Drug Injection Partners Research Articles

Variation in HIV Transmission Behaviors Among People Who Use Drugs in Rural US Communities

People who use drugs (PWUD) continue to be at risk of HIV infection, but the frequency and distribution of transmission-associated behaviors within various rural communities is poorly understood. To examine the association of characteristics of rural PWUD with HIV transmission behaviors. In this cross-sectional study, surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin) were collected January 2018 through March 2020 and analyzed August through December 2022. A chain-referral sampling strategy identified convenience sample seeds who referred others who used drugs. Rural PWUD who reported any past 30-day injection drug use or noninjection opioid use "to get high" were included. Individual characteristics, including age, race, gender identity, sexual orientation, partnership status, drug of choice, and location, were collected. Past 30-day frequency of behaviors associated with HIV transmission, including drug injection, syringe sharing, opposite- and same-gender partners, transactional sex, and condomless sex, was assessed. Of 3048 rural PWUD (mean [SD] age, 36.1 [10.3] years; 225 American Indian [7.4%], 96 Black [3.2%], and 2576 White [84.5%] among 3045 with responses; and 1737 men [57.0%] among 3046 with responses), most participants were heterosexual (1771 individuals [86.8%] among 2040 with responses) and single (1974 individuals [68.6%] among 2879 with responses). Opioids and stimulants were reported as drug of choice by 1636 individuals (53.9%) and 1258 individuals (41.5%), respectively, among 3033 individuals with responses. Most participants reported recent injection (2587 of 3046 individuals [84.9%] with responses) and condomless sex (1406 of 1757 individuals [80.0%] with responses), among whom 904 of 1391 individuals (65.0%) with responses indicated that it occurred with people who inject drugs. Syringe sharing (1016 of 2433 individuals [41.8%] with responses) and transactional sex (230 of 1799 individuals [12.8%] with responses) were reported less frequently. All characteristics and behaviors, except the number of men partners reported by women, varied significantly across locations (eg, mean [SD] age ranged from 34.5 [10.0] years in Wisconsin to 39.7 [11.0] years in Illinois; P < .001). In multivariable modeling, younger age (adjusted odds ratio [aOR] for ages 15-33 vs ≥34 years, 1.36; 95% CI, 1.08-1.72) and being single (aOR, 1.37; 95% CI, 1.08-1.74) were associated with recent injection; younger age (aOR, 1.49; 95% CI, 1.20-1.85) and bisexual orientation (aOR vs heterosexual orientation, 2.27; 95% CI, 1.60-3.23) with syringe sharing; gender identity as a woman (aOR vs gender identity as a man, 1.46; 95% CI, 1.01-2.12), bisexual orientation (aOR vs heterosexual orientation, 2.59; 95% CI, 1.67-4.03), and being single (aOR, 1.71; 95% CI, 1.15-2.55) with transactional sex; and bisexual orientation (aOR vs heterosexual orientation, 1.60; 95% CI, 1.04-2.46) and stimulants as the drug of choice (aOR vs opioids, 1.45; 95 CI, 1.09-1.93) with condomless sex with someone who injects drugs. This study found that behaviors associated with HIV transmission were common and varied across communities. These findings suggest that interventions to reduce HIV risk among rural PWUD may need to be tailored to locally relevant factors.

Implementation fidelity to HIV assisted partner services (aPS) during scale-up in western Kenya: a convergent mixed methods study

