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Edeza A, Bazzi A, Salhaney P, Biancarelli D, Childs E, Mimiaga MJ, Drainoni ML, Biello K. HIV Pre-exposure Prophylaxis for People Who Inject Drugs: The Context of Co-occurring Injection- and Sexual-Related HIV Risk in the U.S. Northeast. Subst Use Misuse 2019; 55:525-533. [PMID: 31596171 PMCID: PMC7028455 DOI: 10.1080/10826084.2019.1673419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: People who inject drugs (PWID) are at increased risk for HIV infection through sharing contaminated needles and injection equipment, and engaging in condomless sex. Objectives: To qualitatively examine the overlapping nature of these behaviors among PWID in the US Northeast. Methods: We recruited HIV-uninfected PWID and key informants through community-based organizations. Qualitative interviews explored sexual partnerships as they related to sharing contaminated needles and injection equipment, engaging in condomless sex, and associated indications for PrEP among PWID. Results: Among 33 PWID, 66% engaged in condomless vaginal or anal sex in the past 3 months, and 27% had three or more sexual partners in this same time period. Over half engaged in any past month distributive or receptive syringe sharing (64%). We identified three contexts through which overlapping sexual and injection-related HIV risks emerged, including (1) multiple concurrent sexual partnerships; (2) using and injecting drugs with sexual partners (including increase injecting of crystal methamphetamine); and (3) exchanging sex for money or drugs (including among male PWID). Condom use was inconsistent across these contexts. Limited interactions with healthcare providers often resulted in sexual risks being overlooked in light of competing health concerns. Conclusions: Sexual risk for HIV acquisition is complex and multi-faceted among PWID yet may be overlooked by prevention and healthcare providers. Comprehensive HIV prevention efforts must acknowledge the distinct contexts in which overlapping injection and sexual risk behaviors occur. Increased sexual health screening and risk reduction services including PrEP for PWID may help curtail transmission in this population.
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Affiliation(s)
- Alberto Edeza
- Department of Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Health Equity Research, Brown University, Providence, Rhode Island, USA
| | - Angela Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Peter Salhaney
- Department of Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Health Equity Research, Brown University, Providence, Rhode Island, USA
| | - Dea Biancarelli
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ellen Childs
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Matthew J. Mimiaga
- Department of Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Health Equity Research, Brown University, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Brown University Alpert Medical School, Providence, Rhode Island, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, ENRM VA Hospita, Bedford, Massachusetts, USA
| | - Katie Biello
- Department of Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Health Equity Research, Brown University, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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Kermode M, Armstrong G, Medhi GK, Humtsoe C, Langkham B, Mahanta J. Sexual behaviours of men who inject drugs in northeast India. Harm Reduct J 2015; 12:4. [PMID: 25889291 PMCID: PMC4352564 DOI: 10.1186/s12954-015-0038-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 01/20/2015] [Indexed: 11/23/2022] Open
Abstract
Background Promoting safer sex behaviours among people who inject drugs is important as drug-using populations with high HIV prevalence can contribute to transition from a concentrated to a generalised epidemic. This study describes the sexual behaviours of men who inject drugs in two Northeast Indian states (Manipur and Nagaland) where HIV prevalence is high, with a focus on the HIV risks for their regular female sexual partners. Methods Data were obtained from two cross-sectional surveys combined (N = 3,362)—both conducted in 2009 using respondent-driven sampling to recruit men who injected drugs. Both surveys asked about demographics, drug use, sexual and injecting risk behaviours, and interventions. One survey tested participants for HIV and syphilis. Statistical analyses included logistic regression modelling to predict inconsistent condom use with regular sexual partners. Results Two thirds of participants (68.2%) had a regular female sexual partner. Of these, 78.4% had sex with their regular partner in the last month, on average five times. Only 10.7% reported consistent condom use with regular partners. Unsafe injecting was common among men with regular partners, and 40.2% had more than one sexual partner in the last year. Half of those with regular partners (51.0%) had never had an HIV test, and 14.3% of those tested were HIV positive. After controlling for confounding, inconsistent condom use with regular partners was associated with being illiterate, married, sharing needle and syringe with others, never having had an HIV test and not receiving condoms from an NGO. Conclusion The findings from this study among men who inject drugs in Manipur and Nagaland highlight the risk of HIV infection for their regular female sexual partners. Promoting better uptake of HIV testing among men who inject drugs will potentially benefit both them and their regular partners. While effectively reaching regular partners is challenging, a number of strategies for improving their situation in relation to HIV prevention are available.
