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Sample records for active injection drug

  1. Association between Pregnancy and Active Injection Drug Use and Sex Work among Women Injection Drug Users in Saint Petersburg, Russia.

    PubMed

    Girchenko, P; Ompad, D C; Bikmukhametov, D; Gensburg, L

    2015-06-01

    Widespread use of unsafe sexual practices among women injecting drugs both practicing and not practicing sex work leads to high levels of unplanned pregnancies in this population. The goal of this study was to investigate the association between pregnancy and active drug use and sex work. Data were collected using a convenience sample of 500 women in Saint Petersburg, Russia, in 2013. All women had recent experience of drug use, of which 200 were pregnant at the time of the study. The study consisted of a structured interview followed by a rapid HIV test. Pregnancy was protective against both active drug use and sex work. For HIV-positive women, these associations were stronger than for HIV-negative women: drug use prevalence ratio (PR) was 0.59 vs 0.85; for sex work, the PRs were 0.36 vs 0.64. Higher levels of education were associated with a lower prevalence ratio for active drug use and sex work in all models. Having children was not associated with active drug use or sex work. Pregnancy might be an optimal time for conducting interventions aimed at cessation of drug use and sex work among women injecting drugs. PMID:25835324

  2. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study).

    PubMed

    Evans, Jennifer L; Hahn, Judith A; Page-Shafer, Kimberly; Lum, Paula J; Stein, Ellen S; Davidson, Peter J; Moss, Andrew R

    2003-03-01

    Female injection drug users (IDUs) represent a large proportion of persons infected with HIV in the United States, and women who inject drugs have a high incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Therefore, it is important to understand the role of gender in injection risk behavior and the transmission of blood-borne virus. In 2000-2002, 844 young (<30 years old) IDUs were surveyed in San Francisco. We compared self-reported risk behavior between 584 males and 260 female participants from cross-sectional baseline data. We used logistic regression to determine whether demographic, structural, and relationship variables explained increased needle borrowing, drug preparation equipment sharing, and being injected by another IDU among females compared to males. Females were significantly younger than males and were more likely to engage in needle borrowing, ancillary equipment sharing, and being injected by someone else. Females were more likely than males to report recent sexual intercourse and to have IDU sex partners. Females and males were not different with respect to education, race/ethnicity, or housing status. In logistic regression models for borrowing a used needle and sharing drug preparation equipment, increased risk in females was explained by having an injection partner who was also a sexual partner. Injecting risk was greater in the young female compared to male IDUs despite equivalent frequency of injecting. Overlapping sexual and injection partnerships were a key factor in explaining increased injection risk in females. Females were more likely to be injected by another IDU even after adjusting for years injecting, being in a relationship with another IDU, and other potential confounders. Interventions to reduce sexual and injection practices that put women at risk of contracting hepatitis and HIV are needed. PMID:12612103

  3. Predictors of Active Injection Drug Use in a Cohort of Patients Infected With Hepatitis C Virus

    PubMed Central

    Reed, Carrie; Bliss, Caleb; Heeren, Timothy; Tumilty, Sheila; Horsburgh, C. Robert; Samet, Jeffrey H.; Cotton, Deborah J.

    2013-01-01

    Objectives. We investigated potential risk factors for active injection drug use (IDU) in an inner-city cohort of patients infected with hepatitis C virus (HCV). Methods. We used log-binomial regression to identify factors independently associated with active IDU during the first 3 years of follow-up for the 289 participants who reported ever having injected drugs at baseline. Results. Overall, 142 (49.1%) of the 289 participants reported active IDU at some point during the follow-up period. In a multivariate model, being unemployed (prevalence ratio [PR] = 1.93; 95% confidence interval [CI] = 1.24, 3.03) and hazardous alcohol drinking (PR = 1.67; 95% CI = 1.34, 2.08) were associated with active IDU. Smoking was associated with IDU but this association was not statistically significant. Patients with all 3 of those factors were 3 times as likely to report IDU during follow-up as those with 0 or 1 factor (PR = 3.3; 95% CI = 2.2, 4.9). Neither HIV coinfection nor history of psychiatric disease was independently associated with active IDU. Conclusions. Optimal treatment of persons with HCV infection will require attention to unemployment, alcohol use, and smoking in conjunction with IDU treatment and prevention. PMID:23153145

  4. Synergistic anti-tumor activity through combinational intratumoral injection of an in-situ injectable drug depot.

    PubMed

    Kim, Da Yeon; Kwon, Doo Yeon; Kwon, Jin Seon; Park, Ji Hoon; Park, Seung Hun; Oh, Hyun Ju; Kim, Jae Ho; Min, Byoung Hyun; Park, Kinam; Kim, Moon Suk

    2016-04-01

    Here, we describe combinational chemotherapy via intratumoral injection of doxorubicin (Dox) and 5-fluorouracil (Fu) to enhance the efficacy and reduce the toxicity of systemically administered Fu and Dox in cancer patients. As the key concept in this work, mixture formulations of Dox-loaded microcapsules (Dox-M) and Fu-loaded Pluronic(®) hydrogels (Fu-HP) or Fu-loaded diblock copolymer hydrogels (Fu-HC) have been employed as drug depots. The in vitro and in vivo drug depot was designed as a formulation of Dox-M dispersed inside an outer shell of Fu-HP or Fu-HC after injection. The Dox-M/Fu-HP and Dox-M/Fu-HC formulations are free flowing at room temperature, indicating injectability, and formed a structural gelatinous depot in vitro and in vivo at body temperature. The Fu-HP, Fu-HC, Dox-M/Fu-HP, Dox-M/Fu-HC, and Dox-M formulations were easily injected into tumor centers in mice using a needle. Dox-M/Fu-HC produced more significant inhibitory effects against tumor growth than that by Dox-M/Fu-HP, while Fu-HP, Fu-HC and Dox-M had the weakest inhibitory effects of the tested treatments. The in vivo study of Dox and Fu biodistribution showed that high Dox and Fu concentrations were maintained in the target tumor only, while distribution to normal tissues was not observed, indicating that Dox and Fu concentrations below their toxic plasma concentrations should not cause significant systemic toxicity. The Dox-M/Fu-HP and Dox-M/Fu-HC drug depots described in this work showed excellent performance as chemotherapeutic delivery systems. The results reported here indicate that intratumoral injection using combination chemotherapy with Dox-M/Fu-HP or Dox-M/Fu-HC could be of translational research by enhancing the synergistic inhibitory effects of Dox and Fu on tumor growth, while reducing their systemic toxicity in cancer patients. PMID:26874285

  5. Active and latent tuberculosis among HIV-positive injecting drug users in Indonesia

    PubMed Central

    Meijerink, Hinta; Wisaksana, Rudi; Lestari, Mery; Meilana, Intan; Chaidir, Lydia; van der Ven, Andre JAM; Alisjahbana, Bachti; van Crevel, Reinout

    2015-01-01

    Introduction Injecting drug use (IDU) is associated with tuberculosis but few data are available from low-income settings. We examined IDU in relation to active and latent tuberculosis (LTBI) among HIV-positive individuals in Indonesia, which has a high burden of tuberculosis and a rapidly growing HIV epidemic strongly driven by IDU. Methods Active tuberculosis was measured prospectively among 1900 consecutive antiretroviral treatment (ART)-naïve adult patients entering care in a clinic in West Java. Prevalence of LTBI was determined cross-sectionally in a subset of 518 ART-experienced patients using an interferon-gamma release assay. Results Patients with a history of IDU (53.1%) more often reported a history of tuberculosis treatment (34.8% vs. 21.9%, p<0.001), more often received tuberculosis treatment during follow-up (adjusted HR=1.71; 95% CI: 1.25–2.35) and more often had bacteriologically confirmed tuberculosis (OR=1.67; 95% CI: 0.94–2.96). LTBI was equally prevalent among people with and without a history of IDU (29.1 vs. 30.4%, NS). The risk estimates did not change after adjustment for CD4 cell count or ART. Conclusions HIV-positive individuals with a history of IDU in Indonesia have more active tuberculosis, with similar rates of LTBI. Within the HIV clinic, LTBI screening and isoniazid preventive therapy may be prioritized to patients with a history of IDU. PMID:25690530

  6. Effects of injectable anticholinergic drugs on soman-induced lethality and convulsant/subconvulsant activity

    SciTech Connect

    Harris, L.W.; Anderson, D.R.; Lennox, W.J.; Bowersox, S.L.; Anders, J.C.

    1993-05-13

    FDA approved, injectable preparations of candidate compounds BENZTROPINE (BZT), 1.0 mg/ml; biperiden (BIP), 5.0 mg/ml; dicyclomine (DCL), 10 mg/ml; 1-hyoscyamine (HYO), 0.5 mg/ml; orphenadrine (ORP), 30 mg/ml; scopolamine (SCP), 1.0 mg/ml were tested in parallel with diazepam (DZ, the standard) in male guinea pigs against ongoing soman induced convulsive (CV)/sub-CV activity. Three trained graders concurrently assigned CV/sub-CV scores (12 - convulsions; 0 normal) to each animal. Animals received (im) pyridostigmine (PYR; 26 ug/kg) 30 min before soman (56 ug/kg; 2 LD50), atropine (2 mg/kg) admixed with 2-PAM (25 mg/kg) at one min after soman, and the candidate drug preparation at 5.67 min post soman, a time when CV activity is assured. BIP and SCP demonstrated efficacy over dosage ranges between 10 and 0.3 and 1.0 and 0.13 mg/kg, respectively, while the other preparations were less effective at their respective maximum dosages. At optimal dosages of SCP (0.5 mg/kg) and BIP (10 mg/kg), the CV/sub-CV scores were significantly lower (p < 0.05) than those of DZ.

