Sharing Needles Research Articles

Association of educational attainment with HIV risk in African American active injection drug users

This study explored the association between educational attainment and HIV/AIDS risk among African American active injection drug users (IDUs) in Chicago, US. Using snowball sampling techniques, 813 African American active IDUs were recruited for semi-structured interviewing and HIV counseling, testing and partner notification. Logistic regression examined the relationship between level of education attained (three categories: less than high school; equivalent to high school; and greater than high school) and HIV risk behaviors (12 unsafe sex and drug-related practices) and HIV serostatus (positive or negative). Compared with the reference category (less than high school education), those with education equal to high school were less likely to share water, p = 0.044, OR = 0.70 (95%CI: 0.50–0.99). Compared with the reference category, those with education greater than high school were less likely to receive money for sex, p = 0.048, OR = 0.62 (95%CI: 0.38–0.99); share needles with person having HIV or AIDS, p = 0.015, OR = 0.58 (95%CI: 0.37–0.90); and test positive for HIV, p = 0.027, OR = 0.58 (95%CI: 0.36–0.94). The significant associations found between educational attainment and certain HIV risk behaviors and HIV serostatus have implications for tailoring HIV prevention efforts for less educated African American IDUs.

NEEDLE SHARING: A REPLY TO WODAK

NEEDLE SHARING: A REPLY TO WODAK

AIDS in Asia: A Continent in Peril

Susan Hunter's book, AIDS in Asia: A Continent in Peril, tackles an important subject. The subheading leaves no doubt that this volume belongs squarely in the next wave school—Africa has been devastated by the AIDS epidemic, and Asia must be next. Hunter's book paints a picture of a continent about to be engulfed in social, economic, and political chaos, all because of 1 small retrovirus. Unfortunately, Hunter presents no data that support this hypothesis. Her chapter on the epidemiology of HIV in Asia, The Looming Mushroom Clouds of Infection, relies heavily on a single report by Nicholas Eberstadt, a demographer and foreign policy analyst who has little experience in the modeling of sexually transmitted and infectious disease. She draws occasionally on advocacy reports by other international organizations such as The Joint United Nations Programme on HIV/AIDS. The book is poorly referenced and shows no evidence that Hunter has attempted to examine surveillance data (much of which is in public domain) or other original data sources. For example, she provides no source for the claim that HIV… typically infects 50%–90% of a developing country's sex workers. Five years of systematic review of primary surveillance data from thousands of sentinel sites throughout Asia has shown only 1 site with rates >50% among sex workers, Mumbai in India. Virtually all the sex worker sites in the Philippines, Indonesia, China, Bangladesh, Pakistan, the most populous countries in the region other than India, report prevalence rates <5%. The book is consistently structured. Each chapter begins with conversations between the downtrodden victims of the HIV epidemic in Asia, persons whose clothing, gestures, and thoughts Hunter describes in heart-rending detail, although they are not, in fact, real persons. Next comes a homily based on the life of Emily Pankhurst, the 19th century English feminist whose relevance to the current HIV epidemic in Asia is uncertain. Then comes a bit of Asian history, a nicely written precis of the Mongol advance or the opium wars, for example, and some observations on historical and cultural injustices of life, injustices that ultimately lead people to have unprotected sex or share needles. Each chapter closes with an apocalyptic statement, along the lines of More and more countries in Asia are teetering on the brink of a violent explosion… and the outcome may be an epidemic the likes of which has never been seen in world history. Hunter may perhaps be forgiven for absorbing the alarmist tone of the advocacy reports she has read, but more attention to the facts would show that this sort of doom mongering is contradicted by every reliable measure of HIV prevalence and sexual behavior in Asia. These data suggest that in Asia (as in the industrial world), HIV will largely be confined to populations with well-defined risk of exposure to the virus. Hunter is absolutely correct in taking Asian governments to task for not doing enough to confront HIV. However, suggesting that HIV is an impending catastrophe that requires turning Asian societies upside down is unhelpful and outdated. This may be true in Africa, where Hunter has more experience, but had she looked beyond the hype at any real data, Hunter would have found that HIV infection does not, in fact, threaten to engulf Asia in social and economic chaos. It is a relatively well-contained infectious disease that, for prevention and control, requires clean needles, condoms, lubricant, screening for sexually transmitted infections, and treatment for a small proportion of the population. Those goals can, and should, be achieved shortly.

