Drug-use Practices Research Articles

Quality, supply chain, and use of Trypanocidal drugs among camel keepers in north-eastern Kenya: A cross-sectional study

The non-cyclic trypanosomiasis (surra), caused by Trypanosoma evansi, and mechanically transmitted by biting flies, hinders camel productivity in Kenya. Trypanocides are the most commonly used drugs to control surra. However, emergence of drug resistance by the parasites is a major limitation to control efforts. There is limited information on the quality of trypanocides, the supply chain and drug-use practices among camel keepers potentially contributing to development of drug resistance in Kenya. We sought to fill this gap by conducting a cross-sectional study among camel keepers in Isiolo and Marsabit counties, Kenya. We mapped the trypanocide drugs supply chain through quantitative and qualitative surveys. We administered a semi-structured questionnaire to camel keepers to generate data on trypanocides-use practices, including the types, sources, person who administers treatment, reconstitution, dosage, route and frequency of administration, among others. Additionally, we tested the quality of trypanocidal drugs retailed in the region. We mapped a total of 55 and 49 agro-veterinary outlets and general (ordinary) shops retailing veterinary drugs in the two counties, respectively. These comprised of 29 and 26 agro-veterinary outlets, as well as 24 and 25 general shops in Isiolo and Marsabit counties, respectively. Overall, the respondents experienced 283 surra cases in the three-month recall period, which were treated with trypanocides. The majority of these cases were diagnosed by camel owners (71.7%) and herders (24.1%). A significant proportion of the cases were treated by camel owners (54.8%), herders (35.3%), the owner's son (3.2%) and veterinary personnel (1.1%) (χ2 = 24.99, p = 0.000). Most of the households sourced the drugs from agro-veterinary outlets (59.0%), followed by general shops (19.8%), veterinary personnel (2.1%), and open-air markets (0.4%) (χ2 = 319.24, p = 0.000). Quinapyramine was the most (56.9%) predominantly used trypanocide in treatment of surra, followed by homidium (19.8%), isometamidium (15.9%), diminazene aceturate (6.7%), and ethidium (0.7%) (χ2 = 340.75, p < 0.000). Only a meager proportion of respondents (15.2%) used the drugs correctly as instructed by the manufacturers. We recorded an association between correct drug usage, with the person who administers the treatment (χ2 = 17.7, p = 0.003), and the type of trypanocide used (χ2 = 19.4, p < 0.001). All the drug samples tested had correct concentrations of active ingredient (100.0%), and therefore of good quality. We have demonstrated that whereas the trypanocides retailed in the region by authorized vendors are of good quality, there is widespread incorrect handling and use of the drugs by unqualified individuals, which may contribute to treatment failure and emergence of trypanocide resistance.

Mortality risk and causes of death among people who use opioids in a take-home naloxone cohort

BackgroundPeople who use opioids (PWUO) have an excess mortality from a range of causes. The cumulative effect of behavioral, social, and health risk factors complicates the interpretation of the effects of suitable interventions. This study explores mortality causes among a cohort of PWUO in the take-home naloxone (THN) program. MethodsThis was a prospective cohort study of PWUO who received THN between 2015 and 2023. Participant data was linked with death registry data. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all causes, internal causes, and accidental opioid overdoses (AOOs). In addition to age and gender, risk factors like main route of administration, polydrug use, self-experienced overdoses, and using while alone were fitted in a Cox Regression model to explore factors associated with mortality. ResultsThe 2194 participants had a considerably higher mortality ratio for all causes investigated when compared to the general population (SMR=10.9, 95 % CI = 9.3,12.6). AOOs were the most prevalent cause of death (49 %). Those who reported frequent opioid use while alone had an elevated risk of dying of 2.6 (95 % CI = 1.1,6.4) compared to those who never used while alone. ConclusionsFrequent opioid use while alone was associated with elevated mortality risk, supporting the importance of overdose prevention education with naloxone distribution, and additional efforts to improve environmental and social areas for safer drug-use practices among PWUO. The variety of mortality causes found in this study illustrates the need for multifaceted and targeted interventions for people at risk of overdosing.

