Negative Injecting Drug Users Research Articles

A five-year prospective cohort study of HIV/HCV infections in community-related injecting drug users

Objective: To explore incidences of HIV and HCV infections in injecting drug users (IDUs) in community. Methods: A community-based survey was conducted to recruit 200 HIV sero-negative IDUs for a prospective cohort study based on the local needle and syringe exchange program in Longyang district of Baoshan city, Yunnan province from June 2014 to June 2019, China. Follow-up was carried out every six month to investigate the prevalence of drug use behavior and sexual behavior in IDUs. Blood samples were collected from them to test HIV and HCV serum antibodies. The cohort was opened for recvuitment every year to replenish the cohort to 200 subjects. Results: A total of 231 IDUs were recruited after 5 years of follow-up. Cohort retention rate was 82.0% (164/200) in 5 years. No HIV sero-positive conversion was found during the 5-year study. There were 89 HCV negative IDUs. Totally, 384.6 person years were observed and the HCV sero-positive conversion in this cohort was 0.26 per 100 person-years. Conclusion: It was found that the incidences of HIV and HCV in IDUs in communities of the study area were at low levels, while comprehensive and effective intervention measures are still needed to control HIV and HCV infections in this population.

Anti-HIV seropositivity was related to HBsAg seropositivity among injecting drug users in Taiwan

In Taiwan, the number of new cases of human immunodeficiency virus (HIV) infection via drug injection has been increasing since 2003. Due to HIV and hepatitis B virus (HBV) having similar transmission routes, HBV and HIV infections among injecting drug users (IDUs) has become an important public health issue. The aim of this study was explore the prevalence of HBV infection among IDUs with and without HIV infection, and examine whether HIV infection is associated with HBV infection among IDUs in Southern Taiwan. We enrolled 566 IDUs, including 87 anti-HBV positive IDUs and 479 anti-HBV negative IDUs, and also analyzed the results of liver function tests, HBV DNA, anti-HIV, HIV RNA, and CD4 cell count. The results showed that the prevalence of HBV infection among IDUs was 15.4%. The prevalence of hepatitis B surface antigen (HBsAg) was higher among individuals born before 1985 (15.9% vs. 4.0%), but this was not significant. Anti-HIV seropositivity was related to HBsAg seropositivity [odds ratio (OR) = 2.47, 95% confidence interval = 1.26–4.82, p = 0.008). Anti-HCV and anti-HIV were risk factors for abnormal alanine aminotransferase (ALT; OR = 2.11, 95% confidence interval = 1.005–4.42, p = 0.048 and OR = 1.47, 95% confidence interval = 1.02–2.10, p = 0.04, respectively), and HBsAg was not a factor related to abnormal ALT. In conclusion, the prevalence of HBV infection was similar in the general population and in IDUs, and due to anti-HIV seropositivity being significantly related to HBsAg seropositivity, HBV infection among IDUs is still important. We suggest that for IDUs, HBsAg should be monitored closely.

Detection of HCV-Specific IFN-γ Responses in HCV Antibody and HCV RNA Negative Injecting Drug Users