Impact of a harm-reduction programme on soft tissue infections among injecting drug users of Kolkata, India.

Sir,Injecting drug users (IDUs) play an important role in spreading HIV as amply documented in several developing countries (1). India has also experienced a similar type of HIV spread among IDUs, which was detected for the first time in Manipur, a northeastern state of India bordering Myanmar, in 1990 (2). Soft tissue infections, including abscesses and cellulites, are the major complications, which may result from sharing of injecting equipment in unhygienic conditions among IDUs.The present study was undertaken in Tiljala slum area, Kolkata, West Bengal, India, to determine the impact of a harm-reduction programme on soft tissue infections among IDUs of Kolkata. Observations were made in a cohort of street IDUs. A needle-syringe exchange intervention programme was initiated in Kolkata in October 2000. The IDU cohort was observed daily through peer outreach workers supervised by field supervisors from January 2000 to March 2002, and the findings were recorded in a pre-designed proforma.The rate of soft tissue infections ranging from 6.3% to 22.6% was observed during the pre-intervention period among IDUs. Since October 2000, the scenario changed significantly following the start of the intervention providing fresh syringes and needles daily in exchange of used ones. The syringe-needle exchange programme continued until March 2002. It was observed that the threat of development of abscess reduced significantly to a very low level (at times 0%) which persisted as long as the intervention programme continued (Fig.). The appearance of skin or soft tissue abscess, among IDUs, represents the culmination of several discrete pathologic processes (3). The mass effect and chemical properties of the injection create local injury and necrosis which ultimately produces tissue abscess/cellulities (4). In the present study, abscess rates were as high as 22.6% in September 2000, whereas they declined to very low levels (at times 0%), after the intervention started. Skin-popping has been described as clinical characteristics of patients with abscess relating to druguse through injection (5). Moreover, the practice of booting is also a risk factor for abscess, particularly among IDUs who do not practise skin-popping. This may be caused by extravasations of the drug and blood mixture from the vein, which provides both a local mass effect and nutrient media for bacterial growth. In another study, it was observed that failure to clean the skin before the injection of drugs was associated with abscess (6). So, primary prevention strategies for the reduction of soft tissue infections among IDUs should ideally include increasing access to sterile injection-equipment, alcohol swabs, promoting hygiene, including hand-washing, cleaning the injection-site before injection, using a sterile syringe for every injection and avoiding needle contamination, and re-use and sharing needles. …

HIV in Correctional Facilities: Role of Self-Report in Case Identification

For treatment of HIV/AIDS in jails and prisons to be effective, these institutions must identify as many HIV-positive inmates as they can. We compare HIV status among a drug-addicted jail population determined through a physical examination and a voluntary HIV testing program, with self-reported status in an interview. Of 360 subjects interviewed and given physical examinations, approximately one third (110) took the voluntary HIV test and all were negative, and only 1 was identified as HIV-positive in the physical. However, 7 (2%) stated in the interview that they were HIV positive, none of whom took the HIV test. Five of the 7 also self-reported injection drug use and having shared needles. We conclude that inmate self-report is an important pathway for HIV case finding in correctional institutions.

Injection drug use and HIV/AIDS in China: review of current situation, prevention and policy implications.