BackgroundHIV assisted partner services (aPS) is an intervention to improve HIV status awareness among sex and drug-injecting partners of people newly diagnosed with HIV (index clients). Implementation fidelity—the degree to which an intervention is conducted as intended – is critical to effectiveness, but there are limited data about aPS fidelity when delivered by HIV testing service (HTS) providers. We explored factors affecting implementation fidelity to aPS in two high-HIV prevalence counties in western Kenya.MethodsWe used convergent mixed methods adapting the conceptual framework for implementation fidelity within the aPS scale-up project. This was an implementation study examining scale-up of APS within HTS programs in Kisumu and Homa Bay counties that recruited male sex partners (MSPs) of female index clients. We defined implementation fidelity as the extent to which HTS providers followed the protocol for phone and in-person participant tracing at six expected tracing attempts. Quantitative data were collected from tracing reports in 31 facilities between November 2018 and December 2020, and in-depth interviews (IDIs) were conducted with HTS providers. Descriptive statistics were used to describe tracing attempts. IDIs were analyzed using thematic content analysis.ResultsOverall, 3017 MSPs were mentioned of whom 98% (2969/3017) were traced, with most tracing attempts being successful (2831/2969, 95%). Fourteen HTS providers participated in the IDIs—mostly females (10/14, 71%) with a median age of 35 years (range 25–52), who all had post-secondary education (14/14, 100%). The proportion of tracing attempts occurring by phone ranged from 47 to 66%, with the highest proportion occurring on the first attempt and lowest on the sixth attempt. Contextual factors either enhanced or impeded implementation fidelity to aPS. Positive provider attitudes towards aPS and conducive work environment factors promoted implementation fidelity, while negative MSP responses and challenging tracing conditions impeded it.ConclusionInteractions at the individual (provider), interpersonal (client—provider), and health systems (facility) levels affected implementation fidelity to aPS. As policymakers prioritize strategies to reduce new HIV infections, our findings highlight the importance of conducting fidelity assessments to better anticipate and mitigate the impact of contextual factors during the scale-up of interventions.

Cascading Risks for Preventable Infectious Diseases in Children and Adolescents during the 2022 Invasion of Ukraine

Russia’s military incursion into Ukraine triggered the mass displacement of two-thirds of Ukrainian children and adolescents, creating a cascade of population health consequences and producing extraordinary challenges for monitoring and controlling preventable pediatric infectious diseases. From the onset of the war, infectious disease surveillance and healthcare systems were severely disrupted. Prior to the reestablishment of dependable infectious disease surveillance systems, and during the early months of the conflict, our international team of pediatricians, infectious disease specialists, and population health scientists assessed the health implications for child and adolescent populations. The invasion occurred just as the COVID-19 Omicron surge was peaking throughout Europe and Ukrainian children had not received COVID-19 vaccines. In addition, vaccine coverage for multiple vaccine-preventable diseases, most notably measles, was alarmingly low as Ukrainian children and adolescents were forced to migrate from their home communities, living precariously as internally displaced persons inside Ukraine or streaming into European border nations as refugees. The incursion created immediate impediments in accessing HIV treatment services, aimed at preventing serial transmission from HIV-positive persons to adolescent sexual or drug-injection partners and to prevent vertical transmission from HIV-positive pregnant women to their newborns. The war also led to new-onset, conflict-associated, preventable infectious diseases in children and adolescents. First, children and adolescents were at risk of wound infections from medical trauma sustained during bombardment and other acts of war. Second, young people were at risk of sexually transmitted infections resulting from sexual assault perpetrated by invading Russian military personnel on youth trapped in occupied territories or from sexual assault perpetrated on vulnerable youth attempting to migrate to safety. Given the cascading risks that Ukrainian children and adolescents faced in the early months of the war—and will likely continue to face—infectious disease specialists and pediatricians are using their international networks to assist refugee-receiving host nations to improve infectious disease screening and interventions.

Exploring the acceptability of HIV partner notification in prisons: Findings from a survey of incarcerated people living with HIV in Indonesia.

