Heterosexual Intravenous Drug Users Research Articles

Unprotected anal Intercourse among Iranian Intra-Venous Drug Users

Purpose: To assess the prevalence and associated factors of unprotected anal intercourse among Iranian male heterosexual Intra-Venous Drug Users (IDUs).Methods: In a cross-sectional study 360 male heterosexual IDUs were sampled from streets of eight different geographical parts of Iran. Variables such as socio-demographics, HIV knowledge (10 items), and HIV attitude (16 items) were entered to a logistic regression to determine the predictors of unprotected anal intercourse during the past month.Results: From all, 20.8% reported unprotected anal intercourse during the past month. HIV knowledge was not significantly different among IDUs with and without unprotected anal intercourse. High age [odds ratio (OR) = 0.954, 95% confidence intervals (CI) = 0.916–0.992] was associated with a lower likelihood of unprotected anal intercourse, while being not married (OR = 2.301, 95% CI = 1.151–4.601), and high perceived HIV risk (OR = 1.776, 95% CI = 1.376–2.290) were associated with a higher likelihood of unprotected anal intercourse.Conclusion: Although the results might not be generalizable to all Iranian IDUs, this study findings may still be helpful for design and implementation of public health programs in Iran to prevent sexual transmission of HIV through IDUs.

AIDS-Related Kaposi Sarcoma

K aposi sarcoma (KS) is the most common tumor that occurs in patients infected with the human immunodeficiency virus (HIV) and is an acquired immunodeficiency syndrome (AIDS)–defining illness according to the guidelines of the Centers for Disease Control and Prevention (CDC). In the United States, KS is over 20000 times more common in people with AIDS than in the general population and over 300 times more common than in other immunosuppressed patients such as renal transplant recipients. Although KS has been reported among all risk groups for HIV infection, it is more common in homosexual or bisexual men. As reported to the CDC, KS occurs in roughly 20% of HIV-infected homosexual men, a sharp contrast when compared with the occurrence of KS in 3% of heterosexual intravenous drug users, 3% of transfusion recipients, 3% of women or children, and 1% of hemophiliacs. It is important to stress that, although KS is a reportable manifestation of AIDS, it is generally not reported to the CDC if it occurs after the initial report of AIDS so these percentages more likely represent underreporting.

Antibodies to human herpes virus type 8 (HHV8) in general population and in individuals at risk for sexually transmitted diseases in Western Sicily.

Human herpes virus 8 (HHV8) appears to be the primary aetiologic agent of Kaposi sarcoma (KS). To study the distribution of HHV8, a seroepidemiological study was carried out in western Sicily, where a high incidence rate of classical KS is well documented. A total of 970 sera of healthy human immunodeficiency virus (HIV) negative individuals of general population (1-70 years old) and 742 sera of individuals in different risk groups for HIV infection were evaluated by means of an indirect immunofluorescence assay able to detect antibodies to lytic and latent HHV8 antigens. Crude seroprevalence to HHV8 antigens was 11.5% in the general population, and it increased significantly with age from 6% under age 16 to 22% after age 50. Significantly higher HHV8 seroprevalence rates were detected among HIV positive and negative homosexual men (62% and 22%, respectively), men who had sex with prostitutes (40% and 29%, respectively); female prostitutes (42% and 30%, respectively), and clients at a sexually transmitted disease clinic (male: 60% and 33%, respectively, female: 63% and 43%, respectively). In contrast, heterosexual intravenous drug users had seroprevalence rates comparable to those found in the general population. The results suggest that HHV8 infection is widespread in Western Sicily. The high seroprevalence in individuals with high risk sexual activity point to the role of sexual behaviour in the transmission of the infection in adults, whereas the detection of antibodies in younger population (under 16 years old) is suggestive of a non-sexual route of transmission, probably occurring during childhood by close personal contact.

An isolate of human immunodeficiency virus type 1 originally classified as subtype I represents a complex mosaic comprising three different group M subtypes (A, G, and I).

