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Tsui HY, Lau JTF, Wang Z, Gross DL, Wu AMS, Cao W, Gu J, Li S. Applying the pre-intentional phase of the Health Action Process Approach (HAPA) Model to investigate factors associated with intention on consistent condom use with various types of female sex partners among males who inject drugs in China. AIDS Care 2016; 28:1079-88. [DOI: 10.1080/09540121.2016.1146652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Noor SWB, Ross MW, Lai D, Risser JM. Use of latent class analysis approach to describe drug and sexual HIV risk patterns among injection drug users in Houston, Texas. AIDS Behav 2014; 18 Suppl 3:276-83. [PMID: 24510363 DOI: 10.1007/s10461-014-0713-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Following latent class analysis (LCA) approach we examined patterns of HIV risk using two related domains of behavior: drug use, and sexual activity among 523 injection drug users (IDUs) recruited into the 2009 National HIV behavioral surveillance system. Using posterior probability of endorsing six drug and sexual items, we identified three distinct classes representing underlying HIV risk. Forty percent of our participants were at highest risk, 25 % at medium risk, and 35 % at lowest risk for HIV infection. Compared to the Lowest-risk class members, the Highest-risk class members had riskier drug and sexual behaviors and had higher prevalence of HIV cases (6 vs. 4 %). This analysis underscores the merit of LCA to empirically identify risk patterns using multiple indicators and our results show HIV risk varies among IDUs as their drug and sexual behaviors. Tailored and targeted prevention and treatment interventions for the dual risk pattern are required rather than for drug or sexual risk in silos.
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Affiliation(s)
- Syed W B Noor
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, WBOB-300, 1300 2nd St South, Minneapolis, MN, 55454, USA,
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Assari S, Yarmohamadivasel M, Moghani Lankarani M, Sehat M, Narenjiha H, Rafiey H, Noori R, Shirinbayan P, Ahmadi K. Having Multiple Sexual Partners among Iranian Intra-Venous Drug Users. Front Psychiatry 2014; 5:125. [PMID: 25346698 PMCID: PMC4193211 DOI: 10.3389/fpsyt.2014.00125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 08/25/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transmission of HIV from intra-venous drug users (IDUs) to the community occurs predominantly through high-risk sexual behaviors. Limited information exists regarding the high-risk sexual behaviors of IDUs in Iran. AIM The aim of this study was to determine the prevalence and factors associated with having multiple sexual partners among Iranian IDUs. METHODS This is a national survey on drug-dependent adults. Participants were sampled from medical centers, prisons, and streets of capitals of 29 provinces in Iran between May 2007 and February 2008. We analyzed data of 1416 current IDUs. Socio-demographics and drug use characteristics were entered into a binary logistic regression model to determine predictors of having multiple sexual partners. RESULTS Having multiple sexual partners in the past or at the time of survey was reported by 56.4% of Iranian IDUs. Multivariate analysis showed that the likelihood of having multiple sexual partners in IDUs decreased by being married [odds ratio (OR), 0.38; P < 0.001] and increased by female gender (OR, 13.44; P = 0.02), having illegal income (OR, 1.72; P = 0.003), higher monthly family income (OR, 1.01; P = 0.003), pleasure, curiosity, and recreation as cause of first drug use (OR, 1.37; P = 0.04), ruins as usual place for injection (OR, 1.89; P = 0.001) and history of syringe sharing (OR, 1.50; P = 0.02). CONCLUSION Having multiple sexual partners was reported by majority of Iranian IDUs, and this was linked to socio-demographics, initiation data, and other risk behaviors. This information should be considered in prevention efforts to reduce sexual transmission of HIV infection in Iran.
