Group Of Injecting Drug Users Research Articles

Promoting equitable access to hepatitis C treatment for Indo-Chinese injecting drug users

Increasing the uptake of hepatitis C treatment by injecting drug users (IDUs) is a key strategy in addressing the escalating disease burden of chronic hepatitis C virus (HCV) infection in Australia. Little is known about barriers to treatment uptake among culturally diverse groups of IDUs. Indo-Chinese IDUs represent a marginalised group with high rates of incident and prevalent HCV infection. An ethnographic study was conducted to explore barriers to HCV treatment uptake experienced by Indo-Chinese IDUs and inform the development of policies and practices that promote access to treatment. Following a baseline interview, participants (n=23) received a brief intervention about HCV treatment and an offer of facilitated referral to a tertiary liver clinic. Follow-up interviews were conducted three and six months post intervention, to explore decision-making about treatment-seeking and experiences accessing the clinic. While 'getting rid of' HCV was regarded as highly desirable, only three participants were assessed for treatment. For most participants, seeking treatment was not seen as feasible given social and structural barriers related to their drug use, lack of resources and support. Institutional barriers included the clinic's administrative procedures, limited flexibility and apparent reluctance to consider current IDUs suitable candidates for treatment. Resources and support, fexible, low threshold approaches to assessment and a willingness to provide treatment to current IDUs, would promote equitable access to treatment among these groups.

A meta-analysis of the hepatitis C virus distribution in diverse racial/ethnic drug injector groups

Hepatitis C virus (HCV) is mostly transmitted through blood-to-blood contact during injection drug use via shared contaminated syringes/needles or injection paraphernalia. This paper used meta-analytic methods to assess whether HCV prevalence and incidence varied across different racial/ethnic groups of injection drug users (IDUs) sampled internationally. The 29 prevalence and 11 incidence studies identified as part of the HCV Synthesis Project were categorized into subgroups based on similar racial/ethnic comparisons. The effect estimate used was the odds or risk ratio comparing HCV prevalence or incidence rates in racial/ethnic minority groups versus those of majority status. For prevalence studies, the clearest disparity in HCV status was observed in the Canadian and Australian Aboriginal versus White comparison, followed by the US non-White versus White categories. Overall, Hispanic IDUs had greater HCV prevalence, and HCV prevalence in African-Americans was not significantly greater than that of Whites in the US. Aboriginal groups showed higher HCV seroconversion rates when compared to others, and African-Americans had lower seroconversion rates compared to other IDUs in the US. The findings suggest that certain minority groups have elevated HCV rates in comparison to other IDUs, which may be a consequence of stigma, discrimination, different risk behaviors or decreased access to health care, services and preventive education. Future research should seek to explicitly explore and explain racial/ethnic variations in HCV prevalence and incidence, and define the groups more precisely to allow for more accurate detection of possible racial/ethnic differences in HCV rates.

Seroprevalence of Viral Hepatitis and Sexually Transmitted Disease Among Adults with Recently Diagnosed HIV Infection in Southern Taiwan, 2000–2005: Upsurge in Hepatitis C Virus Infections Among Injection Drug Users

The purpose of this study was to compare the seroprevalence of viral hepatitis and sexually transmitted disease (STD) co-infections among three populations at risk recently diagnosed with HIV infection. A retrospective review of medical records was performed to determine the prevalence of several co-infections among adults recently diagnosed with HIV infection between 2000 and 2005 at National Cheng Kung University Hospital in Tainan, Taiwan. Among a total of 484 adults, 124 (25.6%) were men having sex with men (MSM), 105 (21.7%) were heterosexual adults, and 255 (52.7%) were injection drug users (IDUs). The case number of adults with recently diagnosed HIV infection increased annually, from 27 in 2000 to 142 in 2005 (p < 0.001). This trend appeared to be attributable to the upsurge in HIV infection among IDUs beginning in 2003. At the time of HIV diagnosis, mean CD4+ counts were significantly higher and plasma HIV-1 RNA loads were lower in the IDU group than the MSM or heterosexual groups. The hepatitis B virus (HBV) carrier rate was similar in all three groups, with an average rate of 16.5%. The prevalence of treponemal antibody and Entamoeba histolytica indirect hemagglutination antibody was higher in MSM (37.5% and 9.4%, respectively) than in heterosexuals (19.6% and 7.3%, respectively) or IDUs (3.2% and 2.1%). The seroprevalence of hepatitis A virus infection increased with age, with 94.2% (97/103) of patients who were older than 40 years. Hepatitis C virus (HCV) or HBV-HCV co-infections were noted more often in IDUs (97.9% and 16.9%, respectively) than in heterosexuals (10.9% and 2.2%, respectively) and MSM (5.3% and 3.6%, respectively). There was a recent upsurge in HIV-HCV co-infected IDUs in southern Taiwan. A higher rate of co-infection with STDs among HIV-infected MSM highlights the need for integrated STD control efforts in current HIV prevention programs.

