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Estadt AT, Miller WC, Kline D, Whitney BM, Young AM, Todd Korthuis P, Stopka TJ, Feinberg J, Zule WA, Pho MT, Friedmann PD, Westergaard RP, Eagen KV, Seaman A, Ma J, Go VF, Lancaster KE. Associations of hepatitis C virus (HCV) antibody positivity with opioid, stimulant, and polysubstance injection among people who inject drugs (PWID) in rural U.S. communities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104222. [PMID: 37806839 PMCID: PMC10997735 DOI: 10.1016/j.drugpo.2023.104222] [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: 01/19/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND People who inject drugs (PWID) in the rural U.S. often inject stimulants, alone or with opioids. The impact of these substance use patterns may influence HCV risk behaviors. This analysis examines the associations of HCV antibody positivity with injecting only opioids, only stimulants (methamphetamine/cocaine), and opioids and stimulants together among rural PWID. METHODS The Rural Opioid Initiative (ROI) consists of eight research sites that enrolled people who use drugs in rural communities in ten U.S. states from 2018 to 2020. This cross-sectional analysis included adult participants who resided in a study area and injected any drug in the past 30 days. The primary outcome was HCV antibody positivity. The exposure of interest was injection drug use classified as only opioids, only stimulants, separate injections of opioids and stimulants, and same-syringe injection of both in the past 30 days. We used multivariable log-binomial regression with generalized linear mixed models to generate prevalence ratios (P.R.) adjusted for demographics, injection history, health insurance, and substance use treatment. RESULTS Among 3,084 participants enrolled in the ROI, 1,982 met inclusion criteria. Most participants injected opioids and stimulants in the same syringe (34%) or separately (21%), followed by injecting only stimulants (26%), and injecting only opioids (19%). Half (51%) were HCV antibody positive. Compared to people who injected only stimulants, HCV antibody positivity was more prevalent among people who injected opioids alone (aPR=1.62, 95% CI:(1.29-2.03)), injected both opioids and stimulants separately (aPR=1.61, 95% CI:(1.32-1.95)), and in the same syringe (aPR=1.54, 95% CI:(1.28-1.85)). CONCLUSION HCV antibody positivity, indicating prior exposure, was highest among those who had recently injected opioids, alone or with stimulants. Additional nucleic acid testing is necessary to confirm active infection. More research is needed to determine the underlying causes of HCV antibody positivity by injection use.
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Affiliation(s)
- Angela T Estadt
- Ohio State University, College of Public Health, Division of Epidemiology, United States.
| | - William C Miller
- Ohio State University, College of Public Health, Division of Epidemiology, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - David Kline
- Wake Forest University School of Medicine, Division of Public Health Sciences, Department of Biostatistics and Data Science, United States
| | | | - April M Young
- University of Kentucky, Department of Epidemiology and Environmental Health, Center on Drug and Alcohol Research, United States
| | - P Todd Korthuis
- Oregon Health & Science University, Department of Medicine, Section of Addiction Medicine, United States
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, United States
| | - Judith Feinberg
- West Virginia University School of Medicine, Departments of Behavioral Medicine and Psychiatry and Medicine/Infectious Diseases, United States
| | - William A Zule
- RTI International, Research Triangle Park, NC, United States
| | - Mai T Pho
- University of Chicago, Department of Medicine, United States
| | - Peter D Friedmann
- University of Massachusetts Medical School-Baystate and Baystate Health, United States
| | - Ryan P Westergaard
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Infectious Diseases, United States
| | - Kellene V Eagen
- University of Wisconsin - Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, United States
| | - Andrew Seaman
- Oregon Health & Science University, School of Medicine, United States
| | - Jimmy Ma
- University of Washington, Department of Medicine, Division of Allergy and Infectious Diseases, United States
| | - Vivian F Go
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, United States
| | - Kathryn E Lancaster
- Ohio State University, College of Public Health, Division of Epidemiology, United States; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
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Schoenberger SF, Idrisov B, Sereda Y, Kiriazova T, Makarenko O, Bendiks S, Ahuja N, Dutta A, Flanigan T, Gillani FS, Lunze K. Police abuse and care engagement of people with HIV who inject drugs in Ukraine. Glob Public Health 2022; 17:3638-3653. [PMID: 35343870 PMCID: PMC9515241 DOI: 10.1080/17441692.2022.2049341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/17/2022] [Indexed: 02/06/2023]
Abstract
Police abuse affects people who inject drugs (PWID), including those with HIV, and negatively impacts care engagement. This cross-sectional study evaluated police abuse among PWID receiving MOUD (medication for opioid use disorder) living with HIV and associations with HIV treatment adherence and receipt of NGO services. We assessed lifetime and past six-month rates of police abuse among a cohort of Ukrainian PWID with HIV receiving MOUD (n = 190) from August to September 2017. Logistic regression models evaluated associations between past six-month police abuse and past 30-day antiretroviral therapy (ART) adherence, and past six-month NGO service receipt. Almost all (90%) participants reported lifetime police abuse: 77% reported physical violence and 75% reported paying the police to avoid arrest. One in four females (25%) reported police-perpetrated sexual violence. Recent police abuse was reported by 16% of males and 2% of females and was not associated with ART adherence (aOR: 1.1; 95% CI:0.3-5.0) or NGO service receipt (aOR: 3.4; 95% CI:0.6-18.3). While lifetime police abuse rates were high, few participants reported recent police abuse, which was not linked to care engagement. These trends should encourage the Ukrainian government for public health-public safety partnerships and legal interventions to eliminate human rights violations against PWID living with HIV.