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Affiliation(s)
- Shervin Assari
- Department of Health Behavior and Health Education, University of Michigan School of Public Health , Ann Arbor, MI , USA ; Center for Research on Ethnicity, Culture, and Health, University of Michigan School of Public Health , Ann Arbor, MI , USA ; Department of Psychiatry, University of Michigan School of Medicine , Ann Arbor, MI , USA ; Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | | | - Maryam Moghani Lankarani
- Universal Network for Health Information Dissemination and Exchange , Tehran , Iran ; Medicine and Health Promotion Institute , Tehran , Iran
| | - Mahmood Sehat
- Universal Network for Health Information Dissemination and Exchange , Tehran , Iran ; Medicine and Health Promotion Institute , Tehran , Iran
| | - Hooman Narenjiha
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran ; Center for Behavioral and Social Research, Darius Institute , Tehran , Iran
| | - Hassan Rafiey
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran ; Center for Behavioral and Social Research, Darius Institute , Tehran , Iran
| | - Roya Noori
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Peymaneh Shirinbayan
- Pediatric NeuroRehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah Medical Sciences University , Tehran , Iran
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Dual HIV risk: receptive syringe sharing and unprotected sex among HIV-negative injection drug users in New York City. AIDS Behav 2013; 17:2501-9. [PMID: 23640654 DOI: 10.1007/s10461-013-0496-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HIV-negative injection drug users (IDUs) who engage in both receptive syringe sharing and unprotected sex ("dual HIV risk") are at high risk of HIV infection. In a cross-sectional study conducted in New York City in 2009, active IDUs aged ≥18 years were recruited using respondent-driven sampling, interviewed, and tested for HIV. Participants who tested HIV-negative and did not self-report as positive were analyzed (N = 439). Adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) were estimated using multinomial logistic regression. The sample was: 77.7 % male; 54.4 % Hispanic, 36.9 % white, and 8.7 % African-American/black. Dual risk was engaged in by 26.2 %, receptive syringe sharing only by 3.2 %, unprotected sex only by 49.4 %, and neither by 21.2 %. Variables independently associated with engaging in dual risk versus neither included Hispanic ethnicity (vs. white) (aOR = 2.0, 95 % CI = 1.0-4.0), married or cohabiting (aOR = 6.3, 95 % CI = 2.5-15.9), homelessness (aOR = 3.4, 95 % CI = 1.6-7.1), ≥2 sex partners (aOR = 8.7, 95 % CI = 4.4-17.3), ≥2 injecting partners (aOR = 2.9, 95 % CI = 1.5-5.8), and using only sterile syringe sources (protective) (aOR = 0.5, 95 % CI = 0.2-0.9). A majority of IDUs engaged in HIV risk behaviors, and a quarter in dual risk. Interventions among IDUs should simultaneously promote the consistent use of sterile syringes and of condoms.
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A randomized controlled trial to evaluate the relative efficacy of the addition of a psycho-social intervention to standard-of-care services in reducing attrition and improving attendance among first-time users of methadone maintenance treatment in China. AIDS Behav 2013; 17:2002-10. [PMID: 23413126 DOI: 10.1007/s10461-012-0393-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although methadone maintenance treatment (MMT) is an important means of HIV control, MMT clinics commonly have high attrition rates. The randomized controlled trial investigated the relative efficacy of adding a psycho-social intervention to the standard-of-care MMT in reducing attrition and non-attendance among first-time newly admitted MMT users in China (n = 288). Social workers implemented this three-phase intervention that was based on a behavioral maintenance theory. It also involved participants' family members and rectified some MMT-related misconceptions. As compared to the control group, the intervention group showed significantly lower likelihood of attrition (HR = 0.55, 95% confidence interval 0.39-0.80), lower estimated probability of attrition at Month 12 (0.35 vs. 0.55), and higher median number of days of attendance (Month 6: 147 vs. 91 days, p < 0.001; end-date: 225 vs. 142 days, p < 0.001). Further psycho-social services and translational research are warranted.