HIV risk behavior among injection drug users in Tehran, Iran

Iran faces parallel human immunodeficiency virus (HIV) and injection drug use epidemics; more than 62% of known HIV cases occur among injection drug users (IDU). We conducted a formative study of IDU in Tehran to explore risk behavior in the wake of the recent harm reduction efforts. Key informant interviews (n = 40), focus group discussions (nine groups of IDU, n = 66) and a review of existing published and unpublished literature were conducted. Participants included IDU, physicians, policy makers, police, IDU advocates and their families. IDU were diverse in gender, education, income and neighborhood of residence. Interviews were transcribed and analyzed using grounded theory. A typology of IDUs in Tehran, categorized according to self-defined networks as well as HIV risks, is presented. This categorization is based on the groups identified by IDUs, compared to those identified by other key informants, and on a secondary data review. Homeless, female, young IDU and users of a more potent form of heroin were identified as having increased risks for HIV. Participants described shortening transitions from smoked opium to injected opiates. Whereas a majority of participants considered needle sharing less common than previously, sharing continues in locations of group injection, and in states of withdrawal or severe addiction. System-wise barriers to harm reduction were discussed, and include the cost or stigma of purchasing needles from pharmacies, over-burdened clinics, irregular enforcement of laws protecting IDU and lack of efforts to address the sexual risks of IDU. This research is one of the first to describe a diversity of IDU, including women and higher socio-economic class individuals, in Tehran. While efforts in harm reduction in Iran to date have been notable, ongoing risks point to an urgent need for targeted, culturally acceptable interventions.

Syringe vending machines as a form of needle syringe programme: Advantages and disadvantages

In a bid to increase the anonymous and non‐stigmatized access to sterile injecting equipment for injecting drug users (IDUs) and provide extended hours availability, syringe vending machines were introduced into needle syringe programmes (NSPs) in several countries. This article examines, based on existing international experience, the observed advantages and disadvantages of these machines. Despite the disadvantage associated with their lack of ability to establish contact between health staff and IDUs, syringe vending machines appear to largely enhance access to sterile equipment, in particular to the hidden and high‐risk group of IDUs, who for several reasons cannot or do not use existing staffed NSPs. Vending machines that dispense Fitpacks mechanically may also help reduce unsafe disposal of used equipment. As these machines make services more accessible and acceptable to the users and complement other modes of NSPs, they are gradually gaining widespread acceptance in an increasing number of countries.

Assessing the role of syringe dispensing machines and mobile van outlets in reaching hard-to-reach and high-risk groups of injecting drug users (IDUs): a review.

Reaching hard-to-reach and high-risk injecting drug users (IDUs) is one of the most important challenges for contemporary needle syringe programs (NSPs). The aim of this review is to examine, based upon the available international experience, the effectiveness of syringe vending machines and mobile van/bus based NSPs in making services more accessible to these hard-to-reach and high-risk groups of IDUs. A literature search revealed 40 papers/reports, of which 18 were on dispensing machines (including vending and exchange machines) and 22 on mobile vans. The findings demonstrate that syringe dispensing machines and mobile vans are promising modalities of NSPs, which can make services more accessible to the target group and in particular to the harder-to-reach and higher-risk groups of IDUs. Their anonymous and confidential approaches make services attractive, accessible and acceptable to these groups. These two outlets were found to be complementary to each other and to other modes of NSPs. Services through dispensing machines and mobile vans in strategically important sites are crucial elements in continuing efforts in reducing the spread of HIV and other blood borne viruses among IDUs.

