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Salekešin M, Vorobjov S, Des Jarlais D, Uusküla A. Mortality among people who inject drugs - the interwoven roles of fentanyl and HIV: a community-based cohort study. Eur J Public Health 2024; 34:329-334. [PMID: 38041408 PMCID: PMC10990538 DOI: 10.1093/eurpub/ckad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Excess all-cause mortality is a key indicator for assessing direct and indirect consequences of injection drug use and data are warranted to delineate sub-populations within people who inject drugs at higher risk of death. Our aim was to examine mortality and factors associated with mortality among people who inject drugs in Estonia. METHODS Retrospective cohort study using data from people who inject drugs recruited in the community with linkage to death records. Standardized mortality ratios were used to compare the cohort mortality to the general population and potential predictors of death were examined through survival analysis (Cox regression). The cohort include a total of 1399 people who inject drugs recruited for cross-sectional surveys using respondent driven sampling between 2013 and 2018 in Estonia. A cohort with follow-up through 2019 was formed with linkage to national causes of death registry. RESULTS Among 1399 participants with 4684 person-years of follow-up, 10% were deceased by 2019. The all-cause mortality rate in the cohort was 28.9 per 1000 person-years (95% confidence interval 25.3-35.3). Being HIV positive, injecting mainly opioids (fentanyl), living in the capital region and the main source of income other than work were associated with greater mortality risk. CONCLUSIONS While low-threshold services have been available for a long time for people who inject drugs, there is still a need to widen the availability and integration of services, particularly the integration of HIV and opioid treatment.
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Affiliation(s)
- Maris Salekešin
- Department of Risk Behavior Studies, National Institute for Health Development, Tallinn, Estonia
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Sigrid Vorobjov
- Department of Risk Behavior Studies, National Institute for Health Development, Tallinn, Estonia
| | - Don Des Jarlais
- School of Global Public Health, New York University, New York, USA
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Uusküla A, Raag M, Barnes DM, Tross S, Ave T, Des Jarlais DC. Adapted "Break the Cycle for Avant Garde" intervention to reduce injection assisting and promoting behaviours in people who inject drugs in Tallinn, Estonia: A pre- post trial. PLoS One 2023; 18:e0266815. [PMID: 37256867 DOI: 10.1371/journal.pone.0266815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 01/13/2023] [Indexed: 06/02/2023] Open
Abstract
In the context of established and emerging injection drug use epidemics, there is a need to prevent and avert injection drug use. We tested the hypothesis that an individual motivation and skills building counselling, adapted and enhanced from Hunt's Break the Cycle intervention targeting persons currently injecting drugs would lead to reduction in injection initiation-related behaviours among PWID in Tallinn, Estonia. For this quasi-experimental study, pre-post outcome measures included self-reported promoting behaviours (speaking positively about injecting to non-injectors, injecting in front of non-injectors, offering to give a first injection) and injection initiation behaviours (assisting with or giving a first injection) during the previous 6 months. Of 214 PWID recruited, 189 were retained (88.3%) for the follow-up at 6 months. The proportion of those who had injected in front of non-PWID significantly declined from 15.9% to 8.5%, and reporting assisting with 1st injection from 6.4% to 1.06%. Of the current injectors retained in the study, 17.5% reported not injecting drugs at the follow up. The intervention adapted for the use in the setting of high prevalence of HIV and relatively low prevalence of injection assisting, tested proved to be effective and safe.
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Affiliation(s)
- Anneli Uusküla
- Department of Family medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Mait Raag
- Department of Family medicine and Public Health, University of Tartu, Tartu, Estonia
| | - David M Barnes
- College of Global Public Health, New York University, New York, New York, United States of America
| | - Susan Tross
- HIV Center for Clinical and Behavioural Studies, Department of Psychiatry, Columbia University Medical Center, New York, New York, United States of America
| | - Talu Ave
- Department of Family medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Don C Des Jarlais
- College of Global Public Health, New York University, New York, New York, United States of America
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Des Jarlais D, Uuskula A, Talu A, Barnes DM, Raag M, Arasteh K, Org G, Demarest D, Feelemyer J, Berg H, Tross S. Implementing an Updated "Break the Cycle" Intervention to Reduce Initiating Persons into Injecting Drug Use in an Eastern European and a US "opioid epidemic" Setting. AIDS Behav 2019; 23:2304-2314. [PMID: 30879209 DOI: 10.1007/s10461-019-02467-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We tested the hypothesis that an updated "Break the Cycle" (BtC) intervention, based in social cognitive theory and motivational interviewing, would reduce the likelihood that current persons who inject drugs (PWID) would assist persons who do not inject drugs (non-PWID) with first injections in Tallinn, Estonia and Staten Island, New York City. 402 PWID were recruited, a baseline interview covering demographics, drug use, and assisting non-PWID with first drug injections was administered, followed by BtC intervention. 296 follow-up interviews were conducted 6 months post-intervention. Percentages assisting with first injections declined from 4.7 to 1.3% (73% reduction) in Tallinn (p < 0.02), and from 15 to 6% (60% reduction) in Staten Island (p < 0.05). Persons assisted with first injections declined from 11 to 3 in Tallinn (p = 0.02) and from 32 to 13 in Staten Island. (p = 0.024). Further implementation research on BtC interventions is urgently needed where injecting drug use is driving HIV/HCV epidemics and areas experiencing opioid epidemics.
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Affiliation(s)
- Don Des Jarlais
- Social and Behavioral Sciences, College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA.
| | - Anneli Uuskula
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ave Talu
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - David M Barnes
- Social and Behavioral Sciences, College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - Mait Raag
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kamyar Arasteh
- Social and Behavioral Sciences, College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - Greete Org
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Donna Demarest
- CHASI: Community Health Action of Staten Island, New York, USA
| | - Jonathan Feelemyer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hayley Berg
- Social and Behavioral Sciences, College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies at The New York State Psychiatric Institute and Columbia University, New York, USA
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Uusküla A, Barnes DM, Raag M, Talu A, Tross S, Des Jarlais DC. Frequency and factors associated with providing injection initiation assistance in Tallinn, Estonia. Drug Alcohol Depend 2018; 188:64-70. [PMID: 29754028 PMCID: PMC6875682 DOI: 10.1016/j.drugalcdep.2018.03.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/01/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED Injection drug use is expanding in numerous regions in the world. Persons who inject drugs (PWID) play an important role encouraging new persons into injecting, by providing injection initiation assistance ("assisting" behaviors) and stimulating interest in injection ("promoting" behaviors). OBJECTIVES To describe the prevalence of assisting and promoting behaviors, and to identify factors associated with assisting, among PWID in Tallinn, Estonia. METHODS In 2016, PWID were recruited through respondent-driven sampling (RDS), interviewed, and HIV tested. RDS weights were used to estimate the prevalence of assisting and promoting behaviors and, in multivariable regression modeling, to identify factors associated with assisting. RESULTS Among 299 PWID recruited, 13.7% had ever assisted a non-PWID with their first injection. Regarding past-six-month promoting behaviors: 9.4% talked positively about injecting to non-PWID, 16.2% injected in front of non-PWID, and 0.6% offered to help with a first injection. Significant predictors of ever assisting with a first injection included: gender (men: aOR 6.31, 95% CI 2.02-19.74); age (30 years or younger: aOR 3.89, 95% CI 1.40-10.16); receptive sharing of syringes or needles (aOR 4.73, 95% CI 1.32-16.98); ever testing for HIV (aOR 8.44, 95% CI 1.15-62.07); and having peers who helped someone with their first injection (aOR 3.44, 95% CI 1.31-9.03). CONCLUSION Demographic and drug-use related factors are associated with having initiated someone into injecting. Interventions targeting PWID and non-PWID are needed to prevent injection initiation.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
| | - David M. Barnes
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, The Baron Edmond de Rothschild Chemical Dependency Institute, New York, NY, USA
| | - Mait Raag
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ave Talu
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Susan Tross
- Department of Psychiatry, Columbia University Medical Center, HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Don C. Des Jarlais
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, The Baron Edmond de Rothschild Chemical Dependency Institute, New York, NY, USA
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Tavitian-Exley I, Boily MC, Heimer R, Uusküla A, Levina O, Maheu-Giroux M. Polydrug Use and Heterogeneity in HIV Risk Among People Who Inject Drugs in Estonia and Russia: A Latent Class Analysis. AIDS Behav 2018; 22:1329-1340. [PMID: 28699018 PMCID: PMC5878835 DOI: 10.1007/s10461-017-1836-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Non-medical drug injection is a major risk factor for HIV infection in Russia and Estonia. Multiple drug use (polydrug) has further been associated with increased harms. We compared HIV, injecting and sexual risk associated with polydrug use among people who injected drugs (PWID) in 2012–2013 in Kohtla-Järve (Estonia, n = 591) and St Petersburg (Russia, n = 811). Using latent class analysis, we identified five (poly)drug classes, the largest consisting of single-drug injectors among whom an opioid was the sole drug injected (56% of PWID). The four remaining polydrug classes included polydrug-polyroute injectors who injected and used opiates and stimulants (9%), opiate-stimulant poly-injectors who injected amphetamine-type-stimulants with a primary opiate (7%) and opiate-opioid poly-injectors who injected opioids and opiates (16%). Non-injection stimulant co-users were injectors who also used non-injection stimulants (12%). In multivariable multinomial regressions, all four polydrug classes were associated with greater injection risks than single-drug injection, while opiate-stimulant and opiate-opioid poly-injection were also associated with having multiple sex partners. Riskier behaviours among polydrug-injectors suggest increased potential for transmission of blood-borne and sexually-transmitted infections. In addition to needles/syringes provision, services tailored to PWID drug and risk profiles, could consider drug-appropriate treatment and sexual risk reduction strategies to curb HIV transmission.
