Sharing Injection Paraphernalia Research Articles

Hepatitis B Virus in People who Inject Drugs and Men who Have Sex With Men With HIV in India: A Cross-sectional Study.

People with HIV (PWH) who are coinfected with hepatitis B virus (HBV) have a higher risk of mortality compared with PWH alone. Populations such as people who inject drugs (PWID) and men who have sex with men (MSM) are particularly at high risk for HBV acquisition; yet, limited epidemiological data from these populations exist on HBV prevalence from low- and middle-income country settings (LMICs). We characterized the prevalence and correlates of HBV serological markers in a sample of PWID and MSM with HIV recruited across 15 Indian cities using hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), and hepatitis B surface antibody (anti-HBs). Testing of stored specimens for the presence of these markers was performed on the Abbott ARCHITECT i1000 as per the manufacturer's instructions. Correlates of ever being infected with HBV (reactive for anti-HBc and/or HBsAg) and chronic HBV (reactive for HBsAg) among those ever infected were assessed using univariable and multivariable multilevel logistic regression models accounting for site-level clustering. A total of 2198 (95%) of the 2314 participants recruited for the trial were screened for HBV markers. The median age among the PWID and MSM participants was 30 and 32 years, respectively. The prevalence of ever being infected with HBV was 75.6% vs 46.9% in PWID vs MSM, respectively (P < .01); prevalence of chronic infection was also higher in PWID vs MSM (14.1% vs 9.5%; P < .01). Correlates of ever being infected with HBV among PWID included unstable housing (adjusted odds ratio [aOR], 5.02) and sharing injection paraphernalia (aOR, 2.70), and among MSM, correlates included history of injection drug use (aOR, 4.87) and gender identity. The prevalence of isolated core (anti-HBc in the absence of anti-HBs) was 34.7% vs 29.4% in PWID vs MSM (P < .05). Vaccination serostatus was <10% in both populations. In this large sample of PWID and MSM with HIV, we observed a high prevalence of serology consistent with HBV infection and low vaccination, highlighting the need for routine screening and catch-up vaccination. The high prevalence of isolated anti-HBc reactivity highlights the need to understand the risk of reactivation with this serological pattern.

Longitudinal analysis of HIV-risk behaviors of participants in a randomized trial of prison-initiated buprenorphine

BackgroundIt has been estimated that approximately 15% of people who are incarcerated in the US have histories of opioid use disorder. Relapse to opioid use after release from prison poses a serious risk of HIV infection. Prison-initiated buprenorphine may help to reduce HIV infection given the association between opioid use and HIV-risk behaviors.MethodsThe present study is a secondary analysis of longitudinal data gathered from a randomized controlled trial of buprenorphine-naloxone for people who were incarcerated (N = 211) between 2008 and 2012. It compares the impact of assignment to initiate buprenorphine in prison (N = 106 randomized, N = 104 analyzed) versus in the community (N = 107 randomized, N = 107 analyzed) and whether or not participants entered community treatment on the frequency of HIV-risk behaviors in the 12 months following release from prison. Data were analyzed hierarchically and for each outcome variable, a multilevel, over-dispersed Poisson model was fit to the data. Outcome variables were the number of times the following behaviors occurred in the last 30 days: (1) having sex without a condom (2) injecting drugs (3) using unsterilized needles, and (4) sharing injection paraphernalia.ResultsParticipants assigned to begin buprenorphine in the community experienced a greater decrease in injection drug use over time compared to participants assigned to begin buprenorphine in prison. There were no significant associations between treatment assignment or community treatment entry and instances of having sex without a condom, sharing injection paraphernalia, or using unsterilized needles.ConclusionsOverall, the present study did not find support for the initiation of buprenorphine in prison (as opposed to the community) as a means to reduce incidences of HIV-risk behaviors. Avenues for future research in the nexus of HIV-risk reduction, criminal justice, and pharmacotherapy are discussed.Trial registration This study was supported by the National Institute on Drug Abuse (NIDA), Buprenorphine for Prisoners (PI: Kinlock; R01DA021579). ClinicalTrials.gov identifier: NCT 00574067

A Cohort Approach to Real-Time Detection of Acute HIV Infections Among People Who Inject Drugs in St. Petersburg, Russia.