  7. The Impact of Engagement in Street-based Income Generation Activities on Stimulant Drug Use Cessation among People who Inject Drugs

    PubMed Central

    Ti, Lianping; Richardson, Lindsey; DeBeck, Kora; Nguyen, Paul; Montaner, Julio; Wood, Evan; Kerr, Thomas

    2014-01-01

    Background Despite the growing prevalence of illicit stimulant drug use internationally, and the widespread involvement of people who inject drugs (IDU) within street-based drug markets, little is known about the impact of different types of street-based income generation activities on the cessation of stimulant use among IDU. Methods Data were derived from an open prospective cohort of IDU in Vancouver, Canada. We used Kaplan-Meier methods and Cox proportional hazards regression to examine the effect of different types of street-based income generation activities (e.g., sex work, drug dealing, and scavenging) on time to cessation of stimulant use. Results Between December, 2005 and November, 2012, 887 IDU who use stimulant drugs (cocaine, crack cocaine, or crystal methamphetamine) were prospectively followed-up for a median duration of 47 months. In Kaplan-Meier analyses, compared to those who did not engage in street-based income generation activities, participants who reported sex work, drug dealing, scavenging, or more than one of these activities were significantly less likely to report stimulant drug use cessation (all p<0.001). When considered as time-updated variables and adjusted for potential confounders in a multivariable model, each type of street-based income generation activity remained significantly associated with a slower time to stimulant drug cessation (all p<0.005). Conclusions Our findings highlight the urgent need for strategies to address stimulant dependence, including novel pharmacotherapies. Also important, structural interventions, such as low-threshold employment opportunities, availability of supportive housing, legal reforms regarding drug use, and evidence-based approaches that reduce harm among IDU are urgently required. PMID:24909853

  8. Formal and informal organizational activities of people who inject drugs in New York City: description and correlates.

    PubMed

    Friedman, Samuel R; Pouget, Enrique R; Sandoval, Milagros; Jones, Yolanda; Mateu-Gelabert, Pedro

    2015-01-01

    Little is known about group memberships of people who inject drugs (PWID). Three hundred PWID were interviewed about formal and informal group participation and risk behaviors. Many took part in groups related to problems and resources associated with injecting drugs, religion, sports or gender. Harm reduction group and support group participation was associated with less risk behavior; sports groups participation with more risk behavior. Group involvement by PWID may be important to their lives and/or affect prevention or infectious disease transmission. More research is needed about determinants and consequences of their and other drug users' group memberships. PMID:25774744

  9. Microfabricated injectable drug delivery system

    DOEpatents

    Krulevitch, Peter A.; Wang, Amy W.

    2002-01-01

    A microfabricated, fully integrated drug delivery system capable of secreting controlled dosages of multiple drugs over long periods of time (up to a year). The device includes a long and narrow shaped implant with a sharp leading edge for implantation under the skin of a human in a manner analogous to a sliver. The implant includes: 1) one or more micromachined, integrated, zero power, high and constant pressure generating osmotic engine; 2) low power addressable one-shot shape memory polymer (SMP) valves for switching on the osmotic engine, and for opening drug outlet ports; 3) microfabricated polymer pistons for isolating the pressure source from drug-filled microchannels; 4) multiple drug/multiple dosage capacity, and 5) anisotropically-etched, atomically-sharp silicon leading edge for penetrating the skin during implantation. The device includes an externally mounted controller for controlling on-board electronics which activates the SMP microvalves, etc. of the implant.

  10. Active case finding for tuberculosis among people who inject drugs on methadone treatment in Dar es Salaam, Tanzania

    PubMed Central

    Gupta, A.; Mbwambo, J.; Mteza, I.; Shenoi, S.; Lambdin, B.; Nyandindi, C.; Doula, B. I.; Mfaume, S.; Bruce, R. D.

    2015-01-01

    SUMMARY SETTING Active case finding is a World Health Organization (WHO) endorsed strategy for improving tuberculosis (TB) case detection. Despite WHO recommendations for active case finding among people who inject drugs (PWID), few studies have been published. The historical focus of case finding has been in populations that are human immunodeficiency virus-positive, incarcerated or at higher occupational risk. OBJECTIVE We sought to examine the yield of active case finding among PWID newly started on methadone in Tanzania. DESIGN Of 222 methadone clients, 156 (70%) met with study administrators; 150 consented to participate, 139 (93%) of whom were male. The median age was 34 years. A symptom-based questionnaire was developed by the investigators and administered to every consenting patient by a native Swahili speaker. RESULTS Of the 150 patients surveyed, 16 (11%) had one or more TB symptoms and were referred for laboratory testing. Six new TB cases were identified in this active case finding program, with a prevalence of 4%. CONCLUSION This study presents the first data on TB prevalence in a population of PWID in Tanzania. This prevalence is 23 times that of the general Tanzanian TB prevalence of 0.2%. These results have significant implications for TB control. PMID:24902554

  11. Border crossing to inject drugs in Mexico among injection drug users in San Diego, California.

    PubMed

    Volkmann, Tyson; Shin, Sanghyuk S; Garfein, Richard S; Patterson, Thomas L; Pollini, Robin A; Wagner, Karla D; Artamanova, Irina; Strathdee, Steffanie A

    2012-04-01

    We examined correlates of ever injecting drugs in Mexico among residents of San Diego, California. From 2007 to 2010, injecting drug users (IDUs) in San Diego underwent an interviewer-administered survey. Logistic regression identified correlates of injection drug use in Mexico. Of 302 IDUs, 38% were Hispanic, 72% male and median age was 37; 27% ever injected in Mexico; 43% reported distributive syringe sharing there. Factors independently associated with ever injecting drugs in Mexico included being younger at first injection, injecting heroin, distributive syringe sharing at least half of the time, and transporting drugs over the last 6 months. One-quarter of IDUs reported ever injecting drugs in Mexico, among whom syringe sharing was common, suggesting possible mixing between IDUs in the Mexico-US border region. Prospective studies should monitor trends in cross-border drug use in light of recent Mexican drug policy reforms partially decriminalizing drug possession. PMID:21442300

  12. The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD

    PubMed Central

    Linton, Sabriya L.; Celentano, David D.; Kirk, Gregory D.; Mehta, Shruti H.

    2013-01-01

    Background Few studies have assessed the temporal association between homelessness and injection drug use, and injection-related risk behavior. Methods Among a cohort of 1,405 current and former injection drug users in follow-up from 2005–2009, we used random intercept models to assess the temporal association between homelessness and subsequent injection drug use, and to determine whether the association between homelessness and sustained injection drug use among active injectors differed from the association between homelessness and relapse among those who stopped injecting. We also assessed the association between homelessness and subsequent injection-related risk behavior among participants who injected drugs consecutively across two visits. Homelessness was categorized by duration: none, <1 month, and ≥1 month. Results Homelessness was reported on at least one occasion by 532 (38%) participants. The relationship between homelessness and subsequent injection drug use was different for active injectors and those who stopped injecting. Among those who stopped injecting, homelessness was associated with relapse [<1 month: AOR=1.67, 95% CI (1.01, 2.74); ≥1 month: AOR=1.34 95% CI (0.77, 2.33)]. Among active injectors, homelessness was not associated with sustained injection drug use [<1 month: AOR=1.03, 95% CI (0.71, 1.49); ≥1 month: AOR=0.81 95% CI (0.56, 1.17)]. Among those injecting drugs across two consecutive visits, homelessness ≥1 month was associated with subsequent injection-related risk behavior [AOR=1.61, 95% CI (1.06, 2.45)]. Conclusion Homelessness appears to be associated with relapse and injection-related risk behavior. Strengthening policies and interventions that prevent homelessness may reduce injection drug use and injection-related risk behaviors. PMID:23578590

  13. A brief screening tool to assess the risk of contracting HIV infection among active injection drug users

    PubMed Central

    Smith, Dawn K.; Pan, Yi; Rose, Charles E.; Pals, Sherri L.; Mehta, Shruti H.; Kirk, Gregory D.; Herbst, Jeffrey H.