Background:Detectable HCV-specific cellular immune responses in HCV antibody and RNA negative people who inject drugs (PWID) raise the question of whether some are resistant to HCV infection. Immune responses from people who have been exposed to hepatitis C virus (HCV) and remain anti-HCV negative are of interest for HCV vaccine development; however, limited research addresses this area.Objectives:In a cohort of HCV antibody and RNA negative PWID, we assessed whether the presence of HCV-specific IFN-γ responses or genetic associations provide any evidence of protection from HCV infection.Patients and Methods:One hundred and ninety-eight participants were examined longitudinally for clinical, behavioral, social, environmental and genetic characteristics (IFNL3 genotype [formally IL-28B] and HLA type). Sixty-one of the 198 participants were HCV antibody and RNA negative, with 53 able to be examined longitudinally for HCV-specific IFN-γ ELISpot T cell responses.Results:Ten of the 53 HCV antibody and RNA negative participants had detectable HCV-specific IFN-γ responses at baseline (18%). The magnitude of IFN-γ responses averaged 131 +/- 96 SFC/106 PBMC and the breadth was mean 1 +/- 1 pool positive. The specificity of responses were mainly directed to E2, NS4b and NS5b. Participants with (10) and without (43) HCV-specific IFN-γ responses did not differ in behavioral, clinical or genetic characteristics (P > 0.05). There was a larger proportion sharing needles (with 70%, without 49%, P = 0.320) and a higher incidence of HCV (with 35.1 per 100 py, 95% CI 14.6, 84.4, without 16.0 per 100 py, 95% CI 7.2, 35.6, P = 0.212) in those with IFN-γ responses, although not statistically significant. Half the participants with baseline IFN-γ responses became HCV RNA positive (5/10), with one of these participants spontaneously clearing HCV. The spontaneous clearer had high magnitude and broad Th1 responses, favorable IFNL3 genotype and favorable HLA types.Conclusions:This study demonstrated the detection of HCV-specific IFN-γ responses in HCV antibody and RNA negative individuals, with a tendency for HCV-specific IFN-γ responses to be associated with HCV exposure. The potential role of HCV-specific IFN-γ responses in those who remained HCV RNA negative is of value for the development of novel HCV therapeutics.

Occult hepatitis B virus infection among injecting drug users in the Central-West Region of Brazil

The prevalence of occult hepatitis B virus (HBV) infection was investigated in 149 hepatitis B surface antigen (HBsAg) negative injecting drug users (IDUs) in the Central-West Region of Brazil. Of these individuals, 19 were positive for HBV DNA, resulting in an occult HBV infection prevalence of 12.7% (19/149); six of these 19 individuals had anti-HBV core and/or anti-HBV surface antibodies and 13 were negative for HBV markers. All IDUs with occult hepatitis B reported sexual and/or parenteral risk behaviours. All HBV DNA-positive samples were successfully genotyped. Genotype D was the most common (17/19), followed by genotype A (2/19). These findings reveal a high prevalence of occult HBV infection and the predominance of genotype D among IDUs in Brazil's Central-West Region.

Mortality among injection drug users in Chennai, India (2005–2008)

Injection drug users (IDUs) have estimated mortality rates over 10 times higher than the general population; much of this excess mortality is HIV-associated. Few mortality estimates among IDUs from developing countries, including India, exist. IDUs (1158) were recruited in Chennai from April 2005 to May 2006; 293 were HIV positive. Information on deaths and causes was obtained through outreach workers and family/network members. Mortality rates and standardized mortality ratios were calculated; multivariate Poisson regression was used to identify predictors of mortality. We observed 85 deaths over 1998 person-years (p-y) of follow-up [mortality rate (MR) 4.25 per 100 p-y; 95% confidence interval (CI) = 3.41-5.23]. The overall standardized mortality ratio was 11.1; for HIV-positive IDUs, the standardized mortality ratio was 23.9. Mortality risk among HIV-positive IDUs (MR: 8.88 per 100 p-y) was nearly three times that of negative IDUs (MR: 3.03 per 100 p-y) and increased with declining immune status (CD4 cells > 350: 5.44 per 100 p-y vs. CD4 cells < or = 200: 34.5 per 100 p-y). This association persisted after adjustment for confounders. The leading causes of mortality in both HIV negative and positive IDUs were overdose (n = 22), AIDS (n = 14), tuberculosis (n = 8) and accident/trauma (n = 9). Substantial mortality was observed in this cohort with the highest rates among HIV-positive IDUs with CD4 counts of less than 350 cells/microl. Although, in these 2 years, non-AIDS deaths outnumbered 0002030-related deaths, the relative contribution of 0002030-associated mortality is likely to increase with advancing HIV disease progression. These data reinforce the need for interventions to reduce the harms associated with drug use and increase HAART access among IDUs in Chennai.