Assisted HIV partner notification services provide a safe and effective way for people living with HIV (PLHIV) to inform their partners about the possibility of exposure and to offer them testing, treatment, and support. This study examined whether or not PLHIV in prison might be willing to participate in assisted HIV partner notification services and their reasons for and against disclosing their HIV-positive status to their partners. PLHIV (n = 150) recruited from Jakarta’s two largest all-male prisons completed an interviewer-administered questionnaire collecting demographic and risk behavior data, and attitudes toward HIV disclosure and partner services. Among those who were sexually active and/or injecting drugs before incarceration, two-thirds (66.4%, 91/137) endorsed provider referral as an acceptable way to notify their sex partners, and nearly three quarters (72.4%, 89/123) endorsed provider referral to notify their drug-injecting partners. Only a quarter (25.1%) of participants reported that their main sex partner had ever received an HIV test. Participants with anticipated stigma were less likely to endorse provider referral for sex partners (adjusted odds ratio [aOR] = 0.58, 95% CI: 0.35, 0.96) and drug-injecting partners (aOR = 0.54, 95% CI: 0.29, 1.00). Relationship closeness was associated with higher odds of endorsing provider referral for drug-injecting partners (aOR = 2.08, 95% CI: 1.25, 3.45). Protecting partners from infection and a moral duty to inform were main reasons to disclose, while stigma and privacy concerns were main reasons not to disclose. Most incarcerated PLHIV have at-risk partners in the community who they would be willing to notify if provided with assistance. Assisted partner notification for prison populations offers a promising public health approach to accelerate diagnosis, treatment, and prevention of HIV infection in the community, particularly among women.

Ethical Challenges of HIV Partner Notification in Prisons.

Partner services provide a safe and humane way for people living with HIV (PLWH) to alert their sex and/or drug-injecting partners to the possibility of HIV exposure and the need for HIV testing, yet little is known about the ethical challenges of delivering partner services in prisons. In this article, we consider 7 key ethical and methodological questions that should be considered when developing, testing, or implementing partner services in prison settings. These questions relate to the ethics of: (1) mandatory HIV testing, (2) health illiteracy, (3) level of prison staff involvement, (4) protecting confidentiality, (5) minimizing harm, (6) achieving equivalency with community standards of care, and (7) providing HIV prevention and treatment services to index patient and their partners. By assisting PLWH in prison to inform partners with whom they may have shared HIV exposure either before or during incarceration, partner services can help to identify cases of undiagnosed HIV infection for testing and linkage to medical care. The acceptability and effectiveness of a future partner services model for PLWH in prison depends critically on answering these 7 questions to assure the highest ethical standards of research and practice.

SOCIAL NETWORKS AND HEALTH

Social networks and health - an overview: The role of social networks in health, illness, disease and healing - the accepting present, the forgotten past and the dangerous potential for a complacent future, B.A. Pescosolido, J.A. Levy. Linking social network theory to disease prevention: Social support and social networks - synthesis and review, A.D. Faber, S. Wasserman Infectious disease control - combining molecular biological and network methods, A.S. Klovdahl et al Cases, contexts and care - the importance of grounded network analysis, K. Jinnett. Methodological issues in network recall and agreement: Sorry, I forgot - the role of recall error in longitudinal personal network studies, E.R. Wright, B.A. Pescosolido Patterns in the recall of sexual and drug injection partners, D.D. Brewer et al Concordance between drug users' and their network members' reported drug use and HIV status - implications to HIV prevention, C. Latkin et al. Risk exposure and social ties: Ethnicity, social networks and HIV risk in older drug users, J.J. Schensul et al Network ties and disease prevention: Informal social networks and epidemic prevention in a third world context - cholera and HIV/AIDS compared, V. Agadjanian The differential importance of friend, relative and partner relationships for the mental health of young adults, J. McLaughlin et al Gender, social support and experimental similarity during chronic stress - the case of family caregivers, J.J. Suitor, K. Pillemer. Social support and health: Exploring the structural contexts of the support process - social networks, social statuses, social support and psychological distress, V.A. Haines et al Factors related to multiplexity in support networks of persons with severe mental illness, J. Holschuh, S.P. Segal Drug users' lay consultation processes - symptom identification and management, M. Regen et al Gender differences in depressive symptoms - insights from a life span perspective on life stages and social networks, H. Akiyama, T. Antonucci.

