narcology hospital patients. Participants (N = 178) included only those who reported unprotected sex in the past 6 months and were aged 18-55 years and 76% male. Any condom use in the past 6 months was reported by 55% of the sample. History of STIs was reported by 43% of participants; 15% were HIV-infected. Regression analyses adjusted for demographics demonstrated that those reporting multiple sex partners (OR(adj) = 4.2, 95% CI = 2.0-8.7) and sex trade involvement (OR(adj) = 2.4, 95% CI = 1.1-5.1) in the past 6 months had significantly higher odds of reporting any condom use in this same timeframe. HIV/STI and substance use were not associated with increased odds of condom use.
Collapse
|
29
|
Prevalence and factors associated with human immunodeficiency virus infection among sex workers in Samarkand, Uzbekistan. Sex Transm Dis 2009; 36:70-2. [PMID: 19131908 DOI: 10.1097/olq.0b013e31818adb54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
30
|
Gu J, Chen H, Chen X, Lau JTF, Wang R, Liu C, Liu J, Lei Z, Li Z. Severity of drug dependence, economic pressure and HIV-related risk behaviors among non-institutionalized female injecting drug users who are also sex workers in China. Drug Alcohol Depend 2008; 97:257-67. [PMID: 18482804 DOI: 10.1016/j.drugalcdep.2008.03.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 03/29/2008] [Accepted: 03/31/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Female injecting drug users (IDUs) who are also sex workers (FSW-IDUs) is an important bridge population transmitting HIV from the IDU population to clients of FSWs. Little is known about the relationships between severity of drug dependence, economic pressure and relevant HIV-related risk behaviors. METHODS 281 non-institutionalized participants were recruited using snowball sampling methods. Anonymous face-to-face interviews were administered by trained doctors. RESULTS 64.1% of participants used condoms inconsistently with their clients in the past 6 months; 28.5% served at least 2 clients per day and 48.4% practiced at least one of the three studied needle sharing behaviors. Severity of drug dependence (adjusted OR=1.05, p<0.01) and economic pressure (adjusted OR=1.07 to 2.52, p<0.05) were significantly associated with inconsistent condom use with clients in the last 6 months. Severity of drug dependence (adjusted OR=1.15, p<0.01) and variables related to perceived economic pressure (adjusted OR=1.09-3.05, p<0.05) were significantly associated with higher frequency of commercial sex transaction. Severity of drug dependence (adjusted OR=1.07, p<0.01) were also associated with needle sharing behaviors. In summary models, severity of drug dependence (OR=1.17, p<0.001), economic pressure (OR=1.39, p<0.001) and their interaction term (OR=0.98, p<0.001) were all associated with inconsistent condom use with clients in the last 6 months. CONCLUSIONS Prevalence of unprotected commercial sex was high and was independently associated with severity of drug dependence and economic pressure; severity of drug dependence was also associated with needle sharing behaviors. Such issues need to be fully considered when planning research studies and interventions.
Collapse
Affiliation(s)
- Jing Gu
- Centre for Epidemiology & Biostatistics, School of Public Health, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
Gender shapes the experience of drug use and its associated risks. In most parts of the world, however, harm reduction and drug treatment programmes that tailor their services to meet women's needs are rare or nonexistent. Many existing services inadvertently exclude women, and discriminatory policies and social stigma drive women drug users from care and expose them to human rights abuses. Women drug users often provide sex in exchange for housing, sustenance and protection, suffer violence from sexual partners and practise unsafe sex. This paper, drawing upon evidence from existing studies, examines ways in which gender-related factors can increase women drug users' vulnerability and decrease their access to harm reduction, drug treatment and sexual and reproductive health services. It recommends designing services with low-threshold access for women drug users that help them to become more independent, involving the women in designing services and policies, making programmes available for mothers, incorporating sexual and reproductive health into harm reduction services, providing gender-sensitive drug treatment and integrated harm reduction programmes for drug-using sex workers, connecting with domestic violence and rape prevention services and educating mainstream providers. Overall, investigating the circumstances women drug users face will help to formulate policies and programmes that better serve women who use drugs.