High Prevalence of HIV, HIV/Hepatitis C Virus Coinfection, and Risk Behaviors Among Injection Drug Users in Chennai, India: A Cause for Concern

To estimate the prevalence of HIV and hepatitis C virus (HCV) and hepatitis B virus (HBV) coinfections and current risk behaviors among HIV-positive and -negative injection drug users (IDUs) in Chennai, India. Cross-sectional analysis of a convenience sample of 912 IDUs recruited between March 2004 and April 2005. Specimens were tested for HIV, HBV, and HCV. Adjusted prevalence ratios (PRs) were estimated using Poisson regression with robust variance estimates. The prevalence of HIV, hepatitis B surface antigen, and anti-HCV were 29.8%, 11.1%, and 62.1%, respectively. Among HIV-infected IDUs, prevalence of coinfection with anti-HCV and hepatitis B surface antigen/anti-HCV were 86% and 9.2%, respectively. In multivariate analysis, injecting at a dealer's place (PR: 1.57) and duration of injection drug use >or=11 years (PR: 3.02) were positively associated with prevalent HIV infection. Contrastingly, alcohol consumption >or=1 per week (PR: 0.55) was negatively associated with HIV. HIV-positive IDUs were as or more likely compared with HIV-negative IDUs to report recent high-risk injection-related behaviors. There is a high burden of HIV, HCV, and HBV among IDUs that needs to be addressed by improving access to therapies for these infections; furthermore, preventive measures are urgently needed to prevent further spread of HIV, HBV, and HCV in this vulnerable population.

Injection Drug Users' Strategies to Manage Perceptions of Personal Risk: How Do IDUs See HIV as Having Affected Them?

The U.S. public health community is in its 3rd decade of seeking to prevent and treat HIV/AIDS. Injection drug users (IDUs) are central to targeted HIV prevention interventions as approximately one third of new U.S. infections are attributable to injection drug use (Santibanez et al.,Journal of Urban Health, 83[1], 86-100, 2006). Targeted behavior change efforts are often explicitly built upon the risk perception of targeted individuals. In this article, we consider the efficacy of behavior change based on IDUs' perceptions of elevated risk. Our qualitative analysis of 28 interviews with HIV negative IDUs in inner city Baltimore suggests that participants did not see themselves as personally affected by HIV. Rather, respondents constructed accounts in which they differentiated themselves from the type of people who are so affected, thereby creating a less stigmatizing identity. We argue that effective HIV prevention should explicitly acknowledge and address the stigmatized IDU identity, rather than assuming readiness for behavior change.

Liver enzyme flares and occult hepatitis B in persons with chronic hepatitis C infection

Background Occult hepatitis B (HBV) has been reported in numerous clinical settings, but it remains unclear whether occult HBV contributes to liver damage. Given that typical chronic HBV infections often have periodic flairs in viral replication and liver damage, we hypothesized that occult HBV may also have flares in viral replication that are associated with increased liver enzymes. Study design We screened hepatitis B surface antigen negative injection drug users with untreated chronic hepatitis C viral (HCV) infection for unexplained ALT/AST flares. To further enrich for individuals with possible occult HBV flares, we studied those individuals whose flares were associated with IgM antibodies to hepatitis B core antigen. Serum samples were assayed for HBV DNA and serologies were performed in serum collected 6 months before, at the time, and 6 months after the flare. HCV RNA levels were also determined. Controls consisted of individuals who also had ALT/AST flares but who were negative for IgM antibodies to hepatitis B core antigen. Results Seven study cases and eight control cases were identified. HBV DNA was detectable during the enzyme flares in 7/7 study cases versus 3/8 controls, p = 0.026. HBV DNA levels during the flare were low, averaging 1943 ± 2341 copies/ml, but were higher in study cases versus controls, p = 0.002. No change in HCV levels was associated with the flares. Conclusions In this population at high risk for occult HBV, AST/ALT flares can be associated with detection of HBV DNA. These findings may link occult hepatitis B to liver injury.

