Sexually transmissible diseases in injecting drug users

The Epidemic of Human Immunodeficiency Virus, Hepatitis C Virus, and Syphilis Infection, and the Correlates of Sexually Transmitted Infections among Men Who Have Sex with Men in Zhenjiang, Jiangsu, China

A cross sectional survey was performed to investigate the epidemic of human immunodeficiency virus (HIV), hepatitis C virus (HCV), syphilis, and HIV-1 subtype infections among men who have sex with men (MSM) and to evaluate factors that were correlated with sexually transmitted infections (STIs) among 657 MSM in Zhenjiang, Jiangsu, during 2012-2013. Data on socio-demographic parameters and risky behaviors were collected, and blood samples were obtained. In this survey, the prevalence of STIs due to HIV (5.3%), HCV (0.6%), and syphilis (19.2%) were measured. Of 35 HIV-infected MSM, 1 (0.2%) and 17 (2.6%) were co-infected with HCV and syphilis. Among 33 samples with available HIV-1 genomic fragment sequences, 6.1% B, 72.7% CRF01_AE, and 21.2% CRF07_BC were identified. Multivariate logistic regression analysis showed that age > 30 years (odds ratio [OR] 2.002; 95% confidence interval [CI], 1.144-3.502) and having had STI symptoms in the past year (OR, 11.673; 95% CI, 3.092-44.078) were positively correlated with having an STI, while consistent use of a condom when having sex with male partners (OR, 0.621; 95% CI, 0.408-0.945) was significantly associated with a low STI rate. The worsening epidemic of HIV, HCV, and syphilis infections, and the prevalence of complex subtypes of HIV-1 and other risk factors suggest that effective intervention strategies should be strengthened for MSM in Zhenjiang, Jiangsu.

The prevalence and incidence of sexually transmitted infections in a prospective cohort of injection drug users in Vancouver, British Columbia

BACKGROUND

While several studies have reported on sexual risk behaviours and the prevalence of sexually transmitted infections (STIs) among injection drug users (IDUs), there are fewer prospective studies that have been able to examine populations of IDUs with no history of STIs. Therefore, the authors examined prevalence, correlates and factors associated with time to first STI infection in a prospective cohort of IDUs in Vancouver, British Columbia.

METHODS

The authors examined the prevalence and correlates of STIs among IDUs at the time of recruitment into a prospective cohort study. The authors also evaluated the cumulative rate of time to first STI among IDUs with no history of STIs at baseline using the Kaplan-Meier method, and modelled factors independently associated with first STI using Cox regression.

RESULTS

Between May 1996 and November 2003, 1560 individuals were recruited into the cohort; of these individuals, 745 reported a history of STI at baseline. Among the 815 who did not report an STI at baseline, 671 (82%) had at least one follow-up visit and were eligible for the analysis of time to first STI. After 36 months of follow-up, the cumulative rate of first STI was 8.2% for men and 15.9% for women (log-rank P<0.001), whereas the cumulative rate of first STI was 8.0% for IDUs who did not report sex trade involvement versus 19.8% for IDUs who reported sex trade involvement (log-rank P<0.001). In multivariate analyses, the risk of first STI remained independently associated with unprotected sex with regular partners (relative hazard=2.04, 95% CI 1.29 to 3.23; P=0.001) and unprotected sex with sex trade clients (relative hazard=2.36, 95% CI 1.46 to 3.82; P=0.005).

CONCLUSIONS

In the present study, the authors found that STIs were associated with both regular sex partnerships and sex trade involvement. These findings are of particular concern because both unprotected sex with regular partners and sex trade involvement is common among IDUs. Interventions to encourage condom use among IDUs, particularly those with regular sex partners and those involved in the sex trade, should be further developed.

