Sexually transmitted infections, sexual risk behaviours and perceived barriers to safe sex among drug users

OBJECTIVE

Drug users are at elevated risk of HIV and other sexually transmitted infections (STIs). This study examines prevalence of STIs and perceived barriers to safe sex among drug users accessing low-threshold primary healthcare in inner-city Sydney.

METHODS

Data were extracted manually from clients' medical records and analysed using STATA.

RESULTS

Prevalence of HIV, syphilis, chlamydia and gonorrhoea were low (<2%), whereas hepatitis C (62%), hepatitis A (30%), and previous exposure to hepatitis B (25%) were more common. Recent unprotected vaginal and anal intercourse were reported by 85% and 26% of clients, respectively. Younger clients and those with a history of sex work or recent anal intercourse were more likely to report multiple recent unprotected sex partners. Having a regular sex partner was the most prevalent barrier to condom use (37%), and was more likely to be identified by clients who were older, of Indigenous descent, and/or heterosexual. Drug intoxication was a second important barrier (20%), and was more commonly identified by excessive alcohol users.

CONCLUSIONS

Targeted programs might increase awareness regarding the benefits of condom use and potential sexual risk associated with regular partners. Periodic assessments of alcohol use, and brief interventions for drug users who report problematic use, should also be considered.

What's the Cost of Finding the Right Fit? The Cost of Conducting NSP Business in a Range of Modalities

The aim of this study was to calculate the cost of a range of needle and syringe program (NSP) models to contribute to planning for effective NSP delivery. Existing health service data was used to estimate the cost per needle distributed across four modes of service delivery (Primary NSP, including one model of Primary NSP providing primary health care; Secondary NSP; Vending Machine and Outreach) over three years. Costs were primarily affected by the ratio of the volume of equipment distributed to staff costs. The average cost per unit for Primary, Secondary and Outreach modes was approximately $1.00. The cost for Vending Machine provision (accounting for income from service users) was the cheapest option at $0.30–0.40 per unit. When income from services users are not included in calculations, other considerations may be more important than cost when making decisions about providing access to NSP services to a marginalized client group with diverse needs.

High prevalence of HIV, syphilis and HCV, and low methadone maintenance treatment in a migrant population in Beijing

OBJECTIVES

To provide evidence for policy makers for human immunodeficiency virus (HIV) prevention and control, we investigated HIV, syphilis, and hepatitis C virus (HCV) infection and the availability of methadone maintenance treatment (MMT) among migrant drug users in Beijing.

METHODS

A total of 222 participants from 3 main communities where drug abusers reside were interviewed, completed a questionnaire, and were screened for HIV using enzyme-linked immunosorbent assay, confirmed by Western blot. Descriptive statistics, χ tests, and binary logistic regression models were used to analyze differences in HIV and sexually transmitted diseases among different subpopulations.

RESULTS

The prevalence of HIV and syphilis in the migrant population was much higher than in permanent residents (43.0% vs 2.1% and 13.3% vs 4.3%, respectively). The HIV-infected cases in the migrant population were 33-fold higher than in permanent residents. Compared with permanent residents, the availability of MMT was much lower in the migrant population (21.9% vs 70.2%), and they were less knowledgeable about MMT (37.0% vs 84.0%). Even for those who were knowledgeable about MMT, methadone treatment was still lower (46.8% vs 82.3%). Compared with the MMT group, higher infection rates of HIV and HCV were found in the no-MMT group (36.7% vs 10.6% and 64.8% vs 50.0%, respectively). Education and employment status contributed to the different distributions between permanent residents and the migrant population and the MMT and no-MMT groups.

CONCLUSIONS

The prevalence of HIV, syphilis, and HCV infection was higher, and the use of MMT was lower in the migrant population. The migrant population is a noticeable challenge for HIV prevention and control in Beijing.

The cost of providing primary health-care services from a needle and syringe program: a case study

INTRODUCTION AND AIMS

Targeted primary health-care services for injecting drug users have been established in several countries to reduce barriers to health care, subsequent poor health outcomes and the considerable costs of emergency treatment. The long-term sustainability of such services depends on the resources required and the coverage provided. This study assesses the additional cost required to operate a nurse-led primary health care in an existing needle syringe program setting, estimates the costs per occasion of service and identifies key factors influencing improved service utilisation.

DESIGN AND METHODS

Using standard costing methods and the funder perspective, this study estimates costs using the 'ingredients' approach where the costs of inputs are based on quantities and unit prices (the ingredients).

RESULTS

During the 2009-2010 fiscal year, the primary health-care clinic provided 1252 occasions of service to 220 individuals, who each made an average of 3.9 presentations. A total cost of AU$250,626 was incurred, 69% of which was for personnel and 22% for pathology. During the study period the average cost per occasion of service was AU$199.96, which could be as low as AU$93.32 if the clinic reached its full utilisation level.

DISCUSSION AND CONCLUSIONS

Although the average number of presentations per client was satisfactory, the clinic was underutilised during the study period. Proactive engagement of clients at the needle syringe program shopfront and an increased range of services offered by the clinic may help to attract more clients.

The accessibility, acceptability, health impact and cost implications of primary healthcare outlets that target injecting drug users: a narrative synthesis of literature

BACKGROUND

Injecting drug users (IDUs) are at increased risk of health problems ranging from injecting-related injuries to blood borne viral infections. Access to primary healthcare (PHC) is often limited for this marginalised group. Many seek care at emergency departments and some require hospital admission due to late presentation. The costs to both the individual and the health system are such that policymakers in some settings have implemented IDU-targeted PHC centres, with a number of models employed. However, there is insufficient evidence on the effectiveness of these centres to inform health service planning. A systematic review examining such interventions is not possible due to the heterogeneous nature of study designs. Nevertheless, an integrative literature review of IDU-targeted PHC may provide useful insights into the range of operational models and strategies to enhance the accessibility and acceptability of these services to the target population.

METHODS

Available literature describing the impact of IDU-targeted PHC on health outcomes, cost implications and operational challenges is reviewed. A narrative synthesis was undertaken of material sourced from relevant journal publications, grey literature and policy documents.

RESULTS

Several models have proven accessible and acceptable forms of PHC to IDUs, improving the overall healthcare utilisation and health status of this population with consequent savings to the health system due to a reduction in visits to emergency departments and tertiary hospitals.

CONCLUSIONS

Although such findings are promising, there remains a dearth of rigorous evaluations of these targeted PHC, with the public health impact of such outlets yet to be systematically documented.