Impact of a reduction in heroin availability on patterns of drug use, risk behaviour and incidence of hepatitis C virus infection in injecting drug users in New South Wales, Australia

In early 2001, Australia experienced a sudden and dramatic reduction in the availability of heroin. Research examining the impact of the reduction on drug-related harms has yielded a conflicting picture. The current study uses data from a prospective cohort study of anti-HCV negative injecting drug users (IDU) ( n = 368) to examine patterns of injecting drug use, risk behaviours and HCV incidence before and after the reduction. The proportion of participants mainly injecting heroin declined sharply from 74% to 47% after the onset of the reduction and continued throughout 2001. There was marked shift to other drugs, mainly cocaine and amphetamine. Cocaine injectors had the highest risk profile and the highest incidence of HCV (82.6 per 100 person years, 95% CI 52.0–131.0). While HCV seroconversions increased by year, this increase was not statistically significant. We observed a reduction in heroin injection and a concomitant increase in cocaine injection and a significant association between cocaine injection and incident HCV infection during a period of reduced heroin availability. Results suggest that attempts to suppress drug markets by manipulating availability may result in collateral damage in the form of drug-related harms, indicating a need for more sophisticated understandings of the potential trade-offs involved in attempting to suppress the supply of illicit drugs.

High hepatitis C incidence in new injecting drug users: a policy failure?

Objective: Evidence of ongoing hepatitis C (HCV) transmission among injecting drug users (IDUs) suggests a need for a better understanding of seroconversion characteristics among new IDUs and other vulnerable subgroups. This study aimed to determine incidence of HCV and associated risk factors among new IDUs in Sydney. Methods: IDUs who had injected drugs in the past six months and who were unaware of their antibody HCV status or knew their serostatus to be negative were recruited through street-based outreach, methadone clinics and needle and syringe programs in south-western Sydney. Anti-HCV negative IDUs (n=215) were enrolled and followed-up at 3–6 monthly intervals. New IDUs (n=204) were defined as aged below 30 years or injecting for 6 years at baseline. Results: A total of 61 seroconversions were observed and incidence was 45.8 per 100 person years. Independent predictors of seroconversion were duration of injecting < 1 year (IRR=3.10; 95% Cl 1.47-6.54), female gender (IRR=2.0; 95% CI 1.16-3.45), culturally and linguistically diverse background (CALDB) (IRR=2.03; 95% CI 1.06-3.89) and intravenouscocaine use (IRR=2.37; 95% CI 1.26-4.44). While new IDUs shared common risk factors, strong associations were observed between HCV seroconversion and sharing syringes, sharing other injecting equipment and backloading in CALDB new IDUs. Conclusion: Incidence of HCV infection among new IDUs in Sydney is unacceptably high. Implications: Extremely high rates of incident infection among newly initiated CALDB IDUs indicate an urgent need for enhanced policy and resource commitments to reduce the vulnerability of this group to HCV and other blood-borne infections.

High hepatitis C incidence in new injecting drug users: a policy failure?

Evidence of ongoing hepatitis C (HCV) transmission among injecting drug users (IDUs) suggests a need for a better understanding of seroconversion characteristics among new IDUs and other vulnerable subgroups. This study aimed to determine incidence of HCV and associated risk factors among new IDUs in Sydney. IDUs who had injected drugs in the past six months and who were unaware of their antibody HCV status or knew their serostatus to be negative were recruited through street-based outreach, methadone clinics and needle and syringe programs in south-western Sydney. Anti-HCV negative IDUs (n = 215) were enrolled and followed-up at 3-6 monthly intervals. New IDUs (n = 204) were defined as aged below 30 years or injecting for < or = 6 years at baseline. A total of 61 seroconversions were observed and incidence was 45.8 per 100 person years. Independent predictors of seroconversion were duration of injecting < 1 year (IRR = 3.10; 95% CI 1.47-6.54), female gender (IRR = 2.0; 95% CI 1.16-3.45), culturally and linguistically diverse background (CALDB) (IRR = 2.03; 95% CI 1.06-3.89) and intravenous cocaine use (IRR = 2.37; 95% CI 1.26-4.44). While new IDUs shared common risk factors, strong associations were observed between HCV seroconversion and sharing syringes, sharing other injecting equipment and backloading in CALDB new IDUs. Incidence of HCV infection among new IDUs in Sydney is unacceptably high. Extremely high rates of incident infection among newly initiated CALDB IDUs indicate an urgent need for enhanced policy and resource commitments to reduce the vulnerability of this group to HCV and other blood-borne infections.