Delivery of HIV Transmission Risk-Reduction Services by HIV Care Providers in the United States-2013.

Evidence-based guidelines have long recommended that HIV care providers deliver HIV transmission risk-reduction (RR) services, but recent data are needed to assess their adoption. The authors surveyed a probability sample of 1234 US HIV care providers on delivery of 9 sexual behavior- and 7 substance use-related HIV transmission RR services and created an indicator of "adequate" delivery of services in each area, defined as performing approximately 70% or more of applicable services. Providers were most likely to encourage patients to disclose HIV status to all partners since HIV diagnosis (81%) and least likely to ask about disclosure to new sex and drug injection partners at follow-up visits (both 41%). Adequate delivery of sexual behavior- and substance use-related RR services was low (37% and 43%, respectively). The majority of US HIV care providers may need additional support to improve delivery of comprehensive HIV transmission RR services.

Interviewer Effects in the Elicitation of Sexual and Drug Injection Partners

Interviewer effects, or variations in interviewee responses associated with interviewers, are not uncommon in survey research. Such effects are more likely when interview questions are open-ended. Recent research shows moderate interviewer effects in the number of personal network members elicited, with intraclass correlations ranging between 0.13 and 0.15 after adjustment for respondent and interviewer characteristics. It is crucial that network elicitation be as complete as possible, because most network measures are sensitive to missing data. Sexual and drug injection networks shape the transmission of sexually transmitted diseases, HIV, and other infectious agents. The elicitation of sexual and drug injection partners involves asking sensitive open-ended questions, which may increase the likelihood of interviewer effects. Therefore, we assessed the magnitude of interviewer effects in the elicitation of such partners. The results from five data sets suggest no or relatively small interviewer effects on the number of partners elicited (intraclass correlations = 0.06, median = -0.01). We found similar results when we adjusted for numerous covariates and when we examined interviewer effects on the number of partners that interviewees estimated (prior to listing partners individually) they had. Moreover, there is no consistent interaction between interviewer and interviewee sex on the number of sexual partners elicited, indicating that, on average, male and female interviewers are equally effective with interviewees of either sex.

Comparison of Daily Reports and Retrospective Recall for Eliciting Drug Injection Partners

To understand the spread of bloodborne viruses in injection drug users (IDUs), it is important to ascertain networks of injection contact. However, in retrospective interviews, IDUs often forget many injection partners. We compared retrospective recall with daily reporting.We gave mobile phones to 14 IDUs who had participated in the first daily reporting study of the project. For four weeks, participants reported their injection partners in automated daily telephone interviews. Then, in a retrospective interview, they recalled their partners from the four-week period and received location and network cues to enhance recall. The 11 participants who reported partners in the daily interviews missed 3.4 (out of 28) such interviews on average. In the daily reports, they listed a mean of 6.4 unique partners. In the retrospective interview, they recalled a mean of 5.1 partners, including a mean of 0.8 in response to the recall cues (a 17% increase on average). One-third of cue-elicited partners were mentioned in the daily reports. In the retrospective interview, participants forgot 2.7 partners on average, and listed a mean of 1.5 partners not in the daily reports (perhaps partners on days with missing daily reports). The total number of partners reported at follow-up was moderately positively correlated with the total number of unique partners reported during the daily interviews (r = 0.66, intraclass correlation = 0.64). There was some under- and over-reporting of partnership risk at follow-up, relative to risk reported in the daily interviews, which could be due to missing daily reports and misreporting at follow-up, respectively. Other results mirrored prior research on correlates of forgetting. First, the number of partners freely recalled at follow-up correlated moderately positively with the number of partners elicited by the recall cues (r = 0.52). Second, forgotten partnerships involved, on average, slightly less risk and slightly greater injection frequency. Forgotten partnerships were moderately less recent, though still within the 28-day study period, and one-third of forgotten partnerships occurred within 14 days of the follow-up interview. In conclusion, daily reporting of injection partners is feasible and may be a useful adjunct to retrospective recall in some situations. The replication of the recall cues' effectiveness suggests that such techniques should be used as standard practice in injection network elicitation.