To detect acute HIV infections (AHIs) in real time among people who inject drugs (PWID) in St. Petersburg, Russia and to test the feasibility of this approach. Prospective cohort study. One hundred seronegative or acutely HIV-infected at screening PWID were enrolled and followed until the end of the 12-month pilot period. Each participant was evaluated, tested, and counseled for HIV monthly. Two HIV tests were used: HIV antibody and HIV RNA PCR. If diagnosed with AHI, participants were followed weekly for a month; then, monthly for 3 months; and then, quarterly for the duration of the follow-up period. HIV risk behavior was assessed at each study visit. Most enrolled PWID were 30-39 years old, male, completed high school or more, not employed full-time, heroin users, and frequently shared injection paraphernalia. AHI prevalence at screening was 1.8% [95% confidence interval (CI): 0.4, 5.5]. Three participants with AHI at enrollment represented 3% (95% CI: 0.6, 8.5) of the 100 participants who consented to enroll. Among the HIV-uninfected participants (n = 97), the AHI incidence over time was 9.3 per 100 person-years. Persons with AHI were more likely to report alcohol intoxication within the prior 30 days. This was the first study to detect AHI using a cohort approach. The approach proved to be feasible: recruitment, retention, AHI detection, and virological endpoints were successfully reached. A cost analysis in a real-world setting would be required to determine if this strategy could be brought to scale. The study revealed continued high HIV incidence rate among PWID in St. Petersburg, Russia and the importance of prevention and treatment programs for this group.

Predictors of HIV Risk Behavior in Iranian Women Who Inject Drugs

This study aimed to investigate predictors of drug-related HIV risk behaviors among women who inject drugs. A total of 163 women were recruited from harm-reduction-oriented drug-treatment centers in Tehran, Iran. Each completed a set of measures that included the Risk Behavior Assessment, Beck Depression Inventory–Second Edition, Revised Self-Efficacy Scale, and Peer Group Beliefs Regarding HIV-related Risk Behaviors Scale. The results indicated that past attempts to abstain from drugs, using methadone maintenance treatment programs, and acceptance of peers’ risky norms were significant predisposing, enabling, and reinforcing predictors of frequency of injection, respectively. Furthermore, predictors of frequency of sharing injection paraphernalia included purchasing drugs jointly with other drug users and peers’ norms conforming injecting drug use behaviors. Harm reduction services that take into consideration cultural and peer norms, as well as the development and implementation of HIV prevention programs, are likely to reduce drug-related HIV risk behaviors in women who inject drugs.

High variability of HIV and HCV seroprevalence and risk behaviours among people who inject drugs: results from a cross-sectional study using respondent-driven sampling in eight German cities (2011-14).

BackgroundPeople who inject drugs (PWID) are at increased risk of acquiring and transmitting HIV and Hepatitis C (HCV) due to sharing injection paraphernalia and unprotected sex. To generate seroprevalence data on HIV and HCV among PWID and related data on risk behaviour, a multicentre sero- and behavioural survey using respondent driven sampling (RDS) was conducted in eight German cities between 2011 and 2014. We also evaluated the feasibility and effectiveness of RDS for recruiting PWID in the study cities.MethodsEligible for participation were people who had injected drugs within the last 12 months, were 16 years or older, and who consumed in one of the study cities. Participants were recruited, using low-threshold drop-in facilities as study sites. Initial seeds were selected to represent various sub-groups of people who inject drugs (PWID). Participants completed a face-to-face interview with a structured questionnaire about socio-demographics, sexual and injecting risk behaviours, as well as the utilisation of health services. Capillary blood samples were collected as dried blood spots and were anonymously tested for serological and molecular markers of HIV and HCV. The results are shown as range of proportions (min. and max. values (%)) in the respective study cities. For evaluation of the sampling method we applied criteria from the STROBE guidelines.ResultsOverall, 2,077 PWID were recruited. The range of age medians was 29–41 years, 18.5–35.3 % of participants were female, and 9.2–30.6 % were foreign born. Median time span since first injection were 10–18 years. Injecting during the last 30 days was reported by 76.0–88.4 % of participants. Sharing needle/syringes (last 30 days) ranged between 4.7 and 22.3 %, while sharing unsterile paraphernalia (spoon, filter, water, last 30 days) was reported by 33.0–43.8 %. A majority of participants (72.8–85.8 %) reported incarceration at least once, and 17.8–39.8 % had injected while incarcerated. Between 30.8 and 66.2 % were currently in opioid substitution therapy. Unweighted HIV seroprevalence ranged from 0–9.1 %, HCV from 42.3–75.0 %, and HCV-RNA from 23.1–54.0 %. The implementation of RDS as a recruiting method in cooperation with low-threshold drop in facilities was well accepted by both staff and PWID. We reached our targeted sample size in seven of eight cities.ConclusionsIn the recruited sample of mostly current injectors with a long duration of injecting drug use, seroprevalence for HIV and HCV varied greatly between the city samples. HCV was endemic among participants in all city samples. Our results demonstrate the necessity of intensified prevention strategies for blood-borne infections among PWID in Germany.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3545-4) contains supplementary material, which is available to authorized users.