Narcofeminism and its multiples: From activism to everyday minoritarian worldbuilding

Sociology has a long-standing interest in the consumption of licit and illicit drugs, particularly as a feminist concern with scholars highlighting the ways in which drugs are used as regulatory technologies to control the conduct and subjectivities of women and other marginalised groups. This monograph flips the focus from a feminist sociological concern with drugs as a means of confining minoritised peoples, to explore what they can do as a feminist practice. Employing the drug-user activist concept of ‘narcofeminism’, it aims to rethink how drugs are conceived in sociology and chart their role in shaping selves and worlds. This article introduces the guiding philosophy of the narcofeminist movement as articulated in an interview we conducted with founding narcofeminist activists from Eastern Europe and Central Asia. Threaded through the interview are vivid examples of the ingrained and overlapping hostilities that differentially constitute drug consumption practices for women and gender minorities, and the brave acts of resistance they perform in response. In introducing the collection, we foreground a key aim that has guided its development: thinking with the insights of narcofeminism, we have sought to address the complexities of drug use and to hold in focus its potentialities both in terms of its harms and benefits, risks and rewards and, importantly, to reflect on how people navigate these counterposing forces in their situated practices of drug use. We also discuss how the collection advances the sociology of drugs by bridging disciplinary divides and disrupting binary distinctions between licit and illicit drugs, volition and compulsion, pleasure and pain, and discourse and practice, among others. This article provides an overview of the contributions that comprise the monograph, highlighting how they grapple with the ethico-political commitments of narcofeminism to rethink drug consumption as a mode of living, capable of transforming social worlds.

Systematic Review and Meta-Analysis on Knowledge Attitude and Practices on African Animal Trypanocide Resistance.

Background: African trypanocide resistance is an emerging public health emergency whose control requires a revisit on farmer’s knowledge, attitudes, and practices in developing countries. African animal trypanocide resistance (AATr) is rife in an environment where drug use and policy decisions are disjointed. The objective of the study was to identify community factors responsible for the development of AATr. This was important since diminazene aceturate (DA), isometamidium chloride (ISM), and homidium bromide (HB) have existed for over 30 years and no new drugs have been provided to farmers. Methods: An electronic keyword search across 12 databases was conducted using a search criterion from 1806 to June 2022. This generated a total of 24 publications, but after removing duplicates, review articles, and nonrelated articles, a total of eight papers were included in the analysis by following the PRISMA checklist. A meta-analysis was conducted on the data extracted and the risk ratio and inverse variance at 95% confidence interval were calculated using RevMan®. Results: All the eight articles in the study showed that DA was the most preferred trypanocide in both West and Eastern Africa. Poor farmer knowledge of AATr and limited drug options were major drivers for trypanocide resistance. In addition, farmer treatments, use of untrained personnel, poor administration, poor dosing, and preparation of trypanocides were major drivers for the development of AATr and similarities were identified in DA and ISM practices (P = 0.13). Conclusions: AATr is spread in developing countries due to a lack of community knowledge, attitudes, and drug-use practices. This situation could be reversed through interdisciplinary collaborations in endemic communities by promoting effective treatments and responsible drug handling.

Evaluation of off-label anti-vascular endothelial growth factor and steroid implant medication uses in macular edema due to retinal vein occlusion in Turkey.