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Affiliation(s)
- Samantha F Schoenberger
- Clinical Addiction and Research Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Bulat Idrisov
- Institute for Leadership and Health Management, Sechenov First Moscow State Medical University, Moscow, Russia
- Bashkir State Medical University, Ufa, Russia
- Moscow Institute of Physics and Technology, Moscow, Russia
| | | | | | | | - Sally Bendiks
- Clinical Addiction and Research Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Arunima Dutta
- Section of Internal Medicine, McLaren Flint/Michigan State University, Flint, MI, USA
| | - Timothy Flanigan
- Division of Infectious Disease, Alpert Medical School of Brown University, The Miriam & Rhode Island Hospitals, Brown University, Providence, RI, USA
| | - Fizza S Gillani
- Division of Infectious Disease, Alpert Medical School of Brown University, The Miriam & Rhode Island Hospitals, Brown University, Providence, RI, USA
| | - Karsten Lunze
- Clinical Addiction and Research Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Owczarzak J, Kazi AK, Mazhnaya A, Alpatova P, Zub T, Filippova O, Phillips SD. "You're nobody without a piece of paper:" visibility, the state, and access to services among women who use drugs in Ukraine. Soc Sci Med 2020; 269:113563. [PMID: 33309442 DOI: 10.1016/j.socscimed.2020.113563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023]
Abstract
In Ukraine, women constitute a third of all new HIV infections, and injection drug use accounts for nearly half of HIV infections among women. Women who use drugs (WWUD) often have diminished access to drug use treatment, HIV care, and other health and social services or underutilize women-specific services such as maternal health services. While interpersonal and contextual factors diminish access to and utilization of services among WWUD, rules, processes, and bureaucratic structures also systematically exclude women from accessing services and resources. Institutions, bureaucratic processes, and instruments of legibility such as documents regulate who can and cannot access services and raise questions about "deservingness." In this paper, we use the lens of bureaucracy to explore paperwork as a form of structural violence through its production of "legible" citizens, often through reinforcement of gender stereotypes and moral narratives of deservingness. Between December 2017 and October 2018, we interviewed 41 medical and social service providers and 37 WWUD in two Ukrainian cities. Our analysis revealed that requirements for internal passports and residency permits-the primary state apparatus through which rights to services are granted in Ukraine-compelled participants to continually render themselves visible to the state in order to receive services, despite financial, logistical and other challenges that undermined women's ability to obtain documents. These requirements exposed them to new forms of stigma and exclusion, such as reduced opportunities for employment and losing custody of children. Nongovernmental organizations, due to funding cuts, curtailed direct services such as support groups but became liaisons between clients and the state. They enforced new narratives of deservingness, such as the ability to define "good" behavior or reward social relationships with agency staff. Ukraine's current reforms to social safety net institutions present an opportunity to interrogate underlying assumptions about spheres of responsibility for the country's most marginalized and stigmatized groups.
