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Colón-López V, Alvelo-Fernández PM, Centeno-Alvarado N, Agudelo Salas IY, Rolón Colón Y, Pabón Martínez M, Rodríguez-Lebrón JL, Reyes-Pulliza JC. Seroprevalence and risk factors associated with hepatitis C: a cross-sectional study of persons who inject drugs in Puerto Rico, 2018. BMC Public Health 2023; 23:704. [PMID: 37072733 PMCID: PMC10111640 DOI: 10.1186/s12889-023-15341-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/28/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND People Who Inject Drugs (PWID) are at a higher risk of acquiring bloodborne infections. We aimed to estimate the seroprevalence of the Hepatitis C Virus (HCV) in PWID and identify correlates and risk factors using data from the Puerto Rico National HIV Behavioral Surveillance System, PWID cycle 5, conducted in 2018. METHODS A total of 502 San Juan Metropolitan Statistical Area participants were recruited through the Respondent Driven Sampling method. Sociodemographic, health-related, and behavioral characteristics were assessed. Testing for HCV antibodies was completed after the face-to-face survey. Descriptive and logistic regression analyses were performed. RESULTS Overall seroprevalence of HCV was 76.5% (95% CI: 70.8-81.4%). A significantly (p < 0.05) higher HCV seroprevalence was observed among PWID with the following characteristics: heterosexuals (78.5%), high school graduates (81.3%), tested for sexually transmitted infections (STI) in the past 12 months (86.1%), frequent speedball injection (79.4%), and knowing the HCV serostatus of the last sharing partner (95.4%). Adjusted logistic regression models showed that having completed high school and reported STI testing in the past 12 months were significantly associated with HCV infection (ORa = 2.23; 95% CI: 1.06-4.69; ORa = 2.14; 95% CI: 1.06-4.30, respectively). CONCLUSIONS We report a high seroprevalence of HCV infection in PWID. Social health disparities and potential missed opportunities validate the continuing call for local action for public health and prevention strategies.
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Affiliation(s)
- Vivian Colón-López
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, Primer Piso Oficina #151 Paseo José C. Barbosa San Juan, San Juan, 00935, Puerto Rico.
| | - Paola M Alvelo-Fernández
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, Primer Piso Oficina #151 Paseo José C. Barbosa San Juan, San Juan, 00935, Puerto Rico
| | - Nadia Centeno-Alvarado
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Ivony Y Agudelo Salas
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Yadira Rolón Colón
- HIV/AIDS Surveillance Program, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - María Pabón Martínez
- HIV/AIDS Surveillance Program, Puerto Rico Department of Health, San Juan, Puerto Rico
| | | | - Juan C Reyes-Pulliza
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Gökengin D, Wilson-Davies E, Nazlı Zeka A, Palfreeman A, Begovac J, Dedes N, Tarashenko O, Stevanovic M, Patel R. 2021 European guideline on HIV testing in genito-urinary medicine settings. J Eur Acad Dermatol Venereol 2021; 35:1043-1057. [PMID: 33666276 DOI: 10.1111/jdv.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
Testing for HIV is critical for early diagnosis of HIV infection, providing long-term good health for the individual and prevention of onward transmission if antiretroviral treatment is initiated early. The main purpose of the 2021 European Guideline on HIV Testing in Genito-Urinary Settings is to provide advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. The guideline presents the details of best practice and offers practical guidance to clinicians and laboratories to identify and offer HIV testing to appropriate patient groups.
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Affiliation(s)
- D Gökengin
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Ege University, Izmir, Turkey.,Ege University HIV/AIDS Research and Practice Center, Izmir, Turkey
| | - E Wilson-Davies
- Southampton Specialist Virology Center, University Hospitals Southampton, Southampton, UK
| | - A Nazlı Zeka
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Dokuz Eylül University, Izmir, Turkey
| | - A Palfreeman
- Department of Infectious Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Begovac
- Department of Infectious Diseases, University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Dedes
- Positive Voice, Athens, Greece
| | - O Tarashenko
- Head Center of Hygiene and Epidemiology, Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
| | - M Stevanovic
- Clinic for Infectious Diseases and Febrile Conditions, Skopje, Former Yugoslav Republic of Macedonia
| | - R Patel
- Solent NHS Trust, Southampton, UK
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3
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Mueses-Marín HF, Galindo-Orrego MI, Tello-Bolívar IC, Galindo J. [Characteristics of people who voluntarily repeat the HIV test, 2012-2015]. ACTA ACUST UNITED AC 2019; 20:484-490. [PMID: 30843985 DOI: 10.15446/rsap.v20n4.63628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/16/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the characteristics of people with risky sexual behavior who participated in campaigns directed to take the first HIV test and voluntarily returned to retake the test afterwards. MATERIALS AND METHODS In Cali Colombia, between 2012 and 2015, 82 people over the age of 18 participated voluntarily in this campaign. A structured questionnaire was applied to assess sociodemographic characteristics, knowledge and behaviors related to HIV. Descriptive and comparative analyses of related samples were performed. RESULTS The average age of the participants was 26.9±8.6 years. 100% were homosexual men, mostly with low educational attainment and income. Nearly half of the sample reported risky use of alcohol and psychoactive substances. Most of them had little knowledge about HIV transmission and a low rate of condom use with a stable partner. The comparison between the moment when the first HIV test was taken and the repetition did not show significant changes regarding knowledge and behaviors, only a lower report of substance use (p=0.0209) and an increase in the practice of tattoos/piercings (p=0.0455). The reactive result of the second test was 4.9% (95%CI: 0.1%-9.6%). CONCLUSION The results suggest that the voluntary return to retake the HIV test in this group of people who share risk practices for HIV infection does not show changes in knowledge or behavior.
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Affiliation(s)
- Hector F Mueses-Marín
- HM: Estadístico. M. Sc. Epidemiología. Corporación de Lucha Contra el Sida. Cali, Colombia.
| | | | - Inés C Tello-Bolívar
- IT: Trabajadora Social. Especialista Administración en Salud. Corporación de Lucha Contra el Sida. Cali, Colombia.
| | - Jaime Galindo
- JG: MD. Especialista en Medicina Interna. Corporación de Lucha Contra el Sida. Cali, Colombia.