    2015-01-01

    Objective To incorporate preexposure prophylaxis (PrEP) and other biomedical or intensive behavioral interventions into the care of injection drug users, healthcare providers need validated, rapid, risk screening tools for identifying persons at highest risk of incident HIV infection. Methods To develop and validate a brief screening tool for assessing the risk of contracting HIV (ARCH), we included behavioral and HIV test data from 1904 initially HIV-uninfected men and women enrolled and followed in the ALIVE prospective cohort study between 1988 and 2008. Using logistic regression analyses with generalized estimating equations (GEE), we identified significant predictors of incident HIV infection, then rescaled and summed their regression coefficients to create a risk score. Results The final logistic regression model included age, engagement in a methadone maintenance program, and a composite injection risk score obtained by counting the number of the following five behaviors reported during the past six months: injection of heroin, injection of cocaine, sharing a cooker, sharing needles, or visiting a shooting gallery. The area under the receiver operating characteristic curve was 0.720, possible scores on index ranged from 0 to 100 and a score ≥46 had a sensitivity of 86.2% and a specificity of 42.5%, appropriate for a screening tool. Discussion We developed an easy to administer 7-question screening tool with a cutoff that is predictive of incident HIV infection in a large prospective cohort of injection drug users in Baltimore. The ARCH-IDU screening tool can be used to prioritize persons who are injecting illicit drugs for consideration of PrEP and other intensive HIV prevention efforts. PMID:25961495

  14. Effect of peer-led outreach activities on injecting risk behavior among male drug users in Haryana, India

    PubMed Central

    2014-01-01

    Background For the past two decades, there has been an enduring HIV epidemic among injecting drug users (IDUs) in India, and the Indian national AIDS control program (NACP) led by the National AIDS Control Organization (NACO) has kept IDUs at the forefront along with other key populations, in its efforts to prevent HIV. Given this, the objective of this study is to examine the association between IDUs’ degree of exposure to peer-led education sessions (under NACP) and their needle sharing practices in Haryana, India. Methods The data for this study were drawn from a program monitoring system for the years 2009–2010 and 2010–2011. The relationship between IDUs’ background characteristics/injecting practices and degree of exposure to the program was assessed using chi-square and Student’s t tests. Generalized estimating equations (GEE) were used to examine changes in needle sharing practices over time by degree of exposure to peer-led education sessions. Further, the analysis was stratified by frequency of injecting drug use. All statistical analyses were conducted using STATA version 11. Results The proportion of IDUs who shared needles substantially decreased from 2009 to 2011, particularly among those who attended three or more peer-led education sessions (49% vs 11%, p < 0.001) in a month. Further, subgroup analysis by frequency of injecting drugs demonstrates that this decline was significant among IDUs who injected frequently (adjusted odds ratio = 0.6, 95% confidence interval = 0.3–0.9, p = 0.043). Conclusion The study results indicate that repeated peer-led outreach sessions are more effective than exposure to a single education session. Hence, HIV prevention programs must promote repeated peer contacts with IDUs every month (at least two meetings) in order to promote safe injecting practices and behavior change. PMID:24495379

  15. Assessing candidacy for acute hepatitis C treatment among active young injection drug users: a case-series report.

    PubMed

    Asher, Alice; Lum, Paula J; Page, Kimberly

    2012-01-01

    Treatment for acute hepatitis C virus (HCV) infection has significantly better outcomes than treatment for chronic infection. The short window of the acute period poses challenges for young injection drug users (IDU), who are at highest risk of HCV infection, to demonstrate treatment candidacy. We recruited patients with acute HCV from a prospective cohort study to examine clinical and behavioral issues related to treatment candidacy. We report on outcomes and how nursing case management affected candidacy. All five acutely-infected participants reported daily drug use at baseline. All established primary care and decreased their drug use. None received treatment for their acute infection; one was treated within 12 months of infection. Establishing treatment candidacy for young IDU in the acute phase involves various health domains. An acute infection's short period poses many challenges to establishing candidacy, but it is a window of opportunity to engage young IDU in health care. PMID:21497111

  16. Assessing Candidacy for Acute Hepatitis C Treatment Among Active Young Injection Drug Users: A Case-Series Report

    PubMed Central

    Asher, Alice; Lum, Paula J.; Page, Kimberly

    2011-01-01

    Treatment for acute hepatitis C virus (HCV) infection has significantly better outcomes than treatment for chronic infection. The short window of the acute period poses challenges for young injection drug users (IDU), who are at highest risk of HCV infection, to demonstrate treatment candidacy. We recruited patients with acute HCV from a prospective cohort study to examine clinical and behavioral issues related to treatment candidacy. We report on outcomes and how nursing case management affected candidacy. All 5 acutely-infected participants reported daily drug use at baseline. All established primary care and decreased their drug use. None received treatment for their acute infection; one was treated within 12 months of infection. . Establishing treatment candidacy for young IDU in the acute phase involves various health domains. Acute infection's short period poses many challenges to establishing candidacy, but it is a window of opportunity to engage young IDU in health care. PMID:21497111

  17. Factors Associated with Initiating Someone into Illicit Drug Injection

    PubMed Central

    Bluthenthal, Ricky N; Wenger, Lynn; Chu, Daniel; Quinn, Brendan; Thing, James; Kral, Alex H

    2014-01-01

    Aims Most people who inject drugs (PWID) were first initiated into injection by a current PWID. Few studies have examined PWID who assist others into drug injection. Our goal is to describe the prevalence of and risk factors for initiating someone into injection in the last 12 months. Methods We recruited a cross-sectional sample of PWID (N=605) in California from 2011 to 2013. We examined bivariate and multivariate risk factors for initiating someone into injection with a focus on behaviors that might encourage injection initiation such as injecting in front of non-PWID, describing how to inject to non-PWID, and willingness to initiate someone into drug injection. Results Having initiated someone into injection was reported by 34% of PWID overall and 7% in the last 12 months. Forty-four PWID had assisted 431 people into injection in the past year. Factors independently associated with initiating someone into injection in the last 12 months were having injected any person in past month – referred to as being a street doctor‟ -- (Adjusted Odds Ratio [AOR]=3.49; 95% confidence interval [CI]=1.72, 7.08), having described how to inject to non-injectors (2.76; 95% CI=1.28, 5.93), self-reported likelihood of initiating someone in the future (AOR=6.37; 95% CI=3.12, 13.01), and non-injection powder cocaine use in past month (AOR=4.40; 95% CI= 1.90, 10.19). Conclusion Active PWID are important in facilitating the process of drug injection uptake. Interventions to reduce initiation should include efforts to change behaviors and intentions among PWID that are associated with injection uptake among others. PMID:25282308

  18. Innovative Drug Injection via Laser Induced Plasma

    NASA Astrophysics Data System (ADS)

    Han, Tae-hee; Yoh, Jack J.

    2010-10-01

    A laser based needle-free liquid drug injection device has been developed. A laser beam is focused inside the liquid contained in the rubber chamber of micro scale. The focused laser beam causes explosive bubble growth and the sudden volume increase in a sealed chamber drives a microjet of liquid drug through the micronozzle. The exit diameter of the nozzle is 125 um and the injected microjet reaches an average velocity of 264 m/s. This device adds the time-varying feature of microjet to the current state of liquid injection for drug delivery.

  19. Assisted injection among people who inject drugs in Thailand

    PubMed Central

    2013-01-01

    Background Assisted injection is common among people who inject drugs (IDU), and has been associated with elevated risk for HIV infection and overdose. However, this practice has not been explored in the Asian context, including in Thailand, where HIV prevalence among IDU remains high. Methods Using multivariate logistic regression, we examined the prevalence and correlates of assisted injecting among IDU participating in the Mitsampan Community Research Project in Bangkok. We also sought to identify reasons for engaging in assisted injecting and those who provide this form of assistance. Results In total, 430 IDU participated in this study, including 376 (87.5%) who reported having ever required assistance injecting, and 81 (18.8%) who reported assisted injecting in the previous six months. In multivariate analyses, assisted injecting in the previous six months was independently and positively associated with being female (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI]: 1.40 – 4.18), being a weekly heroin injector (AOR = 1.78; 95% CI: 0.99 – 3.20), syringe sharing (AOR = 2.08; 95% CI: 1.18 – 3.68) and soft-tissue infection (AOR = 3.51; 95% CI: 1.43 – 2.53). Having a longer injecting career (AOR = 0.96; 95% CI: 0.94 – 0.99) was negatively associated with assisted injecting. Primary reasons given for engaging in assisted injecting included being new to injecting and lacking knowledge on how to inject. The most common providers of assistance with injecting were close friends. Conclusion We found a high prevalence of assisted injecting among IDU in Bangkok, with females, frequent heroin injectors, those with shorter injecting careers being more likely to engage in this practice. Those who require help with the injecting process are more likely to share syringes, and have skin infections. These findings indicate the need for interventions focused on promoting safer and self-administered injections. PMID:24020370

  20. Needle Exchange Programs and Drug Injection Behavior

    ERIC Educational Resources Information Center

    DeSimone, Jeff

    2005-01-01

    This study examines how drug injection and needle sharing propensities respond when a needle exchange program (NEP) is introduced into a city. I analyze 1989-1995 Drug Use Forecasting data on adult male arrestees from 24 large U.S. cities, in nine of which NEPs opened during the sample period. After controlling for cocaine and heroin prices, AIDS…