Collapse
|
32
|
Changes in HIV prevalence and risk among new injecting drug users in a Russian city of high HIV prevalence. J Acquir Immune Defic Syndr 2008; 47:623-31. [PMID: 18209680 DOI: 10.1097/qai.0b013e318165dbf7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure HIV prevalence and associated risk factors among recent initiates into drug injecting in 2001 and 2004 in Togliatti City, Russian Federation. DESIGN Two unlinked, anonymous, cross-sectional, community-recruited surveys of injecting drug users (IDUs) with oral fluid samples for anti-HIV testing. METHODS IDUs completed an interviewer-administered questionnaire, and oral fluid samples were tested for antibodies to HIV. Demographic characteristics and injecting risk behaviors were compared between subsamples of IDUs who reported injecting for 3 years or less in each of the survey years, 2001 (n = 138) and 2004 (n = 96). Univariable and multivariable analyses explored risk factors with anti-HIV among these new injectors. RESULTS Among IDUs overall, although HIV prevalence was high, a lower prevalence was found in 2004 (38.5%, 95% confidence interval [CI]: 34.1 to 42.9) than in 2001 (56%, 95% CI: 51.2 to 60.8). A significantly lower prevalence of HIV was found among new injectors in 2004 (11.5%, 95% CI: 5.0 to 17.9) than in 2001 (55.2%, 95% CI: 46.7 to 63.8). Proportionally, fewer new injectors reported injecting daily, injecting with used needles/syringes, and frontloading in 2004 compared with 2001. Decreased odds of anti-HIV were associated with being recruited in 2004 and with a history of drug treatment. Increased odds of HIV were associated with exchanging sex, duration of injection, and frontloading. CONCLUSIONS Findings indicate a decrease in HIV prevalence among new injectors between 2001 and 2004 and emphasize the role of provision of needle/syringes through pharmacies and providing access to voluntary HIV testing. These findings have implications for other cities in which explosive HIV outbreaks have occurred.
Collapse
|
33
|
Gollub EL. A neglected population: drug-using women and women's methods of HIV/STI prevention. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2008; 20:107-120. [PMID: 18433317 DOI: 10.1521/aeap.2008.20.2.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Women drug users are at extremely high risk of HIV and sexually transmitted infections (STIs) from sexual transmission, but remain seriously neglected in intervention research promoting women-initiated methods of HIV/STI prevention. Sparse available data indicate a high interest and enthusiasm for women-initiated methods among these women. Moreover, drug-using women may be in a position to capitalize most on the myriad advantages of women-initiated methods and be the least hindered by their disadvantages, as compared with other populations of at-risk women. These advantages include, for example, the potential for prior placement and use of a female condom without being noticed by a drunk or "high" partner, long-term and/or clandestine use of cervical barriers, and the "contraceptive justification" to partners or clients initially unwilling to accede to use of a female barrier. Targeted, community-based outreach and educational efforts to this extremely hard-to-reach group as well as expanded public funding for women's methods are urgent priorities.
Collapse
Affiliation(s)
- Erica L Gollub
- Visiting Professor of Epidemiology, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux II/INSERM U897, Bordeaux, France.
| |
Collapse
|
34
|
Abdala N, Krasnoselskikh TV, Durante AJ, Timofeeva MY, Verevochkin SV, Kozlov AP. Sexually transmitted infections, sexual risk behaviors and the risk of heterosexual spread of HIV among and beyond IDUs in St. Petersburg, Russia. Eur Addict Res 2008; 14:19-25. [PMID: 18182769 DOI: 10.1159/000110407] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS This study investigates whether sexual transmitted behaviors and infections (STIs) among injection drug users (IDUs) may promote the spread of HIV among and beyond IDUs in Russia. METHODS We conducted a cross-sectional survey of behavior and tested for STIs in a convenience sample of 159 IDUs in St. Petersburg, Russia. RESULTS The median age was 27 and 57% were male. Almost all were sexually active, half had casual partners and 40% reported > or =2 sex partners in the previous 3 months. Of those who answered, 81% reported sex without condoms, 44% reported having sex with at least one partner who was not an IDU. Of 139 (87%) subjects who were actively injecting, 29% reported receptive syringe sharing. Twenty percent of subjects were seropositive for HIV-1 and 42% of HIV-1-negative subjects tested positive for an STI. CONCLUSIONS The sample exhibited high levels of sexual risk behaviors and STIs, and a large proportion had sexual partners who were not IDUs. This population requires comprehensive interventions that ensures access to condoms and sterile injection supplies and that encourage safer sexual behaviors in an attempt to keep sexual transmission of HIV low.
