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Socias ME, Cui Z, Le Foll B, Lei J, Stewart S, Anand R, Jutras-Aswad D. Sexually transmitted and blood-borne infection risk reduction with methadone and buprenorphine/naloxone among people with prescription-type opioid use disorder: Findings from a Canadian pragmatic randomized trial. HIV Med 2024; 25:817-825. [PMID: 38506171 DOI: 10.1111/hiv.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION People who use drugs are disproportionally affected by sexually transmitted and blood-borne infections (STBBIs). While the benefits of methadone in reducing injecting-risk behaviours are well documented, less is known on its impacts on sexual-related risks, as well as its comparative effectiveness to buprenorphine/naloxone, particularly in the context of highly potent opioids. The aim of this study was to estimate the relative effects of buprenorphine/naloxone and methadone on injecting and STBBI risks among people with prescription-type opioid use disorder (POUD). METHODS Secondary analysis of a pan-Canadian pragmatic 24-week randomized clinical trial comparing methadone and buprenorphine/naloxone models of care among 272 people with POUD (including licit or illicit opioid analgesics, fentanyl). The Risk Behaviour Survey was used to collect injecting and sexual risks at baseline, and weeks 12 and 24. RESULTS In total, 210 participants initiated treatment (103 buprenorphine/naloxone and 107 methadone). At baseline, 113/205 (55.1%) participants reported recently injecting drugs, 37/209 (17.7%) unsafe injection practices and 67/162 (41.4%) high-risk sex. Both methadone and buprenorphine/naloxone were associated with reductions in the prevalence of injection drug use and high-risk sex at weeks 12 and 24 with no interactions between treatment arm and time. CONCLUSION Methadone and buprenorphine/naloxone were similarly effective in reducing injecting and sexual risk behaviours among people with POUD. CLINICAL TRIALS REGISTRATION clinicaltrials.gov NCT03033732.
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Affiliation(s)
- M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute and Acute Care Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology & Toxicology, Medical Sciences Building, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jingxin Lei
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Sherry Stewart
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rohan Anand
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Kajaia M, Butsashvili M, DeHovitz JA, Kamkamidze G, Gulbiani L, Abzianidze T, DjibutiMD M. Prevalence and predictors of condom use among people who inject drugs in Georgia. RESEARCH SQUARE 2024:rs.3.rs-4521575. [PMID: 38978572 PMCID: PMC11230473 DOI: 10.21203/rs.3.rs-4521575/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background People who inject drugs (PWID) are more likely to engage in risky sexual behavior placing them at high risk of acquiring HIV and other STIs. This study aims to assess the prevalence and predictors of inconsistent condom use with casual and/or paid sexual partners among PWID in Georgia. Methods Integrated Bio-Behavioral Surveillance Survey was conducted among PWID in seven major cities of Georgia. Study design was cross-sectional with respondent-driven sampling (RDS) methodology. Data collection was carried out through individual face-to-face interviews. In this paper we analysed subsample of 619 PWID who reported having casual and/or paid sexual partners during last 12 months and described prevalence and predictors of consistent condom use. Results Consistent condom use during casual and/or paid sex in past 12 months was reported by 49.4% of respondents. The likelihood of consistent use with casual and/or paid sexual partners was statistically significantly associated with residence, family income, drug use frequency, drug dependance and HIV risk self-perceptions. In multivariate analysis independent predictors of always using condom at casual/paid sex during the last 12 months were place of residence (aOR = 6.4; 95% CI: 3.2-12.7), family income (aOR = 2.1; 95% CI:1.3-3.5) and drug use frequency (aOR = 0.6; 95% CI: 0.4-0.9). Conclusion The study revealed low prevalence of consistent condom use with casual and/or paid sexual partners among PWID in Georgia. Integration of safe sex educational interventions in harm reduction services will improve the rates of condom use among PWID and should focus PWID with lower socio-economic status and residing outside capital city.
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Affiliation(s)
- Maia Kajaia
- Ivane Javakhishvili Tbilisi State University
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3
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Gabriel W, Sazonova Y, Kulchynska R, LaMonaca K, Salyuk T, Smyrnov P, Altice FL. Alcohol Use Disorder and HIV Risk in a National Survey of Men Who Have Sex with Men in Ukraine. Int J Behav Med 2024:10.1007/s12529-024-10272-8. [PMID: 38914921 DOI: 10.1007/s12529-024-10272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Problematic alcohol consumption is associated with risk behaviors associated with HIV transmission. Despite the high prevalence of problematic alcohol consumption in Ukraine, however, there are little empirical data examining its association with risk behaviors also associated with HIV transmission in men who have sex with men (MSM), a key population where HIV incidence is increasing, METHOD: Correlates of prevalent HIV infection and their association between drinking severity levels and behaviors also associated with increased likelihood of HIV acquisition were analyzed from a 2017 nationally representative survey (IBBS) of 4938 MSM in Ukraine using bivariate analyses and multivariate regression. RESULTS Overall, 42.6% of MSM participants met screening criteria for alcohol use disorder (AUD), with 24.2%, 12.0%, and 6.3% meeting criteria for moderate, high, and severe risk of harm from alcohol consumption, respectively. Multivariate regression revealed that these risk categories were correlated with behaviors associated with increased HIV transmission risk, including reports of (1) > 5 sexual partners; (2) sex with a partner of unknown HIV status; (3) sex work; (4) any drug use; and (5) not testing for HIV (past year). HIV testing was infrequent, with only 44.1% having been tested in the previous year. CONCLUSION The high prevalence of problematic alcohol use in Ukrainian MSM and its association with behaviors also associated with HIV transmission supports the importance of routine screening of MSM for AUD. Moreover, among those screening positive for a potential AUD, targeted HIV prevention strategies to scale-up pre-exposure prophylaxis, consistent condom use, and treatment for AUD are needed.
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Affiliation(s)
- Walter Gabriel
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, 06510, USA.
| | - Yana Sazonova
- Monitoring and Evaluation Unit, ICF "Alliance for Public Health", Kiev, Ukraine
| | - Roksolana Kulchynska
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kiev, Ukraine
| | - Katherine LaMonaca
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Tatiana Salyuk
- Monitoring and Evaluation Unit, ICF "Alliance for Public Health", Kiev, Ukraine
| | - Pavlo Smyrnov
- Monitoring and Evaluation Unit, ICF "Alliance for Public Health", Kiev, Ukraine
| | - Frederick L Altice
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, 06510, USA
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4
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Feelemyer JP, Richard E, Khan MR, Scheidell JD, Caniglia EC, Manandhar-Sasaki P, Ban KF, Charles D, Braithwaite RS. Does the Association Between Stimulant use and High Risk Sexual Behavior Vary by Injection Drug Use, Sexual Minority Status, or HIV Infection Status? A Meta-analysis. AIDS Behav 2023; 27:2883-2890. [PMID: 36786937 PMCID: PMC10423740 DOI: 10.1007/s10461-023-04012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
There is strong evidence linking stimulant use, namely methamphetamine use, to sexual risk behavior among sexual minority men (SMM); we do not, however, have a good understanding of this relationship among other at-risk populations. In this study, we systematically reviewed associations between stimulant use (i.e., methamphetamine, crack cocaine, cocaine) and sexual risk behaviors among populations facing elevated risk of HIV transmission and acquisition (i.e., SMM, people who inject drugs (PWID), and people living with HIV/AIDS (PLWH)). Random-effects meta-analyses and sensitivity analyses that included crude and adjusted estimates separately were conducted to evaluate the impact of potential confounding variables. The results showed strong relationships between stimulant use and condomless sex, transactional sex, and multiple sexual partners. Results were broadly consistent when analyses were stratified by type of stimulant (methamphetamine, crack cocaine, and other stimulants) and risk group. Sensitivity analyses with confounding variables did not greatly impact results. The results indicate that stimulant use is associated with numerous sexual risk behaviors regardless of risk group, suggesting prevention efforts focused on reducing methamphetamine-related HIV risk should target a range of at-risk populations.