Barriers to use of Needle and Syringe Programmes in a high drug use area of Sydney, New South Wales

Objective: Most surveillance of injecting drug users (IDUs) in Australia is done with samples of participants drawn from those who attend Needle and Syringe Programmes (NSPs). We investigated the barriers and preferences to NSP access of a group of IDUs who do not use NSPs as their primary source of injecting equipment from a defined geographical area in Sydney, which has been estimated to house the highest number of IDUs in Australia. Method: A cross-sectional, interviewer-administered questionnaire was completed by 294 participants, most of whom were recruited through the personal and extended networks of peer interviewers. Participants were considered in two groups: those who did not use NSPs (non-NSP users) and those who used NSPs infrequently (infrequent NSP users). Results: Infrequent NSP users were more likely than non-NSP users to report reasons of convenience and NSP operation as barriers to access. Non-NSP users reported barriers related to lack of awareness of NSPs and that they did not need to access NSPs. Fixed locations and vending machines were most frequently endorsed by both groups as the “best way” to distribute injecting equipment. However, issues of stigma and maintaining anonymity were concerns for participants in both groups. Compared to non-NSP users, infrequent users were more likely to reside in areas with a large drug user population, obtain safe injecting information from health workers, have injected drugs for longer, have injected alone, have been tested for blood borne viruses, report greater connectedness to drug user networks and be less concerned about contacting NSP staff. Conclusion: Understanding the preferences of IDU, including those who do not attend NSP, is central to providing health services which meet their needs and in developing hepatitis C prevention programmes which reach this target group. The effects of stigma on the health care choices of IDUs must be recognised in planning developments in NSP service, or alternatives to NSPs.

More Severe Parenchymal Injury in Chronic Hepatitis C Acquired by Recent Injection Drug Use

Histologic liver injury is reported to be less severe in persons who acquire hepatitis C through injection drug use (IDU) than by blood transfusion. Because age correlates with histologic severity, it may be that differences between routes of acquisition reflect the younger age of most drug abusers. The early histopathologic changes of hepatitis C acquired through IDU are less defined, probably because of the lack of liver biopsy material from a cohort of patients not long after initial exposure. The availability of material from a cohort of patients who had liver biopsy for IDU-related hepatitis C in the 1970s enabled us to compare the histology with that of current patients. Liver biopsies of a group of injection drug users (n=70, all males; mean age, 27.6 years, designated as Group 1) in the 1970s cohort were compared with biopsies of patients (n=63, all males; mean age, 48 years, designated as Group 2, 23 who admitted past IDU) entering a treatment trial in 1999. All patients were positive for anti-HCV at the time of biopsy. The histologic features of the 23 patients in Group 2 with a history of IDU did not differ significantly from the other 40 patients who denied past IDU. Using a modified Histologic Activity Index (HAI), there was no difference between Group 1 and Group 2 in portal inflammation or periportal injury. However, parenchymal (lobular) injury and inflammation was significantly (P<0.0001) greater in Group 1 than Group 2. Fibrosis was significantly (P=0.014) greater in Group 2. The degree of parenchymal injury was greater in Group 1 than Group 2, perhaps because they were closer to the time of exposure or possibly because of a stronger immunologic response in younger patients. The degree of hepatic fibrosis was greater in Group 2, suggesting that progression with age may be the natural history of chronic hepatitis C.

Marginalized and Socially Integrated Groups of IDUs in Hungary: Potential Bridges of HIV Infection

The discrepancy in HIV rates among Eastern and central European injecting drug users (IDUs) suggests that, in addition to risk behaviors, social contact patterns also play an important role. We identify two groups of IDUs in Budapest, Hungary, marginalized IDUs (M-IDUs) and socially integrated IDUs (SI-IDUs) and compare their HIV/hepatitis B virus (HBV)/hepatitis C virus (HCV) social and risk network characteristics, risk behaviors, and travel patterns. Between May 2003 and January 2004, 29 nontreatment-recruited young IDUs in Budapest participated in ethnographic interviews and focus groups. The mean age was 23.6 years (SD=3.6); eight were female and two Roma/Gypsy. Most injected heroin (n=23) and/or amphetamines (n=10) in the past 30 days. M-IDUs had no legal employment, injected heroin and sniffed glue, and stopped using drugs in treatment/prison. SI-IDUs had regular jobs or were students, injected heroin and sniffed cocaine, and stopped using drugs before exams/tests. Both M-IDUs and SI-IDUs shared injecting equipment on occasion and used condoms rarely. M-IDUs had a large social network of "buddies" and a small risk network of "friends". SI-IDUs had two separate large social networks of "buddies": a M-IDU and a non-IDU network; and a small risk network of "friends". Both groups reported monogamous sexual relationships. M-IDUs traveled within Hungary, whereas SI-IDUs traveled to Western Europe. If an HIV epidemic among IDUs in Hungary is not prevented, SI-IDUs may form a potential "bridge" of HIV infection between high-risk IDU populations and the low-risk general population, whereas M-IDUs may become cores of infection. Different approaches may be appropriate for M-IDUs and SI-IDUs to prevent HIV.

HIV-1 binding and neutralizing antibodies of injecting drug users

Previous studies have demonstrated a stronger seroreactivity against some synthetic peptides responsible for inducing neutralizing antibodies in injecting drug users (IDU) compared to that of individuals sexually infected with HIV-1 (S), but the effectiveness in terms of the neutralizing ability of these antibodies has not been evaluated. Our objective was to study the humoral immune response of IDU by determining the specificity of their antibodies and the presence of neutralizing antibodies. The neutralization capacity against the HIV-1 isolate MN (genotype B), the primary HIV-1 isolate 95BRRJ021 (genotype F), and the seroreactivity with peptides known to induce neutralizing antibodies, from the V2 and V3 loops of different HIV-1 subtypes, were analyzed. Seroreactivity indicates that IDU plasma are more likely to recognize a broader range of peptides than S plasma, with significantly higher titers, especially of V3 peptides. Similar neutralization frequencies of the MN isolate were observed in plasma of the IDU (16/47) and S (20/60) groups in the 1:10 dilution. The neutralization of the 95BRRJ021 isolate was more frequently observed for plasma from the S group (15/23) than from the IDU group (15/47, P = 0.0108). No correlation between neutralization and seroreactivity with the peptides tested was observed. These results suggest that an important factor responsible for the extensive and broad humoral immune response observed in IDU is their infection route. There was very little difference in neutralizing antibody response between the IDU and S groups despite their differences in seroreactivity and health status.

Scapegoating, self-confidence and risk comparison: The functionality of risk neutralisation and lay epidemiology by injecting drug users

This paper investigates the competing rationalities of scientific and lay epidemiology and how the tension between the two impacts on the efficacy of health promotion messages for injecting drug users (IDUs). It proposes that behaviours, which may be difficult to understand when viewed at an individual level, are, in fact, rational within particular cultural contexts. The study used qualitative semi-structured interviews with 60 heroin users. A number of different types of risk neutralisation were observed in this group of interviewees, including: scapegoating, self-confidence and risk comparison. Interviewees commonly used lay epidemiology to justify and rationalise their risk neutralisation strategies. The paper provides concrete examples of the ways in which this group of IDUs neutralise risk through the use of these strategies. The findings illustrate how many of the psychological constructs surrounding the perception of risk which focus on individual behaviour are fundamentally simplistic and often unhelpful in understanding the behaviours of this group of people. It is concluded that some ‘risk’ behaviours are often functional and rational within the context of prohibitionist drug policies which create an environment in which the IDU often has little real agency to reduce the risks associated with their drug use.

Displacement of Canada's largest public illicit drug market in response to a police crackdown.

Law enforcement is often used in an effort to reduce the social, community and health-related harms of illicit drug use by injection drug users (IDUs). There are, however, few data on the benefits of such enforcement or on the potential harms. A large-scale police "crackdown" to control illicit drug use in Vancouver's Downtown Eastside provided us with an opportunity to evaluate the effect. As part of our ongoing prospective cohort study of IDUs in Vancouver, we examined data collected from 244 IDUs in the 3 months before the police crackdown and from 142 IDUs in the 3 months after the start of the crackdown, on Apr. 7, 2003. All study subjects were active drug users. We also examined external data on needle exchanges and syringe disposal. The 2 groups of IDUs were statistically similar: they were mainly young (mean age 39 years) and male (63%), and they had injected illicit drugs for 13 years on average. Ethnic background and the proportion homeless were also similar. There were no statistically significant reported differences (all p > 0.1) in the street price of heroin, cocaine or "crack" in the 2 periods. In the 3-month periods before and after the crackdown, respectively, the rates of daily heroin injection were 27.9% and 26.8%, daily cocaine injection 28.7% and 27.5%, and daily crack use 59.4% and 60.6% (all p > 0.1). The proportions of study subjects receiving methadone treatment, 41.0% and 44.4% (p = 0.516), did not differ. However, the proportions reporting a change in where drugs were used, 22.5% and 33.8% (p < 0.05), and the proportions reporting a change in the neighbourhood of use because of police presence, 18.1% and 26.8% (p < 0.05), increased significantly. Needle-exchange data confirmed that the community levels of drug use were unchanged. Disposal statistics demonstrated that the monthly average number of used syringes found on the streets outside the traditional area of drug use increased from 784 in the 3 months before Apr. 1 to 1253 in the subsequent 3 months (p = 0.002) and the monthly average number of used syringes found in public boxes for the safe disposal of syringes decreased from 865 to 502 (p = 0.018). The effort to control illicit drug use did not alter the price of drugs or the frequency of use, nor did it encourage enrollment in methadone treatment programs. Several measures indicated displacement of injection drug use from the area of the crackdown into adjacent areas of the city, which has implications for both recruitment of new initiates into injection drug use and HIV prevention efforts.

Candidate HIV/AIDS vaccines

Candidate HIV/AIDS vaccines

Monitoring hepatitis C virus infection among injecting drug users in the European Union: a review of the literature

Hepatitis C virus (HCV) among injecting drug users (IDUs) is one of the European Union's (EU) major public health problems. This review examines the current state of knowledge regarding HCV among IDUs in EU countries. Studies published between January 1990 and December 2000, were identified through a computerized search (MEDLINE and EMBASE). Ninety-eight studies have reported prevalence for HCV among groups of IDUs in all EU countries except Luxembourg. The prevalence of anti-HCV ranged from 30 to 98%. Incidence rates ranged from 6.2 to 39.3 per 100 person years. This review provides a comprehensive examination of HCV infection among IDUs in the countries of the EU, and quite clearly demonstrates that the quality and epidemiological relevance of the studies published varies widely. Thus, the reported data may not reflect accurately the current or recent past prevalence of HCV among IDUs in the EU. A strategic approach to the surveillance of HCV among IDUs in the EU, utilizing robust and consistent methods, is required urgently.

Between–City Variation in Frequency of Injection Among Puerto Rican Injection Drug Users: East Harlem, New York, and Bayamon, Puerto Rico

Summary: Frequency of injection has been consistently found to be higher among Puerto Rican Injection drug users (IDUs) than among other groups of IDUs. Several explanations have been suggested, but an empirical explanation has yet to be presented. This study compares the frequency of injection of Puerto Rican IDUs in East Harlem, New York, with that of IDUs in Bayamon, Puerto Rico. Study subjects comprised 521 Puerto Rican IDUs from East Harlem and 303 IDUs from Bayamon. The mean frequency of injection among IDUs in East Harlem was 2.8, the corresponding mean in Bayamon was 5.4. Younger IDUs reported a higher number of daily injection episodes than older IDUs, and the IDU group in Bayamon was 5 years younger than the group in East Harlem. The drug use variables accounted for a greater portion of the between-city difference than the demographic and psychosocial variables. Use of noninjected drugs, as well as the use of prescribed methadone, were found to be associated with a lower number of daily injections. Conversely, injection of cocaine, injection of cocaine mixed with heroin (“speedball”), and injection of larger amounts of drug solution were found to be associated with a higher number of daily injections.

Multiple Access to Sterile Syringes for Injection Drug Users: Vending Machines, Needle Exchange Programs and Legal Pharmacy Sales in Marseille, France

Objective: In Marseille, southeastern France, HIV prevention programs for injection drug users (IDUs) simultaneously include access to sterile syringes through needle exchange programs (NEPs), legal pharmacy sales and, since 1996, vending machines that mechanically exchange new syringes for used ones. The purpose of this study was to compare the characteristics of IDUs according to the site where they last obtained new syringes. Methods: During 3 days in September 1997, all IDUs who obtained syringes from 32 pharmacies, four NEPs and three vending machines were offered the opportunity to complete a self-administered questionnaire on demographics, drug use characteristics and program utilization. Results: Of 485 individuals approached, the number who completed the questionnaire was 141 in pharmacies, 114 in NEPs and 88 at vending machines (response rate = 70.7%). Compared to NEP users, vending machine users were younger and less likely to be enrolled in a methadone program or to report being HIV infected, but more likely to misuse buprenorphine. They also had lower financial resources and were less likely to be heroin injectors than both pharmacy and NEP users. Conclusions: Our results suggest that vending machines attract a very different group of IDUs than NEPs, and that both programs are useful adjuncts to legal pharmacy sales for covering the needs of IDUs for sterile syringes in a single city. Assessment of the effectiveness and cost-effectiveness of combining such programs for the prevention of HIV and other infectious diseases among IDUs requires further comparative research.

HIV-1 subtyping in Salvador, Bahia, Brazil: a city with African sociodemographic characteristics.

To investigate the prevalence of the HIV-1 subtypes in different populations from Salvador, Bahia, Brazil, blood samples from 72 HIV-1-seropositive injecting drug users (IDUs) and 62 individuals infected sexually were analyzed using the heteroduplex mobility assay (HMA). In the IDU group, 89.5% were classified as subtype B, 3% as subtype F, and 7.5% showed a B/F HMA profile. In the sexual transmission (ST) group, 95% were identified as B subtype, 3.4% showed a B/F profile, and 1.6% a B/C/E HMA profile. All Brazilian samples that showed multiple reactivities in the HMA analysis clustered on sequencing with B North American/ European HIV-1 isolates in the phylogenetic analysis, whereas the F subtypes clustered with F Brazilian HIV-I isolates. Serologic reactivities of IDU's sera were examined using a panel of synthetic V3 loop peptides representative of the different HIV-1 subtypes. No difference in serologic reactivity between F and B subtype plasma could be observed. Predominance of HIV-I subtype B was identified in both study groups, whereas subtype F was detected only among IDUs in a frequency lower than described for other Brazilian regions.

African–American injection drug users: association between pre-treatment services and entry into and completion of detoxification

Research suggests that African–American injection drug users, when compared with other ethnic and racial groups of injection drug users, are more likely to have no history of substance abuse treatment. The project evaluated was designed to attract African–American injection drug users to treatment by providing comprehensive pre-treatment services including street outreach, drop-in center services, case management, and motivational counseling. The overall program goal was to facilitate clients’ acceptance of referral to treatment and readiness to utilize treatment. The evaluation described here examines whether, for this African–American population of hard-core drug users, utilization of pre-treatment services improved the intermediary treatment outcomes of entry into and completion of detoxification. Findings showed that high utilization of drop-in center services increased the frequency of entrance into detoxification programs. Entrance into detoxification has been shown to be significantly correlated with (a) entrance into further treatment, (b) reduced HIV/AIDS risk, and (c) successful linkage with health care and social services. Contrary to expectations, high utilization of pre-treatment services was not significantly correlated to increased completion of detoxification.

HIV monitoring in Vietnam: system, methodology, and results of sentinel surveillance.

To measure the prevalence of and trends in HIV infections in populations defined by sentinel surveillance in Vietnam. Surveillance was conducted in eight provinces in 1994, expanded to 12 in 1995 and to 20 in 1996. Sentinel populations were sexually transmitted disease (STD) patients, female sex workers (FSW), injecting drug users (IDU), tuberculosis (TB) patients, pregnant women, and military conscripts. Samples were collected twice yearly for high-risk populations and once yearly for low-risk populations. The overall HIV epidemic in Vietnam comprises several different smaller epidemics. It is primarily associated with injecting drug use, but its extent varies widely throughout the country. In 1998, HIV prevalence rates ranged from 0 to 85% (median, 13.1%), with an aggregate prevalence rate (APR; i.e., the sum of HIV-positive study subjects divided by the sum of all study subjects tested in sentinel provinces) of 17% among IDUs; this ranged from 0 to 14.7% (median, 0.8%), with the APR of 2.4% among FSWs; and from 0 to 6% (median, 0%), with the APR of 0.9% among STD patients. The APRs among antenatal women and army conscripts were less than 0.15%. APRs increased significantly from 1994 to 1998 among STD patients (p < .001), FSWs (p < .001), TB patients (p < .001), and pregnant women (p < .05) in original sentinel provinces. HIV prevalence also increased significantly among younger age groups of IDUs and FSWs. Vietnam's HIV epidemic is increasing predominantly and most rapidly among IDUs. However, prevalence rates among FSWs and STD patients are rising but are still low among pregnant women and army conscripts. Vietnam, at present, is still in the early phase of the HIV epidemic and has time to take effective and appropriate actions.

Direct comparison of time to AIDS and infectious disease death between HIV seroconverter injection drug users in Italy and the United States: results from the ALIVE and ISS studies. AIDS Link to Intravenous Experiences. Italian Seroconversion Study.

To compare the rate of HIV disease progression in a sample of polydrug injectors (AIDS Link to Intravenous Experiences [ALIVE] study) with that in a sample of predominantly opiate injectors (Italian Seroconversion Study [ISS]). Prospective cohort studies of HIV-positive individuals whose date of seroconversion (SC) is known with a good degree of precision. The ALIVE study involves a community-based cohort of injection drug users (IDU) in the United States and the ISS reports on a clinic-based cohort of seroconverters in Italy with different exposure modalities to HIV. Data from the two cohorts were combined. The date of SC was estimated as the midpoint in time between the last negative and the first positive HIV test. Time-to-event (i.e., AIDS or death from an infectious disease) statistical methods were used. Relative hazards (RH) of progression to event were adjusted by age at SC, gender, and year of SC. Of the 1003 IDUs (251 from ALIVE and 752 from ISS), 226 progressed to AIDS, and 146 died after AIDS or from an infectious disease; of these, 10 were without an AIDS diagnosis. The two groups of IDUs differed in terms of age at SC (median, 35 years for ALIVE and 25 years for ISS), proportion of women (24% versus 31%), race (7.6% versus 100% white), and year of seroconversion (i.e., ISS participants seroconverted, on average, earlier than ALIVE participants). Although the univariate analysis suggested possible differences for progression to AIDS, or to death from infectious disease between cohorts, multivariate analyses that adjusted for age showed no significant differences by cohort, gender, race, or time of seroconversion. The median time to AIDS for 25-year-old persons was 12.3 years for ALIVE and 11.8 years for ISS; for 35-year-old persons, it was 8.5 and 8.2 years, respectively. These estimates were similar to those for non-IDUs observed in the ISS and to those from large cohort of homosexual men. Our results confirm the importance of accounting for age when considering the incubation period for HIV infection. Despite differences in drug use characteristics, the similar median times to AIDS, for each age, between the two cohorts of IDUs and between the IDUs and the non-IDUs suggest a negligible effect of injection drug use on HIV progression.