Collapse
Affiliation(s)
- N Abdala
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn. 06520, USA.
| | | | | | | | | | | |
Collapse
|
35
|
Azim T, Chowdhury EI, Reza M, Ahmed M, Uddin MT, Khan R, Ahmed G, Rahman M, Khandakar I, Khan SI, Sack DA, Strathdee SA. Vulnerability to HIV infection among sex worker and non-sex worker female injecting drug users in Dhaka, Bangladesh: evidence from the baseline survey of a cohort study. Harm Reduct J 2006; 3:33. [PMID: 17109763 PMCID: PMC1665448 DOI: 10.1186/1477-7517-3-33] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 11/17/2006] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Very little is known about female injecting drug users (IDU) in Bangladesh but anecdotal evidence suggests that they are hidden and very vulnerable to HIV through both their injection sharing and sexual risk behaviors. In order to better understand the risks and vulnerability to HIV of female IDU, a cohort study was initiated through which HIV prevalence and risk behaviors was determined. METHODS All female IDU (those who had injected in the last six months and were 15 years or older) who could be identified from three cities in the Dhaka region were enrolled at the baseline of a cohort study. The study was designed to determine risk behaviors through interviews using a semi-structured questionnaire and measure prevalence of HIV, hepatitis C and syphilis semiannually. At the baseline of the cohort study 130 female IDU were recruited and female IDU selling sex in the last year (sex workers) versus those not selling sex (non-sex workers) were compared using descriptive statistics and logistic regression. RESULTS Of the 130 female IDU enrolled 82 were sex workers and 48 were non-sex workers. None had HIV but more sex workers (60%) had lifetime syphilis than non-sex workers (37%). Fewer sex worker than non-sex worker IDU lived with families (54.9% and 81.3% respectively), but more reported lending needles/syringes (29.3% and 14.6% respectively) and sharing other injection paraphernalia (74.4% and 56.3% respectively) in the past six months. Although more sex workers used condoms during last sex than non-sex workers (74.4% and 43.3% respectively), more reported anal sex (15.9% and 2.1% respectively) and serial sex with multiple partners (70.7% and 0% respectively). Lifetime sexual violence and being jailed in the last year was more common in sex workers. CONCLUSION Female IDU are vulnerable to HIV through their injection and sexual risk behaviors and sex worker IDU appear especially vulnerable. Services such as needle exchange programs should become more comprehensive to address the needs of female IDU.
Collapse
Affiliation(s)
- Tasnim Azim
- HIV/AIDS Programme, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - Ezazul I Chowdhury
- HIV/AIDS Programme, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - Masud Reza
- HIV/AIDS Programme, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - Munir Ahmed
- HIV Programme, CARE, Bangladesh, Dhaka, Bangladesh
| | | | - Repon Khan
- HIV/AIDS Programme, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - Giasuddin Ahmed
- HIV/AIDS Programme, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - Motiur Rahman
- HIV/AIDS Programme, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - Irona Khandakar
- HIV/AIDS Programme, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - Sharful I Khan
- HIV/AIDS Programme, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - David A Sack
- HIV/AIDS Programme, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - Steffanie A Strathdee
- Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine, University of California San Diego School of Medicine, USA
| |
Collapse
|
36
|
Platt L, Rhodes T, Judd A, Koshkina E, Maksimova S, Latishevskaya N, Renton A, McDonald T, Parry JV. Effects of sex work on the prevalence of syphilis among injection drug users in 3 Russian cities. Am J Public Health 2006; 97:478-85. [PMID: 17018827 PMCID: PMC1805018 DOI: 10.2105/ajph.2005.069732] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined risk factors for syphilis infection among injection drug users in 3 Russian Federation cities, focusing particular attention on the potential roles of gender and sex work. METHODS We conducted a cross-sectional survey of injection drug users in Moscow, Volgograd, and Barnaul, collecting behavioral data and testing for antibodies to Treponema pallidum. Associations between presence of antibodies to T pallidum and covariates were explored. RESULTS Overall, the prevalence of antibodies to T pallidum was 11% (95% confidence interval=9.7%, 13.1%). Syphilis was associated with involvement in sex work and with gender in Moscow and Barnaul but not in Volgograd. Female injection drug users not involved in sex work were more likely than men to be younger and to have recently begun to inject; female injection drug users involved in sex work were more likely than those not involved in sex work to inject daily. CONCLUSIONS Syphilis transmission dynamics varied by region. Sex work can increase syphilis risk among injection drug users, potentially feeding the momentum of sexually transmitted HIV and syphilis among noninjectors. Targeted interventions are needed to reduce both sexual and injection risk behaviors among injection drug users.
Collapse
Affiliation(s)
- Lucy Platt
- Centre for Research on Drugs and Health Behavior, Imperial College, London, England.
| | | | | | | | | | | | | | | | | |
Collapse
|