Illicit drug abuse and HIV/AIDS have increased rapidly in the past 10 to 20 years in China. This paper reviews drug abuse in China, the HIV/AIDS epidemic and its association with injection drug use (IDU), and Chinese policies on illicit drug abuse and prevention of HIV/AIDS based on published literature and unpublished official data. As a major drug trans-shipment country with source drugs from the "Golden Triangle" and "Gold Crescent" areas in Asia, China has also become an increasingly important drug consuming market. About half of China's 1.14 million documented drug users inject, and many share needles. IDU has contributed to 42% of cumulatively reported HIV/AIDS cases thus far. Drug trafficking is illegal in China and can lead to the death penalty. The public security departments adopt "zero tolerance" approach to drug use, which conflict with harm reduction policies of the public health departments. Past experience in China suggests that cracking down on drug smuggling and prohibiting drug use alone can not prevent or solve all illicit drug related problems in the era of globalization. In recent years, the central government has outlined a series of pragmatic policies to encourage harm reduction programs; meanwhile, some local governments have not fully mobilized to deal with drug abuse and HIV/AIDS problems seriously. Strengthening government leadership at both central and local levels; scaling up methadone substitution and needle exchange programs; making HIV voluntary counseling and testing available and affordable to both urban and rural drug users; and increasing utilization of outreach and nongovernmental organizations are offered as additional strategies to help cope with China's HIV and drug abuse problem.

Beyond Needle Sharing: Meta-Analyses of Social Context Risk Behaviors of Injection Drug Users Attending Needle Exchange Programs

This study gathered data from U.S. and international needle exchange programs (NEPs). Of particular interest were outcome measures of dependent variables related to behaviors within social contexts of injection drug users (IDUs), an area not well understood. Thirty-one studies, with a total of 86 separate measures of 36 dependent variables were included. Because combining all results into a single meta-analysis would be inappropriate, dependent variables were placed into five categories for five separate meta-analyses: risky contexts, injection frequency, sharing drug paraphernalia, drug preparation, and syringe use. NEP attendance was inversely related to declines in all categorical behaviors except for “risky context.” NEP attenders are slightly more likely to be in a risky circumstance when injecting drugs than non-attenders. While injection frequency declined only slightly among NEP attenders, that result may be interpreted as a positive outcome, given the often-stated criticism that providing clean needles encourages increased drug use. NEP use was weakly associated with a decrease in the sharing of drug paraphernalia. Clean needles alone do not appear to be sufficient motivation to motivate major changes in contextual risk behaviors analyzed herein. Research is needed to assess the impact of interpersonal IDU relationships with other stakeholders (clinic employees, van drivers, medical personnel, nutritionists, sexual partners, etc.) on IDU drug-using behaviors at many levels.

Prevalence and Correlates of HIV Risk Behaviors among Drug Users in China

This study examined the prevalence and correlates of HIV risk behaviors among 1,153 current drug users in China. Chi-squared tests of differences were used to test if drug users differed from non-users; logistic regression was used to identify behavior-specific risk factors. Results indicate that 60% of drug users injected drugs and more than one third shared needles. Compared to non-users, drug users had higher rates of risky sexual behavior and HIV/STDs. Among drug users, ethnic minorities and migrants were most vulnerable to unprotected casual sex and needle sharing. Drug users who experienced social isolation were associated with lower odds of risk behaviors; those who had experiences of anti-social behaviors and commercial sex, poor HIV knowledge, and perceived greater vulnerability were more prone to unprotected casual sex and needle sharing. Additional correlates of unprotected casual sex included being single, depression, and taking drugs/alcohol during sex. Additional risk factors of needle sharing included education and initiated drug use at younger ages. It is imperative that HIV interventions in China target drug users and address behavior-specific risk factors.

Mental Health Status, Drug Treatment Use, and Needle Sharing Among Injection Drug Users

This study examined the relationship among mental health symptoms, drug treatment use, and needle sharing in a sample of 507 injection drug users (IDUs). Mental health symptoms were measured through the ASI psychiatric scale. A logistic regression model identified that some of the ASI items were associated with needle sharing in an opposing direction. Specifically, anxiety was significantly and positively associated with needle sharing. Using psychotropic medication was significantly and negatively associated with sharing needles. Those who had higher levels of drug injecting were more likely to share needles and those with an HIV-positive status were less likely to share needles. Finally, IDUs who reported high levels of drug treatment use (in the 75th percentile in terms of number of treatment admissions) were also more likely to share needles. Results suggest that treating mental health problems in IDUs who are not drug free could reduce HIV risk behaviors. The results also suggest the need to develop new intervention methods for high-level drug treatment users who may be "cycling" through treatment with low levels of treatment completion.

