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Abstract
The intent of the HIV sentinel surveillance program in Thailand, as in other countries, is to provide early warning of pending epidemics so that public health of ficials can intensify prevention and control activities to protect their communities. While the intention is clear, questions remain as to how sentinel groups should be selected and if they predict future HIV occurrence. Every six months, serum is collected in Thailand from a sample of six sentinel groups in all provinces of Thailand for determining the prevalence of HIV infection. Among the sentinel groups, the HIV epidemic is rapidly increasing in female sex-workers, males at STD clinics, and females at antenatal clinics, increasing less rapidly among blood donors, and remaining high among IV drug addicts. Two sentinel groups were found to be useful for predicting the future spread of the epidemic to women attending clinics: lower-class female sex-workers and males attending STD clinics.
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Taylor A, Goldberg D, Hutchinson S, Cameron S, Gore SM, McMenamin J, Green S, Pithie A, Fox R. Prevalence of hepatitis C virus infection among injecting drug users in Glasgow 1990-1996: are current harm reduction strategies working? J Infect 2000; 40:176-83. [PMID: 10841096 DOI: 10.1053/jinf.2000.0647] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine the prevalence of HCV antibodies among injecting drug users and to gauge the effectiveness of needle/syringe exchange in preventing the transmission of HCV infection. METHODS Between 1990-1994 and in 1996, annual cross-sectional surveys of injecting drug users in Glasgow were conducted. In order to ensure as representative a sample as possible, the 1949 respondents were recruited from both 'in-treatment' and 'out-of treatment' settings. Injectors were interviewed about their risk behaviours for blood-borne viruses and provided a saliva sample which was initially tested, anonymously, for HIV antibodies, and subsequently tested for hepatitis C infection. RESULTS Among 1949 injectors, the prevalence of salivary antibodies, indicative of hepatitis C viraemia, was 61%(95%, confidence interval (CI) 59%-63%): the estimated prevalence of serum antibody positivity was 72%. Length of injecting, year of commencing drug injecting and the number of times in prison were predictive of antibody positivity. Thirty-one per cent of injectors who commenced their injecting after 1992, following the full establishment of needle/syringe exchange in the city, were salivary antibody positive, and the majority of their infections were acquired outside the prison setting. Respondents who began injecting after the introduction of needle/syringe exchange in the city were significantly less likely to test HCV antibody positive than those who commenced injecting prior to the advent of needle/syringe exchange, after adjusting for length of injecting career. CONCLUSION The prevalence of HCV among injectors in Glasgow has decreased during the era of needle/syringe exchange. However, there is evidence to suggest that the incidence of infection remains high. Since the prevalence of hepatitis C viraemia among the city's injecting population is extremely high, ongoing transmission is inevitable unless more effective interventions are identified and implemented urgently.
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Affiliation(s)
- A Taylor
- Scottish Centre for Infection and Environmental Health, Glasgow, UK
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3
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Hodinka RL, Nagashunmugam T, Malamud D. Detection of human immunodeficiency virus antibodies in oral fluids. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1998; 5:419-26. [PMID: 9665942 PMCID: PMC95593 DOI: 10.1128/cdli.5.4.419-426.1998] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- R L Hodinka
- Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
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4
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Granade TC, Phillips SK, Parekh B, Gomez P, Kitson-Piggott W, Oleander H, Mahabir B, Charles W, Lee-Thomas S. Detection of antibodies to human immunodeficiency virus type 1 in oral fluids: a large-scale evaluation of immunoassay performance. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1998; 5:171-5. [PMID: 9521138 PMCID: PMC121353 DOI: 10.1128/cdli.5.2.171-175.1998] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Paired serum and oral-fluid (OF) specimens (n = 4,448) were collected from blood donors and patients attending local sexually transmitted disease clinics in Trinidad and Tobago and the Bahamas and were tested for the presence of human immunodeficiency virus type 1 (HIV-1) antibodies. Sera were tested by Abbott AB HIV-1/HIV-2 (rDNA) enzyme immunoassay (EIA), and positive specimens were confirmed by Cambridge HIV-1 and HIV-2 Western blotting (WB). OF specimens were collected with the OraSure collection device and were tested by Murex GACELISA and by two EIAs from Organon Teknika (the Oral Fluid Vironostika HIV-1 Microelisa System [OTC-L] and the Vironostika HIV-1 Microelisa System [OTC-M]). EIA-reactive OF specimens were confirmed by miniaturized WB (OFWB). GACELISA detected all 474 HIV-1 seropositive specimens (sensitivity, 100%). OTC-L detected 470 positive specimens (sensitivity, 99.2%), while OTC-M detected 468 positive specimens (sensitivity, 98.8%). Specificities ranged from 99.2 to 100% for the three assays. Concordance of OFWB with serum WB was 99.4%, and banding patterns determined by the two methods were similar. The immunoglobulin G (IgG) concentration of OF specimens ranged from 0.21 to 100 microg/ml, with a mean of 17.1 microg/ml. Significant differences in OF IgG concentrations were observed between HIV antibody-positive and HIV antibody-negative persons (31.94 versus 15.28 microg/ml, respectively [P < 0.0001]). These data further confirm the suitability of OF specimens for detection of HIV-1 antibodies. Currently available HIV-1 antibody assays provide sensitivities and specificities with OF specimens comparable to those achieved with serum specimens.
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Affiliation(s)
- T C Granade
- Division of AIDS, STD, and TB Laboratory Research, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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5
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Abstract
Salivary antibody testing for HIV is proving to be a sensitive and specific procedure, especially useful for epidemiological studies, and has the advantages of being simple and non-invasive. This paper reviews the field and discusses antibody testing of dental patients.
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Affiliation(s)
- C Scully
- Eastman Dental Institute for Oral Health Care Sciences, University of London, UK
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6
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de Almeida OP, de Souza Filho FJ, Scully C, Line SR, Porter S. HIV prevalence in dental outpatients in Brazil. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 84:365-7. [PMID: 9347499 DOI: 10.1016/s1079-2104(97)90033-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A series of dental outpatients in Brazil was anonymously screened for HIV antibodies in whole unstimulated saliva with an immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. Salivary HIV antibodies were detected in 40 patients in the control group who were known to be HIV-seropositive but were not detected in any of a series of 40 known HIV-seronegative patients in the control group, confirming the very high sensitivity and specificity of the immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. Only one patient from 84 consecutive dental outpatients of unknown HIV serostatus who were examined anonymously for HIV by immunoglobulin G antibody-capture enzyme linked immunosorbent assay showed HIV positivity (1.2% of the population).
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Affiliation(s)
- O P de Almeida
- Department of Oral Pathology, Dental School of Piracicaba, University of Campinas, São Paulo, Brazil
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7
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Druce JD, Robinson WF, Locarnini SA, Kyaw-Tanner MT, Sommerlad SF, Birch CJ. Transmission of human and feline immunodeficiency viruses via reused suture material. J Med Virol 1997; 53:13-8. [PMID: 9298726 DOI: 10.1002/(sici)1096-9071(199709)53:1<13::aid-jmv3>3.0.co;2-t] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Several documented cases of human immunodeficiency virus (HIV) infection have involved unconventional or unknown modes of transmission of the virus. Some such cases have occurred within a surgical setting. We investigated the potential for transmission of HIV on suture material that had been reused following passage through an HIV-infected patient. Initial experiments were conducted in vitro using HIV. To provide stronger evidence that HIV could be transmitted via this route, further experiments were undertaken in vivo using a feline immunodeficiency virus (FIV)/cat model. Both methods indicated the possibility of transmission of virus if suture materials were reused.
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Affiliation(s)
- J D Druce
- Victorian Infectious Diseases Reference Laboratory, Fairfield, Australia.
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8
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Abstract
Antibodies to human immunodeficiency virus (HIV) can be detected in oral fluid with great accuracy, due to technical advances in both the collection of oral samples and assays. Reported sensitivities of 97.2-100% and specificities of 97.7-100% compare well with those of serum-based assays and qualify oral fluid for the screening and diagnosis of HIV infection in both high- and low-risk populations. In addition, oral fluid offers several advantages over serum as a testing medium for HIV, including greater safety, ease of collection, and patient acceptability.
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Affiliation(s)
- W Emmons
- Division of Infectious Diseases, Naval Medical Center, Portsmouth, Virginia, USA
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Saville RD, Constantine NT, Holm-Hansen C, Wisnom C, DePaola L, Falkler WA. Evaluation of two novel immunoassays designed to detect HIV antibodies in oral fluids. J Clin Lab Anal 1997; 11:63-8. [PMID: 9021526 PMCID: PMC6760747 DOI: 10.1002/(sici)1098-2825(1997)11:1<63::aid-jcla10>3.0.co;2-n] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/1996] [Accepted: 05/28/1996] [Indexed: 02/03/2023] Open
Abstract
The testing of oral fluid samples for the detection of HIV antibodies offers several advantages over the testing of blood. Our objective was to evaluate a new generation of rapid and simple assays designed specifically to detect HIV-1 and HIV-2 antibodies in oral fluids (saliva). Serum and oral fluid pairs were collected from 615 high- and low-risk individuals in the United States, Peru, and the ivory Coast. Two different oral fluid collection devices and rapid assay systems included: (1) the Orapette/SalivaCard HIV-1/ HIV-2 and (2) the Omni-Sal/ImmunoCcmb II HIV-1 and HIV-2. The corresponding serum pairs were analyzed by conventional ELISAs, and all reactive sera were confirmed with HIV-1 and HIV-2 Western blots. The results indicated a 100% sensitivity for both rapid oral fluid assays, including successful detection of HIV-2 antibodies. Specificities ranged from 99.8% to 100%. One sample produced a reactive result by the SalivaCard while being nonreactive by the other assays including the Western blots. Both assays performed excellently, indicating that antibodies to HIV can be detected reliably in oral fluids by simple and rapid assays. This combination of rapid testing technology and the use of easily collected oral fluid samples offers an efficient and accurate alternative to conventional testing and can be appropriately applied to a variety of testing situations for the laboratory diagnosis of HIV infection.