  1. Injection Drug Users' Involvement In Drug Economy: Dynamics of Sociometric and Egocentric Social Networks.

    PubMed

    Yang, Cui; Latkin, Carl; Muth, Stephen Q; Rudolph, Abby

    2013-07-01

    The purpose of this analysis was to examine the effect of social network cohesiveness on drug economy involvement, and to test whether this relationship is mediated by drug support network size in a sample of active injection drug users. Involvement in the drug economy was defined by self-report of participation in at least one of the following activities: selling drugs, holding drugs or money for drugs, providing street security for drug sellers, cutting/packaging/cooking drugs, selling or renting drug paraphernalia (e.g., pipes, tools, rigs), and injecting drugs in others' veins. The sample consists of 273 active injection drug users in Baltimore, Maryland who reported having injected drugs in the last 6 months and were recruited through either street outreach or by their network members. Egocentric drug support networks were assessed through a social network inventory at baseline. Sociometric networks were built upon the linkages by selected matching characteristics, and k-plex rank was used to characterize the level of cohesiveness of the individual to others in the social network. Although no direct effect was observed, structural equation modeling indicated k-plex rank was indirectly associated with drug economy involvement through drug support network size. These findings suggest the effects of large-scale sociometric networks on injectors' drug economy involvement may occur through their immediate egocentric networks. Future harm reduction programs for injection drug users (IDUs) should consider providing programs coupled with economic opportunities to those drug users within a cohesive network subgroup. Moreover, individuals with a high connectivity to others in their network may be optimal individuals to train for diffusing HIV prevention messages. PMID:25309015

  2. Injection Drug Users’ Involvement In Drug Economy: Dynamics of Sociometric and Egocentric Social Networks

    PubMed Central

    Yang, Cui; Latkin, Carl; Muth, Stephen Q.; Rudolph, Abby

    2014-01-01

    The purpose of this analysis was to examine the effect of social network cohesiveness on drug economy involvement, and to test whether this relationship is mediated by drug support network size in a sample of active injection drug users. Involvement in the drug economy was defined by self-report of participation in at least one of the following activities: selling drugs, holding drugs or money for drugs, providing street security for drug sellers, cutting/packaging/cooking drugs, selling or renting drug paraphernalia (e.g., pipes, tools, rigs), and injecting drugs in others’ veins. The sample consists of 273 active injection drug users in Baltimore, Maryland who reported having injected drugs in the last 6 months and were recruited through either street outreach or by their network members. Egocentric drug support networks were assessed through a social network inventory at baseline. Sociometric networks were built upon the linkages by selected matching characteristics, and k-plex rank was used to characterize the level of cohesiveness of the individual to others in the social network. Although no direct effect was observed, structural equation modeling indicated k-plex rank was indirectly associated with drug economy involvement through drug support network size. These findings suggest the effects of large-scale sociometric networks on injectors’ drug economy involvement may occur through their immediate egocentric networks. Future harm reduction programs for injection drug users (IDUs) should consider providing programs coupled with economic opportunities to those drug users within a cohesive network subgroup. Moreover, individuals with a high connectivity to others in their network may be optimal individuals to train for diffusing HIV prevention messages. PMID:25309015

  3. Childhood Factors that Precede Drug Injection: Is There a Link?

    ERIC Educational Resources Information Center

    Corsi, Karen F.; Winch, Peter J.; Kwiatkowski, Carol F.; Booth, Robert E.

    2007-01-01

    Examination of childhood risk factors for injection drug use may provide clues as to why people progress to injection drug use and it can promote identification of at-risk youth. We surveyed current injection drug users (IDUs) and individuals who never injected drugs (non-IDUs), recruited through street outreach and snowball sampling in Denver,…

  4. Injection and Non-Injection Drug Use and Infectious Disease in Baltimore City: Differences by Race

    PubMed Central

    Keen, Larry; Khan, Maria; Clifford, Lisa; Harrell, Paul T.; Latimer, William W.

    2014-01-01

    Purpose The current study examines differences in the prevalence of biologically-confirmed hepatitis C virus (HCV), HIV, and coinfection between Black and White adult cocaine/heroin users across three drug use subgroups identified in previous research (Harrell et al, 2012): non-injection smoking crack/nasal heroin users, heroin injectors, and polydrug injectors. Results 59% of the 482 participants in the study were male. Significant race differences emerged between drug use subgroup memberships. Non-injection smoking crack/nasal heroin users were predominantly Black (75%), while heroin injectors and polydrug injectors were predominantly White (69% and 72%, respectively). Polydrug injectors accounted for nearly three quarters of the HCV positive diagnoses in Whites. Though HIV disease status, stratified by race, did not differ significantly between drug use subgroups, the non-injection smoking crack/nasal heroin subgroup contained over half of the HIV positive diagnoses in the sample and was predominantly Black. Despite much lower rates of injection, Blacks (8%) had a higher prevalence of coinfection than Whites (3%; X2 (2) = 6.18, p = .015). Conclusions The current findings are consistent with trends in recent HIV transmission statistics where sexual activity has overtaken injection drug use as a HIV risk factor. The current findings also provide further support to the notion of injection drug use as an exceedingly high-risk behavior for HCV and coinfection, specifically those who are polysubstance injectors. PMID:24837755

  5. Injected nanocrystals for targeted drug delivery

    PubMed Central

    Lu, Yi; Li, Ye; Wu, Wei

    2016-01-01

    Nanocrystals are pure drug crystals with sizes in the nanometer range. Due to the advantages of high drug loading, platform stability, and ease of scaling-up, nanocrystals have been widely used to deliver poorly water-soluble drugs. Nanocrystals in the blood stream can be recognized and sequestered as exogenous materials by mononuclear phagocytic system (MPS) cells, leading to passive accumulation in MPS-rich organs, such as liver, spleen and lung. Particle size, morphology and surface modification affect the biodistribution of nanocrystals. Ligand conjugation and stimuli-responsive polymers can also be used to target nanocrystals to specific pathogenic sites. In this review, the progress on injected nanocrystals for targeted drug delivery is discussed following a brief introduction to nanocrystal preparation methods, i.e., top-down and bottom-up technologies. PMID:27006893

  6. Cross-border drug injection relationships among injection drug users in Tijuana, Mexico

    PubMed Central

    Wagner, Karla D.; Pollini, Robin A.; Patterson, Thomas L.; Lozada, Remedios; Ojeda, Victoria D.; Brouwer, Kimberly C.; Vera, Alicia; Volkmann, Tyson A.; Strathdee, Steffanie A.

    2010-01-01

    Background International borders are unique social and environmental contexts characterized by high levels of mobility. Among drug users, mobility increases risk for human immunodeficiency virus (HIV) in part through its effects on the social environment. However, the social dynamics of drug users living in border regions are understudied. Methods 1056 injection drug users (IDUs) residing in Tijuana, Mexico were recruited using respondent-driven sampling (RDS) from 2006 to 2007, and underwent surveys and testing for HIV, syphilis, and tuberculosis (TB). Using logistic regression on baseline data, we identified correlates of having ever injected drugs with someone from the US. Results Almost half (48%) reported ever injecting drugs with someone from the US. In RDS-adjusted logistic regression, factors independently associated with having ever injected with someone from the US included: having greater than middle school education (Adjusted Odds Ratio [AOR] 2.91; 95% Confidence Interval [C.I.] 1.52, 5.91), speaking English (AOR 3.24, 95% C.I. 1.96, 5.36), age (AOR 1.10 per year; 95% C.I. 1.07, 1.14), age at initiation of injection drug use (AOR 0.90 per year; 95% C.I. 0.86, 0.94), homelessness (AOR 2.61; 95% C.I. 1.27, 5.39), and having ever been incarcerated (AOR 11.82; 95% C.I., 5.22, 26.77). No associations with HIV, syphilis, TB, drug use, or injection risk behavior were detected. Conclusion Findings suggest that IDU networks in Mexico and the US may transcend international borders, with implications for cross-border transmission of infectious disease. Binational programs and policies need to consider the structure and geographic distribution of drug using networks. PMID:20889270

  7. Comparison of Active Drug Concentrations in the Pulmonary Epithelial Lining Fluid and Interstitial Fluid of Calves Injected with Enrofloxacin, Florfenicol, Ceftiofur, or Tulathromycin

    PubMed Central

    Foster, Derek M.; Martin, Luke G.; Papich, Mark G.