Maintenance of endemicity in urban environments: a hypothesis linking risk, network structure and geography

In industrialised countries, a rapid epidemic phase of HIV transmission has largely given way to more moderated endemic transmission. The dynamics of endemic transmission may differ substantially from those generating epidemic spread. We hypothesise that three elements play an important role in maintaining endemicity in high prevalence urban environments. First, persons are likely to be subject to multiple risks from multiple sources rather than engaging in a single, hierarchically classified, risk behaviour. Second, the network structure in these environments may include a substrate of "fixed" factors (a large connected component, a characteristic degree distribution and small world phenomenon) upon which is superimposed a number of variable factors (transitivity, assortativity) that determine the level of prevalence. Third, the geographic range of persons in these milieux is constricted, making it likely that new partners will already be connected. The confluence of these three factors assures the ongoing risk bombardment needed for maintenance of endemicity. Further empirical and theoretical analysis will be required in order to validate this hypothesis.

Does integrating viral hepatitis services into a public STD clinic attract injection drug users for care?

OBJECTIVE

Injection drug users (IDUs) are at high risk for multiple health problems, including human immunodeficiency virus (HIV), viral hepatitis, and sexually transmitted diseases (STDs), and are likely to have poor access to health care. To more effectively serve high-risk clients, experts recommend that programs accessed by such client populations offer integrated services. In 2000, the New York City Department of Health and Mental Hygiene integrated viral hepatitis services (vaccine and screening) into a publicly funded STD clinic. We evaluated integrated service delivery to high-risk IDUs at this clinic.

METHODS

Hepatitis data were reviewed to identify clients who self-reported as IDUs. STD medical records of these clients were abstracted to ascertain primary reason for clinic visit, STD/HIV services received, and diagnoses made.

RESULTS

Between May 2000 and March 2004, 8,778 individuals received hepatitis services, of whom 3% (279/8,778) reported injection drug use. Nearly 60% (161/279) of IDUs reported availability of hepatitis services as the primary reason for the clinic visit. Of these 161 clients, 103 (64%) also received other services; 54% (55/103) had an STD exam (yielding 12 new STD diagnoses), and 59% (61/103) had HIV counseling and testing (yielding two new HIV cases). Of these 103 clients, 31 (30%) were referred to the clinic for hepatitis services from a drug treatment center, and 77% (24/31) tested positive for the antibody to hepatitis C virus.

CONCLUSIONS

Integrated hepatitis services appeared to attract IDUs to this STD clinic, where many also benefited from STD/HIV exams, testing, treatment, and referrals they may not have received otherwise.

Screening injecting drug users for sexually transmitted infections and blood borne viruses using street outreach and self collected sampling

BACKGROUND

Injecting drug users (IDUs) are a marginalised population, who infrequently access health services for screening for sexually transmitted infections (STIs) and blood borne viruses (BBVs), and are at high risk of these infections.

OBJECTIVES

To use street outreach and self collection of samples for STI screening, to establish the prevalence of BBVs and STIs, and to identify risk behaviours among a group of culturally diverse street based IDUs.

METHODS

This was a cross sectional study of 314 IDUs in the central business district of Melbourne, Australia, conducted over 3 years (1999-2002). We used street outreach as the recruitment strategy with staff "on foot" in injecting and dealing locations, as well as self collected genital sampling to increase acceptance of screening for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis by polymerase chain reaction (PCR). Individuals were screened for hepatitis A, B, and C, syphilis and HIV, and given the option of a self collected or clinician collected blood sample to increase acceptance of screening for BBVs.

RESULTS

Street outreach was highly effective and self directed STI sampling was more acceptable than practitioner directed sampling (76% versus 9% acceptance, p<0.001). There was a high prevalence of hepatitis C (74%, 95% CI 69 to 79), STIs (8% (5 to 13)), and chlamydia (6% (3 to 10)), and past exposure to hepatitis A and B was common. High rates of recent sharing of injecting equipment, unprotected sex and casual sexual partners, together with low levels of awareness of current hepatitis C infection were identified.

CONCLUSION

Street outreach and self collected genital samples facilitate screening for STIs and BBVs in IDUs and revealed a high prevalence of infections and risk behaviours.