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Assari S, Yarmohmmadi Vasel M, Tavakoli M, Sehat M, Jafari F, Narenjiha H, Rafiey H, Ahmadi K. Inconsistent Condom Use among Iranian Male Drug Injectors. Front Psychiatry 2013; 4:181. [PMID: 24772093 PMCID: PMC3983495 DOI: 10.3389/fpsyt.2013.00181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/13/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the prevalence and associated factors of inconsistent condom use among Iranian male injecting drug users (IDUs). MATERIALS AND METHODS Data came from the national Iranian behavioral survey of drug dependence, which sampled 7743 individuals with drug dependence, from medical centers, prisons, and streets in 29 provinces in Iran, in 2007. This study included all individuals who were male, IDUs, and were sexually active (n = 1131). The main outcome was inconsistent condom use which was assessed using a single item. A logistic regression was used to determine the association between socio-economic data, drug use data, and high risk injection behaviors with inconsistent condom use. RESULT 83.3% of sexually active IDUs (n = 965) reported inconsistent condom use. Based on the logistic regression, likelihood of inconsistent condom use was higher among those with a history of syringe sharing [Odds Ratio (OR); 1.63, 95% Confidence Interval (CI); 1.13-2.34], but lower among those with higher education levels (OR; 0.34, 95% CI; 0.14-0.82), those who mostly inject at home (OR; 0.09, 95% CI; 0.02-0.47), and those with a history of treatment (OR; 0.54, 95% CI; 0.31-0.94). CONCLUSION Because of the link between unsafe sex and risky injecting behaviors among Iranian IDUs, combined programs targeting both sexual and injection behavior may be more appropriate than programs that target sexual or injection behavior. The efficacy of combined programs should be, however, compared with traditional programs that only target sexual or injection behavior of IDUs.
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Affiliation(s)
- Shervin Assari
- Department of Health Behavior and Health Education, University of Michigan School of Public Health , Ann Arbor, MI , USA ; Center for Research on Ethnicity, Culture, and Health, University of Michigan School of Public Health , Ann Arbor, MI , USA
| | | | - Mahmood Tavakoli
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Mahmoud Sehat
- Universal Network for Health Information Dissemination and Exchange , Tehran , Iran ; Medicine and Health Promotion Institute , Tehran , Iran
| | - Firoozeh Jafari
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Hooman Narenjiha
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran ; Center for Behavioral and Social Research, Darius Institute , Tehran , Iran
| | - Hassan Rafiey
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran ; Center for Behavioral and Social Research, Darius Institute , Tehran , Iran
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah Medical Sciences University , Tehran , Iran
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Should associations between HIV-related risk perceptions and behaviors or intentions be positive or negative? PLoS One 2012; 7:e52124. [PMID: 23284896 PMCID: PMC3526527 DOI: 10.1371/journal.pone.0052124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 11/08/2012] [Indexed: 11/24/2022] Open
Abstract
Risk perceptions are important in HIV research and interventions; mixed results were found between HIV-related perceptions and behaviors. We interviewed 377 sexually active injecting drug users in China, finding mixed associations between HIV-related risk perception assessed by two general measures and two previous risk behaviors (syringe sharing: p<.05; unprotected sex: p>.05) – partially supporting the ‘reflective hypothesis’ that reflection on previous behaviors increases risk perceptions. When we use specific measures for risk perceptions (HIV transmission via unprotected sex with specific types of sex partner and via syringe sharing) and use behavioral intention to adopt protective risk behaviors (condom use and avoid syringe sharing totally) as dependent variables, positive significant associations were observed – supporting the motivational hypothesis that risk perceptions motivate one to adopt protective behaviors. The direction and significance of the associations of concern depends on types of measures used. It has important implications on research design, data interpretation and services.
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Lau JTF, Gu J, Tsui HY, Chen H, Holroyd E, Wang R, Hu X. Prevalence and associated factors of condom use during commercial sex by female sex workers who were or were not injecting drug users in China. Sex Health 2012; 9:368-76. [PMID: 22877597 DOI: 10.1071/sh11108] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 01/30/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We compared the prevalence of inconsistent condom use during commercial sex between female sex workers (FSWs) who did or did not inject drugs (FSW-IDUs and FSW-NIDUs) and investigated factors associated with this inconsistent use within these two groups. METHODS Some 158 FSW-NIDUs recruited from sex work venues and 218 FSW-IDUs recruited via the snowball sampling method were interviewed anonymously. RESULTS Only 16.5% of the FSW-IDUs and 51.3% of the FSW-NIDUs had used condoms consistently during commercial sex in the last month (odds ratio (OR)=0.19). Factors significantly associated with inconsistent condom use in both groups included: behavioural intention for condom use (adjusted odds ratio (AOR)=0.05 and 0.13), condom unavailability (AOR=4.77 and 5.33), a perceived need to engage in unprotected sex if the client paid more (AOR=8.74 and 10.84) or insisted on demanding unprotected sex (AOR=19.78 and 7.59), and submissive gender power (AOR=11.65 and 2.58). One factor, perceived susceptibility (AOR=2.64), was significant only among FSW-NIDUs, whereas perceived efficacy of condom use in preventing HIV transmission (AOR=0.08), perceptions that peer FSWs would not use condoms with clients (AOR=2.23), self-hatred (AOR=2.25) and lack of social support (AOR=2.93) were significant only among FSW-IDUs. Injecting with used syringes was also associated with inconsistent condom use among FSW-IDUs (AOR=4.64). CONCLUSIONS FSW-IDUs were more likely than FSW-NIDUs to possess the cognitive and psychosocial conditions associated with unprotected commercial sex. Interventions need to take these differences into account.