HIV prevalence and factors associated with HIV infection among male injection drug users under 30: a cross-sectional study in Long An, Vietnam

BackgroundSufficient targeted HIV prevention activities aiming at reducing HIV transmission within and from an extremely marginalized population of injection drug users (IDUs) must urgently and efficiently be implemented in Vietnam. This study was conducted to facilitate the development of such activities by describing transmission risks of young IDUs and evaluating factors in association with HIV infection.MethodsThirty clusters were selected from 29 hotspot communes in Long An province by probability proportional to size (PPS) sampling method. The snowball technique was used for enrolling participants in each cluster. The cross-sectional association of factors obtained during direct structured interviews to 248 male IDUs aged 14 to 29 years old and with their HIV test results were examined.ResultsThe HIV prevalence among the studied IDUs was 32%. Age range of 18–20 years old, low educational level, sharing injection equipment or injection drug use in the other cities were independently associated with HIV serostatus in the multivariate analysis. Sexual behaviors did not differ between HIV-positive and -negative IDUs. Among HIV seropositive IDUs who had sexual contact with primary (n = 37), casual (n = 6), and commercial (n = 15) partners, only 5.4% (n = 2), 33.3% (n = 2), and 46.7% (n = 7), respectively, responded that they had used condoms every time.ConclusionAbout one-third of young IDUs aged less than 30 identified in the hotspot communes in Long An, Vietnam was found to be infected with HIV, and socio-demographic and injection-related factors might account for the infection risk. Prevailing risky sexual behavior of this extremely marginalized population highlights the need to reduce their high transmission risks as a public health priority.

Demographic characteristics and risk behaviors associated with HIV positive injecting drug users in Xinjiang, China

To determine the demographic characteristics and risk behaviors associated with HIV positive and negative injection drug users (IDUs) who were screened for inclusion in a prospective cohort study to estimate HIV incidence in Xinjiang, China. Data analyses were performed on the demographic and risk assessment data collected at screening from high-risk IDUs, defined as anyone who reported injecting drugs at least three times per week in the last month or injected drugs after sharing equipment on at least three occasions in the last three months. HIV antibody prevalence among 781 IDUs at baseline survey was 29%. The following factors were significantly associated with an increase in risk for HIV infection: age > or =26years (OR=3.16, 95% CI [2.02;4.94]), lack of college education (OR=2.32, 95% CI [1.02;5.25]), frequency of heroin use (OR=1.23, 95% CI [1.02;1.47]) and sharing of rinse water (OR=1.47, 95% CI [1.18;1.84]). Female gender (OR=0.44, 95% CI [0.22;0.86]), being Han vs Uighur ethnicity (OR=0.18, 95% CI [0.11;0.27]), and other race vs Uighur ethnicity (OR=0.23, 95% CI [0.12;0.44]) were significantly associated with a lower risk of HIV infection. HIV infection among high risk IDUs in Xinjiang, China is high and is associated with older male Uighur IDUs who lack college education, frequently inject heroin, and/or share rinse water. There is a great potential for HIV transmission from IDUs to the general population. Therefore, related risk behaviors in IDUs, especially their sexual behavior, should be closely monitored.

