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Palayew A, Schmidt AM, Saeed S, Cooper CL, Wong A, Martel-Laferrière V, Walmsley S, Cox J, Klein MB. Estimating an individual-level deprivation index for HIV/HCV coinfected persons in Canada. PLoS One 2021; 16:e0249836. [PMID: 33872319 PMCID: PMC8055038 DOI: 10.1371/journal.pone.0249836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background HIV-HCV coinfected individuals are often more deprived than the general population. However, deprivation is difficult to measure, often relying on aggregate data which does not capture individual heterogeneity. We developed an individual-level deprivation index for HIV-HCV co-infected persons that encapsulated social, material, and lifestyle factors. Methods We estimated an individual-level deprivation index with data from the Canadian Coinfection Cohort, a national prospective cohort study. We used a predetermined process to select 9 out of 19 dichotomous variables at baseline visit to include in the deprivation model: income >$1500/month; education >high school; employment; identifying as gay or bisexual; Indigenous status; injection drug use in last 6 months; injection drug use ever; past incarceration, and past psychiatric hospitalization. We fitted an item response theory model with: severity parameters (how likely an item was reported), discriminatory parameters, (how well a variable distinguished index levels), and an individual parameter (the index). We considered two models: a simple one with no provincial variation and a hierarchical model by province. The Widely Applicable Information Criterion (WAIC) was used to compare the fitted models. To showcase a potential utility of the proposed index, we evaluated with logistic regression the association of the index with non-attendance to a second clinic visit (as a proxy for disengagement) and using WAIC compared it to a model containing all the individual parameters that compose the index as covariates. Results We analyzed 1547 complete cases of 1842 enrolled participants. According to the WAIC the hierarchical model provided a better fit when compared to the model that does not consider the individual’s province. Values of the index were similarly distributed across the provinces. Overall, past incarceration, education, and unemployment had the highest discriminatory parameters. However, in each province different components of the index were associated with being deprived reflecting local epidemiology. For example, Saskatchewan had the highest severity parameter for Indigenous status while Quebec the lowest. For the secondary analysis, 457 (30%) failed to attend a second visit. A one-unit increase in the index was associated with 17% increased odds (95% credible interval, 2% to 34%) of not attending a second visit. The model with just the index performed better than the model with all the components as covariates in terms of WAIC. Conclusion We estimated an individual-level deprivation index in the Canadian Coinfection cohort. The index identified deprivation profiles across different provinces. This index and the methodology used may be useful in studying health and treatment outcomes that are influenced by social disparities in co-infected Canadians. The methodological approach described can be used in other studies with similar characteristics.
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Affiliation(s)
- Adam Palayew
- Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Alexandra M. Schmidt
- Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sahar Saeed
- Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Curtis L. Cooper
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Valérie Martel-Laferrière
- Department of Microbiology and Infectious Diseases, Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Sharon Walmsley
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- University Health Network, University of Toronto, Toronto, Canada
| | - Joseph Cox
- Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B. Klein
- Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- * E-mail:
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Strickland JC, Staton M, Leukefeld CG, Oser CB, Webster JM. Hepatitis C antibody reactivity among high-risk rural women: opportunities for services and treatment in the criminal justice system. Int J Prison Health 2019; 14:89-100. [PMID: 29869584 DOI: 10.1108/ijph-03-2017-0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose The purpose of this paper is to examine the drug use and criminal justice factors related to hepatitis C virus (HCV) antibody reactivity among rural women in the USA recruited from local jails. Design/methodology/approach Analyses included 277 women with a history of injection drug use from three rural jails in Kentucky. Participants completed health and drug use questionnaires and received antibody testing for HCV. Findings The majority of women tested reactive to the HCV antibody (69 percent). Reactivity was associated with risk factors, such as unsterile needle use. Criminal justice variables, including an increased likelihood of prison incarceration, an earlier age of first arrest, and a longer incarceration history, were associated with HCV reactive tests. Participants also endorsed several barriers to seeking healthcare before entering jail that were more prevalent in women testing HCV reactive regardless of HCV status awareness before entering jail. Originality/value Injection and high-risk sharing practices as well as criminal justice factors were significantly associated with HCV reactivity. Future research and practice could focus on opportunities for linkages to HCV treatment during incarceration as well as during community re-entry to help overcome real or perceived treatment barriers. The current study highlights the importance of the criminal justice system as a non-traditional, real-world setting to examine drug use and related health consequences such as HCV by describing the association of high-risk drug use and criminal justice consequences with HCV among rural women recruited from local jails.