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Affiliation(s)
- Joseph T F Lau
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
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Noor SWB, Ross MW, Lai D, Risser JM. Clustered drug and sexual HIV risk among a sample of middle-aged injection drug users, Houston, Texas. AIDS Care 2012; 25:895-903. [PMID: 23092216 DOI: 10.1080/09540121.2012.733333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recent studies have reported a clustered pattern of high-risk drug using and sexual behaviors among younger injection drug users (IDUs), however, no studies have looked at this clustering pattern in relatively older IDUs. This analysis examines the interplay and overlap of drug and sexual HIV risk among a sample of middle-aged, long-term IDUs in Houston, Texas. Our study includes 452 eligible IDUs, recruited into the 2009 National HIV Behavioral Surveillance project. Four separate multiple logistic regression models were built to examine the odds of reporting a given risk behavior. We constructed the most parsimonious multiple logistic regression model using a manual backward stepwise process. Participants were mostly male, older (mean age: 49.5±6.63), and nonHispanic Black. Prevalence of receptive needle sharing as well as having multiple sex partners and having unprotected sex with a partner in exchange for money, drugs, or other things at last sex were high. Unsafe injecting practices were associated with high-risk sexual behaviors. IDUs, who used a needle after someone else had injected with it had higher odds of having more than three sex partners (odds ratio (OR) = 2.10, 95% confidence interval (CI): 1.40-3.12) in last year and who shared drug preparation equipment had higher odds of having unprotected sex with an exchange partner (OR = 3.89, 95% CI: 1.66-9.09) at last sex. Additionally, homelessness was associated with unsafe injecting practices but not with high-risk sexual behaviors. Our results show that a majority of the sample IDUs are practicing sexual as well as drug-using HIV risk behaviors. The observed clustering pattern of drug and sexual risk behavior among this middle-aged population is alarming and deserve attention of HIV policy-makers and planners.
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Affiliation(s)
- Syed W B Noor
- Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA.
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Lau JTF, Gu J, Tsui H, Chen H, Wang R, Hu X. How likely are HIV-positive female sex workers in China to transmit HIV to others? Sex Health 2011; 8:399-406. [PMID: 21851782 DOI: 10.1071/sh10106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 01/31/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Female sex workers (FSW) are highly marginalised and HIV-positive FSW are under a double stigma. No study has assessed the likelihood of secondary transmission via HIV-positive FSW in China. METHODS A total of 199 FSW who injected drugs were recruited by snowball sampling, and 158 non-injecting FSW were recruited from sex service establishments by convenience sampling in Dazhou, China. All participants were interviewed anonymously using a structured questionnaire. RESULTS If found to be HIV-positive, 11.7% of the participants would continue working as FSW, 24.6% would not care about transmitting HIV to others, 18.8% believed that they would eventually spread HIV to others and 9% would take revenge by spreading HIV to others. In multivariate models, factors associated with ≥ 1 of the four aforementioned perceptions (42.0%) included drug use (odds ratio (OR)=1.82-3.26, P<0.01), perceived discrimination towards people living with HIV and AIDS in China (OR=2.03, P<0.05) and perceived inaccessibility to medical treatments if diagnosed as HIV-positive (OR=2.30, P<0.01); the reverse was true for use of HIV-related services (OR=0.53, P<0.05) and suicidal intentions if found to be HIV-positive (OR=0.42, P<0.05). CONCLUSIONS Improvement of the social, care and medical environment of HIV-positive FSW is likely to reduce secondary transmission via HIV-positive FSW. Special attention should be given to FSW who inject drugs.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, the Chinese University of Hong Kong, 5/F., School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong, China.