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Affiliation(s)
- Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House Room 739, Baltimore, Maryland, USA.
| | - Asiya K Kazi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, Maryland, 21205-1996, USA.
| | - Alyona Mazhnaya
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health,; 624 N. Broadway, Baltimore, MD, 21205-1996, USA.
| | - Polina Alpatova
- Institute of Social-Humanitarian Research, V.N. Karazin Kharkiv National University, 6 Svobody Sq, Office 351, Kharkiv, 61022, Ukraine.
| | - Tatyana Zub
- Department of Sociology, V.N. Karazin Kharkiv National University, 6 Svobody Sq, Office 351, Kharkiv, 61022, Ukraine.
| | - Olga Filippova
- Department of Sociology, V.N. Karazin Kharkiv National University, 6 Svobody Sq, Office 351, Kharkiv, 61022, Ukraine.
| | - Sarah D Phillips
- Department of Anthropology, Indiana University, Student Building 130, 701 E. Kirkwood Ave, Bloomington, IN 47405, USA.
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Gender Differences in Factors Related to HIV Risk Behaviors among People Who Inject Drugs in North-East India. PLoS One 2017; 12:e0169482. [PMID: 28099458 PMCID: PMC5242464 DOI: 10.1371/journal.pone.0169482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022] Open
Abstract
People who inject drugs (PWID) in India are at high risk for HIV, with women being at elevated risk. Using a socio-ecological framework, this study assessed whether factors associated with HIV transmission risk behaviors differed across men and women PWID. Data for this cross-sectional study were collected from 6449 PWID in 7 cities in Northeast India. Men (n = 5653) and women (n = 796) PWID were recruited using respondent-driven sampling (RDS). We assessed sex differences in two recent HIV transmission risk behaviors: multiple sex partners and needle/syringe sharing. We used multi-level logistic regression models, which incorporated sampling weights and random intercepts for city, to assess factors associated with these HIV risks, separately among men and women. The prevalence of HIV was significantly higher among women than men (53% vs 18.4%, p<0.01). Nearly 13% of men and 8% of women (p = .30) had multiple partners. Employment in men and relationship status and stigma in women were significantly associated with multiple partners. Approximately 25% of men and 19% of women engaged in needle sharing (p = .16). Younger age in women and depression symptoms in men were significantly associated with increased risk for sharing needles. We found that sexual and drug related risk behaviors were common among PWID in Northeast India, and there were differences between men and women in the socio-ecologic correlates of these behaviors. Contextually-integrated and gender-specific HIV prevention and intervention efforts are needed that consider factors at individual, interpersonal- and community-levels that uniquely impact HIV risks among PWID.
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Springer SA, Larney S, Alam-mehrjerdi Z, Altice FL, Metzger D, Shoptaw S. Drug Treatment as HIV Prevention Among Women and Girls Who Inject Drugs From a Global Perspective: Progress, Gaps, and Future Directions. J Acquir Immune Defic Syndr 2015; 69 Suppl 2:S155-61. [PMID: 25978482 PMCID: PMC4443704 DOI: 10.1097/qai.0000000000000637] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Although there have been significant reductions in the number of new HIV infections globally from 2009 to 2013, incidence remains unacceptably high for persons who use drugs. In many settings, women and girls who inject drugs (WWID) with HIV/AIDS experience poor treatment access, including evidence-based practices like antiretroviral therapy and drug treatment. Medication-assisted therapies (MAT) for substance use disorders are especially inaccessible, which in their absence, increases HIV transmission risk. Irrespective of setting or culture, drug treatment using MAT is not only effective but also cost-effective at reducing opioid use and linked injection and sexual risks. Data presented here for WWID address their access to MAT for opioid addiction and to treatments being developed that address the relationship, family, and vocational needs of this group. The most glaring finding is that globally, WWID frequently are excluded in surveys or studies with an impressive lack of disaggregated data by gender when surveying access to MAT—even in wealthy countries. Despite this, there have been some striking improvements in implementing drug treatment as prevention, notably in Iran and China. Still, real barriers remain for women and girls to accessing drug treatment, other harm reduction services, and antiretroviral therapy. Development and/or implementation of interventions that facilitate women and girls engaging in drug treatment that address their roles within society, work, and family/relationships, and outcome evaluation of these interventions are crucial.