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Affiliation(s)
- Isabel Tavitian-Exley
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk place, London, W21PG, UK.
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk place, London, W21PG, UK.
| | - Robert Heimer
- Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, USA
| | - Anneli Uusküla
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Olga Levina
- NGO Stellit, St Petersburg, Russian Federation
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
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Uusküla A, Raag M, Vorobjov S, Jarlais DD. Another frontier for harm reduction: contraceptive needs of females who inject drugs in Estonia, a cross-sectional study. Harm Reduct J 2018; 15:10. [PMID: 29506538 PMCID: PMC5838942 DOI: 10.1186/s12954-018-0215-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/21/2018] [Indexed: 01/04/2023] Open
Abstract
Background Despite increasing contraceptive availability, unintended pregnancy remains a global problem. Developing strategies to reverse this trend and increasing occurrence of withdrawal syndrome among newborn children of females currently injecting drugs warrants special attention. The knowledge base on the uptake of effective contraception among females who inject drugs (FWID) is scant. We aimed to examine the prevalence of and factors associated with the use of non-condom contraceptives among sexually active FWID with the focus on effective contraception. Methods In a series of cross-sectional studies (2007–2013), 265 current FWID were recruited through respondent-driven sampling (RDS), interviewed, and tested for HIV. RDS weights were used to estimate the prevalence of effective contraception (hormonal contraception, intrauterine device, sterilization) use in the last 6 months. Results Of the sexually active women with main partners (n = 196) 4.8% (95% CI 2.3–9.7) were using effective contraception, 52.7% (95% CI 42.5–62.7) less-effective or no contraception. 42.5% (95% CI 32.7–52.9) relied on condoms for contraception. The odds for using effective contraception were higher among women with > 10 years of education (OR 7.29, 95% CI 1.4–38.8). None of the women lacking health insurance (n = 84) were using effective contraception. Conclusions The very low coverage with effective contraception highlights the need to improve contraceptive services for FWID. Reproductive health service including contraception should be considered essential components of harm reduction and of comprehensive prevention and care for HIV among persons who use drugs.
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Affiliation(s)
- Anneli Uusküla
- Department of Family medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
| | - Mait Raag
- Department of Family medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Sigrid Vorobjov
- Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Tallinn, Estonia
| | - Don Des Jarlais
- Department of Psychiatry, The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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HEIMER R, USACHEVA N, BARBOUR R, NICCOLAI LM, UUSKÜLA A, LEVINA OS. Engagement in HIV care and its correlates among people who inject drugs in St Petersburg, Russian Federation and Kohtla-Järve, Estonia. Addiction 2017; 112:1421-1431. [PMID: 28233356 PMCID: PMC5526080 DOI: 10.1111/add.13798] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/18/2016] [Accepted: 02/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS HIV infection and mortality in Eastern Europe are driven by unsafe injection drug use. We sought to compare engagement in care from HIV testing through receipt of antiretroviral treatment among HIV-positive people who inject drugs (PWID) in St Petersburg, Russian Federation (RF) and Kohtla-Järve, Estonia and identify factors associated significantly with failure to progress at each stage of the HIV treatment cascade. DESIGN Cross-sectional biobehavioral surveys of PWID with an analysis stratified by location-two Russian-speaking regions with similar HIV epidemic histories and current prevalence. SETTING Field-based surveys conducted in St Petersburg, RF and Kohtla-Järve, Estonia. PARTICIPANTS We recruited 452 HIV-positive PWID in St Petersburg (November 2012 to June 2013) and 370 HIV-positive PWID in Kohtla-Järve (June-August 2012) using respondent-driven sampling. MEASUREMENTS Participants were tested for antibodies to HIV, and administered a questionnaire focusing on participants' medical care histories. Engagement in care was categorized as a cascade of five transitional steps through six stages, ranging from HIV testing to current receipt of antiretroviral medications. FINDINGS Progress along the cascade was greater in Kohtla Järve (32.7% were receiving antiretroviral medications) than in St Petersburg (9.7%). In both locations, we found the steps with high failure rates were the transitions from being aware of one's HIV diagnosis to being in regular care and initiation of highly active antiretroviral therapy (HAART). Factors associated significantly with transition failure in both locations and across steps included high alcohol consumption, variables associated with drug choice and injection frequency and lack of basic medical insurance. CONCLUSION The two steps in treatment cascade for HIV-positive PWID in St Petersburg, RF and Kohtla-Järve, Estonia requiring greatest improvement are retention in regular care and initiation of HAART. Both individual behavioral and structural factors are associated with failure to transition along the cascade.
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Affiliation(s)
- Robert HEIMER
- Department of the Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA,Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
| | | | - Russell BARBOUR
- Department of the Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA,Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
| | - Linda M. NICCOLAI
- Department of the Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA,Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
| | - Anneli UUSKÜLA
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Chan PY, Joseph MA, Des Jarlais DC, Uusküla A. Perceived effectiveness of antiretroviral therapy, self-rated health and treatment adherence among HIV-positive people who inject drugs in Estonia. Int J STD AIDS 2017; 29:13-22. [PMID: 28618981 DOI: 10.1177/0956462417714635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The HIV epidemic in Estonia affects the population of people who inject drugs (PWID) the most, but factors associated with adherence to antiretroviral therapy (ART) among PWID have not been thoroughly examined in Estonia, with particularly limited data regarding beliefs and attitudes of PWID. The objective of this study was to explore the association between ART adherence and individual beliefs, perceived effectiveness of ART, and self-rated health in particular, in this specific population. The study used baseline survey data from a longitudinal intervention study of HIV prevention among PWID in Estonia, in which 107 HIV-infected participants reported current use of ART. Current adherence was measured through the use of a visual analog scale. Approximately half (49%) of the participants reported optimal (≥95%) adherence. The vast majority (81%) believed in the effectiveness of ART. Less than a quarter of the participants (22%) rated their health as good or very good, and a half (52%) reported average health. Individual beliefs and self-reported health were not associated with ART adherence in both bivariate and multivariable analyses. Participants with problem drinking reported significant suboptimal adherence to ART (adjusted odds ratio [AOR] 0.42, 95% CI 0.19-0.97). Daily injection drug use was also associated with suboptimal adherence (AOR 0.34, 95% CI 0.13-0.91). Problem drinking has not been commonly reported as a factor of suboptimal ART adherence among PWID; further research would be useful to identify the pathways that might be involved.