    2016-01-01

    Bacterial pneumonia is the most common reason for parenteral antimicrobial administration to beef cattle in the United States. Yet there is little information describing the antimicrobial concentrations at the site of action. The objective of this study was to compare the active drug concentrations in the pulmonary epithelial lining fluid and interstitial fluid of four antimicrobials commonly used in cattle. After injection, plasma, interstitial fluid, and pulmonary epithelial lining fluid concentrations and protein binding were measured to determine the plasma pharmacokinetics of each drug. A cross-over design with six calves per drug was used. Following sample collection and drug analysis, pharmacokinetic calculations were performed. For enrofloxacin and metabolite ciprofloxacin, the interstitial fluid concentration was 52% and 78% of the plasma concentration, while pulmonary fluid concentrations was 24% and 40% of the plasma concentration, respectively. The pulmonary concentrations (enrofloxacin + ciprofloxacin combined) exceeded the MIC90 of 0.06 μg/mL at 48 hours after administration. For florfenicol, the interstitial fluid concentration was almost 98% of the plasma concentration, and the pulmonary concentrations were over 200% of the plasma concentrations, exceeding the breakpoint (≤ 2 μg/mL), and the MIC90 for Mannheimia haemolytica (1.0 μg/mL) for the duration of the study. For ceftiofur, penetration to the interstitial fluid was only 5% of the plasma concentration. Pulmonary epithelial lining fluid concentration represented 40% of the plasma concentration. Airway concentrations exceeded the MIC breakpoint for susceptible respiratory pathogens (≤ 2 μg/mL) for a short time at 48 hours after administration. The plasma and interstitial fluid concentrations of tulathromcyin were lower than the concentrations in pulmonary fluid throughout the study. The bronchial concentrations were higher than the plasma or interstitial concentrations, with over 900

  8. Comparison of Active Drug Concentrations in the Pulmonary Epithelial Lining Fluid and Interstitial Fluid of Calves Injected with Enrofloxacin, Florfenicol, Ceftiofur, or Tulathromycin.

    PubMed

    Foster, Derek M; Martin, Luke G; Papich, Mark G

    2016-01-01

    Bacterial pneumonia is the most common reason for parenteral antimicrobial administration to beef cattle in the United States. Yet there is little information describing the antimicrobial concentrations at the site of action. The objective of this study was to compare the active drug concentrations in the pulmonary epithelial lining fluid and interstitial fluid of four antimicrobials commonly used in cattle. After injection, plasma, interstitial fluid, and pulmonary epithelial lining fluid concentrations and protein binding were measured to determine the plasma pharmacokinetics of each drug. A cross-over design with six calves per drug was used. Following sample collection and drug analysis, pharmacokinetic calculations were performed. For enrofloxacin and metabolite ciprofloxacin, the interstitial fluid concentration was 52% and 78% of the plasma concentration, while pulmonary fluid concentrations was 24% and 40% of the plasma concentration, respectively. The pulmonary concentrations (enrofloxacin + ciprofloxacin combined) exceeded the MIC90 of 0.06 μg/mL at 48 hours after administration. For florfenicol, the interstitial fluid concentration was almost 98% of the plasma concentration, and the pulmonary concentrations were over 200% of the plasma concentrations, exceeding the breakpoint (≤ 2 μg/mL), and the MIC90 for Mannheimia haemolytica (1.0 μg/mL) for the duration of the study. For ceftiofur, penetration to the interstitial fluid was only 5% of the plasma concentration. Pulmonary epithelial lining fluid concentration represented 40% of the plasma concentration. Airway concentrations exceeded the MIC breakpoint for susceptible respiratory pathogens (≤ 2 μg/mL) for a short time at 48 hours after administration. The plasma and interstitial fluid concentrations of tulathromcyin were lower than the concentrations in pulmonary fluid throughout the study. The bronchial concentrations were higher than the plasma or interstitial concentrations, with over 900

  9. Potential use of safer injecting facilities among injection drug users in Vancouver's Downtown Eastside

    PubMed Central

    Kerr, Thomas; Wood, Evan; Small, Dan; Palepu, Anita; Tyndall, Mark W.

    2003-01-01

    Background The Vancouver Coastal Health Authority will initiate North America's first sanctioned safer injecting facility, as a pilot project, on Sept. 15, 2003. The analyses presented here were conducted to estimate the potential use of safer injecting facilities by local illicit injection drug users (IDUs) and to evaluate the potential impact of newly established Health Canada restrictions and current police activities on the use of the proposed facility. Methods During April and May 2003, we recruited active IDUs in Vancouver's Downtown Eastside to participate in a feasibility study. We used descriptive and univariate statistics to determine potential use of a safer injecting facility and to explore factors associated with willingness to use such a facility with and without federal restrictions and police presence. Results Overall, 458 street-recruited IDUs completed an interviewer-administered survey, of whom 422 (92%) reported a willingness to use a safer injecting facility. Those expressing willingness were more likely to inject in public (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.9–8.0). When the restrictions in the Health Canada guidelines were considered, only 144 (31%) participants were willing to use a safer injecting facility. IDUs who inject alone were more likely (OR 1.8, 95% CI 1.0–3.1) and women were less likely (OR 0.6, 95% CI 0.4–0.9) to be willing to use a safer injecting facility operating under these restrictions. Only 103 (22%) of the participants said they would be willing to use a safer injecting facility if police were stationed near the entrance. Interpretation Most IDUs participating in this study expressed a willingness to use a safer injecting facility. However, willingness declined substantially when the IDUs were asked about using a facility operating under selected Health Canada restrictions and in the event that police were stationed near the entrance. PMID:14557313

  10. Predictors of Sharing Injection Equipment by HIV-Seropositive Injection Drug Users

    PubMed Central

    Latkin, Carl A.; Buchanan, Amy S.; Metsch, Lisa R.; Knight, Kelly; Latka, Mary H.; Mizuno, Yuko; Knowlton, Amy R.

    2009-01-01

    Among HIV-positive injection drug users (IDUs), we examined baseline predictors of lending needles and syringes, and sharing cookers, cotton, and rinse water in the prior 3 months at follow-up. Participants were enrolled in INSPIRE, a secondary prevention intervention for sexually active HIV-positive IDUs in four US cities during 2001–2005. The analyses involved 357 participants who reported injecting drugs in the prior six months at either the 6- or 12-months follow-up visit. About half (49%) reported at least one sharing episode. In adjusted analyses, peer norms supporting safer injection practices, and having primary HIV medical care visits in the prior 6 months were associated with reporting no sharing of injection equipment. Higher levels of psychological distress was associated with a greater likelihood of reporting drug paraphernalia sharing. These findings suggest that intervention approaches for reducing HIV-seropositive IDUs’ transmission of blood-borne infections should include peer-focused interventions to alter norms of drug paraphernalia sharing and promoting primary HIV care and mental health services. PMID:19186356

  11. Predictors of sharing injection equipment by HIV-seropositive injection drug users.

    PubMed

    Latkin, Carl A; Buchanan, Amy S; Metsch, Lisa R; Knight, Kelly; Latka, Mary H; Mizuno, Yuko; Knowlton, Amy R

    2008-12-01

    Among HIV-positive injection drug users (IDUs), we examined baseline predictors of lending needles and syringes and sharing cookers, cotton, and rinse water in the prior 3 months at follow-up. Participants were enrolled in Intervention for Seropositive Injectors-Research and Evaluation, a secondary prevention intervention for sexually active HIV-positive IDUs in 4 US cities during 2001-2005. The analyses involved 357 participants who reported injecting drugs in the prior 6 months at either the 6- or 12-month follow-up visit. About half (49%) reported at least 1 sharing episode. In adjusted analyses, peer norms supporting safer injection practices and having primary HIV medical care visits in the prior 6 months were associated with reporting no sharing of injection equipment. Higher levels of psychological distress were associated with a greater likelihood of reporting drug paraphernalia sharing. These findings suggest that intervention approaches for reducing HIV-seropositive IDUs' transmission of blood-borne infections should include peer-focused interventions to alter norms of drug paraphernalia sharing and promoting primary HIV care and mental health services. PMID:19186356

  12. Factors associated with recent-onset injection drug use among drug users in Pakistan.

    PubMed

    Kuo, Irene; Ul-Hasan, Salman; Zafar, Tariq; Galai, Noya; Sherman, Susan G; Strathdee, Steffanie A

    2007-01-01

    Seventy-two recent-onset injection drug users and 241 non-injection drug users were recruited in Quetta and Lahore, Pakistan, in 2003. Trained interviewers administered questionnaires regarding drug use behaviors and perceived changes in drug cost/supply. Logistic regression identified independent correlates of recent-onset injection. In Lahore, a perceived increase in drug cost was associated with higher odds of recent-onset injection, with no association in Quetta. Recent-onset injection was also associated with family history of drug use, group drug use, and sharing snorting/chasing tools. Changes in perception of the drug supply may be associated with recent-onset injection drug use. Familial/social influences were also associated with recent-onset injection, suggesting peer-led interventions could discourage transition to injection drug use. PMID:17613949

  13. Treatment of severe motion sickness with antimotion sickness drug injections

    NASA Technical Reports Server (NTRS)

    Graybiel, Ashton; Lackner, James R.

    1987-01-01

    This report concerns the use of intramuscular injections of scopolamine, promethazine, and dramamine to treat severely motion sick individuals participating in parabolic flight experiments. The findings indicate that a majority of individuals received benefit from 50-mg injections of promethazine or 0.5 mg-injections of scopolamine. By contrast, 50-mg injections of dramamine and 25-mg injections of promethazine were nonbeneficial. The use of antimotion drug injections for treating space motion sickness is discussed.

  14. Control over Drug Acquisition, Preparation, and Injection: Implications for HIV and HCV Risk among Young Female Injection Drug Users

    PubMed Central

    Wagner, Karla D.; Jackson Bloom, Jennifer; Hathazi, Susan Dodi; Sanders, Bill; Lankenau, Stephen E.