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Affiliation(s)
- Jonathan P Feelemyer
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA.
| | | | - Maria R Khan
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Joy D Scheidell
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Ellen C Caniglia
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Prima Manandhar-Sasaki
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Kaoon Francois Ban
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Dyanna Charles
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
| | - Ronald Scott Braithwaite
- Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA
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Wiginton JM, Booth R, Eaton LA, Smith LR, da Silva CE, Patterson TL, Pitpitan EV. Injection Drug Use and Sexual Risk Behaviors Among People who Inject Drugs in Ukraine: A Random-Intercept Latent Transition Analysis. AIDS Behav 2023; 27:3012-3026. [PMID: 36929321 PMCID: PMC10019801 DOI: 10.1007/s10461-023-04024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
HIV transmission in Ukraine is driven in part by unsafe injection drug use and sexual risk behaviors among people who inject drugs. We performed a random-intercept latent transition analysis on responses to 9 binary injection drug use and sexual behavior items from 1195 people who inject drugs with negative HIV status enrolled in a clustered randomized clinical trial of a social network intervention in Odessa, Donetsk, and Nikolayev, Ukraine. We identified 5 baseline classes: "Social injection/equipment-sharing" (11.7%), "Social injection" (25.9%), "High-risk collective preparation/splitting" (17.0%), "Collective preparation/splitting" (11.3%), and "Dealer-facilitated injection" (34.1%). After 12 months, intervention participants were more likely to transition to the "Collective preparation/splitting" class, which featured the fewest risk behaviors. Transitioning from the "Collective preparation/splitting" to the "Social injection/equipment-sharing" class was associated with HIV acquisition for control participants. Research to illuminate the stability of these patterns and how they may benefit from uniquely tailored programming to reduce unsafe behaviors is needed.
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Affiliation(s)
- John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, La Jolla, CA USA
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA USA
| | - Robert Booth
- Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place, Fitzsimons Building, 2nd Floor, Suite C2000, Aurora, CO 80045 USA
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Family Studies Building, Storrs, CT 06279 USA
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Cristina Espinosa da Silva
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
- Department of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA USA
| | - Thomas L. Patterson
- Departments of Medicine and Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Eileen V. Pitpitan
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182 USA
- Department of Medicine, University of California-San Diego, La Jolla, CA USA
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Davis A, Mergenova G, Landers SE, Sun Y, Rozental E, Gulyaev V, Gulyaev P, Nurkatova M, Terlikbayeva A, Primbetova S, Altice FL, Remien RH. Implementation of a Dyad-Based Intervention to Improve Antiretroviral Therapy Adherence Among HIV-Positive People Who Inject Drugs in Kazakhstan: A Randomized Trial. RESEARCH ON SOCIAL WORK PRACTICE 2023; 33:313-324. [PMID: 37576461 PMCID: PMC10421639 DOI: 10.1177/10497315221117543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose HIV-positive people who inject drugs (PWID) in Kazakhstan face many challenges to antiretroviral therapy (ART) adherence. Interventions that leverage social support from an intimate partner, family member, or friend may be effective in improving ART adherence among this population. The purpose of this paper is to describe the implementation process of a dyad-based intervention among HIV-positive PWID and their treatment support partners. Method Sixty-six HIV-positive PWID and 66 of their treatment support partners will be enrolled in this pilot randomized controlled trial in Almaty, Kazakhstan, and randomized as dyads to receive an adapted version of the SMART Couples intervention or standard of care. Results Several implementation strategies were used to facilitate intervention delivery, including remote delivery, training of staff, supervision, technical assistance, quality assurance, and collection of assessments through diverse sources. Discussion This trial responds to a need for dyad-based ART adherence interventions adapted specifically for HIV-positive PWID.
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Affiliation(s)
- Alissa Davis
- School of Social Work, Columbia University, New York, United States
| | | | - Sara E. Landers
- School of Social Work, Columbia University, New York, United States
| | - Yihang Sun
- School of Social Work, Columbia University, New York, United States
| | - Elena Rozental
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Valera Gulyaev
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Pavel Gulyaev
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Mira Nurkatova
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | | | - Frederick L. Altice
- School of Medicine and School of Public Health, Yale University, New Haven, United States
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Institute, New York, United States
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Jarlais DD, Bobashev G, Feelemyer J, McKnight C. Modeling HIV transmission among persons who inject drugs (PWID) at the "End of the HIV Epidemic" and during the COVID-19 pandemic. Drug Alcohol Depend 2022; 238:109573. [PMID: 35926301 PMCID: PMC9278993 DOI: 10.1016/j.drugalcdep.2022.109573] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/30/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We explore injecting risk and HIV incidence among PWID in New York City (NYC), from 2012 to 2019, when incidence was extremely low, <0.1/100 person-years at risk, and during disruption of prevention services due to the COVID-19 pandemic. METHODS We developed an Agent-Based model (ABM) to simulate sharing injecting equipment and measure HIV incidence in NYC. The model was adapted from a previous ABM model developed to compare HIV transmission with "high" versus "low" dead space syringes. Data for applying the model to NYC during the period of very low HIV incidence was taken from the "Risk Factors" study, a long-running study of participants entering substance use treatment in NYC. Injecting risk behavior had not been eliminated in this population, with approximately 15 % reported recent syringe sharing. Data for possible transmission during COVID-19 disruption was taken from previous HIV outbreaks and early studies of the pandemic in NYC. RESULTS The modeled incidence rates fell within the 95 % confidence bounds of all of the empirically observed incidence rates, without any additional calibration of the model. Potential COVID-19 disruptions increased the probability of an outbreak from 0.03 to 0.25. CONCLUSIONS The primary factors in the very low HIV incidence were the extremely small numbers of PWID likely to transmit HIV and that most sharing occurs within small, relatively stable, mostly seroconcordant groups. Containing an HIV outbreak among PWID during a continuing pandemic would be quite difficult. Pre-pandemic levels of HIV prevention services should be restored as quickly as feasible.