Full-length reference clones and sequences are currently available for eight human immunodeficiency virus type 1 (HIV-1) group M subtypes (A through H), but none have been reported for subtypes I and J, which have only been identified in a few individuals. Phylogenetic information for subtype I, in particular, is limited since only about 400 bp of env gene sequences have been determined for just two epidemiologically linked viruses infecting a couple who were heterosexual intravenous drug users from Cyprus. To characterize subtype I in greater detail, we employed long-range PCR to clone a full-length provirus (94CY032.3) from an isolate obtained from one of the individuals originally reported to be infected with this subtype. Phylogenetic analysis of C2-V3 env gene sequences confirmed that 94CY032.3 was closely related to sequences previously classified as subtype I. However, analysis of the remainder of its genome revealed various regions in which 94CY032.3 was significantly clustered with either subtype A or subtype G. Only sequences located in vpr and nef, as well as the middle portions of pol and env, formed independent lineages roughly equidistant from all other known subtypes. Since these latter regions most likely have a common origin, we classify them all as subtype I. These results thus indicate that the originally reported prototypic subtype I isolate 94CY032 represents a triple recombinant (A/G/I) with at least 11 points of recombination crossover. We also screened HIV-1 recombinants with regions of uncertain subtype assignment for the presence of subtype I sequences. This analysis revealed that two of the earliest mosaics from Africa, Z321B (A/G/?) and MAL (A/D/?), contain short segments of sequence which clustered closely with the subtype I domains of 94CY032.3. Since Z321 was isolated in 1976, subtype I as well as subtypes A and G must have existed in Central Africa prior to that date. The discovery of subtype I in HIV-1 hybrids from widely distant geographic locations also suggests a more widespread distribution of this virus subtype, or at least segments of it, than previously recognized.

Condom use and sexual habits of heterosexual intravenous drug users in northern Italy.

In order to assess modes of human immunodeficiency virus (HIV) transmission from heterosexual intravenous drug users (IVDUs) to their partners, condom use and sexual habits with both steady and occasional partners were investigated. A total of 349 heterosexual IVDUs (247 men and 102 women) who ignored, at the time of interview, their HIV serostatus were interviewed. Respondents were asked for information on condom use and sexual habits for the three year period prior to the interview. Nearly 40% of IVDUs reported sexual intercourse with both steady partners and occasional partners. Fifty-four percent of their steady partners and 48% of their occasional partners were individuals who did not belong to groups at risk for HIV infection. Anal intercourse with steady partners was reported by 29% of IVDUs and 24% of IVDUs with occasional partners. Condom use during vaginal intercourse was seldom reported: 83% of IVDUs never used a condom with steady partners and 75% did not use one with occasional partners. IVDUs who were 1) unmarried, 2) enrolled in the study after 1986, 3) partners of not at-risk individuals, 4) partners of a foreigner and, 5) aware of their partners HIV seropositivity showed significantly higher, albeit still low, frequencies of condom use with steady partners. Conversely, all these factors seemed to have little impact on condom use with occasional partners. Condom use and sexual habits were similarly reported by HIV-positive and HIV-negative IVDUs. The present study shows that high-risk sexual behaviours among IVDUs are very widespread and it stresses the need for intensive counselling to promote condom use among IVDUs.

Preventing AIDS among Black Gay Men and Black Gay and Heterosexual Male Intravenous Drug Users

The black population is disproportionately affected by acquired immune deficiency syndrome (AIDS). Among those black people most at risk of becoming infected with the human immunodeficiency virus are black men who use intravenous drugs and black men who are gay. This article explores the complex cultural, economic, and social factors obstructing the reduction of the AIDS rate among these men. Implications and recommendations are made for developing effective AIDS prevention efforts by highlighting race-specific resources and supports for high-risk black men.

Sentinel surveillance of human immunodeficiency virus infection in sexually transmitted disease clinics in the United States.

