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Cocaine Self-Administration Influences Central Nervous System Immune Responses in Male HIV-1 Transgenic Rats. Cells 2022; 11:cells11152405. [PMID: 35954251 PMCID: PMC9368446 DOI: 10.3390/cells11152405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 01/19/2023] Open
Abstract
Cocaine use increases the neurotoxic severity of human immunodeficiency virus-1 (HIV-1) infection and the development of HIV-associated neurocognitive disorders (HAND). Among the studied cellular mechanisms promoting neurotoxicity in HIV-1 and cocaine use, central nervous system (CNS) immunity, such as neuroimmune signaling and reduced antiviral activity, are risk determinants; however, concrete evidence remains elusive. In the present study, we tested the hypothesis that cocaine self-administration by transgenic HIV-1 (HIV-1Tg) rats promotes CNS inflammation. To test this hypothesis, we measured cytokine, chemokine, and growth factor protein levels in the frontal cortex (fCTX) and caudal striatum (cSTR). Our results demonstrated that cocaine self-administration significantly increased fCTX inflammation in HIV-1Tg rats, but not in the cSTR. Accordingly, we postulate that cocaine synergizes with HIV-1 proteins to increase neuroinflammation in a region-selective manner, including the fCTX. Given the fCTX role in cognition, this interaction may contribute to the hyperimmunity and reduced antiviral activity associated with cocaine-mediated enhancement of HAND.
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Du C, Hua Y, Clare K, Park K, Allen CP, Volkow ND, Hu XT, Pan Y. Memantine Attenuates Cocaine and neuroHIV Neurotoxicity in the Medial Prefrontal Cortex. Front Pharmacol 2022; 13:895006. [PMID: 35694269 PMCID: PMC9174902 DOI: 10.3389/fphar.2022.895006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Individuals with substance use disorder are at a higher risk of contracting HIV and progress more rapidly to AIDS as drugs of abuse, such as cocaine, potentiate the neurotoxic effects of HIV-associated proteins including, but not limited to, HIV-1 trans-activator of transcription (Tat) and the envelope protein Gp120. Neurotoxicity and neurodegeneration are hallmarks of HIV-1-associated neurocognitive disorders (HANDs), which are hypothesized to occur secondary to excitotoxicity from NMDA-induced neuronal calcium dysregulation, which could be targeted with NMDA antagonist drugs. Multiple studies have examined how Gp120 affects calcium influx and how cocaine potentiates this influx; however, they mostly focused on single cells and did not analyze effects in neuronal and vascular brain networks. Here, we utilize a custom multi-wavelength imaging platform to simultaneously study the neuronal activity (detected using genetically encoded Ca2+ indicator, GcaMP6f, expressed in neurons) and hemodynamic changes (measured by total hemoglobin and oxygenated hemoglobin within the tissue) in the prefrontal cortex (PFC) of HIV-1 Tg rats in response to cocaine and evaluate the effects of the selective NMDA antagonist drug memantine on cocaine and HIV neurotoxicity compared to those of non-HIV-1 Tg animals (controls). Our results show that memantine improved cocaine-induced deficit in cerebral blood volume while also attenuating an abnormal increase of the neuronal calcium influx and influx duration in both control rats and HIV-1 Tg rats. Cocaine-induced neuronal and hemodynamic dysregulations were significantly greater in HIV-1 Tg rats than in control rats. With memantine pretreatment, HIV-1 Tg rats showed attenuated cocaine’s effects on neuronal and hemodynamic responses, with responses similar to those observed in control rats. These imaging results document an enhancement of neuronal Ca2+ influx, hypoxemia, and ischemia with cocaine in the PFC of HIV-1 Tg rats that were attenuated by memantine pretreatment. Thus, the potential utility of memantine in the treatment of HAND and of cocaine-induced neurotoxicity deserves further investigation.