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Affiliation(s)
- Pui Y Chan
- 1 Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michael A Joseph
- 1 Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Anneli Uusküla
- 3 Department of Public Health, University of Tartu, Tartu, Estonia
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The Role of Internalized Stigma in the Disclosure of Injecting Drug Use Among People Who Inject Drugs and Self-Report as HIV-Positive in Kohtla-Järve, Estonia. AIDS Behav 2017; 21:1034-1043. [PMID: 27990583 DOI: 10.1007/s10461-016-1647-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Disclosure of injecting drug use and its associations with stigma have received very little research attention. This cross-sectional study examined the role of internalized HIV and drug stigma (i.e., self-stigmatization) in the disclosure of injecting drug use among people who inject drugs (PWID) self-reporting as HIV-positive (n = 312) in Kohtla-Järve, Estonia. The internalization of both stigmas was relatively high. On average, PWID disclosed to three disclosure targets out of seven. Disclosure was highest to close friends and health care workers and lowest to employers and casual sex partners. Internalized drug stigma was negatively associated with disclosure to other family members (AOR = 0.48; 95% CI 0.30-0.77) and health care workers (AOR = 0.46; 95% CI 0.25-0.87). Internalized HIV stigma was positively associated with disclosure to health care workers (AOR = 2.26; 95% CI 1.27-4.00). No interaction effect of internalized stigmas on disclosures emerged. We concluded that effects of internalized stigmas on disclosures are few and not uniform.
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Uusküla A, Raag M, Marsh K, Talu A, Vorobjov S, Des Jarlais D. HIV prevalence and gender differences among new injection-drug-users in Tallinn, Estonia: A persisting problem in a stable high prevalence epidemic. PLoS One 2017; 12:e0170956. [PMID: 28152026 PMCID: PMC5289488 DOI: 10.1371/journal.pone.0170956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION New injectors / younger drug users are an important population to target for intervention because they are often at especially high risk of HIV and HCV infection. We examined HIV prevalence and gender differences in HIV prevalence and risk behavior among new injection-drug-users in Tallinn, Estonia. METHODS Respondent driven sampling (RDS) interview surveys and HIV testing were conducted in Tallinn in 2009, 2011 and 2013. We classified "new injectors" as persons who reported their first injection as occurring within three years of the study interview. Recruiting trees of the three individual RDS studies were joined to form one RDS dataset and RDS estimates for prevalence and means were derived. Bootstrap tests were used to compare data from men and women, HIV infected and uninfected. RESULTS Among 110 new injectors (34 women and 76 men) the mean age was 24.5 (SD 7.5) years; 63% reported injecting mainly fentanyl, 34% injecting mainly amphetamine, 36% sharing syringes, 89% were sexually active, and, of these, 88% did not always use condoms in the last 6 months. HIV prevalence was 18% (95%CI 8-28%) (41% (95%CI 19-63%) among female and 7% (95%CI 2-12%) among male new injectors). Based on self-reports, 8.1% of all new injectors (and 22% of female new injectors) were HIV positive before starting to inject drugs. 40% of HIV infected reported receiving antiretroviral therapy. In multivariable analysis, gender (male: OR 0.12, 95% CI 0.03-0.45), main drug injected (fentanyl: OR 6.7, 95% CI 1.3-35.7) and syringe sharing (distributive: OR 0.11, 95% CI 0.02-0.55; and receptive: OR 3.7, 95% CI 1.0-13.5) were associated with the HIV seropositivity. CONCLUSIONS New injectors exhibit high-risk behavior and correspondingly high HIV prevalence. Sexual transmission of HIV infection, including before injection initiation, is likely to be a significant contributor to HIV risk among female new injectors. This highlights the need to identify and target new injectors and their partners with gender specific interventions in addition to interventions to reduce initiation into injecting and ensuring provision of ART to HIV positive new injectors.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Mait Raag
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kristina Marsh
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ave Talu
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Don Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel Medical Center, New York, New York, United States of America
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Uusküla A, Raag M, Vorobjov S, Rüütel K, Lyubimova A, Levina OS, Heimer R. Non-fatal overdoses and related risk factors among people who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia. BMC Public Health 2015; 15:1255. [PMID: 26684815 PMCID: PMC4683801 DOI: 10.1186/s12889-015-2604-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 12/11/2015] [Indexed: 01/09/2023] Open
Abstract
Background This study seeks to identify the prevalence of, and risk factors associated with, non-fatal overdose among people currently injecting drugs (PWID) in St. Petersburg (Russia) and in Kohtla-Järve (Estonia). Methods Five hundred eighty-eight study participants in Kohtla-Järve (in 2012) and 811 in St. Petersburg (in 2012–2013) were recruited using respondent driven sampling for interviewing and HIV testing. Results Three-quarters (76 %) of the current PWID were male. Participants from St. Petersburg were older (mean age 32.1 vs. 29.6 years, p < 0.0001) and reported a longer average duration of injecting drugs (mean duration: 13.3 vs. 10.9 years, p < 0.0001). Main drugs injected were opioids (fentanyl in Kohtla-Järve, heroin in St Petersburg). HIV prevalence was 63 % (95 % CI 59–67 %) in Kohtla-Järve and 56 % (95 % CI 52–59 %) in St. Petersburg. Two thirds of the PWID in Kohtla-Järve and St. Petersburg reported ever having experienced a drug overdose involving loss of consciousness or stopping breathing. In Kohtla-Järve, 28 % (95 % CI 24–31 %) of participants and, in St Petersburg, 16 % (95 % CI 14–19 %) of participants reported an overdose within the previous 12 months. Characteristics of injection drug use practice (longer duration of injection drug use, main drug injected), correlates of high-risk injection behaviour (higher injecting frequency, sharing), and problem alcohol use were associated with the risk of overdose within the previous 12 months. The significant factors effects did not differ between the sites. Conclusions PWID are at high risk for overdose. Effective overdose prevention efforts at the public health scale are therefore warranted.
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Affiliation(s)
- Anneli Uusküla
- Department of Public Health, University of Tartu, Ravila st 19, 50409, Tartu, Estonia.
| | - Mait Raag
- Department of Public Health, University of Tartu, Ravila st 19, 50409, Tartu, Estonia.
| | - Sigrid Vorobjov
- Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
| | - Kristi Rüütel
- Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
| | | | | | - Robert Heimer
- Department of Epidemiology of Microbial Diseases and the Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, 60 College St, New Haven, CT, 06510, USA.