    2013-01-01

    Young female injection drug users (IDUs) are at risk for HIV/HCV, and initiating the use of a new drug may confer additional and unexpected risks. While gender differences in the social context of injection drug use have been identified, it is unknown whether those differences persist during the initiation of a new drug. This mixed-methods study examined the accounts of 30 young female IDUs in Los Angeles, CA, USA from 2004 to 2006, who described the social context of initiating injection drug use and initiating ketamine injection. The analysis aimed to understand how the social context of young women's injection events contributes to HIV/HCV risk. Women's initiation into ketamine injection occurred approximately 2 years after their first injection of any drug. Over that time, women experienced changes in some aspects of the social context of drug injection, including the size and composition of the using group. A significant proportion of women described injection events characterized by a lack of control over the acquisition, preparation, and injection of drugs, as well as reliance on friends and sexual partners. Findings suggest that lack of control over drug acquisition, preparation, and injection may elevate women's risk; these phenomena should be considered as a behavioral risk factor when designing interventions. PMID:24364027

  15. Injection drug users’ involvement in drug dealing in the downtown eastside of Vancouver: Social organization and systemic violence

    PubMed Central

    Small, Will; Maher, Lisa; Lawlor, Jeff; Wood, Evan; Shannon, Kate; Kerr, Thomas

    2014-01-01

    Background Illicit drug markets are a key component of the risk environment surrounding injection drug use. However, relatively few studies have explored how injection drug users’ (IDUs) involvement in drug dealing shapes their experiences of drug market-related harm. This exploratory qualitative study aims to understand IDUs’ dealing activities and roles, as well as the perceived benefits and risks related to participation in illicit drug markets, including experiences of drug market violence. Methods Ten IDUs with extensive involvement in drug dealing activities were recruited from the Vancouver Injection Drug User Study (VIDUS) and participated in semi-structured qualitative interviews, which elicited discussion of experiences dealing drugs, perceived benefits and hazards related to dealing, and understandings of drug market violence. Results Participant's involvement in drug market activities included corporate sales, freelance or independent sales, and opportunistic sales termed “middling” as well as drug market-related hustles entailing selling bogus drugs and robbing dealers. Participants primarily dealt drugs to support their own illicit drug use, and we found that arrest and criminal justice involvement, hazards stemming from drug debts, and drug market-related violence were key risks related to dealing activities. Conclusion The challenges of managing personal consumption while selling drugs exacerbates the hazards associated with drug dealing. Efforts to address drug dealing among IDUs should consider both drug dependency and the material conditions that propel drug users towards dealing activities. Interventions should explore the potential of combining enhanced drug treatment programs with low threshold employment and alternative income generation opportunities. PMID:23664788

  16. First injection of ketamine among young injection drug users (IDUs) in three U.S. cities

    PubMed Central

    Lankenau, Stephen E.; Sanders, Bill; Bloom, Jennifer Jackson; Hathazi, Dodi; Alarcon, Erica; Tortu, Stephanie; Clatts, Michael C.

    2007-01-01

    Ketamine, a dissociative anesthetic, has emerged as an increasingly common drug among subgroups of young injection drug users (IDUs) in cities across the United States. In-depth qualitative interviews were conducted with 213 young IDUs aged 16–28 years recruited in New York, New Orleans, and Los Angeles between 2004 and 2006. While some initiated injection drug use with ketamine, the drug was more frequently injected by IDUs with extensive polydrug using histories. IDUs initiating with ketamine commonly self-injected via an intramuscular mode of administration. The injection group provided crucial knowledge and material resources that enabled the injection event to occur, including ketamine, syringes, and injection skills. Injection paraphernalia was commonly shared during the first injection of ketamine, particularly vials of pharmaceutically-packaged liquid ketamine. Injection events infrequently occurred in a rave or club and more typically in a private home, which challenges ketamine’s designation as a ‘club’ drug. The first injection of ketamine was a noteworthy event since it introduced a novel drug or new mode of administration to be further explored by some, or exposed others to a drug to be avoided in the future. Risk reduction messages directed towards young IDUs should be expanded to include ketamine. PMID:16979848

  17. Incarceration is associated with used syringe lending among active injection drug users with detectable plasma HIV-1 RNA: a longitudinal analysis

    PubMed Central

    2013-01-01

    Background Informed by recent studies demonstrating the central role of plasma HIV-1 RNA viral load (VL) on HIV transmission, interventions to employ HIV antiretroviral treatment as prevention (TasP) are underway. To optimize these efforts, evidence is needed to identify factors associated with both non-suppressed VL and HIV risk behaviours. Thus, we sought to assess the possible role played by exposure to correctional facilities on VL non-suppression and used syringe lending among HIV-seropositive people who use injection drugs (PWID). Methods We used data from the ACCESS study, a community-recruited prospective cohort. We used longitudinal multivariate mixed-effects analyses to estimate the relationship between incarceration and plasma HIV-1 RNA > 500 copies/mL among antiretroviral therapy (ART)-exposed active PWID and, during periods of non-suppression, the relationship between incarceration and used syringe lending. Results Between May 1996 and March 2012, 657 ART-exposed PWID were recruited. Incarceration was independently associated with higher odds of VL non-suppression (Adjusted Odds Ratio [AOR] = 1.54, 95% Confidence Interval [95% CI]: 1.10, 2.16). In a separate multivariate model restricted to periods of VL non-suppression, incarceration was independently associated with lending used syringes (AOR = 1.81, 95% CI: 1.03, 3.18). Conclusions The current findings demonstrate that incarceration is associated with used syringe lending among active PWID with detectable plasma HIV-1 RNA. Our results provide a possible pathway for the commonly observed association between incarceration and increased risk of HIV transmission. Our results suggest that alternatives to incarceration of non-violent PWID and evidence-based combination HIV prevention interventions for PWID within correctional facilities are urgently needed. PMID:24289651

  18. Injecting Equipment Sharing in Russian Drug Injecting Dyads

    PubMed Central

    Gyarmathy, V. Anna; Li, Nan; Tobin, Karin E.; Hoffman, Irving F.; Sokolov, Nikolai; Levchenko, Julia; Batluk, Julia; Kozlov, Andrei A.; Kozlov, Andrei P.; Latkin, Carl A.

    2010-01-01

    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. PMID:19214731

  19. Drug delivery from injectable calcium phosphate foams by tailoring the macroporosity-drug interaction.

    PubMed

    Pastorino, David; Canal, Cristina; Ginebra, Maria-Pau

    2015-01-01

    In this work, novel injectable calcium phosphate foams (CPFs) were combined with an antibiotic (doxycycline) to design an innovative dosage form for bone regeneration. The material structure, its drug release profile and antibiotic activity were investigated, while its clinical applicability was assessed through cohesion and injectability tests. Doxycycline had a clear effect on both the micro and macro structure of the CPFs, owing to its role as a nucleating agent of hydroxyapatite and to a drying effect on the paste. Doxycycline-loaded CPFs presented interconnected macroporosity, which increased drug availability compared with calcium phosphate cements, and was a critical parameter controlling the release kinetics which followed a non-Fickian diffusion model. Up to 55% (1mg) of the drug was released progressively in 5days, the percentage released being proportional to the macroporosity of the CPFs. All doxycycline-containing foams had immediate cohesion and were injectable. Moreover, antibacterial activity was observed against Staphylococcus aureus and Escherichia coli. Thus, in addition to enhancing osteoconduction and material resorption, macroporosity enables tuning of the local delivery of drugs from injectable calcium phosphates. PMID:25448345

  20. Prevalence and correlates of neck injection among people who inject drugs in Tijuana, Mexico

    PubMed Central

    RAFFUL, CLAUDIA; WAGNER, KARLA D.; WERB, DAN; GONZÁLEZ-ZÚÑIGA, PATRICIA E.; VERDUGO, SILVIA; RANGEL, GUDELIA; STRATHDEE, STEFFANIE A.

    2016-01-01

    Introduction and Aims Injecting drugs in the neck has been related to adverse health conditions such as jugular vein thrombosis, deep neck infections, aneurysm, haematomas, airway obstruction, vocal cord paralysis and wound botulism, among others. We identified prevalence and correlates of neck injection among people who inject drugs (PWID) in Tijuana, Mexico. Design and Methods Beginning in 2011, PWID aged ≥18 years who injected drugs within the last month were recruited into a prospective cohort. At baseline and semi-annually, PWID completed interviewer-administered surveys soliciting data on drug-injecting practices. Logistic regression was used to identify predictors of injecting in the neck as the most frequent injection site at a single visit. Results Of 380 PWID, 35.3% injected in the neck at least once in the past 6 months, among whom 71.6% reported it as their most common injection site, the most common injecting site after the arms (47%). Controlling for age, years injecting and injecting frequency, injecting heroin and methamphetamine two or more times per day and having sought injection assistance were associated with injecting in the neck [adjusted odds ratios (AOR): 2.12; 95% confidence intervals (CI): 1.27–3.53 and AOR: 2.65; 95% CI: 1.52–4.53 respectively]. Discussion and Conclusions Injecting in the neck was very common among PWID in Tijuana and was associated with polydrug use and seeking injection assistance. Tailoring harm reduction education interventions for individuals who provide injection assistance (‘hit doctors’) may allow for the dissemination of safe injecting knowledge to reduce injection-related morbidity and mortality. PMID:25867795

  1. Hepatitis C virus infection in a large cohort of homosexually active men: independent associations with HIV-1 infection and injecting drug use but not sexual behaviour.