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Affiliation(s)
- Justin C Strickland
- Department of Psychology, College of Arts and Sciences, University of Kentucky , Lexington, Kentucky, USA
| | - Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky , Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky , Lexington, Kentucky, USA
| | - Carl G Leukefeld
- Department of Behavioral Science, College of Medicine, University of Kentucky , Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky , Lexington, Kentucky, USA
| | - Carrie B Oser
- Center on Drug and Alcohol Research, University of Kentucky , Lexington, Kentucky, USA.,Department of Sociology, College of Arts and Sciences, University of Kentucky , Lexington, Kentucky, USA
| | - J Matthew Webster
- Department of Behavioral Science, College of Medicine, University of Kentucky , Lexington, Kentucky, USA.,Center on Drug and Alcohol Research, University of Kentucky , Lexington, Kentucky, USA
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Reyes-Urueña J, Brugal MT, Majo X, Domingo-Salvany A, Caylà JA. Cross sectional study of factors associated to self-reported blood-borne infections among drug users. BMC Public Health 2015; 15:1122. [PMID: 26566634 PMCID: PMC4644320 DOI: 10.1186/s12889-015-2442-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/22/2015] [Indexed: 11/16/2022] Open
Abstract
Background The study’s aim was to estimate the self-reported prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV), and to describe their associated risk factors in a population of users of illicit drugs recruited in Catalonia- Spain, during 2012. Methods Cross-sectional study. People with illicit drugs use were selected in three different types of healthcare centres. The questionnaire was a piloted, structured ad hoc instrument. An analysis was made to identify factors associated to self-reported HCV, HIV and co-infection. Correlates of reported infections were determined using univariate and multivariate Poisson regression (with robust variance). Results Among 512 participants, 39.65 % self-reported positive serostatus for HCV and 14.84 % for HIV, co-infection was reported by 13.48 %. Among the 224 injecting drug users (IDUs), 187 (83.48 %), 68 (30.36 %) and 66 (29.46 %) reported being positive for HCV, HIV and co-infection, respectively. A higher proportion of HIV-infected cases was observed among women, (18.33 % vs. 13.78 % in men). Prevalence of HCV, HIV and co-infection were higher among participants with early onset of drug consumption, long periods of drug injection or who were unemployed. A positive serostatus was self-reported by 21(7.34 %) participants who did not report any injection; among them 16 and eight, reported being positive for HCV and HIV, respectively; three reported co-infection. Only two people declared exchanging sex for money. For those that reported a negative test, the median time since the last HIV test was 11.41 months (inter-quartile range (IQR) 4–12) and for the HCV test was 4.5 months (IQR 2–7). Conclusions Among drug users in Catalonia, HIV, HCV and co-infection prevalence are still a big issue especially among IDUs. Women and drug users who have never injected drugs are groups with a significant risk of infection; this might be related to their high-risk behaviours and to being unaware of their serological status.