HIV Prevalence and Correlates of Receptive Needle Sharing Among Injection Drug Users in the Mexican-U.S. Border City of Tijuana

Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities. In 2003, street-recruited injection drug users (IDUs) in Tijuana underwent interviews on injection risk behaviors and rapid HIV antibody tests. Logistic regression was used to identify correlates of receptive needle sharing at the last injection episode. Of 402 IDUs, 87.6% were male; the median age was 34. HIV prevalence was 4.01% (95%CI: 2.29–6.51). One third reported receptive needle sharing at last injection. Factors independently associated with receptive needle sharing were years living in Tijuana (Adjusted Odds Ratio [AdjOR]= 0.97 per year, 95% CI: 0.96–0.99), being bisexual/homosexual (AdjOR=2.12; 95% CI: 1.30 – 3.44), unemployed (AdjOR=2.5; 95% CI: 1.52–4.10), never having an HIV test (AOR: 4.02; 95% CI: 2.44–6.60), having friends who placed importance on avoiding HIV (AdjOR: 0.36; 95% CI: 0.19–0.68) and last injecting in a shooting gallery (AdjOR=l.98; 95% CI: 1.21–3.24). These results underscore the need to increase access to voluntary HIV testing and counseling to IDUs and migrants in Tijuana, as well as expand access to sterile syringes in an effort to avert widespread HIV transmission.

Injecting drug use, risk behaviour and risk environment in Hungary: A qualitative analysis

There is an absence of qualitative research investigating risk behaviour and risk environments associated with the transmission of blood-borne viruses (BBVs) among injecting drug users (IDUs) in Hungary. Qualitative interviews were conducted with 33 IDUs who had injected at least once during last 30 days. Participants were residents of Budapest and Pécs, mostly aged 22–25 years, and comprised 22 men and 11 women. The interviews focused on the preparation and division of drug solution and on the shared use of needles and syringes and other injecting paraphernalia, as well as the physical, social, economic and policy components of the injecting micro-environment. Interviews were analysed using Atlas.ti computer software. Findings identified that the division of the drug solution between injectors typically involved the shared use of cooking equipment, filters and water containers. Collective preparation was often followed by shared needle and syringe use. Withdrawal symptoms were perceived to increase the likelihood of such risky behaviour. This study highlights BBV risks arising from the micro-risk environment of injecting drug use, and emphasises the importance of setting and context in harm reduction interventions.

Social and Geographic Distance in HIV Risk

The objective of this study was to examine the relationship between social distance (measured as the geodesic, or shortest distance, between 2 people in a connected network) and geographic distance (measured as the actual distance between them in kilometers [km]). We used data from a study of 595 persons at risk for HIV and their sexual and drug-using partners (total N = 8920 unique individuals) conducted in Colorado Springs, Colorado, from 1988 to 1992--a longitudinal cohort study that ascertained sociodemographic, clinical, behavioral, and network information about participants. We used place of residence as the geographic marker and calculated distance between people grouped by various characteristics of interest. Fifty-two percent of all dyads were separated by a distance of 4 km or less. The closest pairs were persons who both shared needles and had sexual contact (mean = 3.2 km), and HIV-positive persons and their contacts (mean = 2.9). The most distant pairs were prostitutes and their paying partners (mean = 6.1 km). In a connected subset of 348 respondents, almost half the persons were between 3 and 6 steps from each other in the social network and were separated by a distance of 2 to 8 km. Using block group centroids, the mean distance between all persons in Colorado Springs was 12.4 km compared with a mean distance of 5.4 km between all dyads in this study (P <0.0001). The subgroup of HIV-positive people and their contacts was drawn in real space on a map of Colorado Springs and revealed tight clustering of this group in the downtown area. The association of social and geographic distance in an urban group of people at risk for HIV provides demonstration of the importance of geographic clustering in the potential transmission of HIV. The proximity of persons connected within a network, but not necessarily known to each other, suggests that a high probability of partner selection from within the group may be an important factor in maintenance of HIV endemicity.