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Affiliation(s)
- Sandra A. Springer
- Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT
| | - Sarah Larney
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - Zahra Alam-mehrjerdi
- National Drug and Alcohol Research Centre (NDARC), Faculty of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Frederick L. Altice
- Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT
| | - David Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Treatment Research Institute, Philadelphia, PA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Corsi KF, Dvoryak S, Garver-Apgar C, Davis JM, Brewster JT, Lisovska O, Booth RE. Gender differences between predictors of HIV status among PWID in Ukraine. Drug Alcohol Depend 2014; 138:103-8. [PMID: 24613219 PMCID: PMC4002293 DOI: 10.1016/j.drugalcdep.2014.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The HIV epidemic in Ukraine is among the largest in Europe. While traditionally the epidemic has spread through injection risk behavior, sexual transmission is becoming more common. Previous research has found that women in Ukraine have higher rates of HIV and engage in more HIV risk behavior than men. This study extended that work by identifying risk factors that differentially predict men and women's HIV status among people who inject drugs (PWID) in Ukraine. METHODS From July 2010 to July 2013, 2480 sexually active PWID with unknown HIV status were recruited from three cities in Ukraine through street outreach. The average age was 31 years old. RESULTS Women, who made up twenty-eight percent of the sample, had higher safe sex self-efficacy (p<.01) and HIV knowledge (p<.001) than men, but scored higher on both the risky injection (p<.001) and risky sex (p<.001) composite scores than men. Risky sex behaviors were associated with women's HIV status more than men's. We also report results identifying predictors of risky injection and sex behaviors. CONCLUSIONS Gender-specific interventions could address problem of HIV risk among women who inject drugs in a country with a growing HIV epidemic. Our findings suggest specific ways in which intervention efforts might focus on groups and individuals who are at the highest risk of contracting HIV (or who are already HIV positive) to halt the spread of HIV in Ukraine.
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Affiliation(s)
- K F Corsi
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States.
| | - S Dvoryak
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | - C Garver-Apgar
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
| | - J M Davis
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
| | - J T Brewster
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
| | - O Lisovska
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | - R E Booth
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States
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The potential for bridging: HIV status awareness and risky sexual behaviour of injection drug users who have non-injecting permanent partners in Ukraine. J Int AIDS Soc 2014; 17:18825. [PMID: 24560341 PMCID: PMC3929068 DOI: 10.7448/ias.17.1.18825] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/17/2013] [Accepted: 01/17/2014] [Indexed: 11/25/2022] Open
Abstract
Objective To quantify potential bridging of HIV transmission between the injection drug using subpopulation to the non-injection drug using population through unprotected heterosexual sex. Design Secondary analysis of cross-sectional data. Methods A sub-sample of participants who reported having a permanent partner who are not injection drug users and have not injected drugs in the past (N=1379) was selected from a survey implemented in 26 Ukrainian cities in 2011. This study evaluates the association between consistent condom use and awareness of HIV status as measured by rapid testing during the study (known/unknown HIV+, known/unknown HIV− and undetermined) among a sub-sample of male injection drug users (IDUs) who have a non-injecting permanent partner. Poisson regression, with robust variance estimates, was utilized to identify associations while adjusting for other factors. Results Reported consistent condom use varied between 15.5% (unknown HIV−) and 37.5% (known HIV+); average use was 19.3%. In multivariate analysis, males who were aware of their HIV+ status were more likely to report recent consistent condom use compared to those who were unaware of their HIV+ status. This association remains after adjustment for age, region, education level, years of injection, alcohol use, self-reported primary drug use and being an NGO client (prevalence ratio=1.65; 95% CI 1.03–2.64). No such association was found for those who were HIV−. Conclusions Our results regarding HIV-positive male IDUs reinforce previous findings that HIV testing and counselling may be an effective means of secondary prevention. Further research is needed to understand how to effectively promote safer sex behaviours for IDUs who are currently HIV−.