Retinal vein occlusion (RVO) is one of the most common causes of vision loss. Anti-vascular endothelial growth factor (anti-VEGF) drugs, ranibizumab and aflibercept, and corticosteroid implants are approved treatment options for RVO-related macular edema (ME) in Turkey. To the best of our knowledge, there is no data regarding the off-label use of these drugs for RVO in English literature. We aimed to evaluate the clinical and demographic characteristics of off-label drug use applications in Turkey for RVO. Applications made to the Turkish Medicines and Medical Devices Agency between January 1 and December 31, 2018, for the use of off-label drugs (ranibizumab, aflibercept, dexamethasone implant) for the diagnosis of RVO from hospitals across Turkey were retrospectively analysed. Data of the applications, such as demographic characteristics, previous treatment regimens, reasons for applications, applicant hospitals and their regions, were recorded. There were 291 approved applications for RVO. The mean age of the patients was 64.88 ± 10.78 years, 48.8% were male, and 51.2% were female. Of these applications, 44.7% were for aflibercept, 35.7% for ranibizumab and 19.6% for dexamethasone implant. No application was made for bevacizumab since it could be used without needing for an application. The most common reasons for applications were due to dose limitations, failure to complete loading doses, and glaucoma, respectively. In terms of the distribution of the applicant hospitals, public university hospitals ranked first with 72.5%, training and research hospitals ranked second with 14.7% and foundation university hospitals ranked third with 13.1% rates. The practice of drug use in RVO in Turkey has changed as of the beginning of 2019. Stepwise therapy has been accepted by the drug regulatory agency Turkish Medicines and Medical Devices Agency. Utilization of licensed drugs, aflibercept, ranibizumab and dexamethasone has been allowed only after administration of 3 doses of intravitreal bevacizumab. After 3 doses of bevacizumab, the physician may continue either with bevacizumab again or a dexamethasone implant. If there is a reason such as the presence of glaucoma, the physician may skip dexamethasone and switch to aflibercept and ranibizumab, but in this case, dexamethasone cannot be administered to the patient for life. The evaluation of the off-label treatments of RVO, which is one of the most frequently followed diseases in retina clinics, not only contributes to the literature but also provides information regarding the most frequently applied treatments and the physicians' off-label drug preferences for RVO.

Assessment of Drug Use Practices Using Standard WHO Indicators in Lumame Primary Hospital.

BackgroundIrrational use of drugs has been one of the major problems around the globe. However, the degree of the problem is higher in developing countries like Ethiopia. The WHO has developed several indicators to evaluate the practices of drug use. This study aimed to assess the overall drug use practices using standard WHO indicators in Lumame Primary Hospital.MethodsHospital-based retrospective cross-sectional study was employed to investigate the overall drug use practices at the hospital. Six hundred prescriptions were selected from a total of 19,242 prescriptions by systematic sampling technique over one year from July 1, 2019, to June 30, 2020, in a retrospective review. For the patient care study, 100 patients were selected for collecting the required information. Facility indicators were assessed by checking the availability of STG/formularies and essential drugs. The results were interpreted according to the standard values of WHO.ResultsAll 600 sampled prescriptions were 100% standard. Weight, dosage form, and quantity were written in 1.5–13.3% of the prescriptions. Patient address was recorded in 51%, while qualification of prescriber and dispenser were recorded in 71.5% and 56% of the cases, respectively, but all other information were complete in 88.5–100% of the prescriptions. The mean number of drugs per encounter, generic prescribing, prescribing from essential drug list, encounters with antibiotics and injectable drugs were 2.3, 97.9%, 99.8%, 48.8%, and 11.2%, respectively. The average dispensing time was found to be 171.9 seconds. Percentage of actually dispensed drugs, adequacy of labeling, patient knowledge, and patient satisfaction were 95.3%, 22.6%, 83%, and 88%, respectively. About 92% of tracer drugs and all reading materials, except national drug list and facility-level drug formulary, were available in the study period.ConclusionGenerally, appreciable results were obtained for most of the indicators but improvement in antibiotic prescribing, polypharmacy and labeling practice is recommended.

Concurrent use of opioids and benzodiazepines/Z-drugs in Alberta, Canada and the risk of hospitalisation and death: a case cross-over study

ObjectivesCoprescribing of benzodiazepines/Z-drugs (BZDs) and opioids is a drug-use pattern of considerable concern due to risk of adverse events. The objective of this study is to estimate the effect of...

Patterns of concomitant use of Ayurveda and conventional anti-diabetic formulations - Experiences at a tertiary care Ayurveda hospital, India.