Drug preparation, injection, and sharing practices in Tajikistan: a qualitative study in Kulob and Khorog.

BackgroundSharing injection equipment remains an important rout of transmission of HIV and HCV infections in the region of Eastern Europe and Central Asia. Tajikistan is one of the most affected countries with high rates of injection drug use and related epidemics.The aim of this qualitative study was to describe drug use practices and related behaviors in two Tajik cities – Kulob and Khorog.MethodsTwelve focus group discussions (6 per city) with 100 people who inject drugs recruited through needle and syringe program (NSP) outreach in May 2014. Topics covered included specific drugs injected, drug prices and purity, access to sterile equipment, safe injection practices and types of syringes and needles used. Qualitative thematic analysis was performed using NVivo 10 software.ResultsAll participants were male and ranged in age from 20 to 78 years. Thematic analysis showed that cheap Afghan heroin, often adulterated by dealers with other admixtures, was the only drug injected. Drug injectors often added Dimedrol (Diphenhydramine) to increase the potency of “low quality” heroin. NSPs were a major source of sterile equipment. Very few participants report direct sharing of needles and syringes. Conversely, many participants reported preparing drugs jointly and sharing injection paraphernalia. Using drugs in an outdoor setting and experiencing withdrawal were major contributors to sharing equipment, using non-sterile water, not boiling and not filtering the drug solution.ConclusionQualitative research can provide insights into risk behaviors that may be missed in quantitative studies. These finding have important implications for planning risk reduction interventions in Tajikistan. Prevention should specifically focus on indirect sharing practices.

The syndemic of HIV, HIV-related risk and multiple co-morbidities among women who use drugs in Malaysia: Important targets for intervention

BackgroundSubstance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders. ObjectivesTo explore HIV risk behaviors, substance use, and social factors associated with poor health outcomes among women who use drugs in Malaysia. MethodsA cross-sectional survey of 103 drug-using women in Kuala Lumpur, Malaysia were recruited to assess their medical, psychiatric and social comorbidity as well as their engagement in nationally recommended HIV testing and monitoring activities. ResultsOne-third reported having ever injected drugs, with most (68.2%) having recently shared injection paraphernalia. Sex work (44.7%) and infrequent condom use (42.4%) were common as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women (62.1%) had unstable living situations and suffered from an unmet need for social support and health services. HIV prevalence was high (20%) with only two thirds of women eligible for antiretroviral therapy having received it. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence (AOR 2.73; 95% CI 1.04-7.14) and negatively associated with drug injection (AOR 0.28; 95% CI 0.10-0.77). Conclusions/ImportanceWomen who use drugs in Malaysia demonstrate considerable medical, psychiatric and social co-morbidity, which negatively contributes to optimal and crucial engagement in HIV treatment-as-prevention strategies. Mental health and social support may be key targets for future public health interventions aimed at drug-using women in Malaysia.

High HIV prevalence in a respondent-driven sampling survey of injection drug users in Tehran, Iran.

Iran is facing unprecedented dual drug use and HIV epidemics. We conducted a cross-sectional survey to obtain HIV prevalence and risk behavior data from injection drug users (IDU) in Tehran. We used respondent-driven sampling (RDS) to recruit IDU through successive waves starting with 24 "seeds," conducted anonymous face-to-face interviews and HIV testing and counseling, and used RDSAT to adjust data. During 44 weeks, 1,726 study referral coupons resulted in 645 (37 %) IDU referrals, of whom 548 (85 %) were enrolled. From those enrolled, 84 % were incarcerated, 47 % employed, 55 % single, 27 % under 30 years of age, and 26 % homeless. The adjusted HIV prevalence was 26.6 % (95 % confidence interval 21.3-32.1), and was higher among certain IDU subgroups (e.g., those who sharing injection paraphernalia). Our estimates of HIV prevalence were higher than some other estimates; however, repeated surveys using similar methodology are needed to monitor the trend of HIV epidemic over time.

Individual and socio-environmental factors associated with unsafe injection practices among young adult injection drug users in San Diego.

Unsafe injection practices significantly increase the risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection among injection drug users (IDUs). We examined individual and socio-environmental factors associated with unsafe injection practices in young adult IDUs in San Diego, California. Of 494 IDUs, 46.9 % reported receptive syringe sharing and 68.8 % sharing drug preparation paraphernalia in the last 3 months. Unsafe injection practices were associated with increased odds of having friends who injected drugs with used syringes, injecting with friends or sexual partners, and injecting heroin. Perceived high susceptibility to HIV and perceived barriers to obtaining sterile syringes were associated with increased odds of receptive syringe sharing, but not with sharing injection paraphernalia. Over half the IDUs reported unsafe injection practices. Our results suggest that personal relationships might influence IDUs' perceptions that dictate behavior. Integrated interventions addressing individual and socio-environmental factors are needed to promote safe injection practices in this population.

Prevalence, correlates, and risk perception of HIV infection among heroin users in Central Taiwan

We investigated the prevalence and correlated factors of human immunodeficiency virus (HIV) among heroin users attending methadone maintenance treatment (MMT) programs in Central Taiwan, and explored the degree of risk perception of HIV infection among the participants. Our study participants were 781 heroin users seeking treatment at the MMT program at Tsaotun Psychiatric Center in Taiwan. The presence of HIV antibodies was identified by microparticle enzyme immunoassay and confirmed by western blot. Multivariate logistic regression was used to identify the independent correlates of HIV infection. The mean age of the sample was 36.1 years [standard deviation (SD) = 7.6]; of the patients, 710 (90.9%) were men. The prevalence of HIV infection among our study population was 20.7%. Multivariate logistic regression analysis revealed that HIV infection was independently associated with the age of the patients of initial heroin use, heroin injection use, nondrug-related criminal convictions, needle-sharing behaviors, and sharing injection paraphernalia. A strong agreement existed between self-reported HIV serostatus and the results of laboratory analyses, with 88.8% of patients reporting their condition correctly. We found a high rate of HIV infection among patients in the MMT program. Factors associated with HIV infection were mostly related to drug-use behaviors. These findings stress the importance of education regarding drug-risk behaviors.

HCV Infection Prevalence Lower Than Expected among 18–40-Year-Old Injection Drug Users in San Diego, CA

San Diego, California shares the world's busiest land border crossing with Tijuana, Mexico-a city where 95% of injection drug users (IDUs) test hepatitis C virus (HCV) antibody-positive. Yet, little is known about the prevalence and risk behaviors for HCV among IDUs in San Diego. In 2009-2010, 18-40-year-old IDUs in San Diego County completed a risk assessment interview and serologic testing for HCV and HIV infection. Recruitment involved respondent-driven sampling, venue-based sampling at a syringe exchange program, and convenience sampling. Correlates of HCV infection were identified by multivariable logistic regression. Among 510 current IDUs, 26.9% (95% CI 23.0-30.7%) and 4.2% (95% CI 2.4-5.9%) had been infected with HCV and HIV, respectively. Overall, median age was 28years; 74% were male; 60% white and 29% Hispanic; and 96% were born in the U.S. Median years of injecting was 6; 41% injected daily; 60% injected heroin most often; 49% receptively shared syringes and 68% shared other injection paraphernalia; and only 22% reported always using new syringes in the past 3months. Two thirds had ever traveled to Mexico and 19% injected in Mexico. HCV infection was independently associated with sharing injection paraphernalia (adjusted odds ratio [AOR] = 1.69) and SEP use (AOR = 2.17) in the previous 3months, lifetime history of drug overdose (AOR = 2.66), and increased years of injecting (AOR = 2.82, all P values <0.05). Controlling for recruitment method did not alter results. HCV infection prevalence among IDUs in San Diego was modest compared to other US cities and much lower than Tijuana. Given that known individual-level HCV risk factors were common in San Diego, the city's lower HCV prevalence might be due to differences in social and structural factors between the cities.

Commentary on Harris &amp; Rhodes (2012): Discouraging syringe re-use by addressing drug injectors’ everyday suffering

Commentary on Harris &amp; Rhodes (2012): Discouraging syringe re-use by addressing drug injectors’ everyday suffering

Perfil de los usuarios de drogas por vía parenteral que mantienen conductas de riesgo relacionadas con la inyección en Cataluña

ObjectivesTo estimate the prevalence of direct and indirect syringe sharing among intravenous drug users (IDUs) attending a harm reduction center in Catalonia (Spain) and to identify factors associated with risk behaviors. MethodsA cross-sectional study was conducted between 2008 and 2009 in harm reduction centers. Behavioral data were collected using anonymous questionnaires administered by trained interviewers. ResultsOf the 748 respondents, 31.5% had shared syringes at least once in the previous 6 months and 55.2% reported sharing injection paraphernalia (spoons, water, filters). A higher risk of syringe sharing was found among IDUs who injected daily (OR=1.5), injected cocaine (OR=1.6), had less than half their supply of syringes from a free source (OR=2.5), had an IDU sexual partner (OR=1.8) or who reported indirect sharing (OR=4.1). A higher risk of indirect sharing was found in respondents who had an illegal source of income (OR=1.5), injected daily (OR=1, 5), injected cocaine (OR=1.4), reported sharing syringes (OR=3.9), or who reported a previous overdose (OR=1.5). ConclusionsDespite the widespread use of harm reduction programs in Catalonia, a significant proportion of IDUs continue to practise injection-related risk behaviors. Further reductions in risk behaviors could be achieved by improving access to all sterile injecting equipment, especially among cocaine injectors and IDUs who inject frequently, and by including IDU sexual partners within the current network of harm reduction centers.

Perceived Serosorting of Injection Paraphernalia Sharing Networks among Injection Drug users in Baltimore, MD

We examined perceived serosorting of injection paraphernalia sharing networks among a sample of 572 injection drug users (IDUs). There was evidence for serosorting of high-risk injection behaviors among HIV-negative IDUs, as 94% of HIV-negative IDUs shared injection paraphernalia exclusively with perceived HIV-negative networks. However, 82% of HIV-positive IDUs shared injection paraphernalia with perceived HIV-negative networks. The findings indicate a potential risk of rapid HIV transmission. Future prevention efforts targeting IDUs should address the limitation of serosorting, and focus on preventing injection paraphernalia sharing regardless of potential sharing networks' perceived HIV status.

Comportamentos de risco ao HIV em utilizadores de heroína em um distrito português: estudo qualitativo

OBJETIVO: Explorar relatos de utilizadores de heroína sobre seus comportamentos de risco para transmissão do vírus da imunodeficiência humana (HIV) no distrito de Vila Real, Portugal, já que a heroína é a droga predominante no que se refere ao uso problemático de drogas em Portugal, e 48% de todas as notificações de infecção por HIV no país são associadas à dependência de drogas. MÉTODO: Utilizadores de heroína recebendo tratamento ambulatorial para dependência em clínica pública foram selecionados aleatoriamente e convidados a participar do estudo. A coleta de dados foi realizada através de entrevista qualitativa semiestruturada, desenvolvida para explorar os relatos dos participantes sobre seu comportamento de risco associado ao uso de heroína. RESULTADOS: Vinte e cinco entrevistas foram realizadas. A idade média foi de 32 anos, e 92% eram homens. Os participantes relataram um tempo médio de uso de heroína de 14,7 anos, e 64% deles mencionaram uso diário da droga. Dois terços relataram uso de heroína e 16% referiram uso intravenoso da droga nos 30 dias anteriores à entrevista. 75% referiram compartilhamento de seringas ou parafernália de injeção. Front-loading ou back-loading foram técnicas comuns e não reconhecidas como comportamento de risco. 84% referiram ter sido testados anteriormente para o HIV. CONCLUSÕES: O desenvolvimento de melhores programas de prevenção ao HIV para este grupo de risco é essencial através do uso de informações sobre movimentos demográficos e padrões de comportamento de utilizadores de heroína, abordando seus comportamentos de risco nas práticas sexuais e no compartilhamento de parafernália de injeção.