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Affiliation(s)
- Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Level 4, 161 Barry St, Carlton, Victoria, 3010, Australia.
| | - Greg Armstrong
- Nossal Institute for Global Health, University of Melbourne, Level 4, 161 Barry St, Carlton, Victoria, 3010, Australia.
| | - Gajendra Kumar Medhi
- Regional Medical Research Centre, Indian Council for Medical Research, Post Box No.105, Dibrugarh, 786001, Assam, India.
| | - Chumben Humtsoe
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, New Delhi, 11019, India.
| | - Biangtung Langkham
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, New Delhi, 11019, India.
| | - Jagadish Mahanta
- Regional Medical Research Centre, Indian Council for Medical Research, Post Box No.105, Dibrugarh, 786001, Assam, India.
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Sirikantraporn S, Mateu-Gelabert P, Friedman SR, Sandoval M, Torruella RA. Resilience among IDUs: planning strategies to help injection drug users to protect themselves and others from HIV/HCV infections. Subst Use Misuse 2012; 47:1125-33. [PMID: 22574849 PMCID: PMC4692460 DOI: 10.3109/10826084.2012.682324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many long-term injection drug users (IDUs) engage in planning strategies. In this pilot study, we examine the relation of one planning strategy to IDUs' engaging in safer injection practices. Sixty-eight IDUs were recruited in 2010 from a New York City (NYC) needle exchange program and referrals to participate in an innovative Staying Safe Intervention that teaches strategies to stay HIV/HCV uninfected. Responses to a baseline 185-item survey were analyzed using correlations and odds ratios. Planning ahead to have steady access to clean equipment was correlated with both individually based and networks-based safety behaviors including storing clean needles; avoiding sharing needles, cookers, and filters with other injectors; and providing clean needles to sex partners. Implications related to resilience in IDUs are discussed and the study's limitations have been noted.
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Affiliation(s)
- Skultip Sirikantraporn
- Institute for AIDS Research, National Development and Research Institutes (NDRI), New York, New York 10010, USA.
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Knowlton AR, Hua W, Latkin C. Social support networks and medical service use among HIV-positive injection drug users: implications to intervention. AIDS Care 2010; 17:479-92. [PMID: 16036234 DOI: 10.1080/0954012051233131314349] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The study used network analysis to identify forms and sources of social support associated with a medical services use among a medically underserved population living with HIV/AIDS. Participants were African American former or current injection drug users (n=295; 34% female, 45% current drug users and 17% AIDS diagnosed). Outcomes were access to the same medical provider, use of outpatient services and emergency room (ER) use with or without subsequent hospitalization. Controlling for AIDS diagnosis, insurance, current drug use and gender, access to the same medical care provider was associated with more females in one's support network and more network sources of emotional support, financial support and instrumental assistance. Adjusting for confounders, outpatient service use was associated with more female support network members and more sources of emotional support. Controlling for participants' drug use and insurance, sub-optimal emergency department use was associated with greater number of active drug users in one's support network. Contrary to other study findings, having a supportive sex partner was associated with lower access to medical care, and kin support was not associated with medical service use. Results indicate that specific sources and forms of social support had differential influences on the sample's utilization of medical services. The findings suggest that promoting HIV-positive African American injection drug users' support network functioning may help improve HIV medical services utilization among this medically underserved population.