Background:Majority of the population relies on traditional medicines for many of their health related problems. Particularly individuals with chronic illness like diabetes mellitus (DM) are more likely to simultaneously use herbal medicines. Many of such users believe that traditional medicines are natural and therefore safe, but this is a dangerous over simplification. Some herbal medicines may be associated with adverse effects, which include interactions with prescribed drugs. Information on such concomitant use of anti-diabetic drugs along with Ayurveda medicines is limited in Indian scenario.Aims and objectives:To survey the patterns of concomitant use of Ayurveda and conventional anti-diabetic drugs by diabetic patients attending an out-patient department of a tertiary care teaching hospital in New Delhi, India through a validated questionnaire.Materials and methods:This is a questionnaire-based survey, carried out after the approval of the Institutional Ethics Committee, subsequently registered at CTRI. A questionnaire to assess the pattern of concomitant use was developed; content was validated and pre-tested by a pilot study in 40 patients, further refined and used in the survey. The data was analyzed to evaluate the patterns of concomitant use of Ayurvedic and conventional anti-diabetic drugs.Results:About 95.9% of diabetic patients were taking herbo-mineral formulations concomitantly with conventional anti-diabetic drugs. Although 45.3% of diabetics were using Ayurveda interventions under the supervision of qualified AYUSH physicians, remaining involved in procuring the drugs over the counter (OTC) or from the local vendors. In majority of these instances, the use of Ayurveda formulations was not communicated with their physicians.Conclusion:The observations reveal that a majority of the diabetics (95.9%) were taking one or the other form of herbal preparations along with their conventional anti-diabetic drugs and about 44% among them were using these concomitantly. Thus, generating awareness on good practices of drug use seems to be essential.

Injecting drug use: Gendered risk

BackgroundResearch demonstrates gender related differences in drug-use practices and risk behaviours. Females’ structural vulnerability stemming from traditional gender roles and gender-power relations may enhance their propensity to experience injecting related risk. In this paper we explore gender differences in injection practices at the initiation event, during the first year of injecting and in the most recent 12-month period, to inform more effective harm reduction strategies. MethodsData used in this study were drawn from the Global Drug Survey 2015. The study employs chi-square and logistic regression to assess gender differences in injection behaviours in a sample of current injectors residing in six global regions: North-West Europe; Southern Eastern Europe; North America. South America and Oceania. ResultsFemales were more likely than males to report being injected by an intimate partner at initiation (OR = 4.4, 95%CI: 2.2–8.8), during the first year of injecting (OR = 4.8, 95% CI: 2.4–9.3) and in the most recent 12-month period (OR = 2.5, 95%CI: 1.0–6.2). Females reported greater difficulties accessing sterile equipment (X2(2,N = 453) = 8.2, p = 0.02) and were more likely to share injecting equipment than males (X2(1,N = 463) = 3.9, p = 0.05). ConclusionsOur findings highlight females’ continued dependence on their intimate partner to administer the injection into the first year of their injecting career. Females remained more likely than males to rely on intimate partners for injection during the most recent 12-month period. Females report greater difficulties in sourcing sterile equipment and are more likely to share injecting equipment. We suggest that these findings reflect the broader social structure in which females are disempowered through traditional gender roles and the lack of gender appropriate harm reduction services.

Jeunes Migrants Et Consommation De Drogues Dans La Region Du Haut-Sassandra En Cote d’Ivoire (Daloa)

The purpose of the present work was to identify the explanatory factors of drug use among young migrants in the Upper Sassandra region, particularly in Daloa. It combined a mixed approach using a questionnaire and interview guide to collect data from all stakeholders involved in the relationship between young migrant status and drug use. In this perspective, young migrants as well as institutional and community actors were interviewed the geographical field of the sub-districts of the city of Daloa which is presented by several works as a hub of immigration. The working hypothesis that the practice of drug use among young migrants in Daloa is determined by factors related to social, psychological and financial vulnerability related to this status is validated in this work.