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Affiliation(s)
- Don Des Jarlais
- School of Global Public Health, New York University, New York, NY, USA.
| | | | | | - Courtney McKnight
- School of Global Public Health, New York University, New York, NY, USA
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Social and structural determinants of health associated with police violence victimization: A latent class analysis of female sex workers who use drugs in Kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103750. [PMID: 35667193 PMCID: PMC10024805 DOI: 10.1016/j.drugpo.2022.103750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Punitive legal environments remain a challenge to HIV prevention efforts in Central Asia, and female sex workers who use drugs are vulnerable to police violence. Little is known about the heterogeneity of police violence against female sex workers who use drugs and factors associated with HIV risk in Central Asia, despite the growing HIV epidemic. METHODS We recruited a community-based sample of 255 female sex workers who use drugs in Almaty, Kazakhstan between February 2015 and May 2017. We used latent class analysis to differentiate women into distinct classes of police violence victimization, and multinomial logistic regression to identify individual-level health outcomes, HIV risk behaviors, and social and structural factors within the risk environment associated with class membership. RESULTS A three-class model emerged: Low Victimization (51%), Discrimination and Extortion (15%), and Poly-Victimization (34%). Relative to Low Victimization, factors associated with Poly-Victimization included being positive for HIV and/or sexually-transmitted infections (STI) (aOR: 1.78 (95% CI: 1.01, 3.14)), prior tuberculosis diagnosis (2.73 (1.15, 6.50)), injection drug use (IDU) (2.00 (1.12, 3.58)), greater number of unsafe IDU behaviors (1.21 (1.08, 1.35)), homelessness (1.92 (1.06, 3.48)), greater drug use (1.22 (1.07, 1.39)) and sex work stigma (1.23 (1.06, 1.43)), greater number of sex work clients (2.40 (1.33, 4.31)), working for a boss/pimp (2.74 (1.16, 6.50)), client violence (2.99 (1.65, 5.42)), economic incentives for condomless sex (2.77 (1.42, 5.41)), accessing needle/syringe exchange programs (3.47 (1.42, 8.50)), recent arrest (2.99 (1.36, 6.55)) and detention (2.93 (1.62, 5.30)), and negative police perceptions (8.28 (4.20, 16.3)). Compared to Low Violence, Discrimination and Extortion was associated with lower odds of experiencing intimate partner violence (aOR= 0.26 (0.12, 0.59)), but no other significant associations with the risk environment upon adjusting for socio-demographic characteristics. CONCLUSION Police violence against female sex workers who use drugs is pervasive in Kazakhstan. Patterns of police violence vary, with greater HIV susceptibility associated with a higher probability of experiencing multiple forms of police violence. Police sensitization workshops that integrate policing and harm reduction, and drug policy reforms that decriminalize drug use may help mitigate the HIV epidemic in Kazakhstan.
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El-Bassel N, Mukherjee TI, Stoicescu C, Starbird LE, Stockman JK, Frye V, Gilbert L. Intertwined epidemics: progress, gaps, and opportunities to address intimate partner violence and HIV among key populations of women. Lancet HIV 2022; 9:e202-e213. [PMID: 35151376 PMCID: PMC10009883 DOI: 10.1016/s2352-3018(21)00325-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
Abstract
The intersection of intimate partner violence and HIV is a public health problem, particularly among key populations of women, including female sex workers, women who use drugs, and transgender women, and adolescent girls and young women (aged 15-24 years). Intimate partner violence results in greater risk of HIV acquisition and creates barriers to HIV prevention, testing, treatment, and care for key populations of women. Socioecological models can be used to explain the unique multilevel mechanisms linking intimate partner violence and HIV. Few interventions, modelling studies, and economic evaluations that concurrently address both intimate partner violence and HIV exist, with no interventions tailored for transgender populations. Most combination interventions target individual-level risk factors, and rarely consider community or structural factors, or evaluate cost-efficacy. Addressing intimate partner violence is crucial to ending the HIV epidemic; this Review highlights the gaps and opportunities for future research to address the intertwined epidemics of intimate partner violence and HIV among key populations of women.
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Affiliation(s)
| | - Trena I Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Claudia Stoicescu
- School of Social Work, Columbia University, New York, NY, USA; Centre for Criminology, Oxford Law Faculty, University of Oxford, Oxford, UK; Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Laura E Starbird
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Victoria Frye
- School of Medicine, The City University of New York, New York, NY, USA
| | - Louisa Gilbert
- School of Social Work, Columbia University, New York, NY, USA
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Jain JP, Abramovitz D, Strathdee SA, Gonzalez-Zuniga P, Rangel G, West BS, Pitpitan EV. Sex Work as a Mediator Between Female Gender and Incident HIV Infection Among People Who Inject Drugs in Tijuana, Mexico. AIDS Behav 2020; 24:2720-2731. [PMID: 32185596 PMCID: PMC7453791 DOI: 10.1007/s10461-020-02828-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We studied mechanisms driving gender differences in HIV incidence among 651 women and men who inject drugs (PWID) in Tijuana, Mexico, hypothesizing that sex work will mediate the association between female gender and HIV incidence. Of 43 HIV seroconversions occurring between 2011 and 2018, 8.8% were among females and 5.2% among males. HIV incidence density was significantly higher among females versus males (1.75 per 100 person years [PY], 95% CI 1.16-2.66, vs. 0.95 per 100 PY, 95% CI 0.62-1.47). Factors significantly associated with HIV seroconversion were: sex work (adjusted hazard ratio [aHR] = 2.25, 95% CI 1.05-4.80); methamphetamine injection (aHR = 2.30, 95% CI 1.12-4.73); and methamphetamine and heroin co-injection in the past six months (aHR = 2.26, 95% CI 1.23-4.15). In mediation analyses, sex work mediated a substantial proportion (84.3%) of the association between female gender and HIV incidence. Interventions should target female PWID who engage in sex work to reduce gender-related disparities in HIV incidence.
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Affiliation(s)
- Jennifer P Jain
- School of Medicine, University of California, San Diego, La Jolla, USA.
- School of Medicine, University of California, San Francisco, San Francisco, USA.
| | | | | | | | - Gudelia Rangel
- United States-Mexico Border Health Commission and El Colegio de la Frontera Norte, Tijuana, Mexico
- El Colegio de La Frontera Norte, Tijuana, Mexico
| | - Brooke S West
- School of Social Work, Columbia University, New York, United States
| | - Eileen V Pitpitan
- School of Medicine, University of California, San Diego, La Jolla, USA
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Rahmalia A, Pohan MN, Wisaksana R, Laga M, Peeters Grietens K. "No good man will ever want me". How structural social inequality increases women's vulnerability to HIV transmission: a qualitative study from Bandung, Indonesia. AIDS Care 2020; 33:1016-1023. [PMID: 32748628 DOI: 10.1080/09540121.2020.1801980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Understanding the pathways that expose women to HIV transmission are vital in improving HIV prevention, especially among a "hidden" group of women without pre-established known risk for HIV. We investigated the pathways which place certain women at greater risk for HIV in a qualitative exploratory study with theoretical sampling using an emergent theory study design in an urban setting in Indonesia. We conducted semi-structured interviews with 47 HIV-infected women, one focus group discussion with five young women who occassionally engage in sex work, participant observation at six sex work venues and two midwife clinics, and 11 informal interviews with midwives, nurses, and obstetricians. Our research found that many women not characterized as belonging to a "high-risk group" or "key population" were nevertheless at increased risk for HIV. A history of sexual abuse, premarital sex, divorce, or involvement in sex work, often precipitated by poverty coupled with discriminatory public health policies further heightened women's exposure to HIV. While reaching at-risk populations is a key strategy in HIV prevention, a novel and more tailored approach is needed to reach more hidden categories of women with less apparent risk behavior yet considerable risk for HIV infection.