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Affiliation(s)
- A R Knowlton
- Faculty of Social and Behavioral Sciences, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Carvajal SC, Estrada AL, Estrada B. Longitudinal Prediction of Unprotected Sex in Predominantly Latino Male IDUs1. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1751-9861.2005.tb00008.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bogart LM, Kral AH, Scott A, Anderson R, Flynn N, Gilbert ML, Bluthenthal RN. Sexual Risk Among Injection Drug Users Recruited From Syringe Exchange Programs in California. Sex Transm Dis 2005; 32:27-34. [PMID: 15614118 DOI: 10.1097/01.olq.0000148294.83012.d0] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to examine correlates of sexual risk among injection drug users (IDUs). STUDY A total of 1445 IDUs were recruited from California syringe exchange programs. RESULTS Consistent condom use was independently related to being HIV-positive, having multiple sex partners, not having a steady partner, not sharing syringes, and not injecting amphetamines for men; and engaging in sex work, not sharing syringes, and not having a steady partner for women. Having multiple recent sexual partnerships that included a steady partner was related to engaging in sex work, speedball injection, and amphetamine use among men; and younger age, having had a sexually transmitted disease (STD), engaging in sex work, and using alcohol among women. Having heterosexual anal sex was related to having had an STD, having multiple sexual partners, using amphetamines, and syringe-sharing for men; and younger age and amphetamine use for women. CONCLUSIONS Comprehensive prevention interventions addressing multiple sexual and injection risk behaviors are needed for IDUs.
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Affiliation(s)
- Laura M Bogart
- Health Program, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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Friedman SR, Flom PL, Kottiri BJ, Neaigus A, Sandoval M, Fuld J, Curtis R, Zenilman JM, Des Jarlais DC. Consistent condom use among drug-using youth in a high HIV-risk neighbourhood. AIDS Care 2002; 14:493-507. [PMID: 12204152 DOI: 10.1080/09540120208629668] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objectives of this study were to determine predictors of consistent condom use in heterosexual relationships of young adults who use hard drugs in a neighbourhood with widespread drug-use-connected HIV. We interviewed 196 18-24 year olds who injected drugs or used heroin, cocaine or crack in the prior year and lived in the Bushwick neighbourhood of New York City. Interviews covered sociodemographics, substance use and sexual networks. The unit of analysis is the relationship; the dependent variable measures consistent condom use over the prior 30 days in a given relationship. Consistent condom use was reported in 26% of 377 non-commercial relationships and in all of 22 commercial relationships. Using multiple logistic regression, consistent condom use in non-commercial relationships was more likely in relationships that are not 'very close'; for men (but not women) with peers whose norms are more favourable to condom use; and for subjects who had concurrent sex partners in the last 12 months. In conclusion, we found that: (1) the lack of relationship between the peer norms of drug-using women and their condom use suggests they may have little control over condom use in their relationships-programmes should attempt to empower young women drug users and to develop ways for their peers to influence the men in their lives; (2) epidemiologically, the positive association of concurrency to consistent condom use suggests that condom use may be restricting HIV spread through the community-the presence of consistent condom use in all of the commercial sexual relationships also may restrict HIV spread; (3) prevention efforts should attempt to change peer cultures as a way to develop self-sustaining risk reduction. These changes should include changes in gender roles and power relations.
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Affiliation(s)
- S R Friedman
- National Development Research Institutes, Inc., New York, NY 10010, USA.
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A Meta-analysis of the Effect of HIV Prevention Interventions on the Sex Behaviors of Drug Users in the United States. J Acquir Immune Defic Syndr 2002. [DOI: 10.1097/00042560-200207011-00008] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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LaBrie JW, Schiffman J, Earleywine M. Expectancies specific to condom use mediate the alcohol and sexual risk relationship. JOURNAL OF SEX RESEARCH 2002; 39:145-152. [PMID: 12476247 DOI: 10.1080/00224490209552134] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The present study tested the role of alcohol expectancies for condom use in mediating the alcohol and risky sex relationship. Expectancies for condom use are specific anticipations for alcohol's effect on one's ability to use a condom. College students (N = 563) reported on beliefs, intentions and actual sexual and drinking behavior. Among the sexually active, alcohol was directly related to future intention to use a condom in drinking situations for men, but not for women. In the men, alcohol expectancies for condom use mediated the relationship between drinking and condom intention. Beliefs that alcohol negatively impacts one's ability to use condoms were associated with more drinking and lower intentions to use a condom. These expectancies may help explain how alcohol affects risky sex in men. Gender differences and implications are discussed.
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Affiliation(s)
- Joseph W LaBrie
- Loyola Marymount University, PO Box 45041, Los Angeles, CA 90045, USA.
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