AIDS in Asia: a continent in peril

Susan Hunter’s book, AIDS in Asia: A Continent in Peril, tackles an important subject. The subheading leaves no doubt that this volume belongs squarely in the “next wave” school—Africa has been devastated by the AIDS epidemic, and Asia must be next. Hunter’s book paints a picture of a continent about to be engulfed in social, economic, and political chaos, all because of 1 small retrovirus. Unfortunately, Hunter presents no data that support this hypothesis. Her chapter on the epidemiology of HIV in Asia, The Looming Mushroom Clouds of Infection, relies heavily on a single report by Nicholas Eberstadt, a demographer and foreign policy analyst who has little experience in the modeling of sexually transmitted and infectious disease. She draws occasionally on advocacy reports by other international organizations such as The Joint United Nations Programme on HIV/AIDS. The book is poorly referenced and shows no evidence that Hunter has attempted to examine surveillance data (much of which is in public domain) or other original data sources. For example, she provides no source for the claim that “HIV... typically infects 50%–90% of a developing country’s sex workers.” Five years of systematic review of primary surveillance data from thousands of sentinel sites throughout Asia has shown only 1 site with rates >50% among sex workers, Mumbai in India. Virtually all the sex worker sites in the Philippines, Indonesia, China, Bangladesh, Pakistan, the most populous countries in the region other than India, report prevalence rates <5%. The book is consistently structured. Each chapter begins with conversations between the downtrodden victims of the HIV epidemic in Asia, persons whose clothing, gestures, and thoughts Hunter describes in heartrending detail, although they are not, in fact, real persons. Next comes a homily based on the life of Emily Pankhurst, the 19th century English feminist whose relevance to the current HIV epidemic in Asia is uncertain. Then comes a bit of Asian history, a nicely written precis of the Mongol advance or the opium wars, for example, and some observations on historical and cultural injustices of life, injustices that ultimately lead people to have unprotected sex or share needles. Each chapter closes with an apocalyptic statement, along the lines of “More and more countries in Asia are teetering on the brink of a violent explosion... and the outcome may be an epidemic the likes of which has never been seen in world history.” Hunter may perhaps be forgiven for absorbing the alarmist tone of the advocacy reports she has read, but more attention to the facts would show that this sort of doom mongering is contradicted by every reliable measure of HIV prevalence and sexual behavior in Asia. These data suggest that in Asia (as in the industrial world), HIV will largely be confined to populations with well-defined risk of exposure to the virus. Hunter is absolutely correct in taking Asian governments to task for not doing enough to confront HIV. However, suggesting that HIV is an impending catastrophe that requires turning Asian societies upside down is unhelpful and outdated. This may be true in Africa, where Hunter has more experience, but had she looked beyond the hype at any real data, Hunter would have found that HIV infection does not, in fact, threaten to engulf Asia in social and economic chaos. It is a relatively well-contained infectious disease that, for prevention and control, requires clean needles, condoms, lubricant, screening for sexually transmitted infections, and treatment for a small proportion of the population. Those goals can, and should, be achieved shortly.

Drug use and risk of bloodborne infections: a survey of female prisoners in British Columbia.