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Affiliation(s)
- Annisa Rahmalia
- Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,Infectious Diseases and Global Health, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mawar Nita Pohan
- Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Rudi Wisaksana
- Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koen Peeters Grietens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Fearnhill E, Gourlay A, Malyuta R, Simmons R, Ferns RB, Grant P, Nastouli E, Karnets I, Murphy G, Medoeva A, Kruglov Y, Yurchenko A, Porter K. A Phylogenetic Analysis of Human Immunodeficiency Virus Type 1 Sequences in Kiev: Findings Among Key Populations. Clin Infect Dis 2019; 65:1127-1135. [PMID: 28575385 DOI: 10.1093/cid/cix499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/24/2017] [Indexed: 12/15/2022] Open
Abstract
Background The human immunodeficiency virus (HIV) epidemic in Ukraine has been driven by a rapid rise among people who inject drugs, but recent studies have shown an increase through sexual transmission. Methods Protease and reverse transcriptase sequences from 876 new HIV diagnoses (April 2013-March 2015) in Kiev were linked to demographic data. We constructed phylogenetic trees for 794 subtype A1 and 64 subtype B sequences and identified factors associated with transmission clustering. Clusters were defined as ≥2 sequences, ≥80% local branch support, and maximum genetic distance of all sequence pairs in the cluster ≤2.5%. Recent infection was determined through the limiting antigen avidity enzyme immunoassay. Sequences were analyzed for transmitted drug resistance mutations. Results Thirty percent of subtype A1 and 66% of subtype B sequences clustered. Large clusters (maximum 11 sequences) contained mixed risk groups. In univariate analysis, clustering was significantly associated with subtype B compared to A1 (odds ratio [OR], 4.38 [95% confidence interval {CI}, 2.56-7.50]); risk group (OR, 5.65 [95% CI, 3.27-9.75]) for men who have sex with men compared to heterosexual males; recent, compared to long-standing, infection (OR, 2.72 [95% CI, 1.64-4.52]); reported sex work contact (OR, 1.93 [95% CI, 1.07-3.47]); and younger age groups compared with age ≥36 years (OR, 1.83 [95% CI, 1.10-3.05] for age ≤25 years). Females were associated with lower odds of clustering than heterosexual males (OR, 0.49 [95% CI, .31-.77]). In multivariate analysis, risk group, subtype, and age group were independently associated with clustering (P < .001, P = .007, and P = .033, respectively). Eighteen sequences (2.1%) indicated evidence of transmitted drug resistance. Conclusions Our findings suggest high levels of transmission and bridging between risk groups.
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Affiliation(s)
| | | | - Ruslan Malyuta
- Perinatal Prevention of AIDS Initiative, Odessa, Ukraine
| | | | | | - Paul Grant
- University College London Hospital NHS Foundation Trust, United Kingdom
| | - Eleni Nastouli
- University College London, United Kingdom.,Perinatal Prevention of AIDS Initiative, Odessa, Ukraine
| | | | - Gary Murphy
- Public Health England, London, United Kingdom; and
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Serodiscordant partnerships and opportunities for pre-exposure prophylaxis among partners of women and men living with HIV in St. Petersburg, Russia. PLoS One 2018; 13:e0207402. [PMID: 30444903 PMCID: PMC6239322 DOI: 10.1371/journal.pone.0207402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/30/2018] [Indexed: 12/17/2022] Open
Abstract
Objective To describe the frequency of being partnered and having an HIV-negative partner, and whether this differed by gender, among a cohort of persons living with HIV (PLWH) who have ever injected drugs; to describe awareness of HIV pre-exposure prophylaxis (PrEP) and perceived partner interest in PrEP. Setting Secondary analyses of an observational cohort study of PLWH who have ever injected drugs in St. Petersburg, Russia. Methods Primary outcomes were 1) being partnered and 2) being in a serodiscordant partnership. The main independent variable was gender. Multivariable GEE logistic regression models were fit for binary outcomes, adjusted for age, income, education, and recent opioid use. Descriptive analyses were performed for partners’ HIV status, substance use, sex risk behaviors, and awareness of PrEP for a subset of participants. Results At baseline, 50% (147/296) reported being in a partnership, and of those, 35% were in a serodiscordant partnership. After adjustment, women had significantly higher odds of being partnered compared to men (aOR = 3.12; 95% CI: 1.77, 5.51), but there were no significant gender differences in the odds of being in a serodiscordant partnership (aOR = 0.58; 95% CI: 0.27, 1.24). Among a sub-sample of participants queried (n = 56), 25% were aware of PrEP for prevention of sexual HIV transmission and 14% for prevention of injection-related transmission. Conclusion Although half of our sample were partnered and one third of these partnerships were serodiscordant, PrEP awareness was low. Substantial opportunities for HIV prevention exist among PLWH who have ever injected drugs in Russia and their HIV-negative partners. Given the high proportion of HIV-negative partners among this ART-naïve sample, efforts to address the associated inherent risks, such as couples-based interventions, are needed to increase condom use, PrEP awareness, or uptake of other HIV-prevention modalities (e.g., ART for the HIV-positive partner).
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Sopheab H, Chhea C, Tuot S, Muir JA. HIV prevalence, related risk behaviors, and correlates of HIV infection among people who use drugs in Cambodia. BMC Infect Dis 2018; 18:562. [PMID: 30424727 PMCID: PMC6234604 DOI: 10.1186/s12879-018-3472-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 10/31/2018] [Indexed: 11/30/2022] Open
Abstract
Background Although HIV prevalence in Cambodia has declined to 0.6% among the general population, the prevalence remains high among female sex workers (14.0%) and men who have sex with men (2.3%). Over the past 10 years, the number of people who use drugs (PWUDs) has increased considerably. PWUDs, especially people who inject drugs (PWIDs), who have multiple sex partners or unprotected sex contribute to a higher HIV prevalence. This paper aims to estimate the prevalence of HIV across PWUD groups and to identify factors associated with HIV infection. Methods Respondent-driven sampling (RDS) was used to recruit 1626 consenting PWUDs in 9 provinces in 2012. Questionnaires and blood specimens were collected. HIV prevalence estimates were calculated using RDSAT 7.1. Individual weightings for HIV were generated with RDSAT and used for a weighted analysis in STATA 13. Multivariate logistic regression was used to identify the independent factors associated with HIV prevalence. Results Most of the PWUDs were men (82.0%), and 7.3% were PWIDs. Non-PWIDs, especially users of amphetamine-type stimulants (ATS), represented the larger proportion of the participants (81.5%). The median age for of the PWUDs was 24.0 years (IQR: 20–29). The HIV prevalence among the PWUDs was 5.1% (95% CI: 4.1–6.2), 24.8%, among PWIDs and 4.0% among non-PWIDs. The HIV prevalence among female PWIDs was 37.5, and 22.5% among male PWIDs. Four factors were independently associated with HIV infection: female sex, with AOR = 7.8 (95% CI: 3.00–20.35); age groups 21–29 and older (AOR = 10.3, 95% CI: 1.2–20.4); and using drugs for ≥12 months (AOR = 4.0, 95% CI: 1.38–11.35). Finally, injecting drugs remained a strong predictor of HIV infection, with an AOR = 4.1 (95% CI: 1.53–10.96). Conclusion HIV prevalence remains high among PWIDs. Harm reduction efforts, such as needle and syringe provision programs, must improve their coverage. Innovative strategies are needed to reach sub-groups of PWUDs, especially women who inject drugs. Furthermore, the large proportion of non-PWIDs, especially ATS users, should not be ignored. Therefore, combined HIV prevention and harm reduction programs should integrate ATS users.