From April 1988 through December 1989, sera obtained for syphilis testing from consecutive patients attending 98 sexually transmitted disease (STD) clinics in 37 metropolitan areas were tested for antibodies to human immunodeficiency virus (HIV) in an unlinked (blinded) survey. HIV seroprevalence in STD clinics ranged from 0 to 38.5% (median, 2.3%), with the highest rates found in the Mid-Atlantic states, Florida, and Puerto Rico. The highest median rates were found in men who have sex with men (36.1%) and heterosexual intravenous (IV) drug users (4.1%). For heterosexual persons who do not report IV drug use, median rates were highest in the 35- to 39-year-old age group for men (6.4%) and the 30- to 34-year-old age group for women (0.9%). Among persons who do not report risk behaviors for HIV infection, men had substantially higher median rates of HIV infection than women (P less than 0.001, Wilcoxon Signed Rank test), and rates were positively correlated with HIV infection rates in IV drug users in the same clinic (Pearson correlation coefficient [r] = 0.8; P less than 0.001). Among heterosexual STD clinic patients who do not report IV drug use, the median HIV infection rate for blacks (1.8%) was at least 2 times higher than the median infection rates for hispanics (0.9%) and whites (0.7%). The results of this study show that HIV infection in STD clinic patients varies by geographic area, sex, race and ethnic group, and risk behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

The changing pattern of human immunodeficiency virus type 1 infection in intravenous drug users. Results of a six-year seroprevalence study in Palermo, Italy.

A cross-sectional seroepidemiologic study was carried out between 1985 and 1990 in 1,567 heterosexual intravenous drug users who had been seen at the AIDS Regional Reference Center in Palermo, Italy, to evaluate the rate of human immunodeficiency virus type 1 (HIV-1) seroprevalence in this group and its long-term trend. Sixty serum samples collected from drug users in 1980 and 1983, before the founding of the Center (1985), were tested as well. Some demographic and behavioral risk factors were studied in a subgroup of intravenous drug users enrolled in 1985, 1987, and 1990 for their possible association with HIV-1. These factors were also studied in relation to hepatitis B virus infection, since both viruses share the same modes of spread. These drug users had a higher prevalence of markers for hepatitis B virus than of HIV-1 antibodies, and the prevalence rates in sera collected declined over time for both infections. The presence of both antibodies to HIV-1 and markers for hepatitis B virus was independently associated with the age of the drug user, the duration of drug use, and the year of serum collection. Antibodies to HIV-1 were observed more frequently in females than in males. No relation was found between education or employment status and the presence of HIV-1 antibodies or hepatitis B virus markers. Although new HIV-1 infections still occur, the decline in seroprevalence observed at the end of the 1980s might be related to modifications in social behavior among newer drug users, partial exhaustion of the susceptible population, and increasing risk awareness in more experienced users.

Heterosexual transmission of HIV-1 associated with the use of smokable freebase cocaine (crack)

A study of risk factors for HIV-1 infection was conducted at a sexually transmitted disease clinic in an area of New York City where the cumulative incidence of AIDS in adults through mid-1990 was 9.1 per 1000 of the population and where the use of illicit drugs, including smokable freebase cocaine (crack), is common. The overall seroprevalence among volunteers was 12% (369 out of 3084), with 80% of those who were seropositive reporting risk behavior associated with HIV-1 infection, including male-to-male sexual contact, intravenous drug use and heterosexual contact with an intravenous drug user. The seroprevalence in individuals denying these risks was 3.6% (50 out of 1389) and 4.2% (22 out of 522) in men and women, respectively. Among these individuals, the behaviors significantly associated with infection were use of crack and prostitution in women, and history of syphilis and crack use in men. These results suggest that in areas where the level of HIV-1 infection in heterosexual intravenous drug users is high and the use of crack is common, increased sexual activity (including the exchange of drugs or money for sex) may result in increased heterosexual transmission of HIV-1.