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Des Jarlais DC, Feelemyer JP, Modi SN, Arasteh K, Hagan H. Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas. Drug Alcohol Depend 2012; 124:95-107. [PMID: 22257753 PMCID: PMC3353009 DOI: 10.1016/j.drugalcdep.2011.12.020] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There are multiple reasons why females who inject drugs may be more likely to become infected with HIV than males who inject drugs. Where this is the case, special HIV prevention programs for females would be needed. DESIGN International systematic review and meta-analysis of studies across 14 countries. METHODS Countries with high seroprevalence (>20%) HIV epidemics among persons who inject drugs (PWID) were identified from the Reference Group to the UN on HIV and Injecting Drug Use. Systematic literature reviews collected data on HIV prevalence by gender for these countries. Non-parametric and parametric tests along with meta-analytic techniques examined heterogeneity and differences in odds ratios (OR) across studies. RESULTS Data were abstracted from 117 studies in 14 countries; total sample size N = 128,745. The mean weighted OR for HIV prevalence among females to males was 1.18 [95% CI 1.10-1.26], with high heterogeneity among studies (I(2)= 70.7%). There was a Gaussian distribution of the log ORs across studies in the sample. CONCLUSION There was a significantly higher HIV prevalence among females compared to males who inject drugs in high seroprevalence settings, but the effect size is extremely modest. The high level of heterogeneity and the Gaussian distribution suggest multiple causes of differences in HIV prevalence between females and males, with a specific difference determined by local factors. Greater understanding of factors that may protect females from HIV infection may provide insights into more effective HIV prevention for both females and males who inject drugs.
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Affiliation(s)
- Don C Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York City 10038, USA.
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Thorne C, Semenenko I, Malyuta R. Prevention of mother-to-child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000-10. Addiction 2012; 107:118-28. [PMID: 21819473 PMCID: PMC3272221 DOI: 10.1111/j.1360-0443.2011.03609.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/20/2011] [Accepted: 08/02/2011] [Indexed: 12/01/2022]
Abstract
AIMS To compare clinical status, mother-to-child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV-infected injecting drug users (IDUs) and non-IDUs. DESIGN AND SETTING Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000-10. PARTICIPANTS Pregnant HIV-infected women, identified before/during pregnancy or intrapartum, and their live-born infants (n = 6200); 1028 women followed post-partum. MEASUREMENTS Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW). FINDINGS Of 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P < 0.01). Among women with undiagnosed HIV at conception, 20% of IDUs were diagnosed intrapartum versus 4% of non-IDUs (P < 0.01). At enrolment, 14% of IDUs had severe/advanced HIV symptoms versus 6% of non-IDUs (P < 0.001). IDUs had higher rates of PTD and LBW infants than non-IDUs, respectively, 16% versus 7% and 22% versus 10% (P < 0.001). IDUs were more likely to receive no neonatal or intrapartum PMTCT prophylaxis compared with non-IDUs (OR 2.81, p < 0.001). MTCT rates were 10.8% in IDUs versus 5.9% in non-IDUs; IDUs had increased MTCT risk (adjusted odds ratio 1.32, P = 0.049). Fewer IDUs with treatment indications received HAART compared with non-IDUs (58% versus 68%, P = 0.03). CONCLUSIONS Pregnant human immunodeficiency virus-infected injecting drug users in Ukraine have worse clinical status, poorer access to prevention of mother-to-child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother-to-child transmission than non-injecting drug user women.
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MESH Headings
- Adult
- Analgesics, Opioid
- Anti-Retroviral Agents/therapeutic use
- Antiretroviral Therapy, Highly Active/statistics & numerical data
- CD4 Lymphocyte Count
- Female
- HIV Infections/drug therapy
- HIV Infections/epidemiology
- HIV Infections/prevention & control
- HIV Infections/transmission
- Health Status
- Healthcare Disparities
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infectious Disease Transmission, Vertical/prevention & control
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Male
- Post-Exposure Prophylaxis/methods
- Post-Exposure Prophylaxis/statistics & numerical data
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/prevention & control
- Pregnancy Outcome
- Prospective Studies
- Risk Factors
- Substance Abuse, Intravenous/epidemiology
- Ukraine/epidemiology
- Young Adult
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Affiliation(s)
- Claire Thorne
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, UK.
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Taran YS, Johnston LG, Pohorila NB, Saliuk TO. Correlates of HIV risk among injecting drug users in sixteen Ukrainian cities. AIDS Behav 2011; 15:65-74. [PMID: 20878228 DOI: 10.1007/s10461-010-9817-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present findings from a HIV survey using respondent driven sampling among 3,711 injecting drug users (IDUs) in 16 cities in Ukraine in 2008. Eligible participants were males and females who injected drugs in the past 1 month, ≥ 16 years and lived/worked in their respective interview area. The impact of injecting and sexual risk behaviors on HIV-infection were analyzed using four logistic models. Overall HIV prevalence was 32%. In the sexual risk model, paying for sex in the past 3 months and condom use during last sex increased the odds of HIV infection. Being female, having greater than 3 years of injection drug use, always sharing equipment and using alcohol with drugs in the past month remained significant in all four models. These findings indicate the urgent need to scale up peer education, needle exchange and methadone substitution programs for IDUs with specific programs targeting the needs of female injectors.