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Affiliation(s)
- Congwu Du
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
- *Correspondence: Congwu Du, ; Nora D. Volkow, ; Xiu-Ti Hu,
| | - Yueming Hua
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
| | - Kevin Clare
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
| | - Kicheon Park
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
| | - Craig P. Allen
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
| | - Nora D. Volkow
- National Institute on Drug Abuse, Bethesda, MD, United States
- *Correspondence: Congwu Du, ; Nora D. Volkow, ; Xiu-Ti Hu,
| | - Xiu-Ti Hu
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL, United States
- *Correspondence: Congwu Du, ; Nora D. Volkow, ; Xiu-Ti Hu,
| | - Yingtian Pan
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
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Harding R, Eisenchlas JH, Strauss R, Sherr L, De Lima L, Cahn P. Sexual risk-taking behaviour among HIV outpatients in Argentina. AIDS Care 2013; 25:1077-82. [PMID: 23336212 DOI: 10.1080/09540121.2012.749336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV prevention strategies must be based on evidence of risk behaviours among people with HIV infection. This study aimed to determine the demographic, behavioural and self-reported disease/treatment variables that predict sexual risk behaviour, defined as unprotected intercourse with a partner of unknown or negative HIV status, among HIV-infected outpatients in Buenos Aires, Argentina. Two hundred consecutive outpatients (response rate 76.5%) participated in a self-complete cross sectional survey. The majority (49.5%) identified as heterosexual, and most were on antiretroviral therapy (ART) (75.5%). Undetectable viral load was currently achieved by 63%. Unprotected intercourse with a person of unknown or discordant status in the previous three months was reported by 20%. In multivariate analysis, risk was associated with lower distress from physical symptoms (p=0.012), greater distress from psychological symptoms (p=0.038) and being on treatment had borderline association with risk (p=0.058). The data reveal an important link between self-reported experience of disease, and treatment, with risk. Secondary prevention, care and treatment should not be conducted in isolation from each other if outcomes are to be optimised.
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Affiliation(s)
- Richard Harding
- a Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute , King's College London , London , UK
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Pando MA, Balán IC, Marone R, Dolezal C, Leu CS, Squiquera L, Barreda V, Fermepín MR, Gallo Vaulet L, Rey J, Picconi M, Carballo-Diéguez A, Avila MM. HIV and other sexually transmitted infections among men who have sex with men recruited by RDS in Buenos Aires, Argentina: high HIV and HPV infection. PLoS One 2012; 7:e39834. [PMID: 22768137 PMCID: PMC3387227 DOI: 10.1371/journal.pone.0039834] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/27/2012] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to estimate the prevalence of HIV and other STIs, among MSM from Buenos Aires (2007–2009). Methods Responding Driven Sampling was used for recruitment of MSM. Participants completed a structured web-based survey and provided biological samples. Results A total of 496 MSM were studied for HIV, HBV, HCV, and T pallidum infections. Chlamydia and HPV diagnoses were only performed in 98 and 109 participants, respectively. Prevalence of HIV was 17.3%, HBV 22.9%, HCV 7.5%, T pallidum 20.5%, HPV 83.5%, and C trachomatis 1.7%. In the year prior to the evaluation, 71% of the participants had had sex with men and/or trans and women (MMW) while 29% had not had sex with women (MM). Comparing MM to MMW, prevalence of HIV (30.7% vs. 11.9%, p<0.001), HBV (36.4% vs. 17.8%, p<0.001), T pallidum (32.1% vs. 15.7%, p<0.001), and HPV (88.3% vs. 70.4%, p = 0.039) were significantly higher among MM, whereas no significant differences were found for HCV and C trachomatis. The MM group had also significantly higher HIV incidence (5.60 vs. 4.28 per 100 persons-year, p = 0.032). HPV genotypes 16, 6, and 11 were the most frequently found; 40.7% of the MSM had more than one genotype and one high risk genotype was detected in 43.6% of participants. Conclusions Both MM and MMW are at high risk of infection for HIV and other STIs. Rates of HIV, HBV, T pallidum and HPV infections are higher in the MM group.
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Affiliation(s)
- María A Pando
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
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Use of respondent driven sampling (RDS) generates a very diverse sample of men who have sex with men (MSM) in Buenos Aires, Argentina. PLoS One 2011; 6:e27447. [PMID: 22102896 PMCID: PMC3213136 DOI: 10.1371/journal.pone.0027447] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 10/17/2011] [Indexed: 11/20/2022] Open
Abstract
Background Prior research focusing on men who have sex with men (MSM) conducted in Buenos Aires, Argentina, used convenience samples that included mainly gay identified men. To increase MSM sample representativeness, we used Respondent Driven Sampling (RDS) for the first time in Argentina. Using RDS, under certain specified conditions, the observed estimates for the percentage of the population with a specific trait are asymptotically unbiased. We describe, the diversity of the recruited sample, from the point of view of sexual orientation, and contrast the different subgroups in terms of their HIV sexual risk behavior. Methodology 500 MSM were recruited using RDS. Behavioral data were collected through face-to-face interviews and Web-based CASI. Conclusion In contrast with prior studies, RDS generated a very diverse sample of MSM from a sexual identity perspective. Only 24.5% of participants identified as gay; 36.2% identified as bisexual, 21.9% as heterosexual, and 17.4% were grouped as “other.” Gay and non-gay identified MSM differed significantly in their sexual behavior, the former having higher numbers of partners, more frequent sexual contacts and less frequency of condom use. One third of the men (gay, 3%; bisexual, 34%, heterosexual, 51%; other, 49%) reported having had sex with men, women and transvestites in the two months prior to the interview. This population requires further study and, potentially, HIV prevention strategies tailored to such diversity of partnerships. Our results highlight the potential effectiveness of using RDS to reach non-gay identified MSM. They also present lessons learned in the implementation of RDS to recruit MSM concerning both the importance and limitations of formative work, the need to tailor incentives to circumstances of the less affluent potential participants, the need to prevent masking, and the challenge of assessing network size.