Sexually Transmitted Diseases in a Population of Intravenous Drug Users: Association with Seropositivity to the Human Immunodeficiency Virus (HIV)

The association between human immunodeficiency virus (HIV) seropositivity and a history of sexually transmitted diseases (STDs), evidence of STDs on physical examination, and sexual and drug use practices was studied in a population of 2921 intravenous drug users (IVDUs) in Baltimore during 1988 and 1989. Overall, 24.1% were HIV-seropositive at baseline, and 60% reported a history of an STD. A significant association was found between HIV seropositivity and a history of syphilis (P = .04); both were more frequent among homosexual/bisexual men than among heterosexual IVDUs. In multivariate analysis, a history of syphilis was independently associated with HIV seroprevalence in homosexual/bisexual male IVDUs, of whom 90% reported a history of sexual intercourse with women. Cocaine injection was independently associated with HIV seropositivity but not a history of syphilis on multivariate analysis. STDs, indicative of unsafe sex practices, are common in this population; efforts are needed to prevent sexual transmission of HIV infection among IVDUs and their sex partners.

Trends in mortality among AIDS patients in Amsterdam, 1982–1988

In this study we evaluated the survival of 515 AIDS patients diagnosed in Amsterdam between 1982 and 1988 and followed-up until April 1990. Non-resident patients survived for a shorter period than resident patients (median survival time 10 versus 16 months). Residents had a 1-, 2- and 3-year survival of 56.1, 33.0 and 17.2%, respectively. Heterosexual intravenous drug users tended to have a better survival than homosexual men, although this was not significant. The survival time was longer for AIDS patients less than 30 years of age at diagnosis and varied for the different clinical manifestations leading to AIDS diagnosis. We calculated the 1- and 2-year survival probability by year of diagnosis for patients initially presenting with a Pneumocystis carinii pneumonia (PCP). The 1-year survival improved greatly in 1986 and continued to rise in the following years. The 2-year survival was similar in 1986 and 1987 (26.8 versus 28.2%) but increased in 1988 (38.9%). We conclude that besides better clinical experience and diagnostic methods, this improvement in prognosis could be explained by the start of secondary prophylaxis for PCP in 1985 and the introduction of zidovudine therapy in 1987.

Sexual risk behavior among heterosexual intravenous drug users

We analyzed the relationship of ethnicity and gender to high-risk sexual behavior among 457 male and female heterosexual intravenous drug users (IVDUs) interviewed in street and clinic settings in San Francisco. Over two-thirds said they never used condoms. More of the black respondents had not been enrolled in treatment. White IVDUs were more likely to report 10 or more partners, anal sex, and a steady drug-injecting partner; black respondents more often reported prostitution. More men said they never used condoms, and more women said they engaged in prostitution. These high-risk sexual behaviors were significantly and independently associated with ethnicity or gender when other sociodemographic variables were held constant. Sexual risk reduction for IVDUs, focusing on condom use, needs to be expanded to reach non-injecting partners. Intervention is critical for the black community, where a high proportion of IVDUs have steady non-injecting partners.

Risk Factors for Human Immunodeficiency Virus Infection in 581 Intravenous Drug Users, Northeast Italy, 1984–1988

Prevalence and risk factors for human immunodeficiency (HIV) virus infection were assessed in 581 heterosexual intravenous drug users (IVDUs), recruited from eight public drug assistance centres in the northeast of Italy, an area at low risk for AIDS. The overall seroprevalence for HIV antibody was rather high, 39% (95% confidence interval (CI): 35-43%). HIV prevalence had risen from 32% in 1984-1985 to 52% in 1987-1988. Thirty-three per cent of female and 41% of male IVDUs had antibodies to HIV (p = 0.07). Seropositivity rates showed a strong east-west geographical gradient (from 16% to 60%, p = 0.005): IVDUs living in the western part of the study area had a nearly sevenfold higher risk of infection (odds ratio (OR) = 6.9, 95% CI: 4.4-13.9) than those living in the eastern part. Sharing of drug injection equipment (OR = 3.6), duration of drug addiction (OR = 2.6), use of heroin in high-incidence cities (OR = 2.3), use of cocaine in addition to heroin (OR = 1.5) and history of prostitution (OR = 2.3) increased the risk of acquiring HIV infection. Over the study period, the ORs associated with area of residence decreased, whereas those associated with the use of heroin in high-incidence cities and with prostitution increased.