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Affiliation(s)
- Heng Sopheab
- School of Public Health at the National Institute of Public Health, Lot #80, Samdech Penn Nouth Blvd. Tuol Kork District, Phnom Penh, Cambodia.
| | - Chhorvann Chhea
- School of Public Health at the National Institute of Public Health, Lot #80, Samdech Penn Nouth Blvd. Tuol Kork District, Phnom Penh, Cambodia
| | - Sovannary Tuot
- Center for Population and Health Research, KHANA, Phnom Penh, Cambodia
| | - Jonathan A Muir
- Department of Epidemiology, University of Washington, Seattle, USA
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15
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Jarlais DCD, McKnight C, Feelemyer J, Arasteh K, Tross S, Campbell AN, Cooper HL, Perlman DC. Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001-2005 and 2011-2015. Drug Alcohol Depend 2018; 185:391-397. [PMID: 29549851 PMCID: PMC6584620 DOI: 10.1016/j.drugalcdep.2017.12.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 12/03/2017] [Accepted: 12/03/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND We examined whether sex disparities (heterosexual male:female) in HIV infection continue to persist at the "end of the HIV epidemic" among persons who inject drugs (PWID) in New York City (NYC). An "end of the epidemic" was operationally defined as 1) prevalence of untreated HIV infection <5%, and 2) estimated HIV incidence <0.5/100 person-years. METHODS PWID were recruited from persons entering substance use treatment programs at Mount Sinai Beth Israel in 2001-2005 and 2011-2015. A structured interview was administered, and HIV and HSV-2 testing was conducted. Incidence was estimated using newly diagnosed cases of HIV. Disparity analyses compared prevalence of HIV, of untreated HIV, HIV risk behaviors, and estimated HIV incidence. RESULTS By 2011-2015, both heterosexual male and female PWID met the two criteria for an "end of the epidemic," and there were no significant differences in the prevalence of untreated HIV infection. A large sex difference remained in estimated HIV incidence. In 2013-2015, estimated HIV incidence was 2.8/10,000 PY for males and 7.1/10,000 PY for females. Females had greater risk for HIV on several factors. CONCLUSION While NYC has reached an "end of the epidemic" for both heterosexual male and female PWID, sex disparities persist, particularly differences in HIV incidence. Eliminating the sex disparities may require a greater focus on factors associated with sexual transmission.
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Affiliation(s)
- Don C. Des Jarlais
- Icahn School of Medicine at Mount Sinai, New York, NY, United States,Corresponding author at: The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, 39 Broadway 5th Floor Suite 530, New York, NY, 10006, United States., (D.C. Des Jarlais)
| | - Courtney McKnight
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Kamyar Arasteh
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Susan Tross
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Aimee N.C. Campbell
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Hannah L.F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - David C. Perlman
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Molecular epidemiology reveals the role of war in the spread of HIV in Ukraine. Proc Natl Acad Sci U S A 2018; 115:1051-1056. [PMID: 29339468 DOI: 10.1073/pnas.1701447115] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Ukraine has one of the largest HIV epidemics in Europe, historically driven by people who inject drugs (PWID). The epidemic showed signs of stabilization in 2012, but the recent war in eastern Ukraine may be reigniting virus spread. We investigated the movement of HIV-infected people within Ukraine before and during the conflict. We analyzed HIV-1 subtype-A pol nucleotide sequences sampled during 2012-2015 from 427 patients of 24 regional AIDS centers and used phylogeographic analysis to reconstruct virus movement among different locations in Ukraine. We then tested for correlations between reported PWID behaviors and reconstructed patterns of virus spread. Our analyses suggest that Donetsk and Lugansk, two cities not controlled by the Ukrainian government in eastern Ukraine, were significant exporters of the virus to the rest of the country. Additional analyses showed that viral dissemination within the country changed after 2013. Spearman correlation analysis showed that incoming virus flow was correlated with the number of HIV-infected internally displaced people. Additionally, there was a correlation between more intensive virus movement and locations with a higher proportion of PWID practicing risky sexual behaviors. Our findings suggest that effective prevention responses should involve internally displaced people and people who frequently travel to war-affected regions. Scale-up of harm reduction services for PWID will be an important factor in preventing new local HIV outbreaks in Ukraine.
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Heath AJ, Kerr T, Ti L, Kaplan K, Suwannawong P, Wood E, Hayashi K. Healthcare avoidance by people who inject drugs in Bangkok, Thailand. J Public Health (Oxf) 2016; 38:e301-e308. [PMID: 26491067 PMCID: PMC5072167 DOI: 10.1093/pubmed/fdv143] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although people who inject drugs (IDU) often contend with various health-related harms, timely access to health care among this population remains low. We sought to identify specific individual, social and structural factors constraining healthcare access among IDU in Bangkok, Thailand. METHODS Data were derived from a community-recruited sample of IDU participating in the Mitsampan Community Research Project between July and October 2011. We assessed the prevalence and correlates of healthcare avoidance due to one's drug use using multivariate logistic regression. RESULTS Among 437 participants, 112 (25.6%) reported avoiding health care because they were IDU. In multivariate analyses, factors independently associated with avoiding health care included having ever been drug tested by police [adjusted odds ratio (AOR) = 1.80], experienced verbal abuse (AOR = 3.15), been discouraged from engaging in usual family activities (AOR = 3.27), been refused medical care (AOR = 10.90), experienced any barriers to health care (AOR = 4.87) and received healthcare information and support at a drop-in centre (AOR = 1.92) (all P < 0.05). CONCLUSIONS These findings highlight the need to address the broader policy environment, which perpetuates the criminalization and stigmatization of IDU, and to expand peer-based interventions to facilitate access to health care for IDU in this setting.
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Affiliation(s)
- A J Heath
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada V6T 1Z3
| | - T Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6
| | - L Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6
| | - K Kaplan
- Treatment Action Group, New York, NH 10016-7701, USA
| | - P Suwannawong
- Thai AIDS Treatment Action Group, Bangkok 10900, Thailand
| | - E Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6
| | - K Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6
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Rahmalia A, Wisaksana R, Meijerink H, Indrati AR, Alisjahbana B, Roeleveld N, van der Ven AJAM, Laga M, van Crevel R. Women with HIV in Indonesia: are they bridging a concentrated epidemic to the wider community? BMC Res Notes 2015; 8:757. [PMID: 26645634 PMCID: PMC4673839 DOI: 10.1186/s13104-015-1748-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/25/2015] [Indexed: 11/22/2022] Open
Abstract
Background Male injecting drug users drove the onset of the HIV epidemic in Indonesia but over time more women have been diagnosed. We examined the relative proportion of female patients in an HIV cohort and characterized their probable transmission route and reproductive profile. Designs Prospective cohort study in a referral hospital in West Java. Methods Interviews with standardized questionnaires, physical and laboratory examinations were done for 2622 individuals enrolled in HIV care between 2007 and 2012. The proportion of women in this cohort was compared with national estimates. The general characteristics of HIV-infected women and men as well as the sexual and reproductive health of HIV-infected women were described. Results The proportion of female patients enrolled in HIV care increased from 22.2 % in 2007 to 38.3 % in 2012, in line with national estimates. Women were younger than men, fewer reported a history of IDU (16.1 vs. 73.8 %, p < 0.001) and more were tested for HIV because of a positive partner (25.5 vs. 4.0 %, p < 0.001). The majority of women were in their reproductive age, had children, and were not using contraceptives at the time of enrolment. Conclusion HIV-infected women in Indonesia have specific characteristics that differ them from women in the general population. Further research to elucidate the characteristics of women exposed to HIV, their access to testing and care and sexual and reproductive needs can help reduce transmission to women and children in the context of concentrated HIV epidemic in Indonesia.