Comparison of daily reports and retrospective recall for eliciting drug injection partners

To understand the spread of bloodborne viruses in injection drug users (IDUs), it is important to ascertain networks of injection contact. However, in retrospective interviews, IDUs often forget many injection partners. We compared retrospective recall with daily reporting.We gave mobile phones to 14 IDUs who had participated in the first daily reporting study of the project. For four weeks, participants reported their injection partners in automated daily telephone interviews. Then, in a retrospective interview, they recalled their partners from the four-week period and received location and network cues to enhance recall. The 11 participants who reported partners in the daily interviews missed 3.4 (out of 28) such interviews on average. In the daily reports, they listed a mean of 6.4 unique partners. In the retrospective interview, they recalled a mean of 5.1 partners, including a mean of 0.8 in response to the recall cues (a 17% increase on average). One-third of cue-elicited partners were mentioned in the daily reports. In the retrospective interview, participants forgot 2.7 partners on average, and listed a mean of 1.5 partners not in the daily reports (perhaps partners on days with missing daily reports). The total number of partners reported at follow-up was moderately positively correlated with the total number of unique partners reported during the daily interviews (r = 0.66, intraclass correlation = 0.64). There was some under- and over-reporting of partnership risk at follow-up, relative to risk reported in the daily interviews, which could be due to missing daily reports and misreporting at follow-up, respectively. Other results mirrored prior research on correlates of forgetting. First, the number of partners freely recalled at follow-up correlated moderately positively with the number of partners elicited by the recall cues (r = 0.52). Second, forgotten partnerships involved, on average, slightly less risk and slightly greater injection frequency. Forgotten partnerships were moderately less recent, though still within the 28-day study period, and one-third of forgotten partnerships occurred within 14 days of the follow-up interview. In conclusion, daily reporting of injection partners is feasible and may be a useful adjunct to retrospective recall in some situations. The replication of the recall cues' effectiveness suggests that such techniques should be used as standard practice in injection network elicitation.

Interviewer effects in the elicitation of sexual and drug injection partners

Interviewer effects, or variations in interviewee responses associated with interviewers, are not uncommon in survey research. Such effects are more likely when interview questions are open-ended. Recent research shows moderate interviewer effects in the number of personal network members elicited, with intraclass correlations ranging between 0.13 and 0.15 after adjustment for respondent and interviewer characteristics. It is crucial that network elicitation be as complete as possible, because most network measures are sensitive to missing data. Sexual and drug injection networks shape the transmission of sexually transmitted diseases, HIV, and other infectious agents. The elicitation of sexual and drug injection partners involves asking sensitive open-ended questions, which may increase the likelihood of interviewer effects. Therefore, we assessed the magnitude of interviewer effects in the elicitation of such partners. The results from five data sets suggest no or relatively small interviewer effects on the number of partners elicited (intraclass correlations = 0.06, median = -0.01). We found similar results when we adjusted for numerous covariates and when we examined interviewer effects on the number of partners that interviewees estimated (prior to listing partners individually) they had. Moreover, there is no consistent interaction between interviewer and interviewee sex on the number of sexual partners elicited, indicating that, on average, male and female interviewers are equally effective with interviewees of either sex.

Interviewing Practices in Partner Notification for STD and HIV

Partner notification, or contact tracing, has long been a cornerstone of efforts to control the spread of sexually transmitted diseases (STD) and HIV. The partner notification process involves persons diagnosed with disease informing sexual partners (and drug injection partners, in the case of HIV) about their exposure to infection and the need for medical examination and treatment. Often this process begins when a public health worker counsels a patient about partner notification and elicits his or her partners who may have been exposed to the infection. Then the patient or public health worker attempts to notify partners and ensure their medical evaluation and treatment. Effective partner notification depends on complete and accurate data on partners. In this report, I review interviewing practices that relate to applied aspects of partner notification and make recommendations for disease control practice and research. I focus on seven areas of partner notification interviewing practice: interview context, interviewing modes, reinterviewing, interview periods, elicitation techniques, interviewer effects, and the reliability and validity of reported partner information.