Heterosexual Transmission of Human Immunodeficiency Virus among Intravenous Drug Users

To examine sexual transmission of human immunodeficiency virus (HIV) among heterosexual intravenous drug users (IVDUs), HIV antibody status of IVDUs with intravenous drug-using sexual partners (IVSPs) was compared with that of IVDUs with no IVSPs. Initial bivariate analyses indicated IVDUs with IVSPs were more likely to be HIV antibody-positive than those with no IVSPs. Analyses by gender indicated that this relationship held for men but not women. IVDUs with IVSPs also differed from those without IVSPs demographically, in drug use, and in other sexual behaviors. When effects of other variables were controlled, no statistically significant relationship was found between injection history of sex partners and HIV status for the total sample or separately for men or women.

Prevalence of HIV antibody and pregnancy in Tayside, 1984-9: background to screening.

To determine age specific prevalence of HIV antibody, incidence of pregnancy, and likelihood of detection and correct assignment to risk category by antenatal screening of women known to be positive for HIV antibody, from 1984 to 1989. Retrospective analysis of reproductive history and risk behaviour of women positive for HIV antibody and prediction of detection by screening on the basis of blood group samples, Guthrie tests, and rubella tests. City of Dundee, where the prevalence of HIV is high, since the appearance of HIV in 1984, predominantly among heterosexual intravenous drug users. All (61) women known to be positive for HIV antibody who had had clinically indicated tests, for whom case notes were available for 60. Risk assessment according to case notes and reported to the laboratory, incidence of infection, geographical location, age, date of positive test result, and reproductive history. With 61 infected women the overall minimum prevalence among women within the city of Dundee was 0.67/1000 and 2.9/1000 among women in their third decade. Of the 60 women whose reproductive history was available, 35 had 57 pregnancies, 36 of which occurred after seroconversion was known to have taken place, representing 8.7% of the total number of affected pregnancies reported for the United Kingdom. If antenatal screening for HIV had been performed between 1984 and 1989 it could not have detected positivity for HIV antibody in 25 (42%) women who had no pregnancies during this time. Among the remaining 35 women, screening samples taken for blood grouping could have identified a maximum of 34 (57%), samples taken to check rubella susceptibility a maximum of 22 (37%), and blood spots on Guthrie cards a maximum of 19 (32%). Retesting would have occurred in 14 women 33 times with samples taken for blood grouping, but three and four women would have been tested twice using samples taken for rubella testing and Guthrie cards respectively. Anonymous screening would have been unable to determine risk category as a history of intravenous drug use was known in 47 (79%) women before testing but this was increased by a further 5 (8%) who admitted to it after the test result was known. Interpreting the results of antenatal screening programmes will be complex and will underestimate overall prevalence of HIV antibody among women; this will be exaggerated by strategies based on anonymous testing with Guthrie cards or on samples taken for rubella testing, which do not include women who have had an earlier loss of pregnancy. Only open testing with consent will permit satisfactory attribution to

Abdominal and anorectal surgery and the acquired immune deficiency syndrome in heterosexual intravenous drug users

Over a period of seven years, 474 patients with acquired immune deficiency syndrome (AIDS) or AIDS-related complex were admitted on 782 occasions to the St. Francis Medical Center, Trenton, New Jersey. Abdominal surgery was performed on 16 (3.4 percent) patients, 14 (88 percent) of whom were heterosexual intravenous drug users. Anorectal surgery was performed on 20 (4.2 percent), 14 (70 percent) of whom were intravenous drug users. Intravenous drug users undergoing abdominal surgery had the same types of surgical abdominal conditions that occur in the general population. None required surgery for complications secondary to cytomegalovirus, visceral lymphoma, or visceral Kaposi's sarcoma. The postoperative morbidity rate was 72 percent. The postoperative mortality rate (30 day) was 0 percent. No intravenous drug users who underwent anorectal surgery had associated anorectal malignancies or infectious diseases. Five of six homosexual patients had either an anorectal malignancy or an associated anorectal infectious disease. Anorectal wounds did not heal within one month in one third of the intravenous drug users. The rate of wound healing was inversely related to the white blood cell count. One third of the intravenous drug users undergoing anorectal surgery were dead within six months.