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Kuo I, Greenberg AE, Magnus M, Phillips G, Rawls A, Peterson J, Hamilton F, West-Ojo T, Hader S. High prevalence of substance use among heterosexuals living in communities with high rates of AIDS and poverty in Washington, DC. Drug Alcohol Depend 2011; 117:139-44. [PMID: 21316871 DOI: 10.1016/j.drugalcdep.2011.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 01/13/2011] [Accepted: 01/15/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the prevalence and patterns of substance use, HIV prevalence, and sexual risk behaviors in a community-based sample of heterosexuals recruited from areas at high risk for HIV/AIDS and poverty in Washington, DC. METHODS Community-recruited heterosexuals aged 18-50 from areas of high AIDS and poverty rates in DC were analyzed. Based on past 12 months use, participants were hierarchically classified into five groups: (1) ever injection drug use (IDU); (2) non-injection crack; (3) non-injection heroin and cocaine; (4) marijuana; and (5) no drug use. Sexual behaviors and HIV serology were also assessed. RESULTS Of 862 participants, 40% were men, most were Black and unemployed, and more than half had ever been incarcerated. Prevalence of past year substance use was high: binge drinking (59%); marijuana (50%); non-injection crack (28%); heroin and/or cocaine injection (28%), non-injection cocaine (13%); and ecstasy (13%). In the hierarchical classification, 25% were ever IDU, 15% non-injection crack users, 2% non-injection heroin and/or cocaine users, 31% marijuana users, and 27% reported no drug use. Overall HIV seroprevalence was 5.7% and differed by drug use group-9.5%, 11.1%, 1.8%, 1.6%, and 3.2%, respectively. Nearly half reported having ≥3 sex partners in the past year; 20% reported exchange partners, and 69% had concurrent sex partners. CONCLUSION Estimated prevalence of substance use in this heterosexual population was high. HIV prevalence among IDUs and non-injection crack users was higher than the estimated population prevalence in Washington, DC. Sexual behaviors above and beyond drug use are likely to be driving HIV transmission.
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Affiliation(s)
- Irene Kuo
- The George Washington University, School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC 20037, USA.
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Chikovani I, Bozicevic I, Goguadze K, Rukhadze N, Gotsadze G. Unsafe injection and sexual risk behavior among injecting drug users in Georgia. J Urban Health 2011; 88:736-48. [PMID: 21717253 PMCID: PMC3157497 DOI: 10.1007/s11524-011-9571-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Injection drug users (IDUs) are at risk for acquiring human immunodeficiency virus (HIV) through parenteral and sexual transmission. In this paper, we describe the prevalence and correlates of unsafe drug injecting and sexual behaviors among IDUs recruited across five cities in Georgia in 2009. IDUs were administered a questionnaire collecting information on demographics, drug use, sexual behaviors, and HIV testing behaviors. Correlates of risky injecting and sexual behaviors were determined using logistic regression. Of 1,127 IDUs, the majority (98.7%) were men, and the median duration of injecting drugs was 7 years. Unsafe injecting behavior at last injection was reported by 51.9% of IDUs, while 16.8% reported both unsafe injecting behavior and not using condoms with last occasional and/or commercial partner. In the multivariate analysis, independent correlates of unsafe injecting behavior at last injection were types of drugs injected [p = 0.0096; (for ephedrine, adjusted odds ratio (aOR) = 7.38; 95% CI, 1.50-36.26)] and not using condoms at last commercial sex (aOR = 2.29, 1.22-4.32). The following variables were significantly associated with unsafe injecting behavior at last injection and not using condoms at last sex with commercial and/or occasional partners in the multivariate analysis: marital status [p = 0.0002; (for divorced, widowed, and separated aOR = 2.62, 1.62-4.25; for single aOR = 1.61, 1.08-2.39)], being a member of a regular injecting group (aOR = 0.62, 0.44-0.88), types of drugs injected in the past month [p = 0.0024; (for buprenorphine aOR = 0.34, 0.18-0.63)], city of residence (p = 0.0083), and not receiving information on HIV (aOR = 1.82, 1.07-3.09). Though only ephedrine was injected by a smaller number of IDUs (9.1%), the vast majority of these (81.4%) reported unsafe injecting practices at last injection. High prevalence of unsafe injecting behaviors and diverse and at-risk sexual partnerships highlight the need to implement complex and targeted HIV interventions among IDUs in Georgia.