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Rafie C, Campa A, Smith S, Huffman F, Newman F, Baum MK. Cocaine reduces thymic endocrine function: another mechanism for accelerated HIV disease progression. AIDS Res Hum Retroviruses 2011; 27:815-22. [PMID: 21142650 PMCID: PMC3180730 DOI: 10.1089/aid.2010.0086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Thymulin is a thymic peptide important for the maturation and differentiation of immature thymocytes, which have been found to be depressed in patients with low-level CD4(+) cell recovery despite viral control. Substance use is associated with faster progression of HIV disease, which has been ascribed to poor adherence to antiretroviral medication. Recent findings of an association between cocaine use and decline in CD4(+) cell counts independent of antiretroviral adherence indicate alternative mechanisms for disease progression. We evaluated the relationship between thymulin activity, CD4(+) and CD8(+) cell counts and the CD4(+)/CD8(+) ratio, and the covariate effects of substance use cross-sectionally in 80 HIV(+) active substance users and over 12 months in 40 participants. Thymulin activity was analyzed in plasma using a modification of the sheep rosette bioassay. Thymulin activity was negatively associated with cocaine use (β = -0.908,95% CI: -1.704, -0.112; p = 0.026). Compared to those who do not use cocaine, cocaine users were 37% less likely to have detectable thymulin activity (RR = 0.634, 95% CI: 0.406, 0.989 p = 0.045) and were 75 times more likely to show a decrease in thymulin activity (OR = 74.7, 95% CI: 1.59, 3519.74; p = 0.028) over time. CD4(+) cell count was positively associated with thymulin activity (β = 0.127, 95% CI: 0.048,0.205; p = 0.002), detectable thymulin activity was 2.32 times more likely in those with a CD4 cell count ≥200 cells/μl (RR = 2.324, 95% CI: 1.196, 4.513, p = 0.013), and those with an increase in CD4 cell counts were more likely to show an increase in thymulin activity (OR = 1.02, 95% CI: 1.00, 1.034; p = 0.041) over time. Thymulin activity is predictive of HIV disease progression and is depressed in cocaine users independent of antiretroviral treatment (ART) and HIV viral load. Understanding the mechanisms for accelerated HIV disease progression provides opportunities to find alternative strategies to counteract immunosuppression.
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Affiliation(s)
- Carlin Rafie
- Virginia Commonwealth University, Massey Cancer Center, Richmond, USA.
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Dos Ramos Farías MS, Garcia MN, Reynaga E, Romero M, Vaulet MLG, Fermepín MR, Toscano MF, Rey J, Marone R, Squiquera L, González JV, Basiletti J, Picconi MA, Pando MA, Avila MM. First report on sexually transmitted infections among trans (male to female transvestites, transsexuals, or transgender) and male sex workers in Argentina: high HIV, HPV, HBV, and syphilis prevalence. Int J Infect Dis 2011; 15:e635-40. [PMID: 21742530 DOI: 10.1016/j.ijid.2011.05.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 05/05/2011] [Accepted: 05/09/2011] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Due to the scarce data on the prevalence of sexually transmitted infections (STIs) among male-to-female trans-sex workers (TSW) and male sex workers (MSW) in Argentina, the present study aimed to estimate the incidence of human immunodeficiency virus (HIV), and the prevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and Treponema pallidum. Human papillomavirus (HPV) and Chlamydia trachomatis infections were tested among TSW. METHODS Two hundred and seventy-three TSW and 114 MSW were recruited by nongovernmental organizations. HIV incidence was estimated by STARHS (serologic testing algorithm for recent HIV seroconversion). HPV and C. trachomatis infections were tested in anal cells from TSW. RESULTS TSW showed significantly higher prevalences of HIV (34.1 vs. 11.4%), HBV (40.2 vs. 22.0%), and T. pallidum (50.4 vs. 20.4%) than MSW. TSW tested positive for HPV in 111/114 cases and for C. trachomatis in 4/80 cases. Investigation of HBV, HCV, HIV, and T. pallidum co-infections showed that 72% of TSW and 39% of MSW had at least one STI. T. pallidum was the most frequent mono-infection. The estimated HIV incidence was 10.7 per 100 person-years (95% confidence interval (CI) 3.8-17.7) for TSW and 2.3 per 100 person-years (95% CI 0-6.7) for MSW. CONCLUSIONS The high prevalence of STIs and the high incidence of HIV demonstrate the great vulnerability of these high-risk populations and indicate the urgent need for preventive strategies on intervention and facilitation of access to healthcare programs.