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Mueses-Marín HF, Tello-Bolívar IC, Galindo-Quintero J. Características en hombres que tienen sexo con hombres VIH+ en Cali-Colombia 2012-2015. REVISTA FACULTAD NACIONAL DE SALUD PÚBLICA 2017. [DOI: 10.17533/udea.rfnsp.v35n2a05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Des Jarlais DC, Kerr T, Carrieri P, Feelemyer J, Arasteh K. HIV infection among persons who inject drugs: ending old epidemics and addressing new outbreaks. AIDS 2016; 30:815-26. [PMID: 26836787 PMCID: PMC4785082 DOI: 10.1097/qad.0000000000001039] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIDS among persons who inject drugs, first identified in December 1981, has become a global epidemic. Injecting drug use has been reported in 148 countries and HIV infection has been seen among persons who inject drugs in 61 countries. Many locations have experienced outbreaks of HIV infection among persons who inject drugs, under specific conditions that promote very rapid spread of the virus. In response to these HIV outbreaks, specific interventions for persons who inject drugs include needle/syringe exchange programs, medicated-assisted treatment (with methadone or buprenorphine) and antiretroviral therapy. Through a 'combined prevention' approach, these interventions significantly reduced new HIV infections among persons who inject drugs in several locations including New York City, Vancouver and France. The efforts effectively ended the HIV epidemic among persons who inject drugs in those locations. This review examines possible processes through which combined prevention programs may lead to ending HIV epidemics. However, notable outbreaks of HIV among persons who inject drugs have recently occurred in several countries, including in Athens, Greece; Tel-Aviv, Israel; Dublin, Ireland; as well as in Scott County, Indiana, USA. This review also considers different factors that may have led to these outbreaks. We conclude with addressing the remaining challenges for reducing HIV infection among persons who inject drugs.
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Affiliation(s)
- Don C Des Jarlais
- aBaron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA bUrban Health Research Initiative British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada cINSERM, U912 (SESSTIM), Marseille, France
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Hatzakis A, Sypsa V, Paraskevis D, Nikolopoulos G, Tsiara C, Micha K, Panopoulos A, Malliori M, Psichogiou M, Pharris A, Wiessing L, van de Laar M, Donoghoe M, Heckathorn DD, Friedman SR, Des Jarlais DC. Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programme. Addiction 2015; 110:1453-67. [PMID: 26032121 PMCID: PMC4854521 DOI: 10.1111/add.12999] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/30/2015] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
AIMS To (i) describe an intervention implemented in response to the HIV-1 outbreak among people who inject drugs (PWIDs) in Greece (ARISTOTLE programme), (ii) assess its success in identifying and testing this population and (iii) describe socio-demographic characteristics, risk behaviours and access to treatment/prevention, estimate HIV prevalence and identify risk factors, as assessed at the first participation of PWIDs. DESIGN A 'seek, test, treat, retain' intervention employing five rounds of respondent-driven sampling. SETTING Athens, Greece (2012-13). PARTICIPANTS A total of 3320 individuals who had injected drugs in the past 12 months. INTERVENTION ARISTOTLE is an intervention that involves reaching out to high-risk, hard-to-reach PWIDs ('seek'), engaging them in HIV testing and providing information and materials to prevent HIV ('test') and initiating and maintaining anti-retroviral and opioid substitution treatment for those testing positive ('treat' and 'retain'). MEASUREMENTS Blood samples were collected for HIV testing and personal interviews were conducted. FINDINGS ARISTOTLE recruited 3320 PWIDs during the course of 13.5 months. More than half (54%) participated in multiple rounds, resulting in 7113 visits. HIV prevalence was 15.1%. At their first contact with the programme, 12.5% were on opioid substitution treatment programmes and the median number of free syringes they had received in the preceding month was 0. In the multivariable analysis, apart from injection-related variables, homelessness was a risk factor for HIV infection in male PWIDs [odds ratio (OR) yes versus no = 1.89, 95% confidence interval (CI) = 1.41, 2.52] while, in female PWIDS, the number of sexual partners (OR for > 5 versus one partner in the past year = 4.12, 95% CI = 1.93, 8.77) and history of imprisonment (OR yes versus no = 2.76, 95% CI = 1.43, 5.31) were associated with HIV. CONCLUSIONS In Athens, Greece, the ARISTOTLE intervention for identifying HIV-positive people among people who inject drugs (PWID) facilitated rapid identification of a hidden population experiencing an outbreak and provided HIV testing, counselling and linkage to care. According to ARISTOTLE data, the 2011 HIV outbreak in Athens resulted in 15% HIV infection among PWID. Risk factors for HIV among PWID included homelessness in men and history of imprisonment and number of sexual partners in women.
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Affiliation(s)
- Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Georgios Nikolopoulos
- IAS/NIDA Fellow, Hellenic Center for Diseases Prevention and Control, Athens, Greece
| | - Chrissa Tsiara
- Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | | | | | - Meni Malliori
- Medical School, University of Athens, Athens, Greece
| | - Mina Psichogiou
- Department of Propedeutic Medicine, Medical School, University of Athens, Athens, Greece
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | | | - Martin Donoghoe
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Beaulieu M, Adrien A, Potvin L, Dassa C. Stigmatizing attitudes towards people living with HIV/AIDS: validation of a measurement scale. BMC Public Health 2014; 14:1246. [PMID: 25476441 PMCID: PMC4289343 DOI: 10.1186/1471-2458-14-1246] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although stigmatization has long been recognized as a major obstacle to HIV prevention. The lack of a valid and reliable measurement tool for stigmatization is a major gap in the research. This study aimed to: 1) develop a scale of stigmatizing attitudes towards people living with HIV (SAT-PLWHA-S) and 2) demonstrate its reliability and validity. METHODS French and English-speaking experts (n = 21) from different professional communities (academics, practitioners) assessed the clarity and relevance of the proposed items. The psychometric properties of the SAT-PLWHA-S were assessed with a random digit dial population based telephone survey (n = 1,500) of respondents in Quebec, Canada. Analyses included exploratory and confirmatory factor analyses, correlations, multiple linear regressions, t-tests, hypothesis testing of factorial structure invariance, and Cronbach's alpha. RESULTS Confirmatory factor analysis (CFA) supported a 27-item structure with seven factors: 1) concerns about occasional encounters; 2) avoidance of personal contact; 3) responsibility and blame, 4) liberalism, 5) non-discrimination, 6) confidentiality of seropositive status, and 7) criminalization of HIV transmission. Cronbach's alphas indicate satisfactory internal consistency. An assessment of concurrent validity using Pearson's correlation and multiple linear regression shows that homophobia and HIV transmission knowledge are significant determinants of stigmatizing attitudes toward PLHIV. Discriminant validity (t-test) results suggest that the SAT-PLWHA-S can differentiate attitudes between different groups and indicates invariant factor structure across language. CONCLUSIONS The results of this study suggest that the SAT-PLWHA-S is a reliable and valid tool for measuring stigmatizing attitudes toward PLHIV and that it can contribute to a deeper understanding of HIV stigma.