The intimate relationship as a site of social protection: Partnerships between people who inject drugs

Public health research treats intimate partnerships as sites of risk management, including in the management of HIV and hepatitis C transmission. This risk-infused biomedical approach tends to undermine appreciation of the emotional and socially situated meanings of care in intimate partnerships. In this article we explore qualitative interview accounts of the care enacted in partnerships between people who inject drugs, drawing on a 2014 study of 34 couples and 12 individuals living in two locations of Australia. A thematic analysis highlights ‘best friend relationships’, ‘doing everything together’, ‘co-dependency’, and ‘doing normalcy’ as core to narratives of care. As we will argue, the accounts position the care undertaken by couples as at once shaped by day-to-day practices of drug use and by social situation, with the partnership enacting care as a form of social protection, including protection from stigma and other environmental hostilities. The intimacy of doing everything together offers insulation against stigma, yet also reproduces its isolating effects. While the care produced in drug-using partnerships is presented as double-edged, we note how interview accounts are used to deflect the charge that these relationships represent harmful co-dependency. Taken together, the interview accounts negotiate a ‘counter-care’ in relation to normalcy, presenting the intimate partnership between people who use drugs as a legitimate embodiment of care.

Indicadores do uso de medicamentos na atenção primária de saúde: uma revisão sistemática.

ABSTRACTObjective.To analyze the rational use of medicines in the context of primary health care (PHC) according to the indicators recommended by the World Health Organization (WHO).Method.A systematic review of the literature was performed following PRISMA guidelines to synthesize the evidence produced by the application of drug use indicators in PHC in the period from 2011 to 2016. The following databases were searched: PudMed, SciELO and Google Scholar, Virtual Health Library/BIREME, and Portal de Periódicos CAPES, using the keywords “World Health Organization,” “indicators,” “drug utilization,” and “rational use of drugs” in Portuguese and English. Original articles describing studies performed at the PHC level, using at least one of the three sets of indicators (prescription, service-related, or health care) were included.Results.Of the 16 studies included, 56.2% were prospective, 37.5% were developed at a local level, 62.5% employed convenience sampling, 56.2% lasted up to 6 months, and 43.8% were performed in Brazil. Prescription indicators were used most (87.5%), followed by service-related indicators (37.5%) and health care indicators (31.3%). None of the scenarios described in the articles fully met the WHO recommendations. The most frequent interventions suggested to resolve the problems related to the rational use of medications included continuing education for rational prescription (56.3%), use of updated lists of essential medicines, including generic drug names and reflecting the needs of the population (31.3%), and implementation of clinical protocols to standardize therapeutic management (31.3%).Conclusions.Application of the WHO indicators revealed irrational practices of drug use in PHC in several countries.

Successful control of a large outbreak of HIV infection associated with injection of cathinone derivatives in Tel Aviv, Israel

ObjectivesOutbreaks of HIV infection have been linked to injectable drug abuse, but specific triggers often remain obscure. We report on an outbreak of primary HIV infection among people who inject drugs (PWID) in Tel Aviv, associated with a local shift in drug-use practices. MethodsA cluster of primary HIV infection cases in PWID was detected in May 2012. Retrospective and prospective multi-hospital case finding was initiated. PWID were interviewed and risk factors for primary HIV infection were identified. Starting in December 2012, a multifaceted intervention was implemented, including educational activities, increasing syringe exchange supplies, active screening, early initiation of antiretroviral therapy, and referral to drug withdrawal programmes. ResultsForty-two PWID with primary HIV infection were detected between May 2012 and April 2013. Compared with the corresponding pre-outbreak period, the annual incidence of primary HIV infection in PWID increased from 0 to 20 cases/1000 population (p <0.0001). Sixty-nine per cent were hospitalized because of concomitant bacterial infections and sepsis. Phylogenetic analysis of HIV isolates from case patients showed tight clustering suggesting a single common source of infection. The outbreak was temporally related to a widespread shift from heroin to injectable cathinone-derivatives and buprenorphine, which entailed high-risk injection practices. Targeted intervention resulted in a dramatic and sustained reduction in HIV infection in the PWID population. ConclusionsInjectable amphetamines are gaining momentum among PWID worldwide. Tracing of this outbreak to cathinone use and implementing a targeted intervention programme effectively terminated the outbreak.