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Affiliation(s)
- María Sol Dos Ramos Farías
- Centro Nacional de Referencia para el SIDA (CNRS), Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Piso 11, C1121ABG, Buenos Aires, Argentina.
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Dilernia DA, Jones LR, Pando MA, Rabinovich RD, Damilano GD, Turk G, Rubio AE, Pampuro S, Gomez-Carrillo M, Salomón H. Analysis of HIV type 1 BF recombinant sequences from South America dates the origin of CRF12_BF to a recombination event in the 1970s. AIDS Res Hum Retroviruses 2011; 27:569-78. [PMID: 20919926 PMCID: PMC3131829 DOI: 10.1089/aid.2010.0118] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-1 epidemics in South America are believed to have originated in part from the subtype B epidemic initiated in the Caribbean/North America region. However, circulation of BF recombinants in similar proportions was extensively reported. Information currently shows that many BF recombinants share a recombination structure similar to that found in the CRF12_BF. In the present study, analyzing a set of 405 HIV sequences, we identified the most likely origin of the BF epidemic in an early event of recombination. We found that the subtype B epidemics in South America analyzed in the present study were initiated by a founder event that occurred in the early 1970s, a few years after the introduction of these strains in the Americas. Regarding the F/BF recombinant epidemics, by analyzing a subtype F genomic segment within the viral gene gag present in the majority of the BF recombinants, we found evidence of a geographic divergence very soon after the introduction of subtype F strains in South America. Moreover, through analysis of a subtype B segment present in all the CRF12_BF-like recombination structure, we estimated the circulation of the subtype B strain that gave rise to that recombinant structure around the same time period estimated for the introduction of subtype F strains. The HIV epidemics in South America were initiated in part through a founder event driven by subtype B strains coming from the previously established epidemic in the north of the continent. A second introduction driven by subtype F strains is likely to have encountered the incipient subtype B epidemic that soon after their arrival recombined with them, originating the BF epidemic in the region. These results may explain why in South America the majority of F sequences are found as BF recombinants.
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Affiliation(s)
- Dario A. Dilernia
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Capital Federal, Buenos Aires, Argentina
| | - Leandro R. Jones
- División de Biología Molecular, Estación de Fotobiología “Playa Unión,” Rawson, Chubut, Argentina
| | - Maria A. Pando
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Capital Federal, Buenos Aires, Argentina
| | - Roberto D. Rabinovich
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Capital Federal, Buenos Aires, Argentina
| | - Gabriel D. Damilano
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Capital Federal, Buenos Aires, Argentina
| | - Gabriela Turk
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Capital Federal, Buenos Aires, Argentina
| | - Andrea E. Rubio
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Capital Federal, Buenos Aires, Argentina
| | - Sandra Pampuro
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Capital Federal, Buenos Aires, Argentina
| | - Manuel Gomez-Carrillo
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Capital Federal, Buenos Aires, Argentina
| | - Horacio Salomón
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Facultad de Medicina, Universidad de Buenos Aires, Capital Federal, Buenos Aires, Argentina
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Segura M, Bautista CT, Marone R, Sosa Estani S, Rey J, Montano SM, Griemberg G, Weissenbacher M, Avila MM. HIV/STI co-infections, syphilis incidence, and hepatitis B vaccination: the Buenos Aires cohort of men who have sex with men. AIDS Care 2011; 22:1459-65. [PMID: 21154033 DOI: 10.1080/09540121003758556] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In a previous cohort study among 327 men who have sex with men (MSM) in Buenos Aires, an HIV incidence rate of 3.9 per 100 persons-year was reported. Using data from this study, we determined: (a) HIV/STI co-infections; (b) clinical manifestations of incident HIV infections; (c) syphilis incidence and its associated risk factors; and (d) adherence and immune response to hepatitis B virus (HBV) vaccine. During the cohort study, 12 incident HIV infections were found. Within this group, HIV infection alone was most frequent (42%), followed by co-infection of HIV/HBV (33%), and triple co-infection of HIV/HBV/syphilis (25%). The most frequent clinical manifestations among incident HIV cases were: pharyngitis, fever, lymphadenopathy, asthenia, and myalgia. Seven new syphilis infections were detected yielding an incidence rate of 2.4 (95% CI=1.07 - 4.73) per 100 persons-year. Sex work was the only significant risk factor associated with syphilis seroconversion (hazard rate=10.93, p-value=0.033). Only 7% of cohort participants reported having received HBV vaccine. Ninety-percent of the 204 cohort members who agreed to be vaccinated completed the HBV vaccination schedule with an immune response rate of 85%. Our findings suggest the need to increase the access to serologic testing for STI and HBV immunization, as well as the developing of effective HIV/STI behavioral and educational prevention programs among MSM in Buenos Aires.