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Affiliation(s)
- Marianne Beaulieu
- Département de médecine sociale et préventive, Université de Montréal, Montréal, Canada.
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8
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Self-reported testing, HIV status and associated risk behaviours among people who inject drugs in Europe: important differences between East and West. AIDS 2014; 28:1657-64. [PMID: 25232900 DOI: 10.1097/qad.0000000000000299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIMS To describe HIV-related risk behaviours, HIV testing and HIV status among people who inject drugs (PWIDs) in the 2000 in European countries with high-prevalence HIV epidemics among PWID. METHODS Data from 12 cross-sectional studies among PWID from seven countries were used. Meta-analysis was used to synthesize the data and meta-regression to explain heterogeneity [in addition to deriving adjusted odds ratios (AORmeta)]. RESULTS Data on 1791 PWID from western (the West) and 3537 from central and eastern (the East) European countries were available. The mean age of participating PWIDs was 30.6 years (SD 7.9), 75% were men, and 36% [95% confidence interval 34-37%) were HIV-infected (30% West, 38% East); 22% had not previously been tested for HIV. The prevalence of reported high-risk behaviour was significantly higher among PWID from the East. Comparison of HIV-infected and uninfected PWID within countries yielded similar results across all countries: HIV-infected PWID were less likely to be sexually active [AORmeta 0.69 (0.58-0.81)], reported less unprotected sex [AORmeta 0.59 (0.40-0.83)], but reported more syringe sharing [AORmeta 1.70 (1.30-2.00)] and more frequent injecting [AORmeta 1.40 (1.20-1.70)] than their HIV-uninfected counterparts. CONCLUSION Despite the absolute differences in reported risk behaviours among PWID in western and eastern Europe, the associations of risk behaviours with HIV status were similar across the sites and regions. There is a substantial potential for further HIV transmission and acquisition based on the continuous risk behaviours reported. HIV prevention and harm reduction interventions targeting PWID should be evaluated.
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Gökengin D, Geretti AM, Begovac J, Palfreeman A, Stevanovic M, Tarasenko O, Radcliffe K. 2014 European Guideline on HIV testing. Int J STD AIDS 2014; 25:695-704. [PMID: 24759563 DOI: 10.1177/0956462414531244] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Testing for HIV is one of the cornerstones in the fight against HIV spread. The 2014 European Guideline on HIV Testing provides advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. It may also be applied in other clinical settings where HIV testing is required, particularly in primary care settings. The aim of the guideline is to provide practical guidance to clinicians and laboratories that within these settings undertake HIV testing, and to indicate standards for best practice.
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Affiliation(s)
- Deniz Gökengin
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, Bornova, İzmir, Turkey
| | - Anna Maria Geretti
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - Josip Begovac
- Department of Infectious Diseases, University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Adrian Palfreeman
- Department of Sexual Health and HIV Medicine, University Hospitals Leicester Infirmary Close, Leicester, UK
| | - Milena Stevanovic
- Clinic for Infectious Diseases and Febrile Conditions, Skopje, Republic of Macedonia
| | - Olga Tarasenko
- Head Center of Hygiene and Epidemiology, Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
| | - Keith Radcliffe
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham, Birmingham, UK
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Sarna A, Tun W, Sharma V, Sebastian M, Madan I, Yadav A, Sheehy M, Lewis D, Thior I. High uptake of HIV testing in a cohort of male injection drug users in Delhi, India: prevalence and correlates of HIV infection. AIDS Behav 2013; 17:2479-89. [PMID: 23474594 DOI: 10.1007/s10461-013-0442-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report baseline findings from a longitudinal cohort study to examine HIV incidence, high-risk injection and sexual behaviors of 3,792 male injection drug users (IDUs) in Delhi. The majority (95.4 %) accepted HIV testing; HIV prevalence was 21.9 %. In multivariate analysis, belonging to states adjacent to Delhi (AOR: 1.23; 95 % CI: 1.07-1.52), earning INR 500-1,500 (AOR: 2.38; 95 % CI: 1.43-3.96); duration of drug use 2-5 years (AOR: 2.02; 95 % CI: 1.09-3.73), 6-10 years (AOR: 2.81; 95 % CI: 1.55-5.11), ≥11 years (AOR: 3.35; 95 % CI: 1.84-6.11); prior HIV testing (AOR: 1.60; 95 % CI: 1.35-1.91), self-reported risky-injection behavior (AOR: 1.60; 95 % CI: 1.33-1.92), and utilization of harm-reduction services (AOR: 1.32; 95 % CI: 1.11-1.58) were positively associated with HIV infection. Alcohol use ≤2 times/week (AOR: 0.67; 95 % CI: 0.55-0.82) or ≥3 times/week (AOR: 0.74; 95 % CI: 0.54-1.01), unit increase in age (AOR: 0.99; 95 % CI: 0.98-1.00), ≥7 years of schooling (AOR: 0.82; 95 % CI: 0.66-1.02) and unsafe sex with any female partner (AOR: 0.69; 95 % CI: 0.55-0.86) were negatively associated with HIV infection. HIV prevalence remains high among male IDUs in Delhi. HIV prevention programs should include comprehensive package of services for IDUs.
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Williams M, Bowen A, Atkinson JS, Nilsson-Schönnesson L, Diamond PM, Ross MW, Pallonen UE. An assessment of brief group interventions to increase condom use by heterosexual crack smokers living with HIV infection. AIDS Care 2011; 24:220-31. [DOI: 10.1080/09540121.2011.597707] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mark Williams
- a College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Anne Bowen
- b School of Nursing , University of Wyoming, School of Nursing , Laramie , WY , USA
| | - John S. Atkinson
- c School of Public Health , University of Texas Health Science Center , Houston , TX , USA
| | | | - Pamela M. Diamond
- c School of Public Health , University of Texas Health Science Center , Houston , TX , USA
| | - Michael W. Ross
- c School of Public Health , University of Texas Health Science Center , Houston , TX , USA
| | - Unto E. Pallonen
- e Center for Health Promotion and Prevention Research , University of Texas Health Science Center , Houston , TX , USA
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Gyarmathy VA, Li N, Tobin KE, Hoffman IF, Sokolov N, Levchenko J, Batluk J, Kozlov AA, Kozlov AP, Latkin CA. Unprotected sex in heterosexual partnerships of injecting drug users in st. Petersburg, Russia. AIDS Behav 2011; 15:58-64. [PMID: 20532604 DOI: 10.1007/s10461-010-9721-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined the association of individual demographic and behavioral attributes, partnership (dyad) and social network characteristics with unprotected sex in the heterosexual dyads of IDUs in St. Petersburg, Russia. Of the individual-level characteristics female gender and younger age; and of the dyad-level characteristics sharing injecting equipment, social exposure to the sex partner ("hanging out with" or seeing each other daily), and both partners self-reporting being HIV infected were associated with unprotected sex. Although self-reported HIV discordant couples were less likely to engage in unprotected sex, it was reported in over half of self-reported HIV discordant relationships. This study highlights the intertwining of sexual risk and injecting risk, and the importance of sero-sorting based on perceived HIV status among IDU sexual partnerships in St. Petersburg, Russia. A combination of social network and dyad interventions may be appropriate for this population of IDUs, especially for IDUs who are both injecting and sex partners, supported by free and confidential rapid HIV testing and counseling services to provide a comprehensive response to the wide-spread HIV epidemic among IDUs in St. Petersburg.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Cais do Sodré, 1249-289 Lisbon, Portugal.