    PubMed Central

    Bodsworth, N J; Cunningham, P; Kaldor, J; Donovan, B

    1996-01-01

    OBJECTIVE: To determine the prevalence and risk factors for hepatitis C virus (HCV) infection in a cohort of homosexually active men, with particular reference to assessing sexual transmission. DESIGN: Prevalence based on cross-sectional testing for HCV (c100 protein) antibody in a cohort using sera stored between 1984 and 1989, and assessment of risk factors using a case-control analysis based on questionnaire data from HCV positive and negative subjects. SUBJECTS/SETTING: 1038 homosexually active men who were participating in a prospective study established to identify risk factors for AIDS. They had been recruited through private and public primary care and sexually transmissible disease (STD) services in central Sydney. MAIN OUTCOME MEASURES: Prevalence of HCV antibody and its association with human immunodeficiency virus type 1 (HIV-1) infection and other STDs, number of sexual partners, sexual practices and recreational drug use. RESULTS: Overall, 7.6% of subjects tested were seropositive for HCV antibody. In univariate analysis, HCV infection was significantly associated with injecting drug use (IDU) (OR = 8.18, p < 0.0001) and HIV infection (OR = 3.14, p < 0.0001) and with self reported history of syphilis (OR = 1.88, p = 0.016), anogenital herpes (OR = 1.93, p = 0.017), gonorrhoea (OR = 2.43, p = 0.009) and hepatitis B (OR = 1.92, p = 0.010). In case control analysis, similar sexual behaviours (partner numbers and practices) were reported by HCV positive and HCV negative subjects except that HCV negative subjects more frequently reported engaging than HCV positive subject in unprotected receptive anal intercourse without ejaculation (OR = 0.61, p = 0.034), unprotected insertive (OR = 0.59, p = 0.039) and receptive (OR = 0.56, p = 0.016) oro-anal intercourse (rimming) and insertive fisting (OR = 0.48, p = 0.034). In multiple logistic regression analyses, only HIV-1 infection (OR = 3.18, p < 0.0001) and IDU in the previous six months (OR = 7.24, p < 0

  2. Clostridium novyi causing necrotising fasciitis in an injecting drug user

    PubMed Central

    Noone, M; Tabaqchali, M; Spillane, J B

    2002-01-01

    Necrotising fasciitis with pronounced local oedema is described in an injecting drug user. Clostridium novyi was an unexpected single pathogen isolated from infected tissue. The patient was among a cluster of cases, all injecting drug users, presenting with toxaemia and soft tissue infection. The causal role and pathogenicity of C novyi is discussed. PMID:11865011

  3. Side Effects of Injectable Fertility Drugs (Gonadotropins)

    MedlinePlus

    ... usually are used during fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF). Injections of gonadotropins ... Gestation. When using injectable gonadotropins alone or with IUI, up to 30% of pregnancies are associated with ...

  4. Non-Injection Drug Use Patterns and History of Injection among Street Youth

    PubMed Central

    Hadland, Scott E.; Kerr, Thomas; Marshall, Brandon D.L.; Small, William; Lai, Calvin; Montaner, Julio S.; Wood, Evan

    2010-01-01

    Aims Efforts to prevent youth from initiating injection drug use require an understanding of the drug use patterns that predispose to injecting. Here we identify such patterns and describe the circumstances of first injection among street youth. Methods From October 2005 to November 2007, data were collected for the At Risk Youth Study, a prospective cohort of 560 street-recruited youth aged 14–26 in Vancouver, Canada. Non-injection drug use behaviors were compared between those with and without a history of injection through multiple logistic regression. The circumstances of first injection were also examined in gender-stratified analyses. Results Youth who had previously injected were more likely to have engaged in non-injection use of heroin or of crystal methamphetamine. Daily users of marijuana were less likely to have injected. Among prior injectors, the median age of first injection was lower among females. Females were also more likely to have had a sexual partner present at first injection and to have become a regular injector within one week of initiation. Conclusion Preventing transition to injection among street youth may require special attention to predisposing drug use patterns and should acknowledge gender differences in the circumstances of first injection. PMID:20130409

  5. Injectable micellar supramolecular hydrogel for delivery of hydrophobic anticancer drugs.

    PubMed

    Fu, CuiXiang; Lin, XiaoXiao; Wang, Jun; Zheng, XiaoQun; Li, XingYi; Lin, ZhengFeng; Lin, GuangYong

    2016-04-01

    In this paper, an injectable micellar supramolecular hydrogel composed of α-cyclodextrin (α-CD) and monomethoxy poly(ethylene glycol)-b-poly(ε-caplactone) (MPEG5000-PCL5000) micelles was developed by a simple method for hydrophobic anticancer drug delivery. By mixing α-CD aqueous solution and MPEG5000-PCL5000 micelles, an injectable micellar supramolecular hydrogel could be formed under mild condition due to the inclusion complexation between α-CD and MPEG segment of MPEG5000-PCL5000 micelles. The resultant supramolecular hydrogel was thereafter characterized by X-ray diffraction (XRD) and Scanning electron microscopy (SEM). The effect of α-CD amount on the gelation time, mechanical strength and thixotropic property was studied by a rheometer. Payload of hydrophobic paclitaxel (PTX) to supramolecular hydrogel was achieved by encapsulation of PTX into MPEG5000-PCL5000 micelles prior mixing with α-CD aqueous solution. In vitro release study showed that the release behavior of PTX from hydrogel could be modulated by change the α-CD amount in hydrogel. Furthermore, such supramolecular hydrogel could enhance the biological activity of encapsulated PTX compared to free PTX, as indicated by in vitro cytotoxicity assay. All these results indicated that the developed micellar supramolecular hydrogel might be a promising injectable drug delivery system for anticancer therapy. PMID:26886821

  6. [Drugs administration by subcutaneous injection within palliative care].

    PubMed

    Tanguy-Goarin, Charlotte; Cogulet, Virginie

    2010-01-01

    Drugs delivery by subcutaneous injection is often the last resort/appeal for a doctor anxious to limit the aggressive and invasive treatments, particularly within palliative care. A review was made to list the drugs which can be administered by this route. Concerned antibiotics are teicoplanin, netilmicin and gentamicin with a risk of skin necrosis for aminoglycosids. Midazolam is useful in various indications and can be associated with morphine in case of dyspnoea. Data about subcutaneous injection of dexamethasone, clonazepam, haloperidol and levomepromazine are published; it is the same for fentanyl, nefopam, ondansetron and metoclopramide. The subcutaneous injection of these quoted drugs is possible, but requires further studies. PMID:21176759

  7. INJECTION DRUG USE AND HIV ANTIRETROVIRAL THERAPY DISCONTINUATION IN A CANADIAN SETTING

    PubMed Central

    Werb, Dan; Milloy, M-J; Kerr, Thomas; Zhang, Ruth; Montaner, Julio; Wood, Evan

    2016-01-01

    We investigated whether drug-related behaviors predicted antiretroviral therapy (ART) discontinuation among a cohort of injection drug users (IDU) in a Canadian setting. Cox regression analyses were used to investigate the impact of drug use patterns on rates of ART discontinuation among a sample of HIV-positive IDU in Vancouver, Canada between May 1996 and April 2008. In total, 408 HIV-positive IDU initiated ART during the study period, among whom 257 (63.0%) discontinued ART at least once. Rates of ART discontinuation were not significantly elevated among those who reported ongoing injection of heroin, cocaine, or other illicit drugs in comparison to those who reported not injecting drugs. However, public drug use was significantly predictive of ART discontinuation. Our findings may contribute to a reconsideration of the role of active drug use in determining retention in ART programs among IDU. PMID:22249956

  8. Income Level and Drug Related Harm among People Who Use Injection Drugs in a Canadian Setting

    PubMed Central

    Long, Cathy; DeBeck, Kora; Feng, Cindy; Montaner, Julio; Wood, Evan; Kerr, Thomas

    2014-01-01

    Background Higher income is generally associated with better health outcomes; however, among people who inject drugs (IDU) income generation frequently involves activities, such as sex work and drug dealing, which pose significant health risks. Therefore, we sought to examine the relationship between level of income and specific drug use patterns and related health risks. Methods This study involved IDU participating in a prospective cohort study in Vancouver, Canada. Monthly income was categorized based on non-fixed quartiles at each follow-up with the lowest level serving as the reference category in generalized linear mixed-effects regression. Results Among our sample of 1,032 IDU, the median average monthly income over the study follow-up was $1050 [Interquartile range=785–2000]. In multivariate analysis, the highest income category was significantly associated with sex work (Adjusted Odds Ratio [AOR]=7.65), drug dealing (AOR=5.06), daily heroin injection (AOR=2.97), daily cocaine injection (AOR=1.65), daily crack smoking (AOR=2.48), binge drug use (AOR=1.57) and unstable housing (AOR=1.67). The high income category was negatively associated with being female (AOR=0.61) and accessing addiction treatment (AOR=0.64), (all p < 0.05). In addition, higher income was strongly associated with higher monthly expenditure on drugs (>$400) (OR=97.8). Conclusion Among IDU in Vancouver, average monthly income levels were low and higher total monthly income was linked to high-risk income generation strategies as well as a range of drug use patterns characteristic of higher intensity addiction and HIV risk. These findings underscore the need for interventions that provide economic empowerment and address high intensity addiction, especially for female IDU. PMID:24380808