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Affiliation(s)
- Marcela Segura
- Departamento de Microbiologia, Parasitologia e Inmunologia, Centro Nacional de Referencia para el SIDA, Universidad de Buenos Aires, Argentina
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10
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Pando M, Gómez-Carrillo M, Vignoles M, Rubio A, dos Ramos Farias M, Vila M, Rossi D, Ralón G, Marone R, Reynaga E, Sosa J, Torres O, Maestri M, Ávila M, Salomón H. Incidence of HIV type 1 infection, antiretroviral drug resistance, and molecular characterization in newly diagnosed individuals in Argentina: A Global Fund Project. AIDS Res Hum Retroviruses 2011; 27:17-23. [PMID: 20860532 DOI: 10.1089/aid.2010.0013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An HIV incidence estimation was performed among men who have sex with men (MSM), drug users (DUs), sex workers (SWs), and pregnant women (PW) from Argentina. Volunteers older than 18 years old without a previous HIV-positive diagnosis were included. HIV-positive samples were analyzed by the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) to estimate incidence. By partial RT-PCR and sequencing of the HIV pol gene, an HIV subtype and resistance profile were determined. A total of 12,192 volunteers were recruited from October 2006 to September 2008. A higher HIV prevalence was detected among trans SWs (33.9%, 38/112), male SWs (10.8%, 12/111), and MSM 10.4% (161/1549). HIV incidence estimates by STARHS was also higher on trans SWs (11.31 per 100 person-years), male SWs (6.06 per 100 person-years), and MSM (6.36 per 100 person-years). Antiretroviral primary resistant mutations were detected in 8.4% of the study group, with a higher frequency in female DUs (33.3%). Phylogenetic analysis showed that 124 (57.9%) samples were subtype B, 84 (39.3%) intersubtype BF recombinants, 5 (2.3%) subtype C, and 1 (0.5%) subtype F in the pol region. Subtype B was most commonly found in MSM and male SWs whereas the intersubtype BF recombinant was more prevalent in female DUs, female SWs, and PW. Given the high HIV prevalence and incidence found in most of these groups, monitoring the continuing spread of the HIV epidemic is essential for determining public health priorities, assessing the impact of interventions, and estimating current and future health care needs.
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Affiliation(s)
- M.A. Pando
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - M. Gómez-Carrillo
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - M. Vignoles
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - A.E. Rubio
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - M.S. dos Ramos Farias
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - M. Vila
- Intercambios Asociación Civil, Buenos Aires, Argentina
| | - D. Rossi
- Intercambios Asociación Civil, Buenos Aires, Argentina
| | - G. Ralón
- Intercambios Asociación Civil, Buenos Aires, Argentina
| | - R. Marone
- Nexo Asociación Civil, Buenos Aires, Argentina
| | - E. Reynaga
- AMMAR, Asociación de Mujeres Meretrices de Argentina, Buenos Aires, Argentina
| | - J. Sosa
- AMMAR, Asociación de Mujeres Meretrices de Argentina, Buenos Aires, Argentina
| | - O. Torres
- Hospital Materno Infantil Ramón Sardá, Buenos Aires, Argentina
| | - M. Maestri
- Hospital Materno Infantil Ramón Sardá, Buenos Aires, Argentina
| | - M.M. Ávila
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - H. Salomón
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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11
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Zocratto KBF, Osimani ML, Peralta LM, Latorre L, Muzzio E, Segura M, Chiparelli H, Proietti FA, Rey J, Vazquez E, Cuchi P, Estani SS, Rossi D, Weissenbacher M, Caiaffa WT. Sexual behavior and HBV infection among noninjecting cocaine users (NICUs). Subst Use Misuse 2010; 45:2026-44. [PMID: 20438315 DOI: 10.3109/10826081003791965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim is to estimate HBV prevalence and the associated risks among noninjecting cocaine users (NICUs). In 2002-2003, a total of 824 NICUs from Buenos Aires (Argentina) and Montevideo (Uruguay) were interviewed using a structured questionnaire. Serologic tests were carried out for Human Immunodeficiency Virus (HIV), hepatitis B (HBV), syphilis, and others. The population was divided into two serologic groups: HBV-infected and seronegative group. Univariate and binary logistic model were developed. The results seem to indicate that, among NICUs, HBV is transmitted through sexual contact. Prevention measures, including vaccine, are needed in order to control and minimize risks. The study's limitations are noted.