Differentiated risk behaviour for HIV and hepatitis among injecting drug users (IDUs)

Needle sharing is a risk factor for contracting blood-borne infections among injecting drug users (IDUs). We explored the relation of socio-financial, physical and mental health factors (ASI) to risk behaviour (Qr23) for contracting blood-borne infections among IDUs (Addiction Severity Index and Questionnaire for risk behaviour). 42 HIV negative IDUs were studied prospectively. The median age was 42.5 (range 18-61) y, 28 of 42 (67%) were males and median duration of injecting was 19.0 (range 0-43) y. HCV and HBV antibodies were found in 37 (88%) and 31 (71%) participants, respectively. Poly drug use was reported by 23 (55%) participants; amphetamine by 10 (24%) and heroin by 9 (21%). From the ASI data we were unable to find any statistically significant factor that was associated with needle sharing (n = 26/42, 61%) or sharing drug mixture/filter (n = 25/42, 59%). 19 (73%) of 26 participants who shared needles also shared drug mixture/filter. Of these 26 IDUs, 7 shared needles with partners, 11 with acquaintances, 3 with strangers and 5 with all categories. In conclusion, the study group showed differentiated risk behaviours for blood-borne infections with regard to various persons and to whom they were exposed. This suggests that IDUs may benefit from individualized counselling regarding risks for infections with HIV, HCV and HBV.

Baseline self-perceived risk of HIV infection independently predicts the rate of HIV seroconversion in a prospective cohort of injection drug users

The identification of individuals at the highest risk of human immunodeficiency virus (HIV) infection is critical for targeting prevention strategies. We evaluated self-perceived risk of HIV infection and rates of subsequent HIV seroconversion among a prospective cohort study of injection drug users (IDUs). We performed an analysis of the time to HIV infection among 994 baseline HIV negative IDUs enrolled in the Vancouver injection drug users study (VIDUS). IDUs were stratified based on their baseline self-perceived risk of HIV seroconversion (higher than others vs same or lower). Kaplan-Meier methods were used to estimate cumulative HIV incidence rates and Cox regression was used to determine adjusted relative hazards for HIV seroconversion. At the end of 24 months after enrolment into the cohort, the cumulative HIV incidence rate was significantly elevated among the 5.9% of the sample who perceived their risk for HIV infection to be higher at baseline (26.6% vs 7.8% log-rank P < 0.001). In a Cox model that adjusted for all variables that were associated with the time to HIV infection in univariate analyses, a higher baseline self-perceived risk of acquiring HIV infection (relative hazard RH: 2.48 [95% Confidence interval (CI): 1.51, 4.10]; P = 0.004) remained independently associated with time to HIV seroconversion. IDUs' perception of their risk for HIV seroconversion upon enrolment into a prospective cohort study was strongly and independently associated with the subsequent rate of HIV seroconversion. Since this risk marker remained independently associated with HIV seroconversion, even after adjustment for time-updated risk behaviours, our findings have major implications that may aid outreach workers in their efforts to identify IDUs who should be targeted with prevention efforts.

Incidence and risk factors of HCV and HIV infections in a cohort of intravenous drug users in the North and East of France.

In order to evaluate the incidence and risk factors of infection by hepatitis C virus (HCV) among injecting drug users (IDUs), we conducted a prospective cohort study of HCV- and human immunodeficiency virus (HIV)-negative IDUs in the North and East of France. A total of 231 HCV and HIV IDUs who had injected drugs at least once in their lifetime were followed up every 3 months over a 12-month period. Serum anti-HCV and anti-HIV were tested at inclusion in the study and at the end of the follow-up. Data on injecting practices were collected at inclusion and at each visit. Of the 231 participants included, 165 (71.4%) underwent a final HCV and HIV serum test. The incidence was nil for HIV infection and 9/100 person-years (95% CI 4.6-13.4) for HCV infection. In a multivariable analysis, we found that syringe and cotton sharing were the only independent predictive factors of HCV seroconversion.