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Affiliation(s)
- Annisa Rahmalia
- Tuberculosis and HIV Research Centre, Faculty of Medicine Universitas Padjadjaran, Jl. Dr. Eijkman No. 38, Bandung, 40161, Indonesia. .,Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Rudi Wisaksana
- Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
| | - Hinta Meijerink
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Agnes R Indrati
- Department of Clinical Pathology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
| | - Bachti Alisjahbana
- Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
| | - Nel Roeleveld
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands. .,Department of Paediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Andre J A M van der Ven
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Crofts N, Azim T. Harm reduction in Asia and the Pacific: an evolving public health response. Harm Reduct J 2015; 12:47. [PMID: 26471163 PMCID: PMC4608147 DOI: 10.1186/s12954-015-0074-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/12/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nick Crofts
- Centre for Law Enforcement and Public Health, 309 George St, Doncaster, Vic, 3108, Australia.
| | - Tasnim Azim
- icddr,b, GPO Box 128, Dhaka, 1000, Bangladesh
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Kermode M, Armstrong G, Medhi GK, Humtsoe C, Langkham B, Mahanta J. Sexual behaviours of men who inject drugs in northeast India. Harm Reduct J 2015; 12:4. [PMID: 25889291 PMCID: PMC4352564 DOI: 10.1186/s12954-015-0038-1] [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: 08/31/2014] [Accepted: 01/20/2015] [Indexed: 11/23/2022] Open
Abstract
Background Promoting safer sex behaviours among people who inject drugs is important as drug-using populations with high HIV prevalence can contribute to transition from a concentrated to a generalised epidemic. This study describes the sexual behaviours of men who inject drugs in two Northeast Indian states (Manipur and Nagaland) where HIV prevalence is high, with a focus on the HIV risks for their regular female sexual partners. Methods Data were obtained from two cross-sectional surveys combined (N = 3,362)—both conducted in 2009 using respondent-driven sampling to recruit men who injected drugs. Both surveys asked about demographics, drug use, sexual and injecting risk behaviours, and interventions. One survey tested participants for HIV and syphilis. Statistical analyses included logistic regression modelling to predict inconsistent condom use with regular sexual partners. Results Two thirds of participants (68.2%) had a regular female sexual partner. Of these, 78.4% had sex with their regular partner in the last month, on average five times. Only 10.7% reported consistent condom use with regular partners. Unsafe injecting was common among men with regular partners, and 40.2% had more than one sexual partner in the last year. Half of those with regular partners (51.0%) had never had an HIV test, and 14.3% of those tested were HIV positive. After controlling for confounding, inconsistent condom use with regular partners was associated with being illiterate, married, sharing needle and syringe with others, never having had an HIV test and not receiving condoms from an NGO. Conclusion The findings from this study among men who inject drugs in Manipur and Nagaland highlight the risk of HIV infection for their regular female sexual partners. Promoting better uptake of HIV testing among men who inject drugs will potentially benefit both them and their regular partners. While effectively reaching regular partners is challenging, a number of strategies for improving their situation in relation to HIV prevention are available.
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Affiliation(s)
- Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Level 4, 161 Barry St, Carlton, Victoria, 3010, Australia.
| | - Greg Armstrong
- Nossal Institute for Global Health, University of Melbourne, Level 4, 161 Barry St, Carlton, Victoria, 3010, Australia.
| | - Gajendra Kumar Medhi
- Regional Medical Research Centre, Indian Council for Medical Research, Post Box No.105, Dibrugarh, 786001, Assam, India.
| | - Chumben Humtsoe
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, New Delhi, 11019, India.
| | - Biangtung Langkham
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, New Delhi, 11019, India.
| | - Jagadish Mahanta
- Regional Medical Research Centre, Indian Council for Medical Research, Post Box No.105, Dibrugarh, 786001, Assam, India.
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Azim T, Bontell I, Strathdee SA. Women, drugs and HIV. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26 Suppl 1:S16-21. [PMID: 25277726 PMCID: PMC4498573 DOI: 10.1016/j.drugpo.2014.09.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/01/2014] [Accepted: 09/05/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Women who use drugs, irrespective of whether these are injected or not, are faced with multiple issues which enhance their vulnerability to HIV. METHODS In this commentary, we explore the HIV risks and vulnerabilities of women who use drugs as well as the interventions that have been shown to reduce their susceptibility to HIV infection. RESULTS Women who inject drugs are among the most vulnerable to HIV through both unsafe injections and unprotected sex. They are also among the most hidden affected populations, as they are more stigmatized than their male counterparts. Many sell sex to finance their own and their partner's drug habit and often their partner exerts a significant amount of control over their sex work, condom use and injection practices. Women who use drugs all over the world face many different barriers to HIV service access including police harassment, judgmental health personnel and a fear of losing their children. CONCLUSION In order to enable these women to access life-saving services including needle-syringe and condom programs, opioid substitution therapy and HIV testing and treatment, it is essential to create a conducive environment and provide tailor-made services that are adapted to their specific needs.
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Affiliation(s)
- Tasnim Azim
- Centre for HIV and AIDS, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
| | - Irene Bontell
- Centre for HIV and AIDS, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh; Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
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Filippovych S. Impact of armed conflicts and warfare on opioid substitution treatment in Ukraine: responding to emergency needs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26:3-5. [PMID: 25483411 DOI: 10.1016/j.drugpo.2014.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 12/22/2022]
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Vitek CR, Čakalo JI, Kruglov YV, Dumchev KV, Salyuk TO, Božičević I, Baughman AL, Spindler HH, Martsynovska VA, Kobyshcha YV, Abdul-Quader AS, Rutherford GW. Slowing of the HIV epidemic in Ukraine: evidence from case reporting and key population surveys, 2005-2012. PLoS One 2014; 9:e103657. [PMID: 25251080 PMCID: PMC4174506 DOI: 10.1371/journal.pone.0103657] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 07/06/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ukraine developed Europe's most severe HIV epidemic due to widespread transmission among persons who inject drugs (PWID). Since 2004, prevention has focused on key populations; antiretroviral therapy (ART) coverage has increased. Recent data show increases in reported HIV cases through 2011, especially attributed to sexual transmission, but also signs of potential epidemic slowing. We conducted a data triangulation exercise to better analyze available data and inform program implementation. METHODS AND FINDINGS We reviewed data for 2005 to 2012 from multiple sources, primarily national HIV case reporting and integrated biobehavioral surveillance (IBBS) studies among key populations. Annually reported HIV cases increased at a progressively slower rate through 2011 with recent increases only among older, more immunosuppressed individuals; cases decreased 2.7% in 2012. Among women <25 years of age, cases attributed to heterosexual transmission and HIV prevalence in antenatal screening declined after 2008. Reported cases among young PWID declined by three-fourths. In 2011, integrated biobehavioral surveillance demonstrated decreased HIV prevalence among young members of key populations compared with 2009. HIV infection among female sex workers (FSW) remains strongly associated with a personal history of injecting drug use (IDU). CONCLUSIONS This analysis suggests that Ukraine's HIV epidemic has slowed, with decreasing reported cases and older cases predominating among those diagnosed. Recent decreases in cases and in prevalence support decreased incidence among young PWID and women. Trends among heterosexual men and men who have sex with men (MSM) are less clear; further study and enhanced MSM prevention are needed. FSW appear to have stable prevalence with risk strongly associated with IDU. Current trends suggest the Ukrainian epidemic can be contained with enhanced prevention among key populations and increased treatment access.