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Affiliation(s)
- Juliana Reyes-Urueña
- Department of Paediatrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain. .,Drug Use Epidemiology Research Group, IMIM-Hospital del Mar Medical Research Institute, Dr Aiguader 88, 08003, Barcelona, Spain. .,Teaching Unit of Preventive Medicine and Public Health, PSMAR-UPF-ASPB, Barcelona, Spain. .,Public Health Agency of Barcelona, Barcelona, Spain.
| | - M Teresa Brugal
- Public Health Agency of Barcelona, Barcelona, Spain. .,Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Xavier Majo
- Department of Health Government of Catalonia, Barcelona, Spain.
| | - Antonia Domingo-Salvany
- Drug Use Epidemiology Research Group, IMIM-Hospital del Mar Medical Research Institute, Dr Aiguader 88, 08003, Barcelona, Spain.
| | - Joan A Caylà
- Department of Paediatrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain. .,Public Health Agency of Barcelona, Barcelona, Spain. .,Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain. .,CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Unemployment, health, and education of HIV-infected males in Germany. Int J Public Health 2015; 61:593-602. [PMID: 26427862 PMCID: PMC4947124 DOI: 10.1007/s00038-015-0750-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 09/24/2015] [Accepted: 09/24/2015] [Indexed: 02/03/2023] Open
Abstract
Objectives The present study on people living with HIV/AIDS (PLWHA) identifies socio-demographic and health-related factors corresponding with their labour market participation. Methods The study sample bases on a German observational sub-study of 527 male PLWHA. The present analysis is restricted to male PLWHA in working age. By means of a multivariate regression, we identify factors that contribute to unemployment and job loss. Results The probability to be unemployed is significantly negatively correlated with age above 40 years and graduation from university and positively correlated with problems with daily activities (frailty) and disease severity (CDC stage C). The probability of employment loss during the 2-year observation period is significantly negatively correlated with the educational level, whereas frailty and hepatitis C (HCV) co-infection increase the odds of employment loss. Conclusions As problems to manage daily activities and disease progression are associated with unemployment, an effective HIV treatment is an important cornerstone for employment. This is also true for the management of comorbidities, such as HCV co-infection, which also negatively affects employment status in our study.
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Freitas SZ, Teles SA, Lorenzo PC, Puga MAM, Tanaka TSO, Thomaz DY, Martins RMB, Druzian AF, Lindenberg ASC, Torres MS, Pereira SA, Villar LM, Lampe E, Motta-Castro ARC. HIV and HCV coinfection: prevalence, associated factors and genotype characterization in the Midwest Region of Brazil. Rev Inst Med Trop Sao Paulo 2015; 56:517-24. [PMID: 25351547 PMCID: PMC4296873 DOI: 10.1590/s0036-46652014000600011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/29/2014] [Indexed: 12/19/2022] Open
Abstract
A cross-sectional study on prevalence, associated factors and genotype
distribution of HCV infection was conducted among 848 HIV-infected patients
recruited at reference centers in the Midwest Region of Brazil. The prevalence
rate of HIV-HCV coinfection was 6.9% (95% CI: 5.2 to 8.6).
In multivariable analysis, increasing age, use of illicit drugs (injection
and non-injection), a history of blood transfusion before 1994, and the
absence of a steady partnership were significant independent associated factors
for HIV-HCV coinfection. The phylogenetic analysis based on the NS5B region
revealed the presence of two major circulating genotypes of HCV: genotypes 1
(58.3%) and 3 (41.7%). The prevalence of HIV-HCV
coinfection was lower than those reported in studies conducted with HIV-infected
patients in different regions of Brazil, due to the fact that illicit drug use
is not a frequent mode of HIV transmission in this region of Brazil. Serologic
screening of HIV-patients for HCV before initiating antiretroviral treatment, a
comprehensive identification of associated factors, and the implementation of
effective harm reduction programs are highly recommended to provide useful
information for treatment and to prevent HCV coinfection in these patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Marina Sawada Torres
- Hematology and Hemotherapy Center of Mato Grosso do Sul, Campo Grande, MS, Brazil