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Gyarmathy VA, Neaigus A, Li N, Ujhelyi E, Caplinskiene I, Caplinskas S, Latkin CA. Infection disclosure in the injecting dyads of Hungarian and Lithuanian injecting drug users who self-reported being infected with hepatitis C virus or human immunodeficiency virus. ACTA ACUST UNITED AC 2010; 43:32-42. [PMID: 20840002 DOI: 10.3109/00365548.2010.513064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to assess the prevalence and correlates of disclosure to network members of being hepatitis C virus (HCV)- or human immunodeficiency virus (HIV)-infected among injecting dyads of infected injection drug users (IDUs) in Budapest, Hungary and Vilnius, Lithuania,. Multivariate generalized estimating equations (GEE) were used to assess associations. Very strong infection disclosure norms exist in Hungary, and HCV disclosure was associated with using drugs and having sex within the dyad. Non-ethnic Russian IDUs in Lithuania were more likely to disclose HCV infection to non-Roma, emotionally close and HCV-infected network members, and to those with whom they shared cookers, filters, drug solutions or rinse water or got used syringes from, and if they had fewer non-IDU or IDU network members. Ethnic Russian Lithuanian IDUs were more likely to disclose HCV if they had higher disclosure attitude and knowledge scores, 'trusted' network members, and had lower non-injecting network density and higher injecting network density. HIV-infected Lithuanian IDUs were more likely to disclose to 'trusted' network members. Disclosure norms matched disclosure behaviour in Hungary, while disclosure in Lithuania to 'trusted' network members suggests possible stigmatization. Ongoing free and confidential HCV/HIV testing services for IDUs are needed to emphasize and strengthen disclosure norms, and to decrease stigma.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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Abel-Ollo K, Rahu M, Rajaleid K, Talu A, Ruutel K, Platt L, Bobrova N, Rhodes T, Uuskula A. Knowledge of HIV serostatus and risk behaviour among injecting drug users in Estonia. AIDS Care 2010; 21:851-7. [PMID: 20024741 DOI: 10.1080/09540120802657522] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We used the findings from two, cross-sectional studies of HIV serostatus and risk behaviours to assess the effects of knowledge of HIV serostatus and risk behaviours (relating to sex and injection drug use) among injecting drug users (IDUs). Respondent-driven sampling was used simultaneously at two sites in Estonia (the capital Tallinn, and the second-largest city of Ida-Virumaa County, Kohtla-Jarve). The research tool was an interviewer-administered survey. Biological samples were collected for HIV testing. Participants were categorised into three groups based on HIV testing results and self-report on HIV serostatus: HIV-negative (n=133); HIV-positive unaware of their serostatus (n=75); and HIV-positive aware of their serostatus (n=168). In total, 65% of the participants tested positive for HIV. Of those 69% were aware of their positive serostatus. HIV-positive IDUs aware of their serostatus exhibited more risk behaviours than their HIV-positive counterparts unaware of their serostatus or HIV-negative IDUs. Effective prevention of HIV among IDUs should therefore, include programmes to reduce high-risk sexual and drug use behaviours at the public health scale and enhanced prevention efforts focusing on HIV-infected individuals.
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Affiliation(s)
- K Abel-Ollo
- Estonian Drug Monitoring Centre, National Institute for Health Development, Tallinn, Estonia.
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Gyarmathy VA, Li N, Tobin KE, Hoffman IF, Sokolov N, Levchenko J, Batluk J, Kozlov AA, Kozlov AP, Latkin CA. Injecting equipment sharing in Russian drug injecting dyads. AIDS Behav 2010; 14:141-51. [PMID: 19214731 PMCID: PMC2818991 DOI: 10.1007/s10461-008-9518-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
Abstract
In this study, we investigated how individual attributes, dyad characteristics and social network characteristics may influence engaging in receptive syringe sharing, distributive syringe sharing and sharing cookers in injecting partnerships of IDUs in St Petersburg, Russia. We found that all three levels were associated with injecting equipment sharing, and that dyad characteristics were modified by characteristics of the social network. Self-reported HIV discordance and male gender concordance played a role in the risk of equipment sharing. Dyad interventions may not be sufficient to reduce injecting risk in IDU partnerships, but a combination of dyad and network interventions that target both IDU partnerships and the entire IDU population may be more appropriate to address injecting risk among IDUs.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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16
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Gyarmathy VA, Li N, Tobin KE, Hoffman IF, Sokolov N, Levchenko J, Batluk J, Kozlov AA, Kozlov AP, Latkin CA. Correlates of unsafe equipment sharing among injecting drug users in St. Petersburg, Russia. Eur Addict Res 2009; 15:163-70. [PMID: 19506377 PMCID: PMC2794890 DOI: 10.1159/000220344] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIMS To assess among injecting drug users (IDUs) in St. Petersburg, Russia, the urban environment, social norms and individual correlates of unsafe injecting. METHODS Between December 2004 and January 2007, 446 IDUs were interviewed in St. Petersburg, Russia. RESULTS Prevalence of HCV was 96% and HIV 44%. 17% reported receptive syringe sharing after an HIV-infected IDU, 49% distributive syringe sharing, 76% sharing cookers, 73% sharing filters and 71% syringe-mediated drug sharing when not all syringes were new. Urban environmental characteristics correlated with sharing cookers and syringe-mediated sharing, and social norms correlated with receptive and distributive syringe sharing and sharing cookers. Individual correlates included cleaning used syringes (all 5 dependent variables) and self-report of HIV infection (receptive and distributive syringe sharing). CONCLUSION HIV status disclosure is an unreliable but frequently used HIV prevention method among IDUs in St. Petersburg, who reported alarmingly high levels of injecting equipment sharing. Voluntary counseling and testing should be widely available for this population. Ethnography is needed to assess the effectiveness of the syringe cleaning process. Prevention interventions need to be ongoing among IDUs in St. Petersburg, and should incorporate urban environmental factors and social norms, which may involve peer education and social network interventions.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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17
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Gyarmathy VA, Neaigus A, Mitchell MM, Ujhelyi E. The association of syringe type and syringe cleaning with HCV infection among IDUs in Budapest, Hungary. Drug Alcohol Depend 2009; 100:240-7. [PMID: 19058925 PMCID: PMC2628960 DOI: 10.1016/j.drugalcdep.2008.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 09/25/2008] [Accepted: 10/12/2008] [Indexed: 11/24/2022]
Abstract