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Friedman SR, Mateu-Gelabert P, Sandoval M. Group sex events amongst non-gay drug users: an understudied risk environment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 22:1-8. [PMID: 20800465 DOI: 10.1016/j.drugpo.2010.06.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 06/11/2010] [Accepted: 06/28/2010] [Indexed: 11/25/2022]
Abstract
This article discusses relevant literature on group sex events--defined as events at which some people have sex with more than one partner--as risk environments, with a particular focus on group sex events where people who take drugs by non-injection routes of administration participate and where the event is not primarily LGBT-identified, at a "classic" crack house, nor in a brothel. It also briefly presents some findings from a small ethnography of such events. Group sex participation by people who take drugs by non-injection routes of administration seems to be widespread. It involves both behavioural and network risk for HIV and STI infection, including documented high-risk behaviour and sexual mixing of STI- and HIV-infected people with those who are uninfected. Indeed several HIV and STI outbreaks have been documented as based on such group sex events. Further, group sex events often serve as potential bridge environments that may allow infections to pass from members of one high-risk-behavioural category to another, and to branch out through these people's sexual and/or injection networks to other members of the local community. The ethnographic data presented here suggest a serious possibility of "third party transmission" of infectious agents between people who do not have sex with each other. This can occur even when condoms are consistently used since condoms and sex toys are sometimes used with different people without being removed or cleaned, and since fingers and mouths come into contact with mucosal surfaces of other members of the same or opposite sex. In addition to being risk environments, many of these group sex events are venues where risk-reducing norms, activities and roles are present--which lays the basis for harm reduction interventions. Research in more geographical locations is needed so we can better understand risks associated with group sex events in which drug users participate--and, in particular, how both participants and others can intervene effectively to reduce the risks posed to participants and non-participants by these group sex events. Such interventions are needed and should be developed.
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Affiliation(s)
- Samuel R Friedman
- National Development and Research Institutes, Inc., 71 West 23d Street, New York, NY 10010, USA.
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Guy R, Gold J, Calleja JMG, Kim AA, Parekh B, Busch M, Rehle T, Hargrove J, Remis RS, Kaldor JM. Accuracy of serological assays for detection of recent infection with HIV and estimation of population incidence: a systematic review. THE LANCET. INFECTIOUS DISEASES 2009; 9:747-59. [PMID: 19926035 DOI: 10.1016/s1473-3099(09)70300-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We systematically reviewed the accuracy of serological tests for recent infections with HIV that have become widely used for measuring population patterns incidence of HIV. Across 13 different assays, sensitivity to detect recent infections ranged from 42-100% (median 89%). Specificity for detecting established infections was between 49.5% and 100% (median 86.8%) and was higher for infections of durations longer than 1 year (median 98%, range 31.5-100.0). For four different assays, comparisons were made between assay-derived population incidence estimates and a reference incidence estimate. The median percentage difference between the assay-derived incidence and reference incidence was 26.0%. Serological assays have reasonable sensitivity for the detection of recent infection with HIV, but are vulnerable to misclassifying established infections as recent-potentially leading to biases in incidence estimates. This conclusion is highly qualified by the apparent absence of a standardised approach to assay evaluation. There is an urgent need for an internationally agreed framework for evaluating and comparing these tests.
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Affiliation(s)
- Rebecca Guy
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
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Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users. J Acquir Immune Defic Syndr 2009; 50:93-9. [PMID: 19295339 DOI: 10.1097/qai.0b013e3181900129] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND HIV infection is prevalent among substance abusers. The effects of specific illicit drugs on HIV disease progression have not been established. We evaluated the relationship between substances of abuse and HIV disease progression in a cohort of HIV-1-positive active drug users. METHODS A prospective, 30-month, longitudinal study was conducted on 222 HIV-1 seropositive drug users in Miami, FL. History of illicit drug, alcohol, and medication use, CD4+ cell count, and viral load were performed every 6 months. RESULTS Crack-cocaine users were 2.14 times [95% confidence interval (CI): 1.08 to 4.25, P = 0.029] more likely to present a decline of CD4 to <or=200 cells/mL, independent of antiretroviral use. Viral load over 30 months was significantly higher in crack users (beta = 0.315, P = 0.037) independent of highly active antiretroviral therapy (HAART) over time. The only multidrug combination that significantly increased the risk of disease progression was crack cocaine with marijuana (hazard ratio = 2.42; 95% CI: 1.042 to 5.617, P = 0.04). Of those on HAART, a significantly lower proportion of crack-cocaine users versus nonusers had controlled viral load (P < 0.001), suggesting lower medication adherence, whereas crack-cocaine users not on HAART showed a greater risk for HIV disease progression than nonusers (hazard ratio = 3.946; 95% CI: 1.049 to 14.85, P = 0.042). CONCLUSIONS Crack-cocaine use facilitates HIV disease progression by reducing adherence in those on HAART and by accelerating disease progression independently of HAART.