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Affiliation(s)
- Ivdity Chikovani
- Curatio International Foundation, 37d I. Chavchavadze Avenue, Tbilisi, 0162, Georgia.
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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]
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Lau JTF, Tsui HY, Gu J, Zhang J, Zhang L, Zhang Y, Cheng F, Wang N. Sexual mixing and condom use with different types of sex partners among non-institutionalized sexually active female injecting drug users in Sichuan, China. AIDS Behav 2011; 15:86-94. [PMID: 20625925 DOI: 10.1007/s10461-010-9754-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Behavioral surveillance data of 1422 sexually active female injecting drug users (IDU) in Sichuan China were analyzed. The prevalence of syringe-sharing was 43.5%. Respectively, 59.0%, 38.5% and 55.7% had regular, non-regular, and commercial sex-partner (RP, NRP, and CSP); 44.3% had multiple types of sex partners; 23.6 and 36.2% of those with RP had NRP and CSP. The prevalence of unprotected sex (last episode) with RP, NRP and CSP were respectively 75.4%, 50.7% and 39.3%; these three variables were associated with each other and with syringe sharing (univariate OR = 1.58-30.13). About 85% of the participants had attempted quitting drug use; the experience was not associated with condom use. HIV voluntary counseling and testing was associated with lower likelihood of unprotected sex with RP, NRP and CSP (multivariate OR= 0.44-0.60); the coverage was only 40.7%. Potential bridging of HIV transmission from IDU to non-IDU populations is a serious concern.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F., Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
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Hu Y, Liang S, Zhu J, Qin G, Liu Q, Song B, Wang Q, Wei D, Zhang L, Qian HZ, Ruan Y, Shao Y. Factors Associated with Recent Risky Drug Use and Sexual Behaviors among Drug Users in Southwestern China. ACTA ACUST UNITED AC 2011; 2. [PMID: 22180851 DOI: 10.4172/2155-6113.1000120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A cross-sectional survey was conducted in 2007 among 504 drug users who were recruited mainly from detoxification centers in southwest China. About one-third (34.3%) of participants reported recent risky drug use behavior, which was defined as injecting drugs in the past 3 months, and more than one-fifth (21.6%) reported recent risky sexual behavior, or had multiple sexual partners in the past 30 days. Male sex (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-3.2) and more episodes of detoxification (OR, 3.7; 95% CI, 2.3-6.0) were associated with higher odds of risky drug use behavior, while unmarried status (OR, 1.7; 95% CI, 1.0-2.9), higher personal annual income (OR, 1.8; 95% CI, 1.1-2.8) and history of sexually transmitted infections (OR, 3.7; 95% CI, 2.1-6.6) were associated with higher odds of having risky sexual behavior. Subgroup analyses showed 15% participants who used drugs in the past 3 months also shared needles, and 77% participants who had multiple sexual partners in the past 30 days did not use condoms during sex with non-primary sexual partners. The study findings are useful for developing HIV risk reduction intervention programs among drug users.
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Affiliation(s)
- Yifei Hu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China
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Zhang L, Li J, Lai W, Feng L, Zeng Y, Liu L, Hu Y, Liu J, Zhang X, Wu P, Vermund SH, Jia Y. Prevalence and correlates of needle-sharing among new and long-term injection drug users in southwest China. Subst Use Misuse 2010; 45:2503-2523. [PMID: 20536355 DOI: 10.3109/10826084.2010.487234] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Three community-based surveys recruited 4,310 injection drug users (IDUs) in China from 2004 to 2006. Of the participants, 54.4% were ≤ 3-year new IDUs; 63.9% reported injecting more than two times daily; 31.5% shared needles in the last six months; 37.4% shared equipments in the last month; 30.2% reported their regular sex partners injected drugs; and 23.5% had commercial sex, with 52.2% reporting no condom use during last sex. The risky injection practices (sharing needles/equipments and high injection frequency) were less frequent among new IDUs, emphasizing that effective prevention needs to identify and intervene with IDUs early on. The study's limitations are noted.