Clinicians working in a women's prison in British Columbia observed hepatitis C sero-conversion among inmates, prompting this study to determine: the characteristics of women who do and do not report illicit drug use in prison; patterns of drug use inside prison; factors associated with illicit drug use that might contribute to bloodborne transmission inside prison. A cross-sectional observational data set was created using an anonymous 61-item self-administered survey. Eighty-three percent (104/126) of eligible inmates participated. Seventy-four percent (77/104) reported their current prison sentence was related to illicit drug use and 25% (26/104) reported their ethnicity as Aboriginal. Ninety-three percent (97/104) reported a prior history of illicit drug use, of whom 70% (68/97) reported a history of injection drug use. Thirty-six percent (37/104) reported illicit drug use in prison, and 21% (22/104) reported injection drug use in prison. Fifty-two percent (54/104) reported hepatitis C sero-positivity, and 8% (8/104) reported HIV sero-positivity. Of the 22 women who reported prison injection drug use, 91% (20/22) reported hepatitis C infection and 86% (19/22) reported injecting with shared needles inside prison, with or without bleach cleaning. Women were more likely to report illicit drug use in prison if they had had illegal sources of income prior to incarceration (p=0.0081, OR 3.19), had previously injected drugs (p=0.036, OR 2.97), and had first injected drugs at a friend's house (p=0.066, OR 2.70). The majority of women reporting prison injection drug use also reported hepatitis C sero-positivity and shared needle use. Canadian prisons are risk situations for transmission of bloodborne pathogens, and provide opportunities for harm reduction strategies.

ASSOCIATION BETWEEN SKIN TATTOOS AND HEPATITIS B OF 1/2000 PRIVATES AT ADISORN FORT HOSPITAL IN SARABURI, THAILAND

The objectives of this study were (1) to determine whether there is association between skin tattoos, Hepatitis-B and prisons, (2) to investigate risk behaviors for Hepatitis-B and (3) to describe characteristics of person who have tattoos. Methods. This retrospective study consisted of a self-administered survey, and an ELISA blood test for viral hepatitis B. The study sample consisted of all 1/2001 privates at Adisorn Fort Hospital Saraburi who had tattoos (n1=46) and simple random sampling of another group of 46 volunteer privates who did not have tattoos. All privates (N = 92) were male, age 22.88; 1.41 years, 67 (72.8%) had graduated from elementary and high school, 29 were positive for Hepatitis-B antibodies (31.5%), 41 (44.6%) had sex with prostitutes, 3 (3.3%) did not use condom, 4 (4.3%) shared razors, 1 (1.1%) shared needles, 25 (27.2%) had been in jail, 87 (94.6%) drank alcohol, 43 (46.7%) had used amphetamines. 20 (28.6%) had tattoos on 2 arms. 10 (14.3%) had tattoo on their back, 9 (19.6%) obtained their tattoos while in prison, 15 (32.6%) had a tattoo that was greater than 20% of the body’s surface area. There was an association between skin tattoo and Hepatitis B (Chi Square, p

Needle sharing among southern Thai drug injectors.

To examine factors associated with needle sharing among injecting drug users (IDU) in southern Thailand. Using a cross-sectional survey, 272 active IDU were interviewed about their socio-economic background, needle sharing and drug use patterns at six drug-treatment clinics in southern Thailand. Ninety-one per cent of IDU gave a past history of ever sharing injecting equipment: of these, 23% currently injected but did not share and 68% still shared. Only 5% of participants knew that bleaching needles could reduce HIV transmission risks. Recent needle sharing was correlated with number of IDU friends (OR 12.23; CI, 5.24-28.51), engaging in illegal jobs (OR 2.74; CI, 1.13-6.67), being unable to use new needles at all times (OR 2.89; CI, 1.17-7.14) and believing that cleaning contaminated shared needles with at least plain water could reduce HIV transmission (OR 3.32; CI, 1.16-6.68). Our data suggest that AIDS prevention efforts should focus on approaches to reduce needle sharing. Needle exchange programs, HIV counseling and testing and bleach distribution may reduce levels of needle-sharing risks.