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Burke SE, Calabrese SK, Dovidio JF, Levina OS, Uusküla A, Niccolai LM, Abel-Ollo K, Heimer R. A tale of two cities: stigma and health outcomes among people with HIV who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia. Soc Sci Med 2015; 130:154-61. [PMID: 25703668 DOI: 10.1016/j.socscimed.2015.02.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Experiences of stigma are often associated with negative mental and physical health outcomes. The present work tested the associations between stigma and health-related outcomes among people with HIV who inject drugs in Kohtla-Järve, Estonia and St. Petersburg, Russia. These two cities share some of the highest rates of HIV outside of sub-Saharan Africa, largely driven by injection drug use, but Estonia has implemented harm reduction services more comprehensively. People who inject drugs were recruited using respondent-driven sampling; those who indicated being HIV-positive were included in the present sample (n = 381 in St. Petersburg; n = 288 in Kohtla-Järve). Participants reported their health information and completed measures of internalized HIV stigma, anticipated HIV stigma, internalized drug stigma, and anticipated drug stigma. Participants in both locations indicated similarly high levels of all four forms of stigma. However, stigma variables were more strongly associated with health outcomes in Russia than in Estonia. The St. Petersburg results were consistent with prior work linking stigma and health. Lower barriers to care in Kohtla-Järve may help explain why social stigma was not closely tied to negative health outcomes there. Implications for interventions and health policy are discussed.
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Affiliation(s)
- Sara E Burke
- Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT 06511, United States.
| | - Sarah K Calabrese
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510, United States
| | - John F Dovidio
- Department of Psychology, Yale University, 2 Hillhouse Avenue, New Haven, CT 06511, United States; Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510, United States
| | - Olga S Levina
- NGO of Social Projects in the Sphere of Population Well-being "Stellit," St. Petersburg, Russia
| | - Anneli Uusküla
- Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
| | - Linda M Niccolai
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510, United States
| | - Katri Abel-Ollo
- Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Robert Heimer
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, United States; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510, United States
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13
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Tun W, Sheehy M, Broz D, Okal J, Muraguri N, Raymond HF, Musyoki H, Kim AA, Muthui M, Geibel S. HIV and STI prevalence and injection behaviors among people who inject drugs in Nairobi: results from a 2011 bio-behavioral study using respondent-driven sampling. AIDS Behav 2015; 19 Suppl 1:S24-35. [PMID: 25398417 PMCID: PMC4352193 DOI: 10.1007/s10461-014-0936-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There is a dearth of evidence on injection drug use and associated HIV infections in Kenya. To generate population-based estimates of characteristics and HIV/STI prevalence among people who inject drugs (PWID) in Nairobi, a cross-sectional study was conducted with 269 PWID using respondent-driven sampling. PWID were predominantly male (92.5 %). An estimated 67.3 % engaged in at least one risky injection practice in a typical month. HIV prevalence was 18.7 % (95 % CI 12.3–26.7), while STI prevalence was lower [syphilis: 1.7 % (95 % CI 0.2–6.0); gonorrhea: 1.5 % (95 % CI 0.1–4.9); and Chlamydia: 4.2 % (95 % CI 1.2–7.8)]. HIV infection was associated with being female (aOR, 3.5; p = 0.048), having first injected drugs 5 or more years ago (aOR, 4.3; p = 0.002), and ever having practiced receptive syringe sharing (aOR, 6.2; p = 0.001). Comprehensive harm reduction programs tailored toward PWID and their sex partners must be fully implemented as part of Kenya’s national HIV prevention strategy.
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Affiliation(s)
- Waimar Tun
- HIV and AIDS Program, Population Council, 4301 Connecticut Avenue, NW, Suite 280, Washington, DC, 20008, USA,
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14
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Uusküla A, Des Jarlais DC, Raag M, Pinkerton SD, Feelemyer J. Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: the case of Tallinn, Estonia. AIDS Care 2014; 27:105-11. [PMID: 25054646 DOI: 10.1080/09540121.2014.940271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The study was undertaken to assess the potential effectiveness of combined HIV prevention on the very high seroprevalence epidemic among persons who inject drugs (PWID) in Tallinn, Estonia, a transitional country. Data from community-based cross-sectional (respondent-driven sampling) surveys of PWID in 2005, 2007, 2009, and 2011 were used together with mathematical modeling of injection-associated HIV acquisition to estimate changes in injection-related HIV incidence during these periods. Utilization of one, two, or three of the interventions available in the community (needle and syringes exchange program, antiretroviral treatment [ART], HIV testing, opioid substitution treatment) was reported by 42.5%, 30.5%, and 11.5% of HIV+ and 34.7%, 36.4%, and 5.7% of HIV- PWIDs, respectively, in 2011. The modeling results suggest that the combination of needle/syringe programs and provision of ART to PWID in Tallinn substantially reduced the incidence of HIV infection in this population, from an estimated 20.7/100 person-years in 2005 to 7.5/100 person-years in 2011. In conclusion, combined prevention targeting HIV acquisition and transmission-related risks among PWID in Tallinn has paralleled the downturn of the HIV epidemic in this population.
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Affiliation(s)
- Anneli Uusküla
- a Department of Public Health , University of Tartu , Tartu , Estonia
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15
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Mehrjerdi ZA, Abarashi Z, Noroozi A, Arshad L, Zarghami M. Correlates of shared methamphetamine injection among methamphetamine-injecting treatment seekers: the first report from Iran. Int J STD AIDS 2013; 25:420-7. [PMID: 24287028 DOI: 10.1177/0956462413512806] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shared methamphetamine injection is an emerging route of drug use among Iranian methamphetamine injectors. It is a primary vector for blood-borne infections. The aim of the current study is to determine the prevalence and correlates of shared methamphetamine injection in a sample of Iranian methamphetamine injecting treatment seekers in the south of Tehran. We surveyed male and female methamphetamine injectors at three drop-in centres and 18 drug-use community treatment programmes. Participants reported socio-demographic characteristics, drug use, high-risk behaviours, current status of viral infections and service use for drug treatment. Bivariate and multivariate logistic regression models were used to test associations between participants' characteristics and shared methamphetamine injection. Overall, 209 clients were recruited; 90.9% were male; 52.6% reported current methamphetamine injection without any shared injection behaviour and 47.4% reported current shared methamphetamine injection. Shared methamphetamine injection was found to be primarily associated with living with sex partners (AOR 1.25, 95% CI 1.13-1.98), reporting ≥3 years of dependence on methamphetamine injection (AOR 1.61, 95% CI 1.27-2.12), injection with pre-filled syringes in the past 12 months (AOR 1.96, 95% CI 1.47-2.42), homosexual sex without condom use in the past 12 months (AOR 1.85, 95% CI 1.21-2.25), the paucity of NA group participation in the past 12 months (AOR 0.67, 95% CI 0.41-0.99), the paucity of attending psychotherapeutic sessions in the past 12 months (AOR 0.44, 95% CI 0.28-0.96) and positive hepatitis C status (AOR 1.98, 95% CI 1.67-2.83). Deeper exploration of the relationship between shared methamphetamine injection and sexual risk among Iranian methamphetamine injectors would benefit HIV/sexually transmitted infection prevention efforts. In addition, existing psychosocial interventions for methamphetamine-injecting population may need to be adapted to better meet the risks of shared methamphetamine injectors.
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Affiliation(s)
- Zahra Alam Mehrjerdi
- Program of International Research and Training, National Drug and Alcohol Research Centre, Faculty of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
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16
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Vorobjov S, Des Jarlais DC, Abel-Ollo K, Talu A, Rüütel K, Uusküla A. Socio-demographic factors, health risks and harms associated with early initiation of injection among people who inject drugs in Tallinn, Estonia: evidence from cross-sectional surveys. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:150-5. [PMID: 23036651 PMCID: PMC3566328 DOI: 10.1016/j.drugpo.2012.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/19/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
AIM To explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia. METHODS IDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation. RESULTS A total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (n = 156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity. CONCLUSIONS Our results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs.