Reconceptualising the Gender of Fitness Doping: Performing and Negotiating Masculinity through Drug-Use Practices

This article analyses self-portrayals and gender constructions among Swedish male bodybuilders who are engaged in fitness doping. The empirical material comes from a larger ethnographic investigation into gym culture. The results show that there is a strong propensity to conform with particular gender fantasies that rests heavily on a binary understanding of gendered, doped bodies. However, this storyline does not apprehend the entire self-presentation of the analysed drug users. Negotiations and inclusive subversions of traditional gender norms are also expressed. For example, the narratives show how the use of performance-enhancing substances makes it possible for (heterosexual) men to approach, touch and express feelings of desire towards other men and their bodies. As such, this practice can be viewed as a contestation of hegemonic gender values, in which masculinity and fitness doping are detached from a quite heterosexist understanding, and turned into a symbolic world of homoerotic pleasure.

Symbolic boundaries, subcultural capital and prescription drug misuse across youth cultures.

Prescription drug misuse among young adults has surged over the past decade. Yet the contexts surrounding this misuse remain unclear, particularly the subcultural contexts. Many young urban adults participate in youth cultures. This article describes the subcultural contexts of prescription drug misuse in youth subcultures. Drawing on ethnographic data collected over 12months from different youth cultural scenes, the authors describe the subcultural bases of prescription drug misuse. The symbolic boundaries and subcultural capital inherent in these scenes shape the ways youth think about drugs and behave accordingly. While young adults are often lumped together by theorists, ethnographic data show considerable variation across these subcultures with regard to what may enable or inhibit prescription drug misuse. The broader subcultural ethos in each scene, as well as attitudes towards other types of drugs, frame the ways that prescription drugs are perceived and used in each of these settings. The findings highlight the role of symbolic boundaries and subcultural capital in shaping routine practices of drug use among young adults. These data show that education campaigns about prescription drug misuse should take into account the variability in youth cultural scenes to maximise the efficacy of these messages aimed at young adults.

Reconceptualising the gender of fitness doping: Performing and negotiating masculinity through drug-use practices

This article analyses self-portrayals and gender constructions among Swedish male bodybuilders who are engaged in fitness doping. The empirical material comes from a larger ethnographic investigation into gym culture. The results show that there is a strong propensity to conform with particular gender fantasies that rests heavily on a binary understanding of gendered, doped bodies. However, this storyline does not apprehend the entire self-presentation of the analysed drug users. Negotiations and inclusive subversions of traditional gender norms are also expressed. For example, the narratives show how the use of performance-enhancing substances makes it possible for (heterosexual) men to approach, touch and express feelings of desire towards other men and their bodies. As such, this practice can be viewed as a contestation of hegemonic gender values, in which masculinity and fitness doping are detached from a quite heterosexist understanding, and turned into a symbolic world of homoerotic pleasure.

High-risk drug-use practices among a large sample of Australian prisoners

Background: Drug injection in prison is associated with a high risk of transmission of blood-borne pathogens including hepatitis C (HCV). The aim of this study was to estimate the prevalence and identify independent correlates of recent in-prison injecting drug use (P-IDU) among a large sample of adult prisoners in Queensland, Australia. Methods: Confidential, structured interviews with 1,322 adult prisoners in Queensland, Australia. Prevalence estimates were corrected for sampling bias using inverse probability weighting. Independent correlates of recent P-IDU were identified using multivariable Poisson regression with backwards elimination. Results: We estimated that among all adult prisoners in Queensland, Australia, the prevalence of lifetime IDU was 55.1%, of lifetime P-IDU 23.0%, and of recent (during current sentence) P-IDU 13.2%. Significant, independent correlates of recent P-IDU included male gender (ARR=3.07, 95%CI 1.83–5.12), being unemployed prior to incarceration (ARR=1.34, 95%CI 1.01–1.76), use of three or more drug types prior to incarceration (ARR=1.80, 95%CI 1.40–2.31), a history of needle/syringe sharing (ARR=5.00, 95%CI 3.06–8.16), receiving a tattoo during the current prison sentence (ARR=2.19, 95%CI 1.67–2.86) and HCV exposure (ARR=1.47, 95%CI 1.08–2.02). Older age was protective (ARR=0.90 per 5 years older, 95%CI 0.83–0.99). Conclusion: Drug injection in prison is common and, given the associations between in-prison drug injection and syringe sharing, unsafe tattooing and HCV exposure, poses a risk to both prisoner health and public health. There remains an urgent need to implement evidence-based infection control measures, including needle and syringe programs, within prison settings.