Maximum impact of HIV prevention measures targeted at injecting drug users.

To examine whether the decrease in HIV incidence and injecting risk behaviours is ongoing in Amsterdam, and to study the determinants of injecting risk behaviours. Prospective open cohort study (1986-1997) amongst injecting drug users (IDU). HIV incidence was studied using Poisson regression analysis. Trends in injecting risk behaviours were determined using 6645 visits of 879 participants, stratified by HIV serostatus and number of the follow-up visit. Generalized estimating equations were used to account for repeated measurements, and additive model structures were used. A large initial risk reduction (1986-1991) occurred concerning borrowing and lending of used needles, multiple needle use and frequent injecting. However, except for frequent injecting, the rate of behaviour change significantly decreased, and from 1991-1993 onwards there was no substantial further risk reduction. HIV incidence followed a similar pattern. Injecting risk was much lower at follow-up visits. The following determinants of borrowing and lending among both HIV-positive and negative IDU were largely comparable: young age, non-injecting heroin and cocaine use, frequent tranquillizer use, multiple needle use, injecting with others, and irregular use of needle-exchange programmes. The observed residual risk, given the extensive HIV prevention measures in Amsterdam, indicates that further prevention is difficult. Because this risk was associated with an HIV incidence of 3-4% per year, HIV prevalence is likely to be high for many years. Therefore, prevention measures should be maintained because of the possibility of behavioural relapse associated with recent availability of potent HIV treatments. To prevent an HIV epidemic amongst a new generation of drug users, prevention of injecting itself is warranted.

Psychopathology in male and female HIV-positive and negative injecting drug users: longitudinal course over 3 years.

To evaluate the impact of HIV illness on psychiatric and psychosocial functioning over 3 years in a sample of male and female HIV-positive injecting drug users (IDU), with a comparison group of HIV-negative male and female IDU. As part of a multidisciplinary study, 121 men (69 HIV-positive, 52 HIV-negative) and 66 women (36 HIV-positive, 30 HIV-negative) were evaluated semiannually for seven visits. Attrition, unrelated to sex or serostatus, was 33%. At baseline, rates of major depression and dysthymia ranged from 15% (HIV-negative men) to 33% (HIV-positive men and HIV-negative women). Global impairment was in the range found in psychiatric patients (mean Global Assessment of Functioning scores, 46-51). Higher levels of social support and less social conflict were independently associated with decreased distress and improved global functioning among both men and women. For both HIV-positive groups, degree of improvement over time was related to degree to HIV progression: those who remained healthier in terms of CD4 count and illness stage showed more improvement. HIV-seronegative status was associated with less distress for men but not for women. Overall, women reported higher levels of psychiatric distress than men. High rates of psychopathology were found in this IDU cohort, independent of HIV status and sex. Although rates of psychopathology, injecting drug use and distress declined slightly during the study, they remained elevated; accordingly, psychiatric services are indicated for this population.

Hiv Risk Behaviour of Idus Before, During and After Imprisonment in New South Wales

Objectives: To assess risk behaviours of HIV infected and HIV negative Injecting Drug Users (IDUs) in and out of prison in New South Wales in a case control study.Methods: 25 (20 M, 5 F) cases and 160 (135 M, 25 F) controls were recruited in 1993. HIV status was determined by testing dried blood spots.Results: Cases and controls were similar on basic demographic characteristics. Reports of injecting by cases and controls were more common before entry (84%, 90%) and after prison discharge (60%, 80%) than during incarceration (44%, 44%). However, reported syringe sharing was more common during imprisonment (64%, 71%) than before entry (19%, 24%) and after prison discharge (20%, 15%). Male cases were significantly more likely to use condoms outside prison (44% vs 7%) but also to be sexually active in prison (60%, 6%) than male controls.Conclusions: This study indicates the potential for HIV transmission among IDUs in prison and following release. To prevent HIV transmission in prisons, prison methadone progr...