Is Injection Serosorting Occurring among HIV-Positive Injection Drug Users? Comparison by Injection Partner’s HIV Status

Research needs to build evidence for the roles that HIV status of injection partners may or may not play in injection risk behaviors of injection drug users (IDUs). Using baseline data collected from a randomized controlled study (INSPIRE) conducted in four cities (Baltimore, Miami, New York, and San Francisco) from 2001 to 2005, we categorized 759 primarily heterosexual HIV-positive IDUs into four groups based on HIV serostatus of drug injection partners. Thirty-two percent of the sample injected exclusively with HIV-positive partners in the past 3 months and more than 60% had risky injection behavior with these partners. Eight percent injected exclusively with HIV-negative partners and 49% injected with any unknown status partners. The remaining 11% reported having both HIV-positive and -negative injection partners, but no partners of unknown HIV status. Riskier injection behavior was found among the group with mixed status partners. The risk among the group with any unknown status partners appeared to be driven by the greater number of injection partners. No major group differences were observed in socio-demographic and psychosocial factors. Our analysis suggests that serosorting appeared to be occurring among some, but not an overwhelming majority of HIV-positive IDUs, and knowledge of HIV status of all injection partners per se did not appear to be as important as knowledge of sexual partner's HIV status in its association with risk behavior.

Erratum

Partner notification has long been practiced to inform the sex and drug-injection partners of people infected with human immunodeficiency virus (HIV) of their possible exposure to HIV and sexually transmitted diseases (STDs).1 In 1998, the Centers for Disease Control and Prevention (CDC) published guidance on partner notification for HIV, called partner counseling and referral services (PCRS), which has the objective of reducing HIV transmission. Because people who are aware of their HIV-infected status are less likely to participate in behaviors that transmit HIV,2 PCRS is designed to reduce HIV transmission by providing HIV counseling and testing services to people at high risk for infection, identifying previously undiagnosed infection, and linking HIV-infected people to care and treatment.3 PCRS has been used by health departments to interview partners of people with known HIV infection, notify them of their possible exposure to HIV, and arrange for them to be tested.4 An HIV-infected person is defined as an index client when he or she is reported to the health department. In traditional PCRS, index clients are located and interviewed by a disease intervention specialist to elicit information about current and past partners.1 Partners may be notified of their exposure to HIV by the index client, the disease intervention specialist, or both of them together. PCRS is comprehensive and includes elicitation, notification, and testing of partners as well as education, risk-reduction counseling, and assessment of the need for referral to psychosocial services, case management, and medical care and treatment. Participation in PCRS by index clients and partners is completely voluntary. CDC launched the Advancing HIV Prevention (AHP) initiative in 2003, aimed at reducing barriers to early diagnosis of HIV infection.5 Preventing HIV transmission by working with HIV-infected people and their partners and implementing new models for diagnosing HIV infections outside medical settings are two key AHP initiative strategies. Incorporating rapid HIV testing into PCRS makes use of both of these strategies. Although PCRS has been used as a strategy to prevent the transmission of HIV for many years, the incorporation of rapid HIV testing is new and offers partners the opportunity to be tested for HIV in the field. When conventional HIV testing methods are used in conjunction with PCRS, disease intervention specialists collect venous blood or oral fluid specimens in the field, which are then processed in a laboratory. Because of the variability in the time it takes laboratories to process specimens, it may take from one to 14 days for test results to be available. Moreover, this type of field-based specimen collection has not been used by all health departments, so in many instances, partners are referred for testing at health department clinics. Under the AHP initiative, CDC funded a project to demonstrate the feasibility of conducting rapid HIV testing in conjunction with traditional and alternative approaches to conducting PCRS. The primary objective of this project was to decrease barriers to early diagnosis of HIV infection among partners of HIV-infected people by demonstrating new models of PCRS that included rapid HIV testing in the field and other settings.