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Mikolajczyk RT, Horn J, Prins M, Wiessing L, Kretzschmar M. Trajectories of injecting behavior in the Amsterdam Cohort Study among drug users. Drug Alcohol Depend 2014; 144:141-7. [PMID: 25248472 DOI: 10.1016/j.drugalcdep.2014.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Injecting frequency among people who inject drugs (IDU) can change along distinct trajectories, which can reflect on incidence of HIV and HCV infections. We aimed at assessing these patterns of longitudinal changes, their predictors and their association with the incidence of HIV and HCV. METHODS We analyzed data from the Amsterdam Cohort Study among Drug Users, selecting participants recruited from 1985 to 2005, injecting drugs before cohort entry and with records in at least three different six months intervals (N=740). We used latent class mixed models to identify distinct trajectories of injecting, multinomial regression to identify socio-demographic variables associated with those patterns and Kaplan-Meier analysis for the estimation of the corresponding cumulative HIV and HCV incidence. RESULTS Five distinct patterns for injecting frequency and for injecting since last visit were identified. The majority of participants (three groups, 69% of participants) had stable risk injecting behavior; the remaining displayed a decrease in injecting over time. Those with longer duration of injecting at cohort entry and those who entered the cohort in earlier years tended to have continuing high risk behavior. The HIV risk was highest among those with continuing high risk behavior and its changes over time mirrored the patterns of change in injecting in a group with decrease in injecting. CONCLUSIONS Individual longitudinal patterns of changes in injecting behavior are related to socio-demographic and drug use variables and are reflected in the incidence of HIV infections. Understanding these associations might provide valuable information for targeted interventions.
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Affiliation(s)
- Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany.
| | | | - Maria Prins
- Department of Internal Medicine, Academic Medical Centre, CINIMA, Amsterdam, The Netherlands; Public Health Service Amsterdam, Cluster Infectious Diseases, Department of Research, Amsterdam, The Netherlands
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Mirjam Kretzschmar
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
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Cocaine use and risk of stroke: a systematic review. Drug Alcohol Depend 2014; 142:1-13. [PMID: 25066468 DOI: 10.1016/j.drugalcdep.2014.06.041] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/17/2014] [Accepted: 06/28/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Both cocaine use and strokes impact public health. Cocaine is a putative cause of strokes, but no systematic review of the scientific evidence has been published. METHODS All relevant bibliographic-databases were searched until January 2014 for articles on the epidemiological association between cocaine use and strokes. Search strings were supervised by expert librarians. Three researchers independently reviewed studies for inclusion and data extraction following STROBE recommendations. Quality appraisal included study validity and bias. Both ischemic and hemorrhagic strokes were considered. RESULTS Of 996 articles, 9 were selected: 7 case-control studies (CCS) and 2 cross-sectional (CSS) studies. One CCS (aOR=6.1; 95% CI: 3.3-11.8) and one CSS (aOR=2.33; 95% CI: 1.74-3.11) showed an association between cocaine and hemorrhagic strokes. The latter study also found a positive relationship with ischemic stroke (aOR=2.03; 95% CI: 1.48-2.79). Another CCS found the exposure to be associated with stroke without distinguishing between types (aOR=13.9; 95% CI: 2.8-69.4). One forensic CCS found that deaths with cocaine-positive toxicology presented a 14.3-fold (95% CI: 5.6-37) and 4.6-fold (95% CI: 2.5-8.5) increased risk of atherosclerosis compared to opioid-related deaths and hanging-deaths respectively. One CCS did not provide an aOR but found a statistically significant association between cocaine and hemorrhagic stroke. Three CCS and one CSS did not find any relationship between cocaine and strokes. Inadequate control for confounding was not uncommon. CONCLUSIONS Epidemiological evidence suggests that cocaine use increases the risk of stroke. Larger, more rigorous observational studies, including cohort approaches, are needed to better quantify this risk, and should consider stroke type, hypertension variation, frequency/length of cocaine use, amphetamines co-use, and other factors.
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Mayor AM, Fernández DM, Colón HM, Thomas JC, Miranda C, Hunter-Mellado RF. Hepatitis-C multimedia prevention program in poor Hispanic HIV-infected injecting drug users: six months after intervention. J Health Care Poor Underserved 2013; 24:29-37. [PMID: 24241258 PMCID: PMC4071764 DOI: 10.1353/hpu.2014.0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In order to prevent the spread of the hepatitis C virus (HCV) amongst Hispanic injection drug users (IDUs), we developed, validated, and implemented a multimedia educational intervention program. METHODS A pre-post intervention study design was used to evaluate long-lasting knowledge and behavior changes in a group of 88 low-income Hispanic HIV-infected IDUs. Pre-intervention data was compared with data measured six months after the intervention. RESULTS A significant increase in the awareness regarding HCV clinical manifestations, HCV risky behaviors, HCV prevention practices, and HIV/HCV co-infection synergisms was observed in the group six months post-intervention. CONCLUSION Our study confirms the long-lasting benefits of multimedia based intervention programs for disseminating HCV prevention strategies in IDUs. Preventive educational approaches that use images, figures, and animations tools can be recommended to target and tailor interventions for vulnerable populations.
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Wieser K, Zingg PO, Betz M, Neubauer G, Dora C. Total hip replacement in patients with history of illicit injecting drug use. Arch Orthop Trauma Surg 2012; 132:1037-44. [PMID: 22476213 DOI: 10.1007/s00402-012-1509-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND A history of illicit injecting drug use makes indication of total hip arthroplasty (THA) in patients with end stage hip osteoarthritis difficult, as the risk of infection with colonized strains is multiplied if the patient continues to inject or inhale illicit drugs. METHODS A retrospective survivorship analysis of a consecutive series of 27 THA in patients with a history of illicit drug use was performed. Follow-up evaluation consisted of (1) a WOMAC score, (2) a standardized interview including queries on drug habits and eventual additional medico-surgical treatments of the affected hip, (3) a clinical examination in order to complete a Harris Hip Score, (4) radiological examination and (5) blood tests (blood sedimentation rates and C-reactive protein). Defined endpoints were death, implant revised or awaiting revision for deep infection or any other reason and lost to follow-up or follow-up after at least 2 years. RESULTS Overall, 5- and 10-year implant survival rates with failure for any reason were 61 % (CI: 41;81) and 52.3 % (CI: 29;76) and for septic reasons 70.6 % (CI: 52;89) and 60.5 % (CI: 36;85), respectively. Even if at the time of THA all patients and respective health care professionals confirmed abstinence of illicit injecting drug use, five patients reported occasional use. Declared abstinence of less than 1 year before THA was associated with higher recurrence rates (p = 0.001) and both with higher septic failure rates (p = 0.023, p = 0.061). Positive serology for human deficiency virus did not increase implant failure rates. CONCLUSION We use this unacceptable high failure rate as evidence when counseling patients and their health care professionals about the appropriate treatment of osteoarthritis in patients with a history of illicit drug use. Furthermore, we support the request of hair analysis for drugs documenting abstinence of at least 1 year before indicating THA.
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Affiliation(s)
- Karl Wieser
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, Switzerland.
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Neale J, Stevenson C. Routine exposure to blood within hostel environments might help to explain elevated levels of hepatitis C amongst homeless drug users: insights from a qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:248-50. [PMID: 22305305 DOI: 10.1016/j.drugpo.2012.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/06/2012] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND Although homelessness is a risk factor for HCV infection, there is a lack of research exploring the relationship between living in a hostel for homeless people and blood-borne viruses. The tendency to focus on risky injecting practices and HCV has also eclipsed the transmission risks potentially posed by spilt and dried blood. METHODS Semi-structured qualitative interviews were conducted with 40 homeless drug users (HDUs) (29 men and 11 women). The aim of the study was to explore the support needs of HDUs staying in emergency hostels or night shelters, but blood emerged as an unexpected recurring topic within participants' accounts. Accordingly, all blood data were coded and analysed inductively. RESULTS Participants reported that spilt and dried blood were routine features of hostel life, particularly in larger night shelters. Given that the hepatitis C virus can survive outside the human body for several weeks and even months, this poses a worrying but largely overlooked transmission risk. According to the HDUs interviewed, hostel providers were often slow to remove blood and other bodily waste, leaving residents to clean it themselves or to avoid soiled areas. CONCLUSIONS The routine presence of blood within hostel environments might help to explain elevated levels of HCV amongst homeless drug users. However, there is a need for robust quantitative and qualitative research to systematically test and explore associations between HCV and hostel life. Recommendations are made for improving hostel cleanliness, apprising hostel staff and residents of HCV and other blood-borne virus transmission risks, and ensuring that blood and other bodily waste are deemed unacceptable features of any hostel setting.
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Affiliation(s)
- Joanne Neale
- Department of Social Work and Public Health, Oxford Brookes University, Jack Straw's Lane, Marston, Oxford OX3 0FL, UK
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Strathdee SA, Hallett TB, Bobrova N, Rhodes T, Booth R, Abdool R, Hankins CA. HIV and risk environment for injecting drug users: the past, present, and future. Lancet 2010; 376:268-84. [PMID: 20650523 PMCID: PMC6464374 DOI: 10.1016/s0140-6736(10)60743-x] [Citation(s) in RCA: 396] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We systematically reviewed reports about determinants of HIV infection in injecting drug users from 2000 to 2009, classifying findings by type of environmental influence. We then modelled changes in risk environments in regions with severe HIV epidemics associated with injecting drug use. Of 94 studies identified, 25 intentionally examined risk environments. Modelling of HIV epidemics showed substantial heterogeneity in the number of HIV infections that are attributed to injecting drug use and unprotected sex. We estimate that, during 2010-15, HIV prevalence could be reduced by 41% in Odessa (Ukraine), 43% in Karachi (Pakistan), and 30% in Nairobi (Kenya) through a 60% reduction of the unmet need of programmes for opioid substitution, needle exchange, and antiretroviral therapy. Mitigation of patient transition to injecting drugs from non-injecting forms could avert a 98% increase in HIV infections in Karachi; whereas elimination of laws prohibiting opioid substitution with concomitant scale-up could prevent 14% of HIV infections in Nairobi. Optimisation of effectiveness and coverage of interventions is crucial for regions with rapidly growing epidemics. Delineation of environmental risk factors provides a crucial insight into HIV prevention. Evidence-informed, rights-based, combination interventions protecting IDUs' access to HIV prevention and treatment could substantially curtail HIV epidemics.
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Affiliation(s)
- Steffanie A Strathdee
- University of California, San Diego, Division of Global Public Health, Department of Medicine, CA 92093-0507, USA.
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Prevalence and Correlates of HIV Infection Among Male Injection Drug Users in Detention in Tehran, Iran. J Acquir Immune Defic Syndr 2010; 53:273-5. [PMID: 20104123 DOI: 10.1097/qai.0b013e3181be6dde] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Keppler K, Stöver H, Schulte B, Reimer J. Prison Health is Public Health! Angleichungs- und Umsetzungsprobleme in der gesundheitlichen Versorgung Gefangener im deutschen Justizvollzug. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:233-44. [DOI: 10.1007/s00103-009-1023-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kheirandish P, SeyedAlinaghi S, Jahani M, Shirzad H, Seyed Ahmadian M, Majidi A, Sharifi A, Hosseini M, Mohraz M, McFarland W. Prevalence and correlates of hepatitis C infection among male injection drug users in detention, Tehran, Iran. J Urban Health 2009; 86:902-8. [PMID: 19844670 PMCID: PMC2791818 DOI: 10.1007/s11524-009-9393-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
For the benefit of planning for the future care and treatment of people infected with hepatitis C virus (HCV) and to help guide prevention and control programs, data are needed on HCV seroprevalence and associated risk factors. We conducted a cross-sectional sero-behavioral survey of injection drug users (IDU) detained for mandatory rehabilitation during a police sweep of Tehran, Iran, in early 2006. During the study period, a consecutive sample comprising 454 of 499 (91.0%) men arrested and determined to be IDU by urine test and physical examination consented to a face-to-face interview and blood collection for HCV antibody testing. Overall, HCV prevalence was 80.0% (95% confidence interval (CI) 76.2-83.6). Factors independently associated with HCV infection included history of incarceration (adjusted OR 4.35, 95% CI 1.88-10.08), age of first injection < or =25 years (OR 2.72, 95% CI 1.09-6.82), and history of tattooing (OR 2.33, 95% CI 1.05-5.17). HCV prevalence in this population of IDU upon intake to jail was extremely high and possibly approaching saturation. Findings support that incarceration is contributing to the increased spread of HCV infection in Iran and calls for urgent increased availability of HCV treatment, long-term preparation for the care of complications of chronic infection, and rapid scale-up of programs for the primary prevention of parenterally transmitted infections among drug users.