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Affiliation(s)
- Sigrid Vorobjov
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
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17
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Risk for Heterosexual HIV Transmission Among Non-Injecting Female Partners of Injection Drug Users in Estonia. AIDS Behav 2013; 17:879-88. [PMID: 22038080 DOI: 10.1007/s10461-011-0078-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The HIV epidemic in Estonia, as with other eastern European countries, is currently concentrated among injection drug users (IDUs). Non-IDUs who have IDU sex partners could serve as a potential bridge in an expanding epidemic. We applied HIV transmission modelling to data collected from non-IDU/IDU heterosexual couples in Kohtla-Järve, Estonia to estimate HIV risk from IDUs to their sex partners based on self-reported sexual behaviors shared by the couple. IDUs and their current main non-injecting sex partners were recruited for an interviewer-administered survey and HIV testing. Bernoulli modelling techniques were applied to estimate the risk of HIV transmission (incidence) among HIV negative non-injecting female partners of male IDUs. The estimated HIV incidence in this population of non-injecting women with only main sexual partners in the last 6 months ranged from 3.24 to 4.94 HIV seroconversions per 100 person years depending on the value used in the models for the per act transmission rate during acute stage infection. Non-IDUs who have IDU sex partners are at high risk for HIV and could serve as a potential bridge to a more generalized epidemic. Whether this might lead to an expansion of the HIV epidemic beyond core groups in Estonia or other Eastern European countries warrants closer study.
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Rüütel K, Parker RD, Sobolev I, Loit HM. Tuberculosis knowledge among injecting drug users visiting syringe exchange programme in Tallinn, Estonia. Cent Eur J Public Health 2013; 20:248-51. [PMID: 23441387 DOI: 10.21101/cejph.a3802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of the current study was to describe tuberculosis (TB) knowledge, beliefs, and experience with TB services among injecting drug users. METHODS Participants for this anonymous, cross-sectional study were recruited from a community based syringe exchange programme in Tallinn, Estonia. A structured questionnaire was completed and included information on socio-demographics, health history, drug use, and knowledge about TB and HIV. RESULTS The study included 407 people (79% male, mean age 27.9 years, mean injection drug use 9.4 years). 32.9% of participants reported HIV infection and 1.7% lifetime history of TB. 26.4% participants (n=106) reported symptoms suggestive of TB. 93% of participants recognized correctly that TB is air-borne infection and 91% that HIV is a risk factor for TB. Only 40% of the participants knew that TB diagnostics and treatment in Estonia are free of charge for everybody and 58% reported they knew where to get health care services in case they suspected that they had TB. TB transmission and treatment adherence knowledge was better among those in contact with either health care or harm reduction services, e.g the community based syringe exchange programme. CONCLUSION Similar to HIV services, TB prevention and education should be integrated into harm reduction and drug treatment programmes to facilitate early diagnosis and treatment of TB among injecting drug users.
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Affiliation(s)
- Kristi Rüütel
- National Institute for Health Development, Tallinn, Estonia.
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19
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Vorobjov S, Uusküla A, Des Jarlais DC, Abel-Ollo K, Talu A, Rüütel K. Multiple routes of drug administration and HIV risk among injecting drug users. J Subst Abuse Treat 2011; 42:413-20. [PMID: 22116012 DOI: 10.1016/j.jsat.2011.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 09/17/2011] [Accepted: 09/21/2011] [Indexed: 10/15/2022]
Abstract
This study assesses relationships between drug administration routes and HIV serostatus, drug use, and sexual behaviors among current injecting drug users (IDUs) in Tallinn, Estonia. We recruited 350 IDUs for a cross-sectional risk behavior survey. Adjusted odds ratios (AORs) were calculated to explore injection risk behavior, sexual behavior, and HIV serostatus associated with multiple route use. Focus groups explored reasons why injectors might use non-injecting routes of administration. Those reporting multiple drug administration routes were less likely to be HIV seropositive (AOR = 0.49, 95% confidence interval [CI] = 0.25-0.97) and had almost twice the odds of having more than one sexual partner (AOR = 1.90, 95% CI = 1.01-3.60) and of reporting having sexually transmitted diseases (AOR = 2.38, 95% CI = 1.02-5.59). IDUs who engage in noninjecting drug use may be reducing their risk of acquiring HIV though sharing injection equipment, but if infected may be a critical group for sexual transmission of HIV to people who do not inject drugs.
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Affiliation(s)
- Sigrid Vorobjov
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
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20
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Gyarmathy VA, Neaigus A. The association between social marginalisation and the injecting of alcohol amongst IDUs in Budapest, Hungary. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:393-7. [PMID: 21764285 DOI: 10.1016/j.drugpo.2011.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 03/21/2011] [Accepted: 05/05/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Alcohol injecting may cause intense irritation, serious vein damage, and additional risks. What little is known about alcohol injecting points to the potential role of social marginalisation. METHODS Injecting drug users (N=215) were recruited between October 2005 and December 2006 in Budapest, Hungary from non-treatment settings. Multivariate logistic regression models identified correlates of lifetime alcohol injecting. RESULTS About a quarter (23%) reported ever injecting alcohol-only 3% reported injecting alcohol in the past 30 days. In multivariate analysis, six variables were statistically significantly associated with ever injecting alcohol: male gender, being homeless, ever sharing cookers or filters and injecting mostly in public places showed a positive association, whilst Roma ethnicity and working at least part time showed a negative association. CONCLUSIONS Our study suggests that alcohol injecting is more of a rare event than a so far undiscovered research and prevention priority. Still, providers of harm reduction services should be aware that alcohol injecting happens, albeit rarely, especially amongst socially marginalised IDUs, who should be counselled about the risks of and discouraged from alcohol injecting.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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21
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Uusküla A, Des Jarlais DC, Kals M, Rüütel K, Abel-Ollo K, Talu A, Sobolev I. Expanded syringe exchange programs and reduced HIV infection among new injection drug users in Tallinn, Estonia. BMC Public Health 2011; 11:517. [PMID: 21718469 PMCID: PMC3146432 DOI: 10.1186/1471-2458-11-517] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 06/30/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Estonia has experienced an HIV epidemic among intravenous drug users (IDUs) with the highest per capita HIV prevalence in Eastern Europe. We assessed the effects of expanded syringe exchange programs (SEP) in the capital city, Tallinn, which has an estimated 10,000 IDUs. METHODS SEP implementation was monitored with data from the Estonian National Institute for Health Development. Respondent driven sampling (RDS) interview surveys with HIV testing were conducted in Tallinn in 2005, 2007 and 2009 (involving 350, 350 and 327 IDUs respectively). HIV incidence among new injectors (those injecting for < = 3 years) was estimated by assuming (1) new injectors were HIV seronegative when they began injecting, and (2) HIV infection occurred at the midpoint between first injection and time of interview. RESULTS SEP increased from 230,000 syringes exchanged in 2005 to 440,000 in 2007 and 770,000 in 2009. In all three surveys, IDUs were predominantly male (80%), ethnic Russians (>80%), and young adults (mean ages 24 to 27 years). The proportion of new injectors decreased significantly over the years (from 21% in 2005 to 12% in 2009, p = 0.005). HIV prevalence among all respondents stabilized at slightly over 50% (54% in 2005, 55% in 2007, 51% in 2009), and decreased among new injectors (34% in 2005, 16% in 2009, p = 0.046). Estimated HIV incidence among new injectors decreased significantly from 18/100 person-years in 2005 and 21/100 person-years in 2007 to 9/100 person-years in 2009 (p = 0.026). CONCLUSIONS In Estonia, a transitional country, a decrease in the HIV prevalence among new injectors and in the numbers of people initiating injection drug use coincided with implementation of large-scale SEPs. Further reductions in HIV transmission among IDUs are still required. Provision of 70 or more syringes per IDU per year may be needed before significant reductions in HIV incidence occur.