  9. Cutaneous manifestations of injectable drug use: hidden secrets.

    PubMed

    Barańska-Rybak, Wioletta; Błażewicz, Izabela; Kąkol, Monika; Roter, Mirosław; Nowicki, Roman

    2014-04-01

    Abscesses related to drug use are the most common cutaneous manifestations among injection drug users, often occurring when the veins become less accessible. In these cases, other techniques may be used to administer drugs, such as skin popping (subcutaneous injection) or muscle popping (intramuscular injection). The main risk factors for abscess formation include skin popping, use of unsterilized needles, and injection of speedball (a mixture of cocaine and heroin). We present a case of recurrent abscesses accompanied by fever, hypersomnia alternating with insomnia, diaphoresis, fatigue, recent weight loss, and agitation following subcutaneous injection of a tramadol, opipramol, and clonazepam mixture. Differential diagnoses included pyoderma gangrenosum on the basis of hepatitis C virus, skin lesions connected with human immunodeficiency virus infection, vasculitis, endocarditis, and serotonin syndrome. The patient was treated with oral antibiotics, surgical incision, and drainage of the abscesses, with consequent improvement. PMID:24818177

  10. Injected Drug May Help Fight Osteoporosis in Women

    MedlinePlus

    ... fullstory_160452.html Injected Drug May Help Fight Osteoporosis in Women Abaloparatide appears to reduce fractures better ... risk of bone fractures in postmenopausal women with osteoporosis better than a placebo and the currently available ...

  11. Longitudinal Trajectories of Ketamine Use among Young Injection Drug Users

    PubMed Central

    Lankenau, Stephen E.; Bloom, Jennifer Jackson; Shin, Charles

    2010-01-01

    Background Ketamine is a dissociative anesthetic that became increasing popular in the club and rave scene in the 1980s and 1990s. Reports surfaced in the late 1990s indicating that ketamine was being injected in several U.S. cities by young injection drug users (IDUs). Since all studies on ketamine injection were cross-sectional, a longitudinal study was undertaken in 2005 to determine: characteristics of young IDUs who continue to inject ketamine; frequency of ketamine injection over an extended time period; risks associated with ongoing ketamine injection; and environmental factors that impact patterns of ketamine use. Methods Young IDUs aged 16 to 29 with a history of injecting ketamine (n=101) were recruited from public locations in Los Angeles and followed during a two-year longitudinal study. A semi-structured instrument captured quantitative and qualitative data on patterns of ketamine injection and other drug use. A statistical model sorted IDUs who completed three or more interviews (n=66) into three groups based upon patterns of ketamine injection at baseline and follow-up. Qualitative analysis focused on detailed case studies within each group. Results IDUs recruited at baseline were typically in their early 20s, male, heterosexual, white, and homeless. Longitudinal injection trajectories included: “Moderates,” who injected ketamine several times per year (n=5); “Occasionals,” who injected ketamine approximately once per year (n=21); and “Abstainers,” who did not inject any ketamine during follow-up (n=40). Findings suggest that ketamine is infrequently injected compared to other drugs such as heroin, cocaine, and methamphetamine. Most IDUs who begin injecting ketamine will stop or curb use due to: negative or ambivalent experiences associated with ketamine; an inability to find the drug due to declining supply; or maturing out of injecting drugs more generally. Conclusion Reducing ketamine injection among young IDUs may best be accomplished

  12. Prevention and Treatment of Hepatitis C in Injection Drug Users

    PubMed Central

    Edlin, Brian R.

    2005-01-01

    Injection drug users constitute the largest group of persons infected with the hepatitis C virus (HCV) in the United States, and most new infections occur in drug users. Controlling hepatitis C in the U.S. population, therefore, will require developing, testing, and implementing effective prevention and treatment strategies for persons who inject drugs. Fortunately, a substantial body of research and clinical experience exists on the prevention and management of chronic viral diseases among injection drug users. The need to implement interventions to stop the spread of HCV among drug users is critical. The capacity of substance-use treatment programs need to be expanded to accommodate all who want and need treatment. Physicians and pharmacists should be educated in how to provide access to sterile syringes and to teach safe injection techniques, both of which are lifesaving interventions. The treatment of hepatitis C in drug users requires an interdisciplinary approach that brings together expertise in treating hepatitis and caring for drug users. Treatment decisions should be made individually by patients with their physicians, based on a balanced assessment of risks and benefits and the patient's personal values. Physicians should carefully assess, monitor, and support adherence and mental health in all patients, regardless of whether drug use is known or suspected. Research is needed to better understand how best to prevent and treat hepatitis C in substance users. In the meantime, substantial progress can be made if existing knowledge and resources are brought to bear. PMID:12407596

  13. Needle and Syringe Cleaning Practices among Injection Drug Users.

    ERIC Educational Resources Information Center

    Fisher, Dennis G.; Harbke, Colin R.; Canty, John R.; Reynolds, Grace L.

    2002-01-01

    Evaluates the effect of needle exchange on the bleach-mediated disinfection (BMD) practices of 176 needle and syringe sharing injection drug users (IDUs). Results reveal that IDUs who traded sex for money or drugs were less likely to practice BMD, and IDUs who reported a reduced number of sex partners were more likely to practice BMD. (Contains 36…

  14. Drug-Related HIV Risk Behaviors and Cocaine Preference among Injection Drug Users in Los Angeles.

    ERIC Educational Resources Information Center

    Longshore, Douglas; And Others

    1993-01-01

    Compared drug-related risk behavior of drug users whose preferred injection drug was cocaine and users with preference for heroin or no preference between the two drugs (total n=422). Found cocaine preference unrelated to likelihood of needle sharing overall, needle sharing with strangers, needle sharing at shooting galleries, and failure to use…

  15. Gender Influences on Initiation of Injecting Drug Use

    PubMed Central

    Ahamad, Keith; DeBeck, Kora; Feng, Cindy; Sakakibara, Todd; Kerr, Thomas; Wood, Evan

    2015-01-01

    Background and Objectives Gender differences in illicit drug use patterns and related harms (e.g. HIV infection) are becoming increasingly recognized. However, little research has examined gender differences in risk factors for initiation into injecting drug use. We undertook this study to examine the relationship between gender and risk of injection initiation among street-involved youth and to determine whether risk factors for initiation differed between genders. Methods From September 2005 to November 2011, youth were enrolled into the At-Risk Youth Study, a cohort of street-involved youth aged 14-26 in Vancouver, Canada. Cox regression analyses were used to assess variables associated with injection initiation and stratified analyses considered risk factors for injection initiation among male and female participants separately. Results Among 422 street-involved youth, 133 (32.5%) were female, and 77 individuals initiated injection over study follow-up. Although rates of injection initiation were similar between male and female youth (p =0.531), stratified analyses demonstrated that, among male youth, risk factors for injection initiation included sex work (Adjusted Hazard Ratio [AHR] =4.74, 95% Confidence Intervals [CI]: 1.45–15.5) and residence within the city's drug use epicentre (AHR =1.95, 95% CI: 1.12–3.41), whereas among female youth, non-injection crystal methamphetamine use (AHR =4.63, 95% CI: 1.89– 11.35) was positively associated with subsequent injection initiation. Conclusion Although rates of initiation into injecting drug use were similar for male and female street youth, the risk factors for initiation were distinct. These findings suggest a possible benefit of uniquely tailoring prevention efforts to high-risk males and females. PMID:24405226

  16. The HIV/AIDS epidemic and changes in injecting drug use in Buenos Aires, Argentina.

    PubMed

    Rossi, Diana; Pawlowicz, María Pía; Rangugni, Victoria; Singh, Dhan Zunino; Goltzman, Paula; Cymerman, Pablo; Vila, Marcelo; Touzé, Graciela

    2006-04-01

    This article discusses the changes in injecting drug use from 1998 to 2003 in Buenos Aires, Argentina. The Rapid Situation Assessment and Response methodology was used to obtain the information. Quantitative and qualitative techniques were triangulated: 140 current IDUs and 35 sex partners of injection drug users (IDUs) were surveyed; 17 in-depth interviews with the surveyed IDUs and 2 focus groups were held, as well as ethnographic observations. The way in which risk and care practices among injecting drug users changed and the influence of the HIV/ AIDS epidemic on this process are described. In recent years, the frequency of injection practices and sharing of injecting equipment has decreased, while injecting drug use is a more hidden practice in a context of increasing impact of the disease in the injecting drug use social networks and changes in the price and quality of drugