Injection Risk Behaviors Research Articles

Sexual and injecting risk behaviours among regular ecstasy users

Substance users may be at a heightened risk for the transmission of HIV and other blood-borne viral infections (BBVI) through injecting drug use or risky sexual behaviours. The current study aimed to investigate the engagement in BBVI-risk behaviours among a sentinel group of regular ecstasy users in Australia, with a particular focus on sexual practices and describe the occurrence of BBVI testing among this group. Participants were regular ecstasy users recruited across Australia in 2007 who were administered a structured interview that contained questions regarding substance use, sexual behaviours and occurrence of BBVI testing. Results indicate high levels of unprotected sex in the past 6 months (77% reported inconsistent condom use with a regular partner; 54% with a casual partner). Half the sample reported never having an HIV test. Unprotected sex was associated with being heterosexual; despite this, heterosexuals were also less likely to report HIV testing status. These data suggest that targeted health promotion messages may be needed for this group of predominantly young, heterosexual substance users who may fall out of the reach of traditional messages.

At-Risk Drinking and Injection and Sexual Risk Behaviors of HIV-Positive Injection Drug Users Entering Drug Treatment in New York City

We analyzed data from 1253 HIV-positive injection drug users (IDUs) entering detoxification or methadone maintenance treatment in New York City between 1990 and 2004 to assess HIV risk behaviors and their association with at-risk drinking (defined as more than 14 drinks per week for males or 7 drinks per week for females) and intoxication. Most (81%) of the participants were male, 50% were Hispanic, and 36% African American. The average age of respondents was 40 years. Injection risk behaviors that were examined were distributive sharing of needles/syringes and distributive sharing of needles/syringes with multiple IDUs. Sexual risk behaviors included multiple sex partners, engaging in unprotected sex, and among women, engaging in trade sex. After adjusting for the effects of other variables, at-risk drinking among cocaine injectors was associated with distributive sharing of needles/syringes. At-risk drinkers were also more likely to engage in unprotected sex with a casual partner. Finally, among cocaine injectors alcohol intoxication during the most recent sex episode was associated with unprotected sex with a casual partner. These observations indicate that among HIV-positive IDUs at-risk drinking is associated with higher rates of injection and sexual risk behaviors and that alcohol intoxication is related to unprotected sex.

Injecting, Sexual Risk Behaviors and HIV Infection in Young Cocaine and Heroin Users in Spain

Aim: To evaluate differences between young cocaine users and heroin users (HUs) regarding the prevalence of sexual and injection risk behavior, and HIV, HCV and HBV infection. Methods: Two community cohorts were recruited in Madrid, Barcelona and Seville; 720 cocaine users, of whom 586 had never used heroin (CUs), and 991 HUs were interviewed. Dried blood spot samples were tested. Results: CUs were less marginalized socially than HUs. Only 0.9% had ever injected versus 64.3%; none had ever injected with borrowed syringes versus 25%; 2.2% had an injecting steady partner in the last 12 months versus 24.9%; 4.8% had ever traded sex versus 16.0%. However, 31.0 versus 12.7% had unprotected sex with more than two occasional partners in the last 12 months; 45.0 versus 21.9% had sniffed through tubes used by more than 10 persons. Only 32.3% knew their HIV status versus 80.3%; 0.4 versus 18.1% were HIV positive; 0.9 versus 51.9% were HCV positive, and 1.5 versus 17.0% were HBV positive. Conclusions: The intense cocaine epidemic has hitherto had little impact on either HIV, HBV or HCV in Spain. However, surveillance should be intensified given the high percentage of CUs having unprotected sex with occasional partners.

The influence of needle exchange programs on injection risk behaviors and infection with hepatitis C virus among young injection drug users in select cities in the United States, 1994–2004

Objective Our purpose was to assess whether participation in needle exchange programs (NEPs) influenced incident hepatitis C virus (HCV) infection through effects on injection risk behaviors among young injection drug users (IDUs) in the United States. Methods Data were drawn from three multi-site studies carried out in four major cities that enrolled IDUs over the period 1994–2004. Bivariate and multivariate analyses were conducted to assess relationships among sociodemographic characteristics, NEP use, injection risk behaviors, and prevalent or incident HCV infection. Results Of the total participants ( n = 4663), HCV seroprevalence was 37%; among those who initially tested negative and completed follow-up at three, six, or 12 months ( n = 1288), 12% seroconverted. Nearly half of participants reported NEP (46%) use at baseline. Multivariate results showed no significant relationship between NEP use and HCV seroconversion. Controlling for sociodemographic characteristics, IDUs reporting NEP use were significantly less likely to share needles (aOR = 0.77, 95% CI = 0.67–0.88). Additionally, controlling for sociodemographic characteristics and program use, sharing needles, sharing other injection paraphernalia, longer injection duration, and injecting daily were all positively related to prevalent infection. Conclusions Our results suggest an indirect protective effect of NEP use on HCV infection by reducing risk behavior.

HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: Implications for intervention

Background Following a heroin shortage, fentanyl and 3-methylfentanyl, known as “China White” and “White Persian”, have become the most widely used drugs, along with amphetamine, among injecting drug users (IDUs) in Tallinn, Estonia. Methods In order to assess the relationships between the injection of fentanyl and amphetamine, and levels of HIV prevalence and risk behaviour, 350 current IDUs were recruited using respondent-driven sampling for an interviewer-administered unlinked cross-sectional survey and HIV testing. IDUs were categorised into groups based on self-report of the main drug used within the last 28 days. Results 77% (256/331) of participants reported fentanyl and 23% (75/331) amphetamine as their main drug of injection. HIV prevalence was 27% (95% confidence interval [CI]: 18.45–35.51) and 62% (95% CI: 56.97–67.03) among amphetamine and fentanyl injectors, respectively. After adjustment, fentanyl injectors had three times the odds of being HIV positive (adjusted odds ratio [AOR] = 2.89; 95% CI: 1.55–5.39). They also had higher odds for injecting in the street with a previously used needle/syringe (AOR = 2.39; 95% CI: 1.14–5.04) and sharing a needle/syringe with somebody known to have HIV (AOR = 3.00, 95% CI: 1.33–6.79). Fentanyl injectors also had higher odds for lifetime overdose (AOR = 3.02, 95% CI: 1.65–5.54). Conclusion The injection of fentanyl is associated with elevated injecting risk behaviour derived from injection practice and situational risk factors, and needs urgently targeted interventions.

Measuring risk of HIV and HCV among injecting drug users in the Russian Federation

The aim of the study was to measure risk of HIV and HCV infection among injecting drug users (IDUs) through force of infection (FOI) models in three cities of the Russian Federation and assess the value of behavioural data and FOI in predicting risk of infection as a method of second-generation surveillance. FOI models were fitted to prevalence data collected through an anonymous, cross-sectional community-recruited survey of IDUs with oral fluid sample collection for antibodies to HIV and HCV. Risk of infection was estimated from FOI estimates obtained by fitting a model to prevalence data by length of injecting career for each city and then overall. Risk behaviours were examined by injecting career length. A total of 1473 IDUs were recruited. Prevalence of HIV was 8.1% (95% CI 6.7-9.6%) and HCV 63.4% (95% CI 60.9-65.9%). A higher FOI in new initiates to injecting (injecting career length <1 year) was found for both HIV and HCV compared with experienced IDUs (injecting career length <5 years). Increased risk of infection was not corroborated by injecting risk behaviours among new initiates into injecting (n = 38). Only 5.7% (n = 2) reported receptive sharing in the last 4 weeks, 57.9% (n = 22) sharing any injecting paraphernalia, 2.6% (n = 1) frontloading and 8.5% (n = 3) ever injecting with used needles/syringes. However, 29% of new initiates reported exchanging sex in the last 4 weeks (29%) compared with 11% long term IDUs. FOI models can play an important role in surveillance of HIV but caution is needed in the interpretation of behavioural data for predicting current or future risk of HIV.

Prevalence of HIV, HCV and sexually transmitted infections among injecting drug users in Rawalpindi and Abbottabad, Pakistan: evidence for an emerging injection-related HIV epidemic

Objectives:To measure the prevalence of hepatitis C virus (HCV), HIV and sexually transmitted infections (STI) among injecting drug users (IDUs) in Rawalpindi and Abbottabad and to examine risk factors associated...

Use of supervised injection facilities and injection risk behaviours among young drug injectors

To study the use of supervised injection facilities (SIFs) as a predictor of safer injecting practices. Cross-sectional study conducted with face-to-face interview using a structured questionnaire with computer-assisted personal interviewing. Dried blood spot samples were collected for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) antibody testing. All participants were street-recruited by chain referral methods in Madrid and Barcelona. A total of 249 young heroin drug injectors recruited by the ITINERE cohort study in two Spanish cities with SIFs. The main outcome measures were self-reported injecting behaviours and SIFs attendance. SIF users were more marginalized socially than non-users. They were also more often regular injectors (weekly or more versus sporadic) [odds ratio (OR) = 4.9, 95% confidence interval (CI): 2.7-8.8], speedball users (OR = 2.5, 95% CI: 1.5-4.3) and anti-HCV-positive (OR = 3.1, 95% CI: 1.4-7.1). In the logistic regression analysis, using SIFs was associated independently with not borrowing used syringes (OR = 3.3, 95% CI: 1.4-7.7). However, no significant association was found between SIF use and not sharing injection equipment indirectly (OR = 1.1, 95% CI: 0.5-2.2). SIFs attract highly disadvantaged drug injectors who engage none the less in less borrowing of used syringes than non-users of these facilities. The risks of indirect sharing should be emphasized when counselling SIF attendees.

Improving survey methods in sero-epidemiological studies of injecting drug users: a case example of two cross sectional surveys in Serbia and Montenegro

BackgroundLittle is known about the prevalence of HIV or HCV in injecting drug users (IDUs) in Serbia and Montenegro. We measured prevalence of antibodies to HIV (anti-HIV) and hepatitis C virus (anti-HCV), and risk factors for anti-HCV, in community-recruited IDUs in Belgrade and Podgorica, and determined the performance of a parallel rapid HIV testing algorithm.MethodsRespondent driven sampling and audio-computer assisted survey interviewing (ACASI) methods were employed. Dried blood spots were collected for unlinked anonymous antibody testing. Belgrade IDUs were offered voluntary confidential rapid HIV testing using a parallel testing algorithm, the performance of which was compared with standard laboratory tests. Predictors of anti-HCV positivity and the diagnostic accuracy of the rapid HIV test algorithm were calculated.ResultsOverall population prevalence of anti-HIV and anti-HCV in IDUs were 3% and 63% respectively in Belgrade (n = 433) and 0% and 22% in Podgorica (n = 328). Around a quarter of IDUs in each city had injected with used needles and syringes in the last four weeks. In both cities anti-HCV positivity was associated with increasing number of years injecting (eg Belgrade adjusted odds ratio (AOR) 5.6 (95% CI 3.2–9.7) and Podgorica AOR 2.5 (1.3–5.1) for ≥ 10 years v 0–4 years), daily injecting (Belgrade AOR 1.6 (1.0–2.7), Podgorica AOR 2.1 (1.3–5.1)), and having ever shared used needles/syringes (Belgrade AOR 2.3 (1.0–5.4), Podgorica AOR 1.9 (1.4–2.6)). Half (47%) of Belgrade participants accepted rapid HIV testing, and there was complete concordance between rapid test results and subsequent confirmatory laboratory tests (sensitivity 100% (95%CI 59%–100%), specificity 100% (95%CI 98%–100%)).ConclusionThe combination of community recruitment, ACASI, rapid testing and a linked diagnostic accuracy study provide enhanced methods for conducting blood borne virus sero-prevalence studies in IDUs. The relatively high uptake of rapid testing suggests that introducing this method in community settings could increase the number of people tested in high risk populations. The high prevalence of HCV and relatively high prevalence of injecting risk behaviour indicate that further HIV transmission is likely in IDUs in both cities. Urgent scale up of HIV prevention interventions is needed.

Longitudinal Analysis of the Relationship Between Perceived Norms and Sharing Injection Paraphernalia

Despite decline in needle sharing in some countries, many injectors continue to share injection paraphernalia such as cookers and cotton. While individual and structural factors are associated with injection risk behavior, little attention has been given to the influence of social network members, such as norms, on injection paraphernalia sharing. The present study is a longitudinal analysis of the association between perceived norms and sharing syringes and non-syringe injection paraphernalia. Participants were enrolled in the STEP into Action study and reported injection drug use at both baseline and follow-up assessments (n = 398). Results showed that descriptive norms, or believing that peers practiced risky injection behaviors, predicted sharing both syringes and nonsyringe paraphernalia. However, there was no association between injunctive norms (i.e., perceived peer approval) and either syringe or non-syringe paraphernalia sharing. Changing norms may lead to sustained behavior change. Accessible, norms-based interventions are needed to discourage drug injectors from sharing injection paraphernalia.

Access to Sterile Injecting Equipment is More Important Than Awareness of HCV Status for Injection Risk Behaviors Among Drug Users

Awareness of hepatitis C virus (HCV) infection status is expected to influence risk behaviors. In 2004–2005, injection drug users (IDUs) recruited from syringe exchange programs (SEPs) and methadone clinics in Montreal, Canada, were interviewed on drug use behaviors (past 6 months) and HCV testing. Subjects (n = 230) were classified as low/intermediate risk (20.4% borrowed drug preparation equipment only) and high risk (19.6% borrowed syringes), and 54.5% reported being HCV positive. Logistic regression modeling showed that compared to no risk (60% borrowed nothing), low/intermediate risk was associated with fewer noninjecting social network members, poor physical health, and problems obtaining sterile injecting equipment. High risk was associated with all of these factors except social networks. HCV status was not associated with any level of risk. Improved access to sterile injecting equipment may be more important than knowledge of HCV status in reducing injection risks among this IDU population. The study limitations are noted and recommendations discussed.

Knowledge of status and assessment of personal health consequences with hepatitis C are not enough to change risk behaviour among injecting drug users in Stockholm County, Sweden

This was a multicentre study with risk perception as the theoretical framework, investigating if risk behaviours change when injecting drug users (IDUs) are aware of their hepatitis C virus (HCV) status and had assessed the health consequences with HCV infection. Two hundred and thirteen participants aged 15-40 y were analysed. Sharing of needles and of other injecting equipment were common both among participants who reported HCV-positive status (74%, 95% confidence interval (CI) 65.3-80.1%) and among those who reported HCV status unknown (68%, 95% CI 56.0-78.4%). Participants associating very severe health consequences with HCV infection and those who did not know of any health consequences with HCV infection shared needles at almost the same rate (78%, 95% CI 62.5-87.7 vs 69%, 95% CI 8.0-78.9, respectively). Sharing of other injecting equipment was most common among participants with verified HCV-positive status (adjusted risk ratio 5.64, 95% CI 2.64-12.07). Knowledge of HCV status and assessment of health consequences with HCV infection were not enough to change injecting risk behaviours. Sharing of other injecting equipment was a more important risk factor than sharing needles for participants with verified HCV-positive status. It is suggested that professionals engage IDUs in risk analysis and open a dialogue about assessment in order to identify, quantify and characterize risks.

Migrant Drug Users: Predictors of HIV-Related Sexual and Injection Risk Behaviors

Puerto Rican drug users recruited in NY who previously used drugs in Puerto Rico (PR) have been found to have higher HIV injection and sex-related risk behaviors than those who had not used in PR. This study examined predictors of risk among migrant Puerto Rican drug users. (For the purpose of this paper, the term "migrant" was used to designate Puerto Rican drug users who had used drugs in Puerto Rico and were recruited in New York or New Jersey). A total of 290 drug users who had previously used drugs in PR were recruited in NY and New Jersey and interviewed regarding drug use history and HIV risk behaviors. Participants engaged in high risk behaviors, e.g., 39% shared injection paraphernalia and 62% reported unprotected sex. Multivariate analyses found that predictors of injection-related risk included being born in PR and purchasing drugs jointly with other drug users; predictors of sex-related risk included younger age and homelessness. Addressing risk reduction among those drug users who were born in Puerto Rico and are younger or homeless was indicated, and efforts to reach those at highest risk through NEPs was recommended.

The efficacy of a network intervention to reduce HIV risk behaviors among drug users and risk partners in Chiang Mai, Thailand and Philadelphia, USA

This HIV Prevention Trials Network study assessed the efficacy of a network-oriented peer education intervention promoting HIV risk reduction among injection drug users and their drug and sexual network members in Chiang Mai, Thailand and Philadelphia, USA. The study was designed to test impact on HIV infection, but the infection rate was low and the study was terminated early. This paper reports efficacy on outcomes of self-reported HIV risk behaviors. We enrolled 414 networks with 1123 participants. The experimental intervention consisted of six small group peer educator training sessions and two booster sessions delivered to the network index only. All participants in both arms received individual HIV counseling and testing. Follow-up visits occurred every six months for up to 30 months. There were 10 HIV seroconversions, 5 in each arm. The number of participants reporting injection risk behaviors dropped dramatically between baseline and follow-up in both arms at both sites. Index members in the intervention arm engaged in more conversations about HIV risk following the intervention compared to control indexes. There was no evidence of change in sexual risk as a result of the intervention. Reductions in injection risk behaviors were observed: 37%, 20%, and 26% reduction in odds of sharing cottons, rinse water and cookers, respectively, and 24% reduction in using a syringe after someone else. Analysis of the individual sites suggested a pattern of reductions in injection risk behaviors in the Philadelphia site. In both sites, the intervention resulted in index injection drug users engaging in the community role of discussing reduction in HIV injection risk behaviors. The intervention did not result in overall reductions in self-reported sexual risk behaviors, and although reductions in injection risk behaviors were observed, the overall efficacy in reducing risk was not established.

Injecting and sexual risk behaviours, sexually transmitted infections and HIV prevalence in injecting drug users in three states in India

To describe and compare sexual and injecting risk behaviours and sexually transmitted infections (STI), hepatitis C virus (HCV) and HIV prevalence in injecting drug users (IDU) in six districts in three states of India: Manipur, Nagaland, and Maharashtra. The respondent-driven sample consisted of 2075 IDU. Consenting participants were administered a structured questionnaire and samples of blood and urine were collected to test for HIV and STI. Data were analysed using RDSAT. In two districts in Manipur, 77 and 98% of IDU injected heroin, whereas the main injecting drug in Nagaland was dextropropoxyphene (99%). In Mumbai/Thane, Maharashtra, the majority of respondents reported using chlorpheniramine (87%) and heroin (99%). In all districts, almost half of IDU reported generally sharing needles and syringes; consistent condom use with non-paid female partners was also low. Approximately one-quarter of IDU in Mumbai/Thane visited a paid partner in the past year. IDU with reactive syphilis serology were higher in Nagaland (7 and 19%) than in Manipur and Maharashtra. HIV in two districts of Manipur (23%, 32%) and Mumbai/Thane (16%) was greater than Nagaland (<2%). HCV prevalence was more than 50% in Mumbai/Thane and Manipur. Irrespective of regional differences, high-risk behaviour of needle sharing and low condom use makes IDU a critical subpopulation for HIV prevention interventions. Interventions need to address the differing drug use patterns in the regions and transmission prevention among non-paid regular and casual female partners of IDU in the northeast districts and paid female partners in Mumbai/Thane.

Potential impact of vaccination on the hepatitis C virus epidemic in injection drug users

Background: Hepatitis C virus (HCV) causes significant morbidity and mortality in injecting drug users (IDU) worldwide. HCV vaccine candidates have shown promise for reducing the infectivity of acute infection and averting chronic infection, yet the impact of varying levels of vaccine efficacy and vaccine delivery strategies on the HCV epidemic in IDU has not been explored.Methods: We utilized extensive data on injecting behavior collected in the UFO study of young IDU in San Francisco to construct a stochastic individual-based model that reflects heterogeneous injecting risk behavior, historical HCV trends, and existing information on viral dynamics and vaccine characteristics.Results: Our modeled HCV rate closely paralleled observed HCV incidence in San Francisco, with estimated incidence of 59% per person year (ppy) early in the epidemic, and 27% ppy after risk reduction was introduced. Chronic HCV infection, the clinically relevant state of HCV infection that leads to liver disease and hepatocellular cancer, was estimated at 22% ppy (±3%) early in the epidemic and 14% ppy (±2%) after risk reduction was introduced. We considered several scenarios, and highlight that a vaccine with 50% to 80% efficacy targeted to high-risk or sero-negative IDU at a high vaccination rate could further reduce chronic HCV incidence in IDU to 2–7% ppy 30 years after its introduction.Conclusions: Our results underscore the importance of further efforts to develop both HCV vaccines and optimal systems of delivery to IDU populations.

Injecting risk behaviour and related harm among men who use performance‐ and image‐enhancing drugs

Performance- and image-enhancing drugs have the potential to be a significant public health issue. Detailed data on PIEDs injection are difficult to obtain because of the illicit and unsupervised way in which many PIEDs are used, and the hidden nature of the group. Our study examines the patterns of use, risk behaviours and related harm associated with PIEDs injection. We also report the ways in which PIEDs users currently seek injecting equipment and harm-reduction advice. Data were obtained via a structured questionnaire administered in face-to-face interviews with 60 men who used PIEDs (primarily anabolic androgenic steroids) for non-medical purposes. Although the rates of needle sharing were low (5%), the men more frequently reported re-use of needles/equipment, injecting from a shared container (bladders, vials, etc.), injecting other illicit drugs, injecting insulin and targeting small muscle groups. Self-reports of being hepatitis C antibody positive were associated with lifetime use of heroin and injection of other illicit drugs. All HIV positive participants were gay/bisexual men. Participants reported a range of other injection-related injuries and diseases such as fevers, scarring and abscesses. 'Risky' injectors (38% of participants) were more likely to initiate PIEDs use at a younger age, use PIEDs in a larger number of cycles per year and report involvement in a violent/aggressive incident than 'low risk' injectors and report involvement in a violent/aggressive incident than 'low risk' injectors. Participants mainly reported seeking information about PIEDs from internet sites (62%) and friends (55%). An over-reliance on personal networks and internet forums limits this groups' access to objective harm reduction advice and primary care services. Targeted, PIEDs-specific interventions are needed.

Disconnects in presumed heterosexual HIV transmission in Malawi

Obtaining large-scale sexual network data is difficult [1] and doing so in a poor country is especially difficult. We congratulate Helleringer and Kohler [2] on their pioneering study of a sexual network on Likoma Island, Malawi. Their approach represents an important step toward appropriate research designs for elucidating HIV transmission dynamics in sub-Saharan Africa. Despite this achievement, their results undermine their assertion that the Likoma sexual network sustains epidemic HIV transmission. In fact, their findings add to the already considerable evidence against penile–vaginal intercourse as the primary driver of HIV transmission in sub-Saharan Africa [3]. In moderate prevalence Likoma, Helleringer and Kohler observed an ‘apparently paradoxical distribution of HIV prevalence’. They found that persons in the core (bicomponents) of the main component of the sexual network were less likely to be HIV infected than those in peripheral positions in the main component or in small network components. This finding is at odds with prior empirical research, which indicates that, when significant HIV transmission occurs, persons located in the core of the corresponding risk network are more likely to be infected. In one high prevalence community, persons in the core of the injection and sexual network had considerably higher HIV prevalence and more frequent risk behaviors than those in peripheral or more isolated positions [4]. In that study, injection and homosexual risk behaviors were positively associated with prevalent HIV infection, but heterosexual risk behaviors were not. Similarly, among heterosexuals in a very low prevalence setting with little ongoing HIV transmission, infected persons were, with one exception, isolates, in small components, or on the periphery of the main component of the risk network [5,6]. In Likoma, it is surprising that self-reported symptoms of sexually transmitted infections (STI) are almost evenly distributed across the sexual network, and are not concentrated in the core as expected. Furthermore, no sexual risk variable (condom use, number of sex partners, STI symptoms, or age difference between sex partners) shows a meaningful association with prevalent HIV infection. Taken together, these observations suggest that the measured sexual network might not underlie HIV transmission in Likoma, and that other unmeasured blood and sexual exposures might be involved. To establish the primary modes of HIV transmission in sub-Saharan Africa with confidence, more appropriate research designs are required. Specifically, it is critical to assess blood and sexual exposures comprehensively (beyond just injections and vaginal intercourse) for incident cases and controls, trace their corresponding contacts and sequence-infected persons' HIV isolates [7–9].

Religiosity, Drug Use, and HIV-Related Risk Behaviors among Heroin Injectors

The association between religiosity and reduced alcohol and drug use in the general population is commonly recognized, but research about the relationship between religiosity and drug-related risk behaviors among illicit drug users has received considerably less attention. This study explores the role of religiosity in explaining heavy polydrug use and other HIV-related risk behaviors among a tri-ethnic sample of 600 male and female active heroin injectors who were recruited from the streets of Miami-Dade County Florida. The effects of three dimensions of religiosity on heavy alcohol use, daily crack-cocaine use, and five HIV-related injection and sex risk behaviors were assessed using multivariate logistic regression techniques that controlled for demographics and self-reported HIV serostatus. The majority of heroin injectors reported some degree of religiosity as expressed by religious intentionality, worship attendance, and religious self-perception. Strong religious intentionality was associated with a decreased likelihood of reusing needles/syringes, but the regression results suggest that religiosity for the most part did not influence heavy polydrug use or other HIV-related risk behaviors of active heroin injectors.

The epidemiology of methamphetamine use and harm in Australia

There has been considerable media attention recently upon possible increases in methamphetamine use in Australia. Much of this debate has focused upon extreme cases of problematic crystal methamphetamine use, without reference to the broader population context. This paper provides data on methamphetamine use in Australia, and documents trends in methamphetamine-related harms. Data used were from: (1) Australian Customs Service drug detections; (2) Australian Crime Commission drug seizure, arrest and clandestine laboratory detections data; (3) National Drug Strategy Household Survey (NDSHS) and Australian Secondary Student Alcohol and Drug Survey (ASSADS); (4) data from the Illicit Drug Reporting System (IDRS) and Ecstasy and related Drug Reporting System (EDRS); and (5) data from NSW Emergency Department Information System, National Hospital Morbidity Database and Australian Bureau of Statistics causes of death databases. There appears to have been an increase in both importation and local manufacture of meth/amphetamine. Population data show that meth/amphetamine use remains low and stable. However, clear increases in crystal methamphetamine use have occurred among sentinel groups of regular drug users. Frequent crystal use among regular injecting drug users is associated with earlier initiation to injecting, greater injection risk behaviours and more extensive criminal activity. In recent years, indicators of meth/amphetamine-related harm have stabilised, following steady increases in earlier years. Some methamphetamine users experience significant problems related to their use; harms are particularly prevalent among regular IDU. Methamphetamine users, however, are a diverse group, and strategies need to be appropriately targeted towards different kinds of users.