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Affiliation(s)
- Anneli Uusküla
- Department of Public health, University of Tartu, Ravila street, 50411 Tartu, Estonia
| | - Don C Des Jarlais
- Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, West 57th Street, New York, NY 10019, USA
| | - Mart Kals
- Department of Public health, University of Tartu, Ravila street, 50411 Tartu, Estonia
| | - Kristi Rüütel
- Department of Infectious Diseases and Drug Prevention, National Institute for Health Development, Hiiu street, 11619 Tallinn, Estonia
| | - Katri Abel-Ollo
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu street, 11619 Tallinn, Estonia
| | - Ave Talu
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu street, 11619 Tallinn, Estonia
| | - Igor Sobolev
- NGO Convictus, Syringe exchange project, Mardi. 10145 Tallinn, Estonia
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Rüütel K, Loit HM, Sepp T, Kliiman K, McNutt LA, Uusküla A. Enhanced tuberculosis case detection among substitution treatment patients: a randomized controlled trial. BMC Res Notes 2011; 4:192. [PMID: 21676222 PMCID: PMC3138461 DOI: 10.1186/1756-0500-4-192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 06/15/2011] [Indexed: 11/21/2022] Open
Abstract
Background Historically, HIV, TB (tuberculosis) and illegal drug treatment services in Estonia have been developed as vertical structures. Related health care services are often provided by different health care institutions and in different locations. This may present obstacles for vulnerable groups, such as injecting drug users (IDU), to access the needed services. We conducted a small scale randomized controlled trial to evaluate a case management intervention aimed at increasing TB screening and treatment entry among IDUs referred from a methadone drug treatment program in Jõhvi, North-Eastern Estonia. Findings Of the 189 potential subjects, 112 (59%) participated. HIV prevalence was 86% (n = 96) and 7.4% (n = 8) of participants were interferon gamma release assay (IGRA) positive (6.5% were both HIV and IGRA-positive, n = 7). Overall, 44% of participants (n = 49) attended TB clinic, 17 (30%) from control group and 32 (57%) from case management group (p = 0.004). None of the participants were diagnosed with TB. In a multivariate model, those randomized to case management group were more likely to access TB screening services. Conclusions These findings demonstrate the urgent need for scaling up TB screening among IDUs and the value of more active approach in referring substitution treatment patients to TB services. Trial registration ClinicalTrials.gov: NCT01290081
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Affiliation(s)
- Kristi Rüütel
- Department of Infectious Diseases and Drug Abuse Prevention, National Institute for Health Development, Tallinn 11619, Estonia.
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Taran YS, Johnston LG, Pohorila NB, Saliuk TO. Correlates of HIV risk among injecting drug users in sixteen Ukrainian cities. AIDS Behav 2011; 15:65-74. [PMID: 20878228 DOI: 10.1007/s10461-010-9817-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present findings from a HIV survey using respondent driven sampling among 3,711 injecting drug users (IDUs) in 16 cities in Ukraine in 2008. Eligible participants were males and females who injected drugs in the past 1 month, ≥ 16 years and lived/worked in their respective interview area. The impact of injecting and sexual risk behaviors on HIV-infection were analyzed using four logistic models. Overall HIV prevalence was 32%. In the sexual risk model, paying for sex in the past 3 months and condom use during last sex increased the odds of HIV infection. Being female, having greater than 3 years of injection drug use, always sharing equipment and using alcohol with drugs in the past month remained significant in all four models. These findings indicate the urgent need to scale up peer education, needle exchange and methadone substitution programs for IDUs with specific programs targeting the needs of female injectors.
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Affiliation(s)
- Yuriy S Taran
- Graduate School for Social Research, Nowy Swiat Street, 72, GSSR, PAN, Warsaw, Poland.
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Arasteh K, Des Jarlais DC. Hazardous drinking and HIV sexual risk behaviors among injection drug users in developing and transitional countries. AIDS Behav 2010; 14:862-9. [PMID: 19023652 DOI: 10.1007/s10461-008-9491-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
Abstract
Studies in North America and Western Europe have reported an association between hazardous drinking and HIV sexual risk behaviors among injection drug users (IDUs). However, we lack such studies from developing and transitional countries, where different cultural norms and contexts of drinking may change this association. We used a multi-site study using standard survey instruments and methods to examine whether hazardous drinking is associated with HIV sexual risk behaviors (defined as unprotected sex and having multiple sex partners) among IDUs in 12 cities across different developing and transitional countries. Data were collected from May 1999 to November 2003. In individual site analyses, hazardous drinking was associated with increased HIV risk behaviors in 10 cities. Mixed effects models of the multi-site data, also, showed an association of hazardous drinking and HIV sexual risk behaviors. These findings in the context of the high prevalence of drinking in many sites point to the importance of addressing alcohol use in HIV education and prevention policy for IDUs.
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Uusküla A, Johnston LG, Raag M, Trummal A, Talu A, Des Jarlais DC. Evaluating recruitment among female sex workers and injecting drug users at risk for HIV using respondent-driven sampling in Estonia. J Urban Health 2010; 87:304-317. [PMID: 20131018 PMCID: PMC2845833 DOI: 10.1007/s11524-009-9427-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 12/11/2009] [Indexed: 10/19/2022]
Abstract
Few recent publications have highlighted theoretical and methodological challenges using respondent-driven sampling (RDS). To explore why recruitment with RDS may work in some populations and not in others, we assess the implementation of RDS to recruit female sex workers (FSWs) and injection drug users (IDUs) into a human immunodeficiency virus biological and risk behavior survey in Tallinn, Estonia. Recruitment of FSWs was slower and more challenging than that of IDUs. The IDU study recruited 350 participants within 7 weeks, while the FSW study recruited 227 participants over 28 weeks. Implementation modifications that did not negatively impact key RDS theoretical and methodological requirements were used to improve recruitment during the FSW study. We recommend that all RDS studies include a formative research process to involve the participation of target populations and key persons associated with these populations in the study planning and throughout the implementation processes to improve recruitment from the outset and to respond to poor recruitment during data collection.
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Affiliation(s)
- Anneli Uusküla
- Department of Public Health, University of Tartu, Ravila 19, Tartu, 50411, Estonia.
| | - Lisa G Johnston
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Mait Raag
- Department of Public Health, University of Tartu, Ravila 19, Tartu, 50411, Estonia
| | - Aire Trummal
- Department of Surveillance and Evaluation, National Institute for Health Development, Tallinn, Estonia
| | - Ave Talu
- Estonian Drug Monitoring Center, National Institute for Health Development, Tallinn, Estonia
| | - Don C Des Jarlais
- Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY, 10003, USA
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Lopes CLR, Teles SA, Espírito-Santo MP, Lampe E, Rodrigues FP, Motta-Castro ARC, Marinho TA, Reis NR, Silva AMC, Martins RMB. Prevalence, risk factors and genotypes of hepatitis C virus infection among drug users, Central-Western Brazil. Rev Saude Publica 2010; 43 Suppl 1:43-50. [PMID: 19669064 DOI: 10.1590/s0034-89102009000800008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 04/30/2009] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To estimate prevalence of hepatitis C virus (HCV) infection and identify risk factors associated and circulating HCV genotypes and subtypes. METHODS Study conducted including 691 drug users attending 26 charitable, private and public drug treatment centers in Goiânia and Campo Grande, central-western Brazil, between 2005 and 2006. Sociodemographic characteristics and risk factors for HCV infection were collected during interviews. Blood samples were tested for HCV antibodies (anti-HCV). Positive samples were submitted to HCV RNA detection by PCR with primers complementary to 5' NC and NS5B regions of viral genome and genotyped by line probe assay (LiPA) and direct nucleotide sequencing followed by phylogenetic analysis. The prevalence and odds ratio were calculated with 95% confidence intervals. Risk factors were first estimated in the univariate analysis (p<0.10) and then analyzed by hierarchical logistic regression. Statistical significance was assessed at a 5% significance level. RESULTS The prevalence of anti-HCV was 6.9% (95% CI: 5.2-9.2). The multivariate analysis of risk factors revealed that age over 30 years and injecting drug use were associated with HCV infection. HCV RNA was detected in 85.4% (41/48) of anti-HCV-positive samples. Thirty-three samples were genotyped as genotype 1 by LiPA, subtypes 1a (63.4%) and 1b (17.1%), and 8 samples (19.5%) were genotype 3, subtype 3a. The phylogenetic analysis of the NS5B region showed that 17 (68%), 5 (20%), and 3 (12%) samples were subtypes 1a, 3a, and 1b, respectively. CONCLUSIONS The results show a high prevalence of HCV infection and predominance of subtype 1a among drug users in Brazil. In addition, injecting drug use was a major risk factor associated with HCV infection.