Projections of AIDS Morbidity and Mortality in San Francisco

To develop a model for predicting acquired immunodeficiency syndrome (AIDS) morbidity in San Francisco, Calif, through June 1993, we combined annual human immunodeficiency virus seroconversion rates for homosexual and bisexual men and for heterosexual intravenous drug users with estimates of the cumulative proportion of the population with AIDS by duration of human immunodeficiency virus infection and with estimates of the size of the at-risk populations. We projected AIDS mortality by applying Kaplan-Meier estimates of survival time following diagnosis to the projected number of cases. The median incubation period for AIDS among homosexual and bisexual men infected with the human immunodeficiency virus was estimated to be 11.0 years (mean, 11.8 years; 95% confidence interval, 10.6 to 13.0 years). The model projects 12,349 to 17,022 cumulative cases of AIDS in San Francisco through June 1993, with 9,966 to 12,767 cumulative deaths.

Human immunodeficiency virus (HIV) seroprevalence in persons attending STD clinics in the United States, 1985-1987.

We reviewed published and unpublished studies on seroprevalence of HIV antibody in persons attending sexually transmitted disease (STD) clinics in the United States from 1985 through 1987. We identified 23 studies from 16 states; nine studies determined risk factors for HIV. Overall, 899 (4.2%) of the 21,352 clinic attendees were seropositive; the seroprevalence rate was higher for men (5.9%) than for women (1.7%). Clinic seroprevalence ranged from 0.5% to 15.2% (median, 3.5%), reflecting in part the proportion of all attendees who were homosexual or bisexual, intravenous-drug users (IVDUs), or heterosexual partners of bisexual men or IVDUs (median proportion, 21.8% for the nine sites with this information). Most HIV-seropositive persons were at recognized risk (median for the same nine studies, 85.3%). Homosexual/bisexual men had the highest seroprevalence (median, 32.2%), followed by heterosexual IVDUs (median, 3.6%). Heterosexuals who denied intravenous-drug use had a median rate of 0.9%, which strongly correlated with rates in IVDUs in the same clinics (r = 0.88). We conclude many STD clinic attendees are infected with HIV. Because AIDS is an STD and seroprevalence has been associated with other STDs, STD clinics are important sites for HIV surveillance and risk-reduction education.

Cocaine Use and HIV Infection in Intravenous Drug Users in San Francisco

We assessed risk factors for human immunodeficiency virus (HIV) infection in 633 heterosexual intravenous drug users. The HIV seroprevalence was 26% in blacks, 10% in Hispanics, and 6% in whites. Intravenous cocaine use significantly increased the risk of HIV infection, with a seroprevalence of 35% in daily cocaine users (odds ratio, 6.4; 95% confidence interval, 3.0 to 13.3). Black subjects were more likely to use cocaine regularly. Drug use in shooting galleries and sharing of drug injection equipment were also associated with HIV infection and were more common in cocaine users. By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection. Methadone therapy was associated with substantial reductions in heroin use and some reduction in cocaine use, but 24% of cocaine users receiving methadone began or increased cocaine injection after entry into treatment.

Observations on the Importance of Social Context in HIV Transmission among Intravenous Drug Users

Human immunodeficiency virus (HIV) is arguably the most significant health consequence associated with intravenous drug use. The primary mode for HIV transmission among intravenous drug users (IVDUs) is the sharing of contaminated hypodermic equipment. These activities take place under social conditions that may vary widely among different groups of IVDUs.In 1987, HIV seroprevalence among heterosexual IVDUs was approximately 15% in San Francisco and 50% in New York City. In New York City 31.6% of AIDS cases were diagnosed among heterosexual IVDUs, while 1.3% of AIDS cases fell into the same category in San Francisco. Different trajectories of HIV infection among IVDUs in San Francisco and New York are explored; possible explanations for disparities are considered; and the social contexts and conditions in which risk behavior takes place are discussed. Implications for public health policy, community-based interventions, and the efficacy of needle-exchange programs are explored.