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Affiliation(s)
- R D Saville
- Department of Microbiology, University of Maryland School of Dentistry, Baltimore, USA
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Tess BH, Granato C, Parry JV, Santos VA, Lago TG, Newell ML, Dunn DT, Rodrigues LC. Salivary testing for human immunodeficiency virus type 1 infection in children born to infected mothers in Sao Paulo, Brazil. The Sao Paulo Collaborative Study for Vertical Transmission of HIV-1. Pediatr Infect Dis J 1996; 15:787-90. [PMID: 8878222 DOI: 10.1097/00006454-199609000-00010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To validate a method for salivary testing for HIV infection in children older than 12 months. METHODS Oral fluid samples were collected via sponge foam swabs from children born to HIV-positive mothers and were tested for antibodies to HIV-1 and HIV-2 with an IgG antibody capture enzyme-linked immunosorbent assay and a modified Western blot for confirmation. In each child serum antibody status was the standard used to validate the salivary antibody test. RESULTS We obtained 331 oral fluid samples from children born to HIV-positive mothers. The specificity and sensitivity of salivary testing compared with results on sera were both 100% (297 of 297 (95% confidence interval 98.8 to 100%) and 34 of 34 (95% confidence interval 89.7 to 100%), respectively). Compliance in the study population increased from 91% to 97% when mothers were offered the opportunity to provide oral fluid from their children instead of blood specimens. CONCLUSION Salivary testing provides an accurate and acceptable noninvasive method for assessing the HIV infection status of children born to infected mothers by using IgG antibody capture enzyme-linked immunosorbent assay alone with a strategy of duplicate retesting of reactive specimens.
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Affiliation(s)
- B H Tess
- London School of Hygiene and Tropical Medicine, United Kingdom
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McCruden EA, Hillan KJ, McKay IC, Cassidy MT, Clark JC. Hepatitis virus infection and liver disease in injecting drug users who died suddenly. J Clin Pathol 1996; 49:552-5. [PMID: 8813952 PMCID: PMC500568 DOI: 10.1136/jcp.49.7.552] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM To determine the extent of liver damage resulting from infection with hepatitis B, C and D viruses (HBV, HCV and HDV) in intravenous drug users (IDUs). METHODS Liver sections taken at necropsy performed to investigate the cause of sudden death in 48 IDUs were scored for necroinflammatory activity and fibrosis. Evidence of infection was by detection of viral antibodies in serum, hepatitis B surface antigen (HBsAg) and HCV RNA by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS Evidence of HCV infection was present in 43 (90%) of 48 serum samples. Six (12%) HBsAg positive serum samples had markers indicative of chronic HBsAg carriage, including three with antibody directed against HDV. Evidence of past HBV infection was found in 27 (69%) of 39 HBsAg negative serum samples. HIV was detected in one (2%) of 48 samples. In five (10%) of 48 samples there was no evidence of current or past infection with HCV, HBV or HIV. All 43 liver sections from HCV positive IDUs scored > or = 1 for necroinflammatory activity, whereas three IDUs without HCV scored 0. Scores for stage of fibrosis were > or = 1 in 15 (35%) of 43 and zero of five IDUs, respectively. Fibrosis scores of > or = 3 were seen only in three IDUs positive for HBV, HDV and HCV. CONCLUSION Inflammatory activity in the liver is present in a high proportion of IDUs in Glasgow and is strongly associated with HCV infection. Severe chronic liver damage was limited to HBsAg carriers superinfected with HDV and HCV.