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Low HIV seroincidence among female commercial sex workers: a barrier for measuring HIV vaccine efficacy. J Acquir Immune Defic Syndr 2009; 49:570. [PMID: 19202462 DOI: 10.1097/qai.0b013e31818d5f9e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Friedman SR, Rossi D, Braine N. Theorizing "Big Events" as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 20:283-91. [PMID: 19101131 DOI: 10.1016/j.drugpo.2008.10.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 10/02/2008] [Accepted: 10/13/2008] [Indexed: 10/21/2022]
Abstract
Political-economic transitions in the Soviet Union, Indonesia, and China, but not the Philippines, were followed by HIV epidemics among drug users. Wars also may sometimes increase HIV risk. Based on similarities in some of the causal pathways through which wars and transitions can affect HIV risk, we use the term "Big Events" to include both. We first critique several prior epidemiological models of Big Events as inadequately incorporating social agency and as somewhat imprecise and over-generalizing in their sociology. We then suggest a model using the following concepts: first, event-specific HIV transmission probabilities are functions of (a) the probability that partners are infection-discordant; (b) the infection-susceptibility of the uninfected partner; (c) the infectivity of the infected--as well as (d) the behaviours engaged in. These probabilities depend on the distributions of HIV and other variables in populations. Sexual or injection events incorporate risk behaviours and are embedded in sexual and injection partnership patterns and community networks, which in turn are shaped by the content of normative regulation in communities. Wars and transitions can change socio-economic variables that can sometimes precipitate increases in the numbers of people who engage in high-risk drug and sexual networks and behaviours and in the riskiness of what they do. These variables that Big Events affect may include population displacement; economic difficulties and policies; police corruption, repressiveness, and failure to preserve order; health services; migration; social movements; gender roles; and inter-communal violence--which, in turn, affect normative regulation, youth alienation, networks and behaviours. As part of these pathways, autonomous action by neighbourhood residents, teenagers, drug users and sex workers to maintain their economic welfare, health or happiness may affect many of these variables or otherwise mediate whether HIV epidemics follow transitions. We thus posit that research on whether and how these interacting causal pathways and autonomous actions are followed by drug-related harm and/or HIV or other epidemics can help us understand how to intervene to prevent or mitigate such harms.
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Affiliation(s)
- Samuel R Friedman
- National Development and Research Institutes, Inc., 71 West 23rd Street, 8th Floor, New York, NY 10010, USA.
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Rossi D, Radulich G, Muzzio E, Naveira J, Sosa-Estani S, Rey J, Griemberg G, Friedman SR, Martínez-Peralta L, Weissenbacher M. Multiple infections and associated risk factors among non-injecting cocaine users in Argentina. CAD SAUDE PUBLICA 2008; 24:965-74. [PMID: 18461225 DOI: 10.1590/s0102-311x2008000500003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 08/27/2007] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to estimate the seroprevalence rates of human immunodeficiency virus (HIV), hepatitis B virus (HBV, core antibody), hepatitis C virus (HCV), and syphilis infections and analyze associated risk factors among 504 non-injecting cocaine users (NICU) in Buenos Aires, Argentina. Participants were interviewed in face-to-face sessions through a short structured questionnaire. Using venipuncture, 10 mL of blood was collected. Seroprevalence rates were: HIV (6.3%), HBV (9%), HCV (7.5%), and VDRL (4.2%). The risk of being infected with HIV, HBV, and HCV was significantly associated with having had a sex partner who was either a drug injector or who was known to be HIV positive. HIV and HCV infections were associated with former imprisonment, and HCV was associated with having been tattooed. Because of the rising number of NICU and the multiple infections detected, it is essential to implement prevention strategies focused on this population.
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Affiliation(s)
- Diana Rossi
- Intercambios: Asociación Civil para el Estudio y Atención de Problemas Relacionados con las Drogas, Avenida Corrientes 2548, Buenos Aires, Argentina.