Memory, Forgetting, and Economic Crisis:

Closely linked to the increase in psychotropic pill consumption, forgetting and remembering emerged from devastated social scenarios as a new local idiom among poor youth in the late 1990s and the new millennium. Drawing on ethnographic fieldwork carried out during the years of the deepest economic crisis in Argentina (2001-03), I argue that psychotropic pill consumption is associated with not only deteriorating economic conditions but also changes in the quality and price of cocaine, and in the scarcity and subsequent change of status of medications during the economic breakdown. Taking into account developments in the field of memory studies, I examine the relationship among political economy, social memory work, and changing drug-use practices. Regarding memory as a social practice, I argue that the growth of psychotropic pill consumption in the late 1990s can be understood through the interplay of Paul Ricoeur's notions regarding different kinds and levels of forgetting. By analyzing changing survival strategies, social network dismantlement, changing mortality patterns, and abusive police repression, I discuss how social fragmentation engendered by structural reforms has modified social memory work.

HIV-Risk Behavior Among Injecting or Non-Injecting Drug Users in Cape Town, Pretoria, and Durban, South Africa

The rapid assessment aimed to describe drug use and sexual practices that place injection and noninjection drug users (IDUs/NIDUs) at risk for HIV in South Africa. The sample comprised 85 key-informant (KI) and focus-group (FG) interviewees in or serving locations with high levels of drug use in Cape Town, Durban, and Pretoria. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. The findings indicated that commonly used drugs had differing effects on sexual and drug-use practices. Risky injecting behaviors among IDUs were common, and most interviewees engaged in sex when on drugs, some without condoms. These behaviors were also influenced by trust in intimate relationships. Injection drug users seemed more knowledgeable about HIV transmission than NIDUs, and 20% of IDUs who agreed to HIV screening tested positive. Views about drug- and HIV-intervention services, accessibility, and their efficacy were mixed. The findings suggest greater synergy is needed between drug- and HIV-intervention sectors and that consideration should be given to making various risk-reduction strategies more accessible. The study's limitations have been noted.

Rétention en traitement et évolution de la clientèle d’un programme montréalais de substitution à la méthadone à exigences peu élevées

To evaluate client treatment retention and evolution in terms of living conditions, at-risk behaviours, and the use of psychoactive substances (PAS) over a one-year period, following admission into a low-threshold methadone program in Montreal. Individual interviews were administered to 114 clients from Relais-Méthadone (RM) at admission and one year after treatment initiation. Participants reported on PAS consumption and unsafe practices of drug use and sexual behaviours at high risk for transmission of HIV, sexually transmitted infections (STI) and other blood-borne viruses (BBV). Services utilized by clients were documented from Relais-Méthadone files. Bivariate analyses were used to compare data recorded at admission and one-year follow-up. The treatment retention rate after one year at RM was 64%. However, by taking into account those clients who were transferred to a regular program during the study period, as well as those who voluntarily tapered their methadone treatment (16.7%), the status of 80.7% of clients demonstrated improvement one year after admission into treatment. Furthermore, the clients who remained in treatment for a year for whom information was available (n = 60) showed a tendency towards more stable living conditions. They also demonstrated a significant decrease in both the number of PAS injections and in risky behaviours related to drug consumption. A statistically significant decrease in the frequency of heroine and cocaine use was also observed. By contrast, however, two thirds of the individuals in treatment after a year (n = 42) maintained or increased their daily consumption of other PAS. The treatment retention rate is comparable to other low or regular threshold substitution programs. The results support previous studies showing that the methadone substitution treatment reduces heroine and cocaine consumption, and decreases the number of unsafe behaviours that could potentially transmit HIV, STI and BBV for the majority of clients who remained in treatment. Future research could focus attention on people who abandon treatment and those who present at-risk behaviours during treatment.