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Roy KM, Bagg J, Bird GL, Spence E, Follett EA, Mills PR, Lau JY. Serological and salivary markers compared with biochemical markers for monitoring interferon treatment for hepatitis C virus infection. J Med Virol 1995; 47:429-34. [PMID: 8636714 DOI: 10.1002/jmv.1890470422] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Paired serum and saliva specimens were collected on a regular basis from 18 asymptomatic blood donors participating in a controlled clinical trial of interferon alpha 2a (IFN) treatment of chronic hepatitis C virus (HCV) infection. Nine patients were randomised to receive interferon and nine to observation only. Serum and salivary HCV RNA was detected by a "nested" polymerase chain reaction (PCR) assay. Complete follow-up data were available for 14 patients (7 treated and 7 untreated). Serum ALT levels declined to normal in five of the seven IFN-treated patients by the twelfth week. Of these five, loss of hepatitis C viraemia was observed in three. Of the seven treated patients, the three responders had a lower viraemia level than the partial or nonresponders. Both nonresponders had infection with type 1 HCV, but the complete and partial responders were infected with types 2 or 3. HCV RNA was detected in the saliva of all seven observation patients during the follow-up period. HCV was also detected in the saliva of the two patients who did not respond to IFN treatment. No correlation was shown between the level of HCV RNA in serum and the presence of HCV RNA in saliva. A role for noninvasive salivary investigations in monitoring treatment is possible, but further refinement of the methodology is required.
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Affiliation(s)
- K M Roy
- Department of Oral Sciences, University of Glasgow Dental School, Scotland
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Granade TC, Phillips SK, Parekh B, Pau CP, George JR. Oral fluid as a specimen for detection and confirmation of antibodies to human immunodeficiency virus type 1. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1995; 2:395-9. [PMID: 7583912 PMCID: PMC170167 DOI: 10.1128/cdli.2.4.395-399.1995] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Paired serum and oral fluid specimens (n = 287) were collected with the Omni-Sal device and were assayed for the presence of antibodies to human immunodeficiency virus type 1 (HIV-1). Enzyme immunoassays (EIAs)--Abbott 3A11, an Organon Teknika Corporation research-use-only test, and the Murex GACELISA--were used per the manufacturers' inserts or were modified slightly to accommodate the oral fluid specimens. Compared with serum Western blot (immunoblot) results, each EIA had a sensitivity of 100% and the specificities were 89.6% for the Abbott 3A11 EIA, 96.5% for the GACELISA, and 97.8% for the Organon Teknika Corporation EIA. Specificities based on specimens that were repeatedly reactive were 99.3% for all EIAs. A miniaturized Western blot technique used for confirmatory testing of both the serum and oral fluid specimens found 149 of the 287 samples to be HIV-1 antibody positive in both sample types. The Western blot banding patterns observed for the serum and oral fluid specimens were essentially identical. Immunoglobulin G concentrations were determined for all oral fluid specimens and ranged from < 0.5 to > 40.0 micrograms/ml. Immunoglobulin G concentrations did not correlate with the ability of any of the EIAs to detect HIV-1-specific antibody or with the ability of the modified Western blot to detect HIV-1 protein-specific antibodies.
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Affiliation(s)
- T C Granade
- Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Green ST, Goldberg DJ, Frischer M, Cameron S, Taylor A, Gruer L. Measuring HIV-1 infection among needle/syringe exchange attenders. Am J Med 1995; 98:596-8. [PMID: 7778578 DOI: 10.1016/s0002-9343(99)80025-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Kleinman DV. Building the capacity for the response of the dental profession to the global HIV pandemic: a case study in international collaboration. J Public Health Dent 1994; 54:234-7. [PMID: 7799299 DOI: 10.1111/j.1752-7325.1994.tb01222.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- D V Kleinman
- National Institute of Dental Research, Bethesda, MD 20892
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Taylor A, Frischer M, McKeganey N, Goldberg D, Green S, Platt S. HIV risk behaviours among female prostitute drug injectors in Glasgow. Addiction 1993; 88:1561-4. [PMID: 8287002 DOI: 10.1111/j.1360-0443.1993.tb03142.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This paper focuses upon HIV-related risk behaviours of 51 female drug injecting prostitutes, interviewed as part of a serial cross-sectional study of injecting drug users in Glasgow. Forty-five per cent injected with used needles and syringes in the 6 months prior to interview. Condom use in private sexual relations was low with only 9% of those with primary partners and 22% of those with casual partners reporting consistent use of condoms with these partners. In contrast, use of condoms for all commercial sexual encounters was almost universal. Prevalence of HIV was 2.2%. Despite this low prevalence, we conclude that the level of injecting-related and private sexual risk behaviours reported here requires the continuing monitoring of drug injecting prostitutes in Glasgow.
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Affiliation(s)
- A Taylor
- Communicable Diseases and Environmental Health (Scotland) Unit, Ruchill Hospital, Glasgow, UK
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