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Segura M, Estani SS, Marone R, Bautista CT, Pando MA, Eyzaguirre L, Sánchez JL, Carr JK, Montano SM, Weissenbacher M, Ávila MM. Buenos Aires cohort of men who have sex with men: prevalence, incidence, risk factors, and molecular genotyping of HIV type 1. AIDS Res Hum Retroviruses 2007; 23:1322-9. [PMID: 18184073 DOI: 10.1089/aid.2007.0063] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The prevalence, incidence, risk factors, and molecular genotyping of HIV-1 infection among men who have sex with men (MSM) were assessed through a prospective cohort study. The study was conducted in Buenos Aires from February 2003 to December 2004. Sociodemographic, sexual risk behavior data, and blood samples for HIV testing were collected at baseline and at 6 and 12 months. Cox regression analysis was applied to determine risk factors associated with HIV seroconversion. HIV-positive samples were analyzed by partial (pro/RT) and full-length genome sequencing. Of 811 HIV-negative participants evaluated at baseline, 327 volunteers that fulfilled the inclusion criteria were enrolled. Retention rates at 6 and 12 months were 97.2% and 91.5%, respectively. Twelve MSM seroconverted for HIV infection [incidence rate = 3.9 (95% CI = 2.0-6.7) per 100 person-years]. HIV seroconversion was associated with a greater number of different sexual contacts in the preceding 6 months (> or =10, hazard ratio = 3.3, 95% CI: 1.1-10.4). By partial pro/RT genotyping analysis, 83% HIV-positive samples were subtype B and 17% samples were BF recombinants, most of these being unique recombinant forms. This study describes for the first time the recruitment and follow-up of a cohort of MSM in Argentina. Retention rates and HIV incidence rate were high. These data should be considered as a promising potential population for HIV vaccine trials.
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Affiliation(s)
- Marcela Segura
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sergio Sosa Estani
- Centro Nacional de Diagnóstico e Investigación de Endemoepidemias/ANLIS, Ministerio de Salud, Buenos Aires, Argentina
| | | | | | - María A. Pando
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland Biotechnology Institute, Baltimore, Maryland
| | - Lindsay Eyzaguirre
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland Biotechnology Institute, Baltimore, Maryland
| | - José L. Sánchez
- Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS) and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Silver Spring, Maryland
| | - Jean K. Carr
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland Biotechnology Institute, Baltimore, Maryland
| | | | - Mercedes Weissenbacher
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- CONICET, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - María M. Ávila
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- CONICET, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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Bastos FI, Caiaffa W, Rossi D, Vila M, Malta M. The children of mama coca: Coca, cocaine and the fate of harm reduction in South America. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:99-106. [PMID: 17689352 DOI: 10.1016/j.drugpo.2006.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 11/22/2006] [Indexed: 11/30/2022]
Abstract
The paper reviews the main findings from substance misuse research carried out over the last two decades in South America looking at the main initiatives aimed at reducing drug related harm and curbing the spread of HIV/AIDS and other sexually transmitted and blood-borne diseases. The current challenges faced by harm reduction in the region are analysed from the perspective of the history of coca and its different uses in South America. Except in Brazil and Argentina, the implementation of initiatives to reduce drug related harm in South America has been very cautious. The paper aims to link the analysis of harms associated with the use of illicit substances, with the often paradoxically harmful effects of supply-side drug policies in the world's largest coca/cocaine producing area. Despite the undeniable success of many initiatives, the broader context of harm maximization through structural violence and entrenched corruption acts as a major disincentive for the comprehensive adoption of sound public health policies.
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Harm reduction theory: users' culture, micro-social indigenous harm reduction, and the self-organization and outside-organizing of users' groups. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006; 18:107-17. [PMID: 17689353 DOI: 10.1016/j.drugpo.2006.11.006] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 10/31/2006] [Accepted: 11/01/2006] [Indexed: 11/16/2022]
Abstract
This paper discusses the user side of harm reduction, focusing to some extent on the early responses to the HIV/AIDS epidemic in each of four sets of localities-New York City, Rotterdam, Buenos Aires, and sites in Central Asia. Using available qualitative and quantitative information, we present a series of vignettes about user activities in four different localities in behalf of reducing drug-related harm. Some of these activities have been micro-social (small group) activities; others have been conducted by formal organizations of users that the users organized at their own initiative. In spite of the limitations of the methodology, the data suggest that users' activities have helped limit HIV spread. These activities are shaped by broader social contexts, such as the extent to which drug scenes are integrated with broader social networks and the way the political and economic systems impinge on drug users' lives. Drug users are active agents in their own individual and collective behalf, and in helping to protect wider communities. Harm reduction activities and research should take note of and draw upon both the micro-social and formal organizations of users. Finally, both researchers and policy makers should help develop ways to enable and support both micro-social and formally organized action by users.
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