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Affiliation(s)
- Linglin Zhang
- Institute for AIDS/STI Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041, PR China
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Wu J, Huang J, Xu D, Lu C, Deng X, Zhou X. Infection status and risk factors of HIV, HBV, HCV, and syphilis among drug users in Guangdong, China--a cross-sectional study. BMC Public Health 2010; 10:657. [PMID: 21040549 PMCID: PMC3091571 DOI: 10.1186/1471-2458-10-657] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 11/01/2010] [Indexed: 11/18/2022] Open
Abstract
Background China has witnessed a remarkable increase in sexually transmitted infections (STIs) and HIV. The study is to assess the prevalence of HIV, HBV, HCV and syphilis and related risk factors among drug users in mandatory detoxification center Qingyuan, Guangdong, China. Method A cross-sectional study on drug use behaviors, sex behaviors, and presence of antibodies to HIV, HCV, Treponema pallidum, and surface antigen of HBV (HBsAg) was conducted among drug users recruited from 3 detoxification centers in Qingyuan, Guangdong, China. Risk factors for each of four infections were analyzed with logistic regression model. Results A total of 740 subjects were recruited, the median age was 31 years old (range 24-38). The seroprevalence rates of HIV, HBsAg, HCV and syphilis were 4.6%, 19.3%, 71.6% and 12.6%, respectively. Risk factors for HIV were intravenous drug use and co-infection with syphilis. Having a regular sexual partner who was a drug user was considered to be a risk factor for HBV. Intravenous drug use was a risk factor for HCV. However, the consistent use of condoms with commercial sex partners was protective for HCV infection. Compared to drug users living in urban area, those living in rural areas were more likely to be infected with syphilis, and there was an association between commercial sex and syphilis. Conclusion The prevalence of HIV, HBV, HCV and syphilis were high among drug users in detoxification centers in Qingyuan, thus, risk reduction programs for the drug user population is urgently required.
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Affiliation(s)
- Jie Wu
- Department of Medical Statistics and Epidemiology, School of Public Health, SUN Yat-sen University, Guangzhou, China
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Gu J, Lau JTF, Chen X, Liu C, Liu J, Chen H, Wang R, Lei Z, Li Z. Using the Theory of Planned Behavior to investigate condom use behaviors among female injecting drug users who are also sex workers in China. AIDS Care 2010; 21:967-75. [PMID: 20024752 DOI: 10.1080/09540120802657548] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Female injecting drug users who are sex workers (IDUFSWs) is a strategic "bridge population" for HIV transmission. Goals of the study were to investigate condom use behaviors during commercial sex among IDUFSWs using the Theory of Planned Behavior (TPB), and to investigate moderating effects that modify the strength of associations between the TPB-related variables and inconsistent condom use during commercial sex. A total of 281 non-institutionalized IDUFSWs were recruited using snowball sampling method. Anonymous face-to-face interviews were administered by trained doctors. The results showed that the prevalence of inconsistent condom use during commercial sex in the last six months was 64%. After adjusting for some significant background variables (e.g. main venue of sex work), all associations between the five TPB-related variables and the studied condom use variable were statistically significant (Odds Ratio (OR) = 0.43-0.68, p<0.001). In the hierarchical nested models, three background variables (age, venue of sex work, and ever used HIV-related interventions) entered in the first step (-2LL = 294.98, p<0.001) and the Social Norm Scale, the Perceived Behavioral Control Scale and the Behavioral Intention Scale were selected by the second step (OR = 0.67 - 0.72, p<0.01; -2LL = 160.99, p<0.001). Significant moderating effects between some TPB-related variables (Positive Condom use Attitude Scale and Behavioral Intention Scale) and duration of sex work and duration of drug use were also reported. The results highlighted the potential of using the TPB to better understand condom use behaviors in IDUFSWs in China. Theory-based research and intervention work should be developed in China in the future.