We assessed whether syringe type, syringe cleaning and distributive syringe sharing were associated with self-reported and laboratory-confirmed HCV infection among Hungarian IDUs. Injecting drug users (N=215) were recruited from non-treatment settings in Budapest, Hungary between October 2005 and December 2006. Multivariate logistic regression models identified correlates of self-report of being HCV infected and testing positive for HCV. While 37% tested positive for HCV, 14% of the total (39% of those who tested positive) self-reported being HCV infected. Using any two-piece syringes was significantly associated with self-reported HCV infection, while distributive syringe sharing was not associated with self-report of being HCV infected. Engaging in receptive sharing of only one-piece syringes but always cleaning before reuse was not associated with testing HCV positive, while any receptive sharing of only one-piece syringes and not always cleaning before reuse was significantly associated with testing HCV positive. Sharing cookers and squirting drugs from one syringe into another syringe were not associated with testing HCV positive. The high percent of those HCV infected who did not know they were infected highlights the need to provide better access to confidential testing and counseling services. Counseling should emphasize secondary prevention of HCV among HCV infected IDUs. Our findings also indicate that syringe type and syringe cleaning practices may play a role in HCV transmission. Ethnographic research should identify the reasons why IDUs may use two-piece syringes and suggest means to reduce their use. Thorough cleaning of one-piece syringes when sterile syringes are unavailable may be an efficient way to reduce the risk of HCV infection.
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Affiliation(s)
- V Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
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18
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Abstract
Testing for HIV is one of the cornerstones in the combat against HIV infection. The 2008 European Guideline on HIV Testing provides advice on testing for HIV infection in individuals aged 16 years and older who have sought evaluation and treatment at sexually transmitted infection services for dermatovenereology clinics across Europe. Its aim is to provide practical guidance to clinicians in these settings who undertake HIV testing and suggest appropriate standards for the audit of service provision.
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Affiliation(s)
- M Poljak
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Liubljana, Zatos̄ka 4, 1000, Ljubljana, Slovenia
| | - E Smit
- Birmingham Heartlands and Solihull NHS Trust, Birmingham
| | - J Ross
- Whitall Street Clinic, Birmingham, UK
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19
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Pallonen UE, Timpson SC, Williams ML, Ross MW. Stages of consistent condom use, partner intimacy, condom use attitude, and self-efficacy in African-American crack cocaine users. ARCHIVES OF SEXUAL BEHAVIOR 2009; 38:149-158. [PMID: 18574684 PMCID: PMC2861298 DOI: 10.1007/s10508-008-9391-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 05/21/2008] [Accepted: 05/31/2008] [Indexed: 05/26/2023]
Abstract
This study examined how condom use attitude, self-efficacy, and partner intimacy related to five stages of consistent condom use. Interview data were collected from sexually active, heterosexual, African-American crack cocaine smokers (N = 366). Dependent measures assessed both the participants' own responses and their perceptions about their last sex partner's own personal condom use attitude and participants' condom use self-efficacy expectations. Partner intimacy was assessed both as a continuous attitudinal and as a discrete relationship measure. Less than 10% were classified as consistent condom users. Two thirds of inconsistent users were in the Precontemplation (PC) stage. The contemplation (C) and preparation (P) stages were equal among the remainder of the inconsistent condom users. Higher partner intimacy reduced modestly readiness for consistent condom use. The stage but not the intimacy group was related to the condom use attitudes and self-efficacy measures. Last partners' perceived own negative attitudes were significantly related to the stages of consistent condom use and was especially low in the action (A) and maintenance (M) stages. Participants' own negative attitudes were unrelated to the stages. Of the self-efficacy measures, both participants' performance and situational condom use self-efficacies increased significantly after the PC stage and were highest in the P, A, and M stages. However, situational self-efficacy accounted for most of performance self-efficacy variance. In sum, consistent condom use was rare. A partner's attitudes and the participants' own situational self-efficacy expectations, rather than intimacy, determined the readiness to adopt consistent condom use.
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Affiliation(s)
- Unto E Pallonen
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030, USA
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20
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Ross MW, Timpson SC, Williams ML, Bowen A. The impact of HIV-related interventions on HIV risk behavior in a community sample of African American crack cocaine users. AIDS Care 2007; 19:608-16. [PMID: 17505921 DOI: 10.1080/09540120600983989] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
While there are reports of the impact of specific interventions designed to reduce HIV drug and sexual risk behaviors, there are few reports of the impact of HIV interventions in a community-based sample. We report on baseline data from a sample of African American crack smokers who were about to participate in an intervention designed to reduce HIV-related risk behaviors. The majority were male (80%), single (70%) and homeless (52%). Data indicated that 29% of the sample had been in a previous HIV intervention in the past 12 months, the majority in a correctional setting or CBO program. There were few systematic demographic differences between the two groups. Those who had been in an intervention reported using male and female condoms significantly more frequently on all measures of condom use, had positive condom use outcome expectations for male condoms and higher affective and situational condom-related self-efficacy beliefs. These data suggest that, at a community level, the spectrum of HIV risk-reduction programs does produce a significant improvement in condom use and related cognitions, although there is a need to cover a greater proportion of the population. Previous exposure to interventions must be a critical covariate in assessing the impact of future interventions.
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Affiliation(s)
- M W Ross
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas, TX 77030, USA.
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21
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Affiliation(s)
- E J Smit
- HPA Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
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22
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Semaan S, Des Jarlais DC, Malow R. Behavior change and health-related interventions for heterosexual risk reduction among drug users. Subst Use Misuse 2006; 41:1349-78. [PMID: 17002987 PMCID: PMC2601640 DOI: 10.1080/10826080600838018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resource-constrained settings and to address relevant contextual factors.