Group Sex Events and HIV/STI Risk in an Urban Network

To describe: (a) the prevalence and individual and network characteristics of group sex events (GSEs) and GSE attendees; and (b) HIV/sexually transmitted infection (STI) discordance among respondents who said they went to a GSE together. In a sociometric network study of risk partners (defined as sexual partners, persons with whom respondents attended a GSE, or drug injection partners) in Brooklyn, NY, we recruited a high-risk sample of 465 adults. Respondents reported on GSE attendance, the characteristics of GSEs, and their own and others' behaviors at GSEs. Sera and urines were collected, and STI prevalence was assayed. Of the 465 participants, 36% had attended a GSE in the last year, 26% had sex during the most recent of these GSEs, and 13% had unprotected sex there. Certain subgroups (hard drug users, men who have sex with men, women who have sex with women, and sex workers) were more likely to attend and more likely to engage in risk behaviors at these events. Among 90 GSE dyads, in which at least 1 partner named the other as someone with whom they attended a GSE in the previous 3 months, STI/HIV discordance was common [herpes simplex virus (HSV-2): 45% of dyads, HIV: 12% of dyads, and chlamydia: 21% of dyads]. Many GSEs had 10 or more participants, and multiple partnerships at GSEs were common. High attendance rates at GSEs among members of large networks may increase community vulnerability to STI/HIV, particularly because network data show that almost all members ofa large sociometric risk network either had sex with a GSE attendee or had sex with someone who had sex with a GSE attended. Self-reported GSE attendance and participation were common among this high-risk sample. STI/HIV discordance among GSE attendees was high, highlighting the potential transmission risk associated with GSEs. Research on sexual behaviors should incorporate measures of GSE behaviors as standard research protocol. Interventions should be developed to reduce transmission at GSEs.

Incorporating Rapid HIV Testing into Partner Counseling and Referral Services

Partner counseling and referral services (PCRS) provide a unique opportunity to decrease transmission of human immunodeficiency virus (HIV) by notifying sex and drug-injection partners of HIV-infected individuals of their exposure to HIV. We incorporated rapid HIV testing into PCRS to reduce barriers associated with conventional HIV testing and identify undiagnosed HIV infection within this high-risk population. From April 2004 through June 2006, HIV-infected people (index clients) were interviewed, and their partners were notified of their potential exposure to HIV and offered rapid HIV testing at six sites in the United States. The numbers of index clients participating and the numbers of partners interviewed and tested were compared by site. Descriptive and bivariate analyses were performed. A total of 2,678 index clients were identified, of whom 779 (29%) provided partner locating information. A total of 1,048 partners were elicited, of whom 463 (44%) were both interviewed and tested for HIV. Thirty-seven partners (8%) were newly diagnosed with HIV. The number of index clients interviewed to identify one partner with newly diagnosed HIV infection ranged from 10 to 137 at the participating sites. PCRS provides testing and prevention services to people at high risk for HIV infection. Incorporating rapid HIV testing into PCRS and identifying previously undiagnosed infections likely confer individual and public health benefits. Further evaluation is needed to determine the best methods of identifying partners with previously unrecognized HIV infection.

Pre-exposure prophylaxis for HIV infection: what if it works?