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Affiliation(s)
- Yuriy S Taran
- Graduate School for Social Research, Nowy Swiat Street, 72, GSSR, PAN, Warsaw, Poland.
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Booth RE, Campbell BK, Mikulich-Gilbertson SK, J. Tillotson C, Choi D, Robinson J, Calsyn DA, Mandler RN, Jenkins LM, Thompson LL, Dempsey CL, Liepman MR, McCarty D. Reducing HIV-related risk behaviors among injection drug users in residential detoxification. AIDS Behav 2011; 15:30-44. [PMID: 20652630 DOI: 10.1007/s10461-010-9751-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study of 632 drug injectors enrolled in eight residential detoxification centers within the National Drug Abuse Treatment Clinical Trials Network tested three interventions to reduce drug and sex risk behaviors. Participants were randomized to: (a) a two-session, HIV/HCV counseling and education (C&E) model added to treatment as usual (TAU), (b) a one-session, therapeutic alliance (TA) intervention conducted by outpatient counselors to facilitate treatment entry plus TAU, or (c) TAU. Significant reductions in drug and sex risk behaviors occurred for all three conditions over a 6-month follow-up period. C&E participants reported significantly greater rates of attending an HIV testing appointment, but this was not associated with better risk reduction outcomes. Reporting treatment participation within 2 months after detoxification and self-efficacy to practice safer injection behavior predicted reductions in injection risk behaviors. Findings indicate that participation in detoxification was followed by significant decreases in drug injection and risk behaviors for up to 6-months; interventions added to standard treatment offered no improvement in risk behavior outcomes.
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Abdala N, White E, Toussova OV, Krasnoselskikh TV, Verevochkin S, Kozlov AP, Heimer R. Comparing sexual risks and patterns of alcohol and drug use between injection drug users (IDUs) and non-IDUs who report sexual partnerships with IDUs in St. Petersburg, Russia. BMC Public Health 2010; 10:676. [PMID: 21054855 PMCID: PMC2988741 DOI: 10.1186/1471-2458-10-676] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 11/05/2010] [Indexed: 11/24/2022] Open
Abstract
Background To date, the great majority of Russian HIV infections have been diagnosed among IDUs and concerns about the potential for a sexual transmission of HIV beyond the IDU population have increased. This study investigated differences in the prevalence of sexual risk behaviors between IDUs and non-IDUs in St. Petersburg, Russia and assessed associations between substance use patterns and sexual risks within and between those two groups. Methods Cross-sectional survey data and biological test results from 331 IDUs and 65 non-IDUs who have IDU sex partners were analyzed. Multivariate regression was employed to calculate measures of associations. Results IDUs were less likely than non-IDUs to report multiple sexual partners and unprotected sex with casual partners. The quantity, frequency and intensity of alcohol use did not differ between IDUs and non-IDUs, but non-IDUs were more likely to engage in alcohol use categorized as risky per the alcohol use disorders identification test (AUDIT-C). Risky sexual practices were independently associated with monthly methamphetamine injection among IDUs and with risky alcohol use among non-IDUs. Having sex when high on alcohol or drugs was associated with unprotected sex only among IDUs. Conclusions Greater prevalence of sexual risk among non-IDUs who have IDU sex partners compared to IDUs suggests the potential for sexual transmission of HIV from the high-prevalence IDU population into the general population. HIV prevention programs among IDUs in St. Petersburg owe special attention to risky alcohol use among non-IDUs who have IDU sex partners and the propensity of IDUs to have sex when high on alcohol or drugs and forgo condoms.