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Affiliation(s)
- Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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23
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Jarlais DCD, Semaan S. Interventions to reduce the sexual risk behaviour of injecting drug users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2005. [DOI: 10.1016/j.drugpo.2005.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Brogly SB, Bruneau J, Lamothe F, Vincelette J, Franco EL. HIV-positive notification and behavior changes in Montreal injection drug users. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2002; 14:17-28. [PMID: 11900107 DOI: 10.1521/aeap.14.1.17.24333] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study examined the effect of an HIV-positive notification on the sexual and injection behaviors, living conditions, and medical demands of injection drug users (IDUs) in Montreal. The behavior changes of 73 IDUs who received an HIV-positive test result, and 219 IDUs who tested negative were compared, and the net difference (ND) in the proportion of IDUs adopting the particular change was determined. No significant changes were found in drug use or needle sharing practices. A higher proportion of IDUs who received an HIV-positive notification acquired unstable living conditions, ND = 20.7% (95% CI = 3.3, 38.1), began medical follow up, ND = 34.4% (95% CI = 20.8, 48.7), and increased needle exchange program (NEP) utilization, ND = 20.5% (95% CI = 8.3, 32.8). Compared with HIV-negative males, more HIV-positive male IDUs stopped sexual relations, ND = 24.6% (95% CI = 0.4, 48.9), and sex work, ND = 31.8% (95% CI = 12.4, 51.3), and fewer began new relations, ND = -38.2% (95% CI = -52.6, -23.9). The medical community and NEPs have an important role in providing support for newly diagnosed IDUs.
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Affiliation(s)
- Susan B Brogly
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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25
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Brown BS, O'Grady KE, Farrell EV, Flechner IS, Nurco DN. Factors associated with frequent and infrequent HIV testing. Subst Use Misuse 2001; 36:1593-609. [PMID: 11758815 DOI: 10.1081/ja-100107571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Drug user treatment clients with 5 or more HIV tests (frequent testees N=43) and 0-2 HIV tests (infrequent testees-N = 56) were compared on demographic characteristics, risk behaviors, perceived risk of HIV infection to self, involvement with family members, and psychological functioning. Extreme groups of HIV testees did not differ on any variables other than an index of perceived vulnerability to HIV infection (e.g., " You think that you really could get AIDS"). That measure of felt vulnerability was not correlated significantly with needle or sexual risk behaviors, family involvement, psychological functioning or other measures of perceived risk. It was reasoned that, in a community in which both dangers and protective behaviors are widely understood, frequent testees experience a generalized and heightened concern unrelated to specific behaviors or characteristics.
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Affiliation(s)
- B S Brown
- University of North Carolina, Wilmington, North Carolina, USA.
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26
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Sica C, Novara C, Carosi G, Casari S, Dorz S, Nasta P, Sanavio E. Predicting health distress and at-risk sexual behaviour in a group of Italian asymptomatic HIV-infected people. Clin Psychol Psychother 2001. [DOI: 10.1002/cpp.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Vidal-Trécan G, Coste J, Varescon-Pousson I, Christoforov B, Boissonnas A. HCV status knowledge and risk behaviours amongst intravenous drug users. Eur J Epidemiol 2000; 16:439-45. [PMID: 10997831 DOI: 10.1023/a:1007622831518] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to identify relationships between injecting and sexual risk behaviours and hepatitis C virus (HCV) status knowledge in intravenous drug users (IDUs). It was a cross-sectional survey (March 1994-June 1995) in 10 drug abuse treatment or psychosocial centres in Paris, France. We used a structured questionnaire about sexual, injecting, HIV and HCV antibody testing practices and results during the previous 6 months. Six hundred and twelve sexually active IDUs aged 18 or older who were current injecting drug users were interviewed. Of 592 respondent IDUs, 37% did not report consistent HCV testing and 34% reported being HCV-positive. HCV-positive IDUs were older than HCV-negatives and HCV-unknowns. HCV-unknowns and HCV-positives had a lower educational level than HCV-negatives. After adjusting for demographic characteristics and HIV status, the factors associated with being HCV-unknown were not using condoms (OR: 2.9; 95% CI: 1.9-4.6) as well as clean equipment (OR: 1.8; 95% CI: 1.2-3.0). Not using new equipment was negatively associated with being HCV-unknown (OR: 0.4; 95% CI: 0.2-0.6) and with being HCV-positive (OR: 0.5; 95% CI: 0.3-0.8). Our study suggests that particular sexual and injecting risk-behaviours are associated with not knowing HCV status. As HCV-unknown IDUs are likely to be at the risk of transmitting HCV or acquiring other infections. HCV testing should be encouraged and associated with sexual counselling. Special attention should be paid to disinfecting practices for HCV-positives and use of new injecting equipment should be recommended for HCV-negatives.
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Affiliation(s)
- G Vidal-Trécan
- Département de Santé publique, CHU Cochin Port-Royal, Université René Descartes, Paris, France.
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28
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Skrondal A, Eskild A, Thorvaldsen J. Changes in condom use after HIV diagnosis. Scand J Public Health 2000; 28:71-6. [PMID: 10817317 DOI: 10.1177/140349480002800112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated changes in condom use after HIV diagnosis. The study population comprised 78 asymptomatic HIV-infected subjects recruited from a clinic in Oslo, Norway, during 1988-92. In total, 240 follow-up visits were carried out. The response variable was repeated measurements of whether or not condoms were always used during anal/vaginal intercourse at follow-up. The explanatory variables were: time from HIV diagnosis to follow-up, exposure group (heterosexually infected, homosexual men, or infected through injecting drug use), time of HIV diagnosis (before 1987 or later), and history of condom use before HIV diagnosis. Random effects logistic regression analysis was used to study incremental changes in condom use, accommodating an unbalanced repeated measurement design. The use of condoms increased monotonously over time after HIV diagnosis in all exposure groups. Condom use was least likely among injecting drug users, subjects diagnosed before 1987 and subjects without a history of frequent condom use before HIV diagnosis.