For all the advances in treatment of HIV infection, the mainstays of prevention have changed little: sexual abstinence, condoms, sterile injection equipment, avoidance of high-risk behaviours, and knowing one’s own serostatus and that of any sexual or drug-injecting partners. Although these strategies can be eff ective and recent years have seen decreases in new infections in some countries and in some risk groups, the 11 000 new infections daily is ample testament that additional methods of prevention are needed. Evidence for successful HIV-prevention technologies is mixed. Randomised studies of male circumcision in South Africa, Kenya, and Uganda were discontinued early after interim review showed reductions in new HIV infections ranging from 60% to 74% in the circumcised men compared with those who were not circumcised. Several topical microbicides are in advanced trials. However, phase III trials of C-31G (originally developed by Cellegy Pharmaceuticals) and cellulose sulphate (Polydex Pharmaceuticals, Nassau, Bahamas) were terminated early because preliminary results suggested no effi cacy (C-31G) or increased risk of HIV transmission (cellulose sulphate). HIV-vaccine research continues despite two completed trials of AidsVax (VaxGen, South San Francisco, CA, USA) that showed no effi cacy. Proof of effi cacy of any present microbicide or vaccine candidate is several years away, and fi rst products will probably be only moderately eff ective. The need to manufacture such a product in large quantities and distribute it around the world will pose additional challenges.

Drug-Scene Roles and HIV Risk Among Puerto Rican Injection Drug Users in East Harlem, New York and Bayamón, Puerto Rico

This article describes and compares distributions of drug-scene roles, frequency of engaging in role behaviors, and relationships of role-holding to high-risk behaviors and sexual partnerships among Puerto Rican injection drug users in New York and Puerto Rico. For this study 561 street-recruited injection drug users in East Harlem, New York, and 312 in Bayamón, Puerto Rico were asked the number of days (in the last 30) in which they earned money or drugs in each of seven drug-scene roles; and about behaviors and egocentric risk partner characteristics in the last 30 days. East Harlem subjects were more likely to get resources by selling drugs and syringes, and buying drugs for someone else; Bayamón subjects were more likely to be “hit doctors,” buy needles for others, operate a shooting gallery, or escort others to shooting galleries. All roles were part-time except shooting gallery management in East Harlem. About 27% of respondents at each site engaged in two or more roles. Many roles were associated with increased odds of injecting more than twice a day, receptive syringe sharing, distributive syringe sharing, receptive paraphernalia sharing, and having a drug-injecting sex partner. Drug-scene role structures vary between cities. Most roles are part-time pursuits. Role-holders have higher-risk behaviors and sexual partnerships than other drug injectors. Although further research is needed, drug-scene role-holders should be targeted for interventions to affect their own risk and their communications with others.

HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: a forgotten issue.

Accumulating findings suggest a relationship between partner violence and HIV risk among women, however, this issue has yet to be adequately researched among men. This study examines the relationship between perpetrating intimate partner violence and HIV risk behavior among a sample of men in methadone maintenance treatment programs (MMTPs). Data were collected on 273 sexually active men, who were recruited from four inner-city MMTP clinics. More than a third of the sample reported perpetrating intimate physical abuse and 15% reported severe physical abuse in the past 12 months. Results from multiple logistic regression analyses indicate that after adjusting for demographic, poverty, and drug-use factors, men who abused an intimate partner were almost 4 times more likely to have more than one intimate partner, almost 3 times more likely to have unprotected anal sex, and 2.6 times more likely to have sex with a drug-injecting sexual partner than their counterparts. This study showed that men who perpetrated partner violence were at higher risk for HIV transmission. HIV prevention interventions need to consider the complex relationship between partner violence and HIV risk.

No Difference between 1- and 2-Year Recall Periods in Locatability of Sexual and Drug Injection Partners

Health professionals engaged in partner notification often limit recall periods (also called interview or notification periods) for HIV contact interviews to one year or less. Periods longer than a year are believed to be unproductive because partners more than a year in the past may be difficult to locate. To test this belief, we compared 1- and 2-year recall periods in terms of the locatability of sexual and drug injection partners. We recruited subjects from the largest HIV testing clinic in Seattle, U.S.A., and a large epidemiologic study of drug injectors in Seattle. After eliciting their partners for the past 1 or 2 years, we asked subjects about their knowledge of different types of locating information for each partner. The proportion of partners who are locatable is similar for 1- and 2-year recall periods. This study highlights the need for research to establish efficient recall periods for HIV contact interviews.