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Affiliation(s)
- Carmen L R Lopes
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, GO, Brasil
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Reid SR. Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review. Harm Reduct J 2009; 6:24. [PMID: 19715601 PMCID: PMC2741434 DOI: 10.1186/1477-7517-6-24] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 08/28/2009] [Indexed: 12/14/2022] Open
Abstract
The reuse of injecting equipment in clinical settings is well documented in Africa and appears to play a substantial role in generalized HIV epidemics. The U.S. and the WHO have begun to support large scale injection safety interventions, increased professional education and training programs, and the development and wider dissemination of infection control guidelines. Several African governments have also taken steps to control injecting equipment, including banning syringes that can be reused.However injection drug use (IDU), of heroin and stimulants, is a growing risk factor for acquiring HIV in the region. IDU is increasingly common among young adults in sub-Saharan Africa and is associated with high risk sex, thus linking IDU to the already well established and concentrated generalized HIV epidemics in the region. Demand reduction programs based on effective substance use education and drug treatment services are very limited, and imprisonment is more common than access to drug treatment services.Drug policies are still very punitive and there is widespread misunderstanding of and hostility to harm reduction programs e.g. needle exchange programs are almost non-existent in the region. Among injection drug users and among drug treatment patients in Africa, knowledge that needle sharing and syringe reuse transmit HIV is still very limited, in contrast with the more successfully instilled knowledge that HIV is transmitted sexually. These new injection risks will take on increased epidemiological significance over the coming decade and will require much more attention by African nations to the range of effective harm reduction tools now available in Europe, Asia, and North America.
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Affiliation(s)
- Savanna R Reid
- School of Community Health Sciences, University of Nevada at Las Vegas, Las Vegas, NV, USA.
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Vorobjov S, Uusküla A, Abel-Ollo K, Talu A, Rüütel K, Des Jarlais DC. Comparison of injecting drug users who obtain syringes from pharmacies and syringe exchange programs in Tallinn, Estonia. Harm Reduct J 2009; 6:3. [PMID: 19232088 PMCID: PMC2653475 DOI: 10.1186/1477-7517-6-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 02/20/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both syringe exchange programs (SEPs) and pharmacy sales of syringes are available in Estonia, though the current high incidence and high prevalence of HIV among injection drug users (IDUs) in Tallinn, Estonia requires large-scale implementation of additional harm reduction programs as a matter of great urgency. The aims of this report were to compare risk behavior and HIV infection and to assess the prevention needs among IDUs who primarily use pharmacies as their source of sterile syringes with IDUs who primarily use SEPs in Tallinn. METHODS A cross-sectional study using respondent-driven sampling was used to recruit 350 IDUs for an interviewer-administered survey and HIV testing. IDUs were categorized into two groups based on their self-reported main source for syringes within the last six months. Odds ratios with 95% CI were used to compare characteristics and risk factors between the groups. RESULTS The main sources of sterile needles for injection drug users were SEP/SEP outreach (59%) and pharmacies (41%). There were no differences in age, age at injection drug use initiation, the main drug used or experiencing overdoses. Those IDUs using pharmacies as a main source of sterile needles had lower odds for being infected with either HIV (AOR 0.54 95% CI 0.33-0.87) or HCV (AOR 0.10 95% CI 0.02-0.50), had close to twice the odds of reporting more than one sexual partner within the previous 12 months (AOR 1.88 95% CI 1.17-3.04) and engaging in casual sexual relationships (AOR 2.09 95% CI 1.24-3.53) in the last six months. CONCLUSION The data suggest that the pharmacy users were at a less "advanced" stage of their injection career and had lower HIV prevalence than SEP users. This suggests that pharmacies could be utilized as a site for providing additional HIV prevention messages, services for IDUs and in linking IDUs with existing harm reduction services.
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Affiliation(s)
- Sigrid Vorobjov
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
- Estonian Centre of Excellence in Behavioural and Health Sciences, Tiigi 78, 50410 Tartu, Estonia
| | - Anneli Uusküla
- Estonian Centre of Excellence in Behavioural and Health Sciences, Tiigi 78, 50410 Tartu, Estonia
- Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
| | - Katri Abel-Ollo
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Ave Talu
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Kristi Rüütel
- Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
- Department of Infectious Diseases and Drug Prevention, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Don C Des Jarlais
- Chemical Dependency Institute, Beth Israel Medical Center, 160 Water St, New York, NY, 10038 USA
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Oliveira MDLA, Bastos FI, Telles PR, Hacker MDA, Oliveira SAND, Miguel JC, Yoshida CFT. Epidemiological and genetic analyses of Hepatitis C virus transmission among young/short- and long-term injecting drug users from Rio de Janeiro, Brazil. J Clin Virol 2009; 44:200-6. [PMID: 19195927 DOI: 10.1016/j.jcv.2008.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 11/07/2008] [Accepted: 12/18/2008] [Indexed: 02/05/2023]
Abstract
BACKGROUND Injecting drug users (IDU) have a key role in Hepatitis C Virus (HCV) epidemiology. Young/short-term IDUs constitute a target group for preventive/harm reduction interventions. OBJECTIVES To investigate HCV transmission among young/short-term (ST) and long-term (LT) IDUs, from the perspective of epidemiology and molecular biology. STUDY DESIGN Cross-sectional study assessing the prevalence of HCV infection/genotypes, as well as risk behaviours/practices among IDUs from Rio de Janeiro. Phylogenetic analyses were performed and the extent of segregation between sequences was quantified by the Association Index. RESULTS ST were more likely to engage into needle-sharing (p=.021) and LT to attend Needle Exchange Programs (p=.006). HCV prevalence was 10.1% vs. 23.4% among initiates and LT, respectively (p<.001). Older age vs. imprisonment and longer duration of IDU career were independent predictors for HCV infection among ST and LT, respectively. Among the latter, NEP attendance was inversely associated with viral infection. HCV3a infections were the most prevalent. A moderate extent of phylogenetic segregation between sequences was found, suggestive of transmission between IDU subgroups. CONCLUSIONS The lower HCV prevalence among young/short-term IDUs cannot be viewed with complacency, due to their frequent engagement into direct/indirect sharing practices and the ongoing transmission between IDU subsets. To avert new infections, preventive/harm reduction policies must be tailored to empirical findings.
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Trends in HCV prevalence, risk factors and distribution of viral genotypes in injecting drug users: findings from two cross-sectional studies. Epidemiol Infect 2009; 137:970-9. [PMID: 19144250 DOI: 10.1017/s0950268808001970] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In the last decade, a declining prevalence of HCV infection has been described in injecting drug users (IDUs) in different countries. This study is the first to assess temporal trends in drug-injecting patterns, HCV infection rates and viral genotype distribution in 770 Brazilian IDUs, recruited by two cross-sectional studies (1994-1997 and 1999-2001). A substantial decline in the prevalence of HCV infection was found over the years (75% in 1994 vs. 20.6% in 2001, P<0.001) that may be a consequence of the significant reduction in the overall frequencies of drug injection and needle-sharing, as well as the participation of IDUs in initiatives aimed at reducing drug-related harm. No trend was found in terms of viral genotype distribution. Despite the favourable scenario, preventive measures must be maintained, especially in vulnerable subgroups such as young or new injectors, where risky behaviours through direct and indirect sharing practices remain common.