Prediction of Needle Sharing Among Injection Drug Users1

The aim of the present study was to identify the psychosocial factors associated with the intention and behavior of not sharing used needles and syringes among 459 intravenous drug users (IDUs). The intention to not share used needles was positively associated with personal normative beliefs and self‐efficacy; it was negatively related to the proportion of injections with lending used needles and borrowing syringes from sexual partners. Borrowing used needles was negatively associated with intention whereas loaning syringes was positively related to a negative HIV test result. These results suggest that it is only when a direct personal exposure to HIV infection is possible (borrowing) that intention not to borrow is highlighted. Moreover, being HIV positive appears to reduce loaning used syringes.

Needle Sharing Infections among Heterogeneous IVDUS

This paper begins with an alternative derivation of the coefficients in a known probability generating function (pgf ), namely that for the number of new infectives generated in a random allocation model of needle sharing among i infectives and n susceptibles. The expectation and variance of the number of new infectives are derived.

Risk factors of HIV infection and needle sharing among injecting drug users in Ho Chi Minh City, Vietnam.

We sought to identify risk factors for needle sharing and HIV infection among injecting drug users (IDUs) in Ho Chi Minh City (HCMC), Vietnam. Three cross-sectional surveys among IDUs, both on the street (in 11 urban districts) and in the rehabilitation center for IDUs in HCMC, were carried out in April of 1995, 1997, and 1998. Outreach workers interviewed IDUs about socio-demographic characteristics, drug use and sexual practices, and HIV knowledge and perceptions. The IDUs were also tested for seropositivity to HIV. Independent predictors for HIV positivity and needle sharing were determined by univariate and multivariate logistic regression for the study sample within the rehabilitation center in 1997 and for that on the street in 1998. The HIV prevalence in 1998 among IDUs was 44% for those on the street and 38.5% for those in the rehabilitation center. Independent predictors for HIV infection in IDUs were being injected by drug dealers (for the 1997 sample), injecting on the street, and sharing the drug pots (for the 1998 sample). The reported rate of needle sharing was low and decreased significantly from 20% in 1995 to 12% in 1998 for the sample of IDUs at the street. In the multivariate analysis, predictors for needle sharing for both study samples were injecting on the street, injecting at shooting galleries, and having shared needles in the past. Adequate and easy access to sterile needles and syringes, and a supportive environment of behavior change, especially in street and shooting gallery could reduce risks of virus transmission in the Vietnamese IDU community.

Intrafamilial transmission and risk assessment of HTLV-I among blood donors in southern Taiwan.

The human T-lymphotropic virus type I (HTLV-I) is one of the important etiological agents of adult T-cell leukemia/lymphoma and of HTLV-I associated myelopathy or tropical spastic paraparesis. There is still a lack of data concerning HTLV-I transmission by seropositive carriers in Taiwan. We investigated the patterns of HTLV-I intrafamilial transmission in HTLV-I seropositive blood donors and assessed the risk factors of HTLV-I transmission in relatives of HTLV-I carriers in Taiwan. A total of twenty HTLV-I seropositive donors and their 103 relatives were enrolled. Among those 103 relatives, 40 (38.8%) were seropositive for HTLV-I. Their ages ranged from one to 70 years old with a mean age of 31.0 +/- 1.65 year-old. Three of the ten wives of male carriers were HTLV-I seropositive. However, none of the six husbands of female carriers were HTLV-I seropositive. Mother-to-child vertical transmission was found in nine of 48 (18.8%) tested. Significant risk factors of HTLV-I transmission among relatives of HTLV-I carriers were hospital admission, previous transfusion, breast feeding, anti-HCV seropositivity and female relatives of age >/= 30 with odds ratio (OR) of 9.73, 8.64, 4.36, 8.86 and 4.91, respectively (all p < 0.05). Nonsignificant risk factors of HTLV-I transmission were sharing needles, operation history, HBsAg seropositivity and male relatives of age >/= 30. Our findings suggest that mother-to-child and husband-to-wife transmissions are the important forms of intrafamilial transmission of HTLV-I in Taiwan. Screening for HTLV-I in family members of HTLV-I seropositive blood donors may be warranted.