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Affiliation(s)
- Parastoo Kheirandish
- Iranian Research Center for HIV/AIDS (IRCHA), Department of Infectious and Tropical Diseases, Tehran University of Medical Sciences, Tehran, Iran
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Camoni L, Regine V, Salfa MC, Nicoletti G, Canuzzi P, Magliocchetti N, Rezza G, Suligoi B, The SerT Study Group, Camoni L, Regine V, Salfa MC, Nicoletti G, Canuzzi P, Magliocchetti N, Rezza G, Suligoi B, The SerT Study Group. Prevalence and correlates of infection with human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among drug users in Italy: A cross-sectional study. ACTA ACUST UNITED AC 2009; 41:520-3. [DOI: 10.1080/00365540902946528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fitzgerald JL. Mapping the experience of drug dealing risk environments: An ethnographic case study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2009; 20:261-9. [DOI: 10.1016/j.drugpo.2008.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 10/03/2008] [Accepted: 10/04/2008] [Indexed: 11/29/2022]
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Homelessness, drug use and Hepatitis C: A complex problem explored within the context of social exclusion. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:429-35. [DOI: 10.1016/j.drugpo.2007.09.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 09/05/2007] [Accepted: 09/07/2007] [Indexed: 02/06/2023]
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Abstract
PURPOSE OF REVIEW Health problems related to substance use are investigated and monitored throughout the world by both international organizations and governments. It is well recognized that prison inmates are a vulnerable group of the population. Research on this group is minimal compared with the general population. The problem of drug use and health consequences among this subpopulation is significant and needs to be explored. RECENT FINDINGS A higher prevalence of drug use is found among prison inmates than among the general population. The health status of prison inmates seems to be lower because of both the inmates' behavior and the prison environment. Various communicable diseases are commonly found such as hepatitis C virus, HIV, and syphilis. SUMMARY The health of prison inmates tended to be worse than in the general population, particularly for those who use drugs. Based on the principle of human rights and equity of access, healthcare services provided to prison inmates should be equivalent to those provided to the general population.
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March JC, Oviedo-Joekes E, Romero M. Inconsistent condom use among socially excluded heroin users. GACETA SANITARIA 2007; 21:321-8. [PMID: 17663876 DOI: 10.1157/13108506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The study focused in sexual behaviour among socially excluded heroin users, identifying factors associated with inconsistent condom use. Data was collected in the cities of Granada and Seville between July and October 2000, through a structured questionnaire, to 391 participants. Twenty two and 15% of participants have made consistent use of condoms in vaginal sex in the last year with occasional and regular partners respectively. There is a greater likelihood of inconsistent condom use with occasional partners among users who had had oral sex, and who does not know if their partner(s) inject or injected drugs. For regular partners those who have an injecting partner and do not speak with their sexual partners about AIDS have a higher probability to do not use always a condom. For both groups, when always the partner is who propose the use of condoms (when used) and not themselves, the risk not to use it is near 4 times more than when themselves propose to use it. Speaking about condoms and AIDS with mate, partners and family, and learning to negotiate the use of condoms seems to be the most important strategies to be approached for this sample, from the social and health care system in order to promote a protected sex.
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