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Increasing prevalence of cocaine as the primary detoxification diagnosis among admissions presenting with current intravenous drug use: a review of detoxification records from northern British Columbia, 1999-2005. Canadian Journal of Public Health 2008. [PMID: 18615936 DOI: 10.1007/bf03405468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to document the trends in drug use among intravenous drug users (IDUs) in northern British Columbia, and to discuss the public health implications. METHOD We conducted a 7-year medical-chart review of all IDU-related admissions (n = 2072) to an inpatient alcohol and drug detoxification centre in Prince George, British Columbia. Primary detoxification diagnosis was modeled onto year of admission using generalized estimating equations (GEE). RESULTS Our study demonstrated an increasing prevalence of cocaine as the primary detoxification diagnosis in IDU-related admissions in northern BC, from 32% of all IDU admissions in 1999 to 64% in 2001, and then a relatively steady elevated rate of approximately 60% between 2001-2005. CONCLUSIONS Given that needle exchange programs and other harm reduction services for IDUs in British Columbia are not readily available in many northern and rural areas, the risks associated with intravenous cocaine use among northern IDUs represent a serious public health challenge. Tailored harm reduction strategies should take into account the prominence of intravenous cocaine use as an HIV risk factor. In areas without well-established intravenous drug use monitoring programs, such as rural and remote areas, detoxification treatment records may serve as important sentinels for changing drug use patterns among IDUs.
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Vicknasingam B, Navaratnam V. The use of rapid assessment methodology to compliment existing national assessment and surveillance data: A study among injecting drug users in Penang, Malaysia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:90-3. [DOI: 10.1016/j.drugpo.2006.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 09/11/2006] [Accepted: 11/03/2006] [Indexed: 10/23/2022]
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Cleland CM, Des Jarlais DC, Perlis TE, Stimson G, Poznyak V. HIV risk behaviors among female IDUs in developing and transitional countries. BMC Public Health 2007; 7:271. [PMID: 17908299 PMCID: PMC2140060 DOI: 10.1186/1471-2458-7-271] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 10/01/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of studies suggest females may be more likely to engage in injection and sex risk behavior than males. Most data on gender differences come from industrialized countries, so data are needed in developing countries to determine how well gender differences generalize to these understudied regions. METHODS Between 1999 and 2003, 2512 male and 672 female current injection drug users (IDUs) were surveyed in ten sites in developing countries around the world (Nairobi, Beijing, Hanoi, Kharkiv, Minsk, St. Petersburg, Bogotá, Gran Rosario, Rio, and Santos). The survey included a variety of questions about demographics, injecting practices and sexual behavior. RESULTS Females were more likely to engage in risk behaviors in the context of a sexual relationship with a primary partner while males were more likely to engage in risk behaviors in the context of close friendships and casual sexual relationships. After controlling for injection frequency, and years injecting, these gender differences were fairly consistent across sites. CONCLUSION Gender differences in risk depend on the relational contexts in which risk behaviors occur. The fact that female and male risk behavior often occurs in different relational contexts suggests that different kinds of prevention interventions which are sensitive to these contexts may be necessary.
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Affiliation(s)
- Charles M Cleland
- Center for Drug Use and HIV Research, National Development and Research Institutes Inc. 71 West 23rd Street, New York, NY 10010, USA
| | - Don C Des Jarlais
- Center for Drug Use and HIV Research, National Development and Research Institutes Inc. 71 West 23rd Street, New York, NY 10010, USA
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 160 Water Street, 24th Floor, New York, NY 10038, USA
| | - Theresa E Perlis
- Center for Drug Use and HIV Research, National Development and Research Institutes Inc. 71 West 23rd Street, New York, NY 10010, USA
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 160 Water Street, 24th Floor, New York, NY 10038, USA
| | - Gerry Stimson
- International Harm Reduction Association; The Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, UK
| | - Vladimir Poznyak
- Department of Mental Health and Substance Dependence, World Health Organization, Geneva, Switzerland
| | - the WHO Phase II Drug Injection Collaborative Study Group
- Professor Moruf Adelekan and Dr Rahim Lawal, University of Ilorin Teaching Hospital, Ilorin – Kwara State, Nigeria; Dr Francisco Inacio Bastos, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Dr Nguyen Tran Hien and Dr Dao Thi Minh An, Hanoi Medical University, Hanoi, Viet Nam; Dr Sylvia Inchaurraga, Universidad Nacional de Rosario, Rosario, Argentina; Dr Don Des Jarlais and Dr Theresa Perlis, National Development and Research Institutes, Inc., New York, USA; Dr Maristela Monteiro, World Health Organization, Geneva, Switzerland; Prof. V. Navaratnam and B. Vicknasingam, Centre for Drug Research, University Sains Malaysia, Malaysia; Dr Augusto Perez Gomez and Dr Ines Elvira Mejia, Programa RUMBOS, Bogotá, Colombia; Dr Fabio Mesquita, Faculdade de Medicina da USP, Santos, Brazil; Dr Sergey Molochko, Minsk City Narcological Dispensary, Minsk, Belarus; Dr Maurice Odek-Ogunde, United States International University, Nairobi, Kenya; Mr Dimitry Ostrovsky, Foundation Vozvrastcheniye, St. Petersburg, Russia; Dr Vladimir Poznyak, World Health Organization, Geneva, Switzerland; Dr Emran Razzaghi and Dr Afarin Rahimi, Iranian Welfare Organization, Teheran, Iran; Professor Gerry Stimson and Mr Chris Fitch, formerly at Imperial College School of Medicine, London, United Kingdom; Dr Olga Balakireva and Dr Marina Varban, Ukrainian Institute for Social Research, Kiev, Ukraine; Prof. Zunyou Wu and Dr Lorraine Yap, Chinese Academy of Preventive Medicine, Beijing, China
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Callaghan RC, Tavares J, Taylor L. Mobility patterns of Aboriginal injection drug users between on- and off-reserve settings in northern British Columbia, Canada. Int J Circumpolar Health 2007; 66:241-7. [PMID: 17655064 DOI: 10.3402/ijch.v66i3.18261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In Canada, public health policymakers and Aboriginal health service leaders have warned that the reciprocal movement of Aboriginal injection drug users (IDUs) between urban and rural settings may serve as a critical vector for the continuing spread of HIV among Aboriginal peoples. The current study aimed to describe the mobility patterns of Aboriginal injection drug users between on- and off-reserve locations in northern British Columbia. STUDY DESIGN Retrospective medical-chart review of inpatient detoxification records. METHODS We employed a medical-chart review of all self-reported Aboriginal IDUs (n = 302) admitted at least twice to an adult inpatient hospital-based substance-abuse detoxification treatment centre between 4 January 1999 and 31 December 2005, and analysed place-of-residence transitions between on- and off-reserve settings. RESULTS Over the course of the 7-year study period, 26% (n = 73) of Aboriginal IDUs changed their primary residence from an off-reserve to an on-reserve location. Almost all (96%, n = 23) of those living on-reserve at their first IDU-related admission had moved to an off-reserve setting at a subsequent visit. CONCLUSIONS The high rates of reciprocal movement between on- and off-reserve locations are a critical public health concern. The results show that the problems associated with both IDU and infectious disease are not limited to urban centres. Our results stand as a clear call for support of Aboriginal-directed, culturally appropriate and accessible services to reduce IDU-related harms. The specifics of such programs are a topic for Aboriginal health care leaders and the communities themselves to discuss, develop and implement.
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Affiliation(s)
- Russell C Callaghan
- Centre for Addiction and Mental Health, Northern Health Authority, Toronto, Ontario, Canada.
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