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

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

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

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

Gender Difference in the Clinical and Behavioral Characteristics of Human Immunodeficiency Virus-infected Injection Drug Users in Taiwan

Injection drug users (IDUs) have become the major contributors to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome epidemic in Taiwan, accounting for more than 60% of new cases in 2005. In Taiwan, gender difference in risk factors for HIV among IDUs has not been reported before. We studied the clinical and sociodemographic characteristics, sexual behaviors, drug use histories and criminal records of male and female HIV-infected IDUs. A total of 100 male and 25 female HIV-infected inmates from two prisons were included. An individually structured interview was conducted with each inmate. Serostatus of hepatitis B virus (HBV) and hepatitis C virus (HCV) were tested. CD4+ T cell count and HIV viral load were also evaluated. The mean age of the HIV-infected inmates was 31.7 +/- 6.4 years. All inmates were co-infected with HCV and 20% were HBV carriers. The mean CD4+ T cell count was 498 cells/microL, and the mean viral load was 20,119 copies/mL. Heroin use history averaged 6.3 +/- 5.1 years, and 84.8% of patients had a previous criminal offense prior to current conviction. Female inmates were significantly younger, had more sexual partners, had more drug-using family members or sexual partners, shared injection paraphernalia more frequently, and started using methamphetamine and heroin at younger ages (p < 0.05). Male inmates tended to be single, had less parental support, had been more frequently convicted of non drug-related crimes, started using non-illicit substances more frequently at younger ages and had sex with prostitutes more frequently (p < 0.05). The results of this study suggest that drug injection risks and sexual behavior related risks are equally important in determining the risk of HIV infection among IDUs. Gender-specific approaches to prevention which reflect differences in gender-related patterns of risk are also needed.

Influence of religiosity on HIV risk behaviors in active injection drug users

Previous studies have shown a positive relationship between religiosity and the practice or adoption of protective health behaviors, including reduction of illicit drug use among hard-core injecting drug users (IDUs). The purpose of this study was to examine the role of religiosity in predicting HIV high-risk drug and sexual practices among a sample of IDUs in Chicago, USA. We hypothesized that high religiosity would be associated with a lower likelihood of IDUs engaging in risky behaviors for HIV transmission. Snowball sampling techniques were used to recruit 1,095 active IDUs for HIV testing, counseling and partner notification. Data were analyzed from 880 subjects who self-identified with one of three religions, Christianity, Islam or Judaism. Logistic regression was used to examine the relationship between religiosity (based on self-reports of personal strength of religious belief: very strong; somewhat strong; not at all), independent of specific religion, and HIV risk behaviors (defined as 12 unsafe sex- and drug-related practices) as well as HIV serostatus. Contrary to our hypothesis, subjects with stronger religiosity were more likely to engage in four risk behaviors related to sharing injection paraphernalia. Compared to those who self-reported having no religiosity, subjects who stated that their lives were strongly influenced by religious beliefs were significantly more likely to share injection outfits, cookers, cotton and water. The association of certain HIV risk behaviors with higher religiosity has implications for HIV prevention and warrants further research to explore IDUs’ interpretation of religious teachings and the role of religious education in HIV prevention programs.

HIV infection and risk factors among Bangkok prisoners, Thailand: a prospective cohort study.

BackgroundIncarceration has been associated with HIV infection among injection drug users. However, data on HIV risk factors of the inmates during incarceration are rarely reported from Thailand.MethodsA prospective cohort of 689 male inmates in a Bangkok central prison was studied during 2001–2002. Follow up visits were conducted for 5 months, with testing for HIV and other infections and interviewing of demographics and risk behaviors.ResultsAmong 689 male inmates, half (50.9 %) were drug injectors. About 49% of the injectors had injection during incarceration. Most (94.9%) of the injectors had shared injection paraphernalia with others. Successful follow up rate was 98.7% after 2,581 person-months observation. HIV incidence was 4.18 per 100 person – years among all inmates, and 11.10 per 100 person – years among the injection inmates. Multivariate analysis identified variables associated with HIV prevalence: history of injection [OR = 2.30, 95%CI: 1.91–2.77], positive urine opiate test [OR = 5.04, 95%CI: 2.63–9.67], history of attendance to drug withdrawal clinics [OR = 2.00, 95%CI: 1.19–3.35] and presence of tattoos on the body [OR = 1.23, 95%CI: 1.01–1.52].ConclusionsThe main HIV risk factors of Bangkok inmates were those related to drug injection. Harm reduction measures and HIV intervention strategies should be implemented to prevent more spread of HIV among the inmates and into the community.