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Affiliation(s)
- Charles R. Vitek
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Kyiv, Ukraine
| | - Jurja-Ivana Čakalo
- World Health Organization Collaborating Centre for HIV Surveillance, University of Zagreb, Zagreb, Croatia
| | - Yuri V. Kruglov
- Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Konstantin V. Dumchev
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Kyiv, Ukraine
| | | | - Ivana Božičević
- World Health Organization Collaborating Centre for HIV Surveillance, University of Zagreb, Zagreb, Croatia
| | - Andrew L. Baughman
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hilary H. Spindler
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Violetta A. Martsynovska
- Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | | | - Abu S. Abdul-Quader
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
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Abstract
PURPOSE OF REVIEW We reviewed the studies published in 2012-2013 that focused on re-emerging and emerging injection and noninjection drug use trends driving HIV risk behaviors and transmission in some parts of the world. RECENT FINDINGS Although HIV incidence has declined in many countries, HIV epidemics remain at troubling levels among key drug-using populations, including females who inject drugs (FWIDs), FWIDs who trade sex, sex partners of people who inject drugs, young people who inject drugs, and people who use noninjection drugs in a number of low-income and middle-income countries such as in Central Asia, Eastern Europe, Southeast Asia, and parts of Africa. SUMMARY HIV epidemics occur within the contexts of global economic and political forces, including poverty, human rights violations, discrimination, drug policies, trafficking, and other multilevel risk environments. Trends of injection and noninjection drug use and risk environments driving HIV epidemics in Central Asia, Eastern Europe, Southeast Asia, and parts of Africa call for political will to improve HIV and substance use service delivery, access to combination HIV prevention, and harm reduction programs.
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Johnston L, Grigoryan S, Papoyan A, Grigoryan T, Balayan T, Zohrabyan L. High HIV and HCV and the unmet needs of people who inject drugs in Yerevan, Armenia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:740-3. [DOI: 10.1016/j.drugpo.2014.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/01/2014] [Accepted: 02/04/2014] [Indexed: 11/29/2022]
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Tsertsvadze T, Chkhartishvili N, Dvali N, Karchava M, Chokoshvili O, Tavadze L, Gamkrelidze A, Zohrabyan L. Estimating HIV incidence in eastern European country of Georgia: 2010-2012. Int J STD AIDS 2014; 25:913-20. [PMID: 24671716 DOI: 10.1177/0956462414525939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The knowledge of HIV incidence is essential to better understand patterns of HIV transmission. We estimated HIV incidence over 2010-2012 in the eastern European country of Georgia. Mathematical modeling using Spectrum software and assay-based recent infection testing algorithm were applied. The study included 1155 HIV patients newly diagnosed in 2010-2012 (84% of total diagnoses). Of them, 231 were determined to be recently infected on the recent infection testing algorithm. The proportion of recent cases did not differ between 2010, 2011 and 2012 (20.4% vs. 19.4% vs. 20.2%, p = 0.94). Both study methods derived comparable estimates ranging from 0.2 to 0.3%, which is up to twice as high as rates of new diagnosis reported in the same period. Despite the relatively stable HIV incidence over 2010-2012, the epidemic continues to grow because of the increasing gap between HIV-infected and diagnosed persons. Increased efforts are needed to reduce the number of people with undiagnosed HIV.
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Affiliation(s)
- Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia I. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | | | - Natia Dvali
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Marine Karchava
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Otar Chokoshvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Lia Tavadze
- UNAIDS Country Office to Georgia, Tbilisi, Georgia
| | - Amiran Gamkrelidze
- National Center for Diseases Control and Public Health, Tbilisi, Georgia
| | - Lev Zohrabyan
- UNAIDS Regional Support Team, Europe and Central Asia, Moscow, Russian Federation
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Beyrer C, Baral SD, Weir B, Curran JW, Chaisson RE, Sullivan P. A call to action for concentrated HIV epidemics. Curr Opin HIV AIDS 2014; 9:95-100. [PMID: 24499807 PMCID: PMC4009618 DOI: 10.1097/coh.0000000000000043] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Brian Weir
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - James W. Curran
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Richard E. Chaisson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of International Health, Johns Hopkins Bloomberg School of Publish Health, Baltimore, Maryland
- Center of Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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El-Bassel N, Shaw SA, Dasgupta A, Strathdee SA. People who inject drugs in intimate relationships: it takes two to combat HIV. Curr HIV/AIDS Rep 2014; 11:45-51. [PMID: 24477931 PMCID: PMC4096813 DOI: 10.1007/s11904-013-0192-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We reviewed papers published during the past 18 months (2012-2013) focusing on micro-social contexts of gender and power inequalities as drivers of HIV risks among people who inject drugs (PWID) in intimate heterosexual relationships. Although there has been a proliferation of social and behavioral research on the micro-social contexts of drug injection in heterosexual intimate relationships, there is still a gap in knowledge of these issues, particularly in low- and middle-income countries. Research has identified couple-based approaches for PWID in intimate relationships as an effective HIV prevention strategy to address micro-social contexts driving HIV risks. While HIV incidence has declined in many countries, prevalence remains at troubling levels among PWID and transmission from PWID to their sex partners is increasing in many parts of the world. HIV prevention among drug-using couples must address the importance of the relationship dyad and micro-social contexts.
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Affiliation(s)
- Nabila El-Bassel
- Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, NY, USA,
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The potential for bridging: HIV status awareness and risky sexual behaviour of injection drug users who have non-injecting permanent partners in Ukraine. J Int AIDS Soc 2014; 17:18825. [PMID: 24560341 PMCID: PMC3929068 DOI: 10.7448/ias.17.1.18825] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/17/2013] [Accepted: 01/17/2014] [Indexed: 11/25/2022] Open
Abstract
Objective To quantify potential bridging of HIV transmission between the injection drug using subpopulation to the non-injection drug using population through unprotected heterosexual sex. Design Secondary analysis of cross-sectional data. Methods A sub-sample of participants who reported having a permanent partner who are not injection drug users and have not injected drugs in the past (N=1379) was selected from a survey implemented in 26 Ukrainian cities in 2011. This study evaluates the association between consistent condom use and awareness of HIV status as measured by rapid testing during the study (known/unknown HIV+, known/unknown HIV− and undetermined) among a sub-sample of male injection drug users (IDUs) who have a non-injecting permanent partner. Poisson regression, with robust variance estimates, was utilized to identify associations while adjusting for other factors. Results Reported consistent condom use varied between 15.5% (unknown HIV−) and 37.5% (known HIV+); average use was 19.3%. In multivariate analysis, males who were aware of their HIV+ status were more likely to report recent consistent condom use compared to those who were unaware of their HIV+ status. This association remains after adjustment for age, region, education level, years of injection, alcohol use, self-reported primary drug use and being an NGO client (prevalence ratio=1.65; 95% CI 1.03–2.64). No such association was found for those who were HIV−. Conclusions Our results regarding HIV-positive male IDUs reinforce previous findings that HIV testing and counselling may be an effective means of secondary prevention. Further research is needed to understand how to effectively promote safer sex behaviours for IDUs who are currently HIV−.
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Friedman SR, West BS, Tempalski B, Morton CM, Cleland CM, Des Jarlais DC, Hall HI, Cooper HLF. Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals? Ann Epidemiol 2014; 24:304-11. [PMID: 24529517 DOI: 10.1016/j.annepidem.2014.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/09/2014] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE We focus on a little-researched issue-how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? METHODS Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls. RESULTS Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. CONCLUSIONS Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.