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Affiliation(s)
- Nadia Abdala
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
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13
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Abstract
Amphetamine-group substances are used worldwide and are more prevalent than either cocaine or opioids. We reviewed published reports about amphetamine-group substances and did a meta-analysis of randomised controlled trials of behavioural interventions for their use. Most research was done in developed countries. Many, but not all, studies show an association between amphetamine-group substance use and risk of HIV infection. Much use of amphetamine-group substances is non-injection and is associated with increased HIV risk, particularly in men who have sex with men. The structural, social, interpersonal, and personal factors that link to amphetamine-group substance use and HIV risk are poorly understood. 13 studies, with a cumulative sample size of 1997 individuals, qualified for the meta-analysis. Overall, high-intensity behavioural interventions were moderately effective in reducing use of amphetamine-group substances (effect size 0.28, 95% CI 0.13-0.44). We did not find conclusive evidence that behavioural interventions as a group are more effective than are passive or minium treatment for reduction of amphetamine-group substance use or sexual risk behaviours. The search for effective, scalable, and sustainable interventions for amphetamine-group substance use, including pharmacotherapies, should be supported and encouraged.
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Affiliation(s)
- Grant Colfax
- HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA 94102, USA.
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14
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Abstract
AIMS To assess the effectiveness of a brief human immunodeficiency virus (HIV) testing and counseling intervention compared to a more time-consuming and expensive street-based intervention with injection drug users (IDUs). DESIGN Cross-over experimental design in which 900 IDUs were recruited, followed by a 'wash-out' period with no recruitment, a reversal of intervention assignment areas and an additional recruitment of 900 IDUs with baseline and 6-month follow-up assessments. SETTING Kiev, Odessa and Makeevka/Donesk Ukraine. PARTICIPANTS A total of 1798 IDUs. MEASUREMENTS HIV testing and audio computer-assisted self-interview (ACASI) data on socio-demographics, drug use and injection and sex-related risk behaviors. FINDINGS Participants in both conditions reduced their injection and sex risks significantly; however, there was little difference in outcomes between conditions. IDUs who knew they were HIV-infected at baseline were significantly more likely to practice safe sex than those unaware or HIV-negative; those who first learned that they were infected at baseline changed their safe sex practices significantly more than those who already knew that they were infected at baseline and those who were HIV-negative. Younger IDUs and those injecting for a shorter period of time reported higher injection and sex risk behaviors following interventions. CONCLUSIONS Awareness of HIV infection by street-recruited drug injectors is associated with reduced sex risks. Additional interventions are required for younger IDUs and those injecting for shorter periods of time.
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Affiliation(s)
- Robert E Booth
- Division of Substance Dependence, Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, USA.
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Abiona TC, Adefuye AS, Balogun JA, Sloan PE. Gender Differences in HIV Risk Behaviors of Inmates. J Womens Health (Larchmt) 2009; 18:65-71. [DOI: 10.1089/jwh.2008.0941] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Titilayo C. Abiona
- HIV/AIDS Research and Policy Institute, Chicago State University, Chicago, Illinois
| | - Adedeji S. Adefuye
- HIV/AIDS Research and Policy Institute, Chicago State University, Chicago, Illinois
| | - Joseph A. Balogun
- College of Health Sciences, Chicago State University, Chicago, Illinois
| | - Patricia E. Sloan
- Office of the President, Chicago State University, Chicago, Illinois
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New challenges for mathematical and statistical modeling of HIV and hepatitis C virus in injecting drug users. AIDS 2008; 22:1527-37. [PMID: 18670211 DOI: 10.1097/qad.0b013e3282ff6265] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Injecting drug users are not only driving blood-borne transmission of HIV and hepatitis C virus but also likely drive sexual transmission of HIV in large parts of the world. Mathematical and statistical modeling can provide important insights in these epidemiological processes and on the potential impact of interventions but have been little used to date. This review aims to discuss the potential areas of application of modeling in the field of viral infections in injecting drug users. After reviewing key examples of published modeling work on HIV and hepatitis C virus in injecting drug users, we discuss recent developments in the epidemiology, diagnosis, treatment and prevention of these infections. In particular, new methods for the diagnosis of early HIV infection, new antivirals for a more effective treatment of HIV, hepatitis B and hepatitis C virus infections, new concepts in design and surveillance of interventions for drug users and increasing possibilities of molecular typing of pathogens are changing the questions and decisions for public health policy makers who deal with drug-related infectious diseases. Research including mathematical modeling is needed to understand the impact of new diagnostic tools, new treatment options and combined intervention strategies on the epidemiology of viral infections in injecting drug users. Methodological advances in mathematical modeling are required to adequately approach some of the ensuing research questions. Modeling has much to offer for solving urgent policy questions, but current levels of funding in modeling research are insufficient and need to be scaled up to make better use of these possibilities.
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