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Affiliation(s)
- Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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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
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Schumacher CM, Go VF, Nam LV, Latkin CA, Bergenstrom A, Celentano DD, Quan VM. Social injecting and other correlates of high-risk sexual activity among injecting drug users in northern Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 20:352-6. [PMID: 19010656 DOI: 10.1016/j.drugpo.2008.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 09/02/2008] [Accepted: 09/08/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sexual risk and STDs are relatively high among injecting drug users (IDUs) in Vietnam. We sought to determine characteristics of sexually active IDUs and correlates of high-risk sexual practices among IDUs in Bac Ninh province in northern Vietnam. METHODS We used data collected for a community-based cross-sectional pilot study to identify correlates of recent high-risk sex (>1 sex partner and inconsistent/no condom use in the past year). Factors associated with high-risk sex were identified using logistic regression. RESULTS Among 216 sexually active male IDUs, one third (n=72) had engaged in high-risk sex within the last year. IDUs who reported injecting with others more frequently, having someone else inject their drugs at last injection, sharing needles or sharing any injection equipment were more likely to have reported recent high-risk sex. Factors independently associated with high-risk sexual activity were not injecting oneself [AOR: 2.22; 95% CI (1.09-4.51)], and sharing needles in the past 12 months [AOR: 2.57; 95% CI (1.10-5.99)]. CONCLUSIONS IDUs who inject socially and IDUs who share needles are likely to engage in high-risk sexual behaviours and may serve as an important bridge group for epidemic HIV transmission in Vietnam. In addition to messages regarding the dangers of sharing needles and other injection equipment, preventive interventions among newly initiated IDUs should also focus on reducing sexual risk.
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Affiliation(s)
- Christina M Schumacher
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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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.
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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
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Kretzschmar M, Zhang W, Mikolajczyk RT, Wang L, Sun X, Kraemer A, Lv F. Regional differences in HIV prevalence among drug users in China: potential for future spread of HIV? BMC Infect Dis 2008; 8:108. [PMID: 18680587 PMCID: PMC2518554 DOI: 10.1186/1471-2334-8-108] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 08/04/2008] [Indexed: 12/02/2022] Open
Abstract
Background Drug use and in particular injecting drug use has been at the forefront of the explosive spread of HIV in general populations in many countries in Asia. There is concern that also in China increased HIV incidence in drug users might spark off a generalized epidemic in the wider population. Close monitoring of HIV incidence and risk factors in drug users is therefore important to be able to target interventions effectively. Second generation surveillance was launched to assess HIV prevalence and risk behaviours jointly with the purpose of describing trends and predicting future developments. To assess whether these goals were fulfilled among drug users in China we provide an analysis of risk factors for HIV infection and of regional differences in HIV prevalence. Methods We analysed data collected in 2005 in 21 drug user second generation surveillance sentinel sites from 14 provinces in China. We used random effects logistic regression to test for risk factors for HIV infection and regional differences. Results The overall HIV-1 antibody prevalence was 5.4% (279/5128); 4.9% among injecting drug users (IDU) not sharing needles and 3.7% among non-injecting drug users. We found substantial heterogeneity among the surveillance sites with prevalence rates ranging between 0% and 54%. HIV status was strongly affected by the regional prevalence of HIV. Risk behaviours were highly prevalent in regions where HIV prevalence is still low. The distribution of duration of drug use in different sites indicated different stages of the drug use epidemics. Conclusion ]Regional differences in HIV prevalence in China reflect different stages of the drug use and HIV epidemics rather than differences in risk behaviours. Therefore, outbreaks of HIV among drug users in regions where prevalence is still low can be expected in the future. However, methodological limitations of surveillance embedded into routine systems limit the usability of existing data. More standardized approaches to data collection in secondary generation HIV surveillance are necessary to better understand regional differences in risk behaviour and prevalence and to design targeted intervention for those regions at risk of experiencing outbreaks.
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Prevalence of Bisexual Behaviors Among Men Who Have Sex With Men (MSM) in China and Associations Between Condom Use in MSM and Heterosexual Behaviors. Sex Transm Dis 2008; 35:406-13. [DOI: 10.1097/olq.0b013e318164467f] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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