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Affiliation(s)
- Samuel R Friedman
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Brooke S West
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY
| | - Barbara Tempalski
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY
| | - Cory M Morton
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY
| | | | | | - H Irene Hall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hannah L F Cooper
- Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
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Determinants of HIV infection among female sex workers in two cities in the Republic of Moldova: the role of injection drug use and sexual risk. AIDS Behav 2013; 17:2588-96. [PMID: 23539186 DOI: 10.1007/s10461-013-0460-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In 2009-2010, females who reported having vaginal, anal or oral sex in exchange for money in the previous year, ≥16 years, and living in either Chisinau (n = 299) or Balti (n = 359), Moldova, were recruited into a respondent driven sampling survey. One fifth reported ever injecting drugs and over 30 % ever had sexual intercourse with men who inject drugs. In both cities, condom use with permanent and casual partners was much lower than condom use with commercial partners. In Chisinau, 6.9 % and in Balti, 24.7 % tested positive for HIV; 18 and 23.7 % had antibodies to hepatitis C; 9.1 and 8.9 % had antibodies to HBV; and, 8.4 and 6.1 % tested positive for syphilis. HIV seropositive FSW in either city were more likely to have ever injected drugs and to be infected with HCV. Limited government initiative and drastic reductions in international funding will likely impact urgently needed HIV prevention and harm reduction services targeting FSW in Moldova.
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Bojko MJ, Dvoryak S, Altice FL. At the crossroads: HIV prevention and treatment for people who inject drugs in Ukraine. Addiction 2013; 108:1697-9. [PMID: 23745777 PMCID: PMC3775865 DOI: 10.1111/add.12243] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Martha J. Bojko
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine,Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Sergey Dvoryak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine,Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA,Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA,University of Malaya, Centre of Excellence on Research in AIDS (CERiA), Kuala Lumpur, Malaysia
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An international systematic review and meta-analysis of multisession psychosocial interventions compared with educational or minimal interventions on the HIV sex risk behaviors of people who use drugs. AIDS Behav 2013; 17:1963-78. [PMID: 23386132 DOI: 10.1007/s10461-012-0403-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This systematic review and meta-analysis examines the effectiveness of multisession psychosocial interventions compared with educational interventions and minimal interventions in reducing sexual risk in people who use drugs (51 studies; 19,209 participants). We conducted comprehensive searches (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and PsychINFO 1998-2012). Outcomes (unprotected sex, condom use, or a composite outcome) were extracted by two authors and synthesised using meta-analysis. Subgroup analyses and meta-regression were conducted to explore heterogeneity. Multisession psychosocial interventions had modest additional benefits compared to educational interventions (K = 46; OR 0.86; 95% CI 0.77, 0.96), and large positive effects compared to minimal interventions (K = 7; OR 0.60; 95% CI 0.46, 0.78). Comparison with previous meta-analyses suggested limited progress in recent years in developing more effective interventions. Multisession psychosocial and educational interventions provided similar modest sexual risk reduction justifying offering educational interventions in settings with limited exposure to sexual risk reduction interventions, messages, and resources.
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30 Years on Selected Issues in the Prevention of HIV among Persons Who Inject Drugs. Adv Prev Med 2013; 2013:346372. [PMID: 23840957 PMCID: PMC3694369 DOI: 10.1155/2013/346372] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/11/2013] [Accepted: 05/18/2013] [Indexed: 11/17/2022] Open
Abstract
After 30 years of extensive research on human immunodeficiency virus (HIV) among persons who inject drugs (PWID), we now have a good understanding of the critical issues involved. Following the discovery of HIV in 1981, epidemics among PWID were noted in many countries, and consensus recommendations for interventions for reducing injection related HIV transmission have been developed. While high-income countries have continued to develop and implement new Harm Reduction programs, most low-/middle-income countries have implemented Harm Reduction at very low levels. Modeling of combined prevention programming including needle exchange (NSP) and antiretroviral therapy (ARV) suggests that NSP be given the highest priority. Future HIV prevention programming should continue to provide Harm Reduction programs for PWID coupled with interventions aimed at reducing sexual transmission. As HIV continues to spread in low- and middle-income countries, it is important to achieve and maintain high coverage of Harm Reduction programs in these locations. As PWID almost always experience multiple health problems, it will be important to address these multiple problems within a comprehensive approach grounded in a human rights perspective.
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Racial and ethnic disparities and implications for the prevention of HIV among persons who inject drugs. Curr Opin HIV AIDS 2012; 7:354-61. [PMID: 22498481 DOI: 10.1097/coh.0b013e328353d990] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW There are now an estimated 16 million people who inject drugs (PWID) throughout the world, 3 million of whom are estimated to be infected with HIV. In many countries, substantial proportions of PWID belong to racial/ethnic/nationality minority groups, and are at increased likelihood of being infected with HIV. This article reviews current evidence on ethnic disparities in HIV infection among PWID and assesses the issues that would need to be addressed to reduce these disparities. RECENT FINDINGS An ongoing systematic review of ethnic disparities has found that, in a pooled weighted odds ratio, ethnic minority PWID are twice as likely to be HIV seropositive than ethnic majority, PWID from the same geographic area. If implemented with sufficient quality and coverage, current HIV prevention programs probably have the capability of ending HIV transmission among both ethnic majority and minority PWID. Large-scale, evidence-based prevention programs need to be implemented in the contexts of patterns of injecting drug use that continue to evolve-with injecting practices spreading to new areas, changes in drugs injected, and some transitions from injecting to noninjecting drug use. Lack of financial resources and policies against evidence-based programming are increasingly important problems that are likely to have particularly adverse effects on ethnic minority PWID. SUMMARY Racial/ethnic/nationality disparities in HIV infection are quite common among PWID. Addressing these disparities will be a fundamental challenge within a human rights approach to public health.
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Wammes JJG, Siregar AY, Hidayat T, Raya RP, van Crevel R, van der Ven AJ, Baltussen R. Cost-effectiveness of methadone maintenance therapy as HIV prevention in an Indonesian high-prevalence setting: a mathematical modeling study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:358-64. [PMID: 22884538 DOI: 10.1016/j.drugpo.2012.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 06/14/2012] [Accepted: 06/22/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Indonesia faces an HIV epidemic that is in rapid transition. Injecting drug users (IDUs) are among the most heavily affected risk populations, with estimated prevalence of HIV reaching 50% or more in most parts of the country. Although Indonesia started opening methadone clinics in 2003, coverage remains low. METHODS We used the Asian Epidemic Model and Resource Needs Model to evaluate the long-term population-level preventive impact of expanding Methadone Maintenance Therapy (MMT) in West Java (43 million people). We compared intervention costs and the number of incident HIV cases in the intervention scenario with current practice to establish the cost per infection averted by expanding MMT. An extensive sensitivity analysis was performed on costs and epidemiological input, as well as on the cost-effectiveness calculation itself. RESULTS Our analysis shows that expanding MMT from 5% coverage now to 40% coverage in 2019 would avert approximately 2400 HIV infections, at a cost of approximately US$7000 per HIV infection averted. Sensitivity analyses demonstrate that the use of alternative assumptions does not change the study conclusions. CONCLUSION Our analyses suggest that expanding MMT is cost-effective, and support government policies to make MMT widely available as an integrated component of HIV/AIDS control in West Java.
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Affiliation(s)
- Joost J G Wammes
- Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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