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Affiliation(s)
- A Skrondal
- Department of Epidemiology, National Institute of Public Health, Oslo, Norway
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29
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Schlumberger MG, Desenclos JC, Papaevangelou G, Richardson SC, Ancelle-Park R. Knowledge of HIV serostatus and preventive behaviour among European injecting drug users: second study. European Community Study Group on HIV in Injecting Drug Users. Eur J Epidemiol 1999; 15:207-15. [PMID: 10395049 DOI: 10.1023/a:1007578402083] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objective of the study was to analyse the effect of knowledge of HIV serostatus on behaviours preventing the acquisition or transmission of HIV among European IDU, and to compare results with a previous similar study conducted 3 years before. Data were gathered in 1992-1993 during a retrospective multicentre cross-sectional study of IDU recruited in 11 European countries, in specialized centers and on the street. We compared, between groups with different HIV serological status (IDU who knew well before their HIV-positive serological status, IDU who knew their HIV-negative serostatus and IDU who did not know before their serological status), the respective proportions of IDU who reported that, during the six months prior to interview, (1) always used condoms, (2) never gave their used injecting equipment to other IDU, (3) always injected drugs safely. We only included IDU who had known their serological status for at least six months prior to interview. Results were compared to the similar survey conducted in 1990. From 2171 IDU recruited, data of 1334 IDU were included in the analysis. Compared with IDU who did not know their HIV serostatus, only IDU knowing their HIV-positive serostatus used condoms significantly more often (37% compared to 15%, rate ratio (RR): 2.4; 95% confidence interval (CI): 1.8-2.3) and never gave their used injecting equipment to other IDU (69% compared to 53%, RR: 1.3; 95% CI: 1.2-1.4). In comparison with the 1990 study, only condom use significantly improved and only for IDU who knew their HIV-negative serostatus (13% compared to 9%, RR: 1.6; 95% CI: 1.1-2.3). This study confirms among European IDU the relation between knowing own HIV serological status to preventive behaviours. However, there were only minor improvements between 1990 and 1992-1993, indicating that prevention of HIV transmission among IDU must be reinforced.
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Affiliation(s)
- M G Schlumberger
- Réseau National de Santé Publique, Hôpital National de Saint-Maurice, France.
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30
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Molitor F, Ruiz JD, Flynn N, Mikanda JN, Sun RK, Anderson R. Methamphetamine use and sexual and injection risk behaviors among out-of-treatment injection drug users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 1999; 25:475-93. [PMID: 10473010 DOI: 10.1081/ada-100101874] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Our primary objective was to examine the relationship between methamphetamine use and sexual risk-taking behaviors--number of sexual partners, frequency of sexual behaviors with regular and casual partners, trading money or drugs for sex, and condom use--among male and female out-of-treatment injection drug users (OTIDUs). As a risk group for human immunodeficiency virus (HIV) transmission, we also investigated injection behaviors by methamphetamine use. Data were collected from 1392 OTIDUs within the California counties of Fresno, Sacramento, and San Diego. Excluded from this cross-sectional survey were male OTIDUs engaging in sex with only or mostly men since 1978. In bivariate analyses, we found that male OTIDUs with a history of methamphetamine use had more sex partners and participated in more acts of anal insertive intercourse with casual partners and vaginal intercourse with regular and casual partners than male OTIDUs never using methamphetamines. In addition, a greater percentage of male OTIDUs using methamphetamines reported trading sex for money or drugs. Methamphetamine-using female OTIDUs participated in more acts of vaginal intercourse with regular male sex partners than female OTIDUs never using methamphetamines. By multivariate logistic regression, we found methamphetamine use related to consistent condom use among male OTIDUs and among male sex partners of female OTIDUs. Discriminant function analyses revealed that sexual risk taking could be differentiated by methamphetamine use among male OTIDUs. Methamphetamine use also correlated with using shared needles or syringes among male and female OTIDUs and was related to not always disinfecting used needles or syringes with bleach. Our findings suggest that methamphetamines may contribute to heterosexual HIV transmission.
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Affiliation(s)
- F Molitor
- California Department of Health Services, Office of AIDS, USA.
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31
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Booth RE, Kwiatkowski CF, Weissman G. Health-related service utilization and HIV risk behaviors among HIV infected injection drug users and crack smokers. Drug Alcohol Depend 1999; 55:69-78. [PMID: 10402151 DOI: 10.1016/s0376-8716(98)00179-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study was designed to assess utilization of health-related services and HIV risk related behaviors by HIV infected drug users one year prior to and two years following the availability of Ryan White Title I funding. Using a cross-sectional design, a total of 777 drug injectors and crack smokers from five US cities were surveyed, over three waves of data collection, about their use of drug treatment, medical services, housing, mental health, and case management and about their sex and drug-related risk behaviors. For all service categories and in each wave, including the year prior to Title I funding, HIV risk behaviors were lower among those who used health-related services, with the exception of housing. Use of services did not increase significantly following the disbursement of Title I funds except for housing and case management. These findings suggest that it may be necessary to increase the attractiveness of health-related services, not just funding for services, for HIV infected substance abusers.
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Affiliation(s)
- R E Booth
- Department of Psychiatry, University of Colorado School of Medicine, Denver 80211, USA.
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32
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Hamers FF, Batter V, Downs AM, Alix J, Cazein F, Brunet JB. The HIV epidemic associated with injecting drug use in Europe: geographic and time trends. AIDS 1997; 11:1365-74. [PMID: 9302447 DOI: 10.1097/00002030-199711000-00011] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To evaluate the magnitude and trends of the HIV epidemic associated with injecting drug use in Europe. METHODS AIDS cases associated with injecting drug users (IDU) diagnosed through 1995 were analysed, including IDU, homo-/bisexual IDU, heterosexual partners of IDU and children whose mothers were IDU. HIV seroprevalence studies among IDU were reviewed. RESULTS Of the 171,932 cumulative AIDS cases, 73,119 (43%) were IDU-associated (IDU, 89.0%; homo-/bisexual IDU, 3.5%: heterosexual partners of IDU, 6.2%; children with IDU mothers, 1.4%). Over 90% of IDU-associated cases were concentrated in south-western European countries with considerably higher rates in Spain (124 cases per million in 1995) than elsewhere (Italy, 68 per million; Portugal, 42 per million; France, 38 per million). During 1990-1995, incidence increased at an average annual rate of 11% overall and > 23% in central and eastern Europe; overall, incidence increased in older persons (12%) while decreasing in those aged 13-24 years (by 6%). HIV prevalence in IDU showed considerable geographic variation across and within countries. In several countries of western Europe, prevalence decreased. In the former Soviet Union, large HIV outbreaks have recently been detected among IDU through systematic HIV testing (e.g., in Ukraine, 6750 HIV infections were diagnosed in IDU tested during 1995-1996). CONCLUSIONS IDU have played a major role in the spread of HIV in Europe. In several western European countries, the incidence of HIV acquired through drug use has declined following high rates in mid-1980s. Studies to assess current transmission are needed and prevention efforts must be maintained. In eastern Europe, emerging epidemics reinforce the urgency for prevention.
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Affiliation(s)
- F F Hamers
- European Centre for the Epidemiological Monitoring of AIDS, Saint-Maurice, France
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MacGowan RJ, Brackbill RM, Rugg DL, Swanson NM, Weinstein B, Couchon A, Scibak J, Molde S, McLaughlin P, Barker T, Voigt R. Sex, drugs and HIV counseling and testing: a prospective study of behavior-change among methadone-maintenance clients in New England. AIDS 1997; 11:229-35. [PMID: 9030371 DOI: 10.1097/00002030-199702000-00014] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine whether changes in injecting drug use and sexual behavior over a 12-month follow-up are associated with HIV counseling and testing (C and T) of injecting drug users in methadone maintenance treatment programs (MMTP) in Massachusetts and Connecticut. METHODS Clients were invited to participate in a longitudinal study involving five interviews. Data were also obtained by ethnographers and from clinical records. Behavioral outcomes of interest were number of drug injections, sharing of unclean 'works' (injecting equipment), number of unprotected sex partners, and number of unprotected sexual episodes. Data analyses included multiple regression, odds ratios, and quantitative analysis of text-based data. RESULTS Subjects reported reductions in both injecting drug use and sexual behavior Primary associations with reduced injecting drug use were remaining in the MMTP and attending HIV-positive support groups. A reduction in high-risk sexual behavior was associated with an HIV-positive test result and duration of HIV counseling in the MMTP. Increase in drug injecting use was associated with an HIV-positive test result. Inconsistent condom use was associated with enrollment in the MMTP where condoms were available only upon request and abstinence and monogamy between uninfected partners were promoted. CONCLUSIONS Injecting drug users who self-select to participate in MMTP and HIV C and T, two public health HIV-prevention interventions, reduce their HIV-risk behaviors. Clients should be encouraged to remain in MMTP and HIV-infected clients should attend support groups for HIV-positive persons. MMTP staff should promote a variety of safer sex behaviors and provide condoms without request.
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Affiliation(s)
- R J MacGowan
- National Center for HIV/STD/TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Pant A, Soellner R. Epidemiology of HIV in Intravenous Drug Users and Public Health Policy in Germany. JOURNAL OF DRUG ISSUES 1997. [DOI: 10.1177/002204269702700102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper assesses AIDS and drug policy development in Germany between 1982 and 1996 and relates it to the development of epidemiological research in HIV among injecting drug users (IDUs). In a historical review, this paper outlines how results of epidemiological HIV surveillance studies among IDUs and public health responses were mutually dependent. The authors argue that a specific development in HIV policy encouraged a confounding of basic methodological concepts (validity and precision) in epidemiological research, which in turn led to misinterpretation of available data on seroprevalence trends in Germany. In order to overcome methodological shortcomings under given legal and practical restrictions, pragmatic approaches to increase validity of seroprevalence and risk factor estimations are discussed.
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Davoli M, Fennema H, Perucci CA, Montiroli PM, van den Hoek A. Migrant injecting users: characteristics of Italian drug users living in Amsterdam. Subst Use Misuse 1996; 31:127-39. [PMID: 8838398 DOI: 10.3109/10826089609045803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of the study was to compare the behavior of Italian injecting drug users (IDUs) in Amsterdam with Italian IDUs who moved abroad but returned with those who never moved. The Italian IDUs in Amsterdam showed a pattern of drug use very similar to the Dutch IDUs. They also reported a high prevalence of needle borrowing, needle lending, and HIV-1 infection. One out of three Italian IDUs in Amsterdam reported nondrug using occasional sexual partners, but condom use was always reported. This study shows that Italian IDUs in Amsterdam are a marginalized population with a high risk of HIV transmission.
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Affiliation(s)
- M Davoli
- Epidemiology Unit Lazio Regional Health Authority, Rome, Italy
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Burke WM, Dhopesh V, Lainfester C. A brief survey of the current sexual practices of a population admitted for inpatient treatment of drug dependence. JOURNAL OF SEX & MARITAL THERAPY 1996; 22:203-208. [PMID: 8880653 DOI: 10.1080/00926239608414657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We studied a population of high-risk drug users concerning their current sexual practices. They had a pattern of inconsistent or infrequent condom use. Only 11.5% reported always using condoms; 38.2% reported never using them; and 50.3% reported using them sometimes. Experimental educational programs have demonstrated the feasibility of changing sexual behaviors in illicit drug users by using innovative techniques targeted specifically at them. The application of sex and marital therapy techniques to changing high-risk behaviors is not widely discussed in the substance abuse literature. The hypothesis that the application of the techniques of sex and marital therapy in educational programs for drug users will improve outcomes of HIV prevention should be tested.
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Affiliation(s)
- W M Burke
- HealthPro/United HealthCare, Westborough, MA 01581, USA
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Davoli M, Perucci CA, Abeni DD, Arcà M, Brancato G, Forastiere F, Montiroli PM, Zampieri F. HIV risk-related behaviors among injection drug users in Rome: differences between 1990 and 1992. Am J Public Health 1995; 85:829-32. [PMID: 7762718 PMCID: PMC1615499 DOI: 10.2105/ajph.85.6.829] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Temporal differences in human immunodeficiency virus (HIV) risk-related behaviors among injection drug users in Rome, Italy, were analyzed in 487 drug users recruited in 1990 and 450 recruited in 1992. Sharing of syringes decreased among self-reported HIV-positive drug users between 1990 and 1992, but there was no change in their sexual behavior. Fewer HIV-seronegative drug users reported passing on used syringes in 1992 than in 1990; however, there was no change in the percentage of seronegative subjects using previously used syringes, and a reduction in condom use with primary partners. There still exists a great potential for transmission of HIV infection among injection drug users and from injection drug users to the general population.
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Affiliation(s)
- M Davoli
- Epidemiology Unit, Regional Health Authority, Rome, Italy
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Richardson SC, Papaevangelou G, Ancelle-Park R. Knowledge, attitudes and beliefs of European injecting drug users concerning preventive measures for HIV. Eur J Epidemiol 1994; 10:135-42. [PMID: 7813690 DOI: 10.1007/bf01730362] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Strategies for controlling the HIV epidemic include education and information campaigns for intravenous drug users (IDUs), as for all high-risk groups, and the provision of various public health measures and treatment. These can only be effective if the IDU is aware of them and has a favourable image of them. A study of 2330 IDUs in 12 European countries recorded awareness and opinions of various categories of measures and institutions. Of all measures, those mentioned most often related to availability of new injecting equipment; specifically unrestricted sales in pharmacies and needle exchanges, which were also thought to be more useful than anything else. Prompted awareness of rehabilitative institutions was well over 90% in most countries, but up to a quarter of IDUs did not trust them and up to one fifth did not think that they were useful. There appears to be a general need for more effective communication with IDUs to improve the image of the services available.
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Affiliation(s)
- S C Richardson
- Panteion University of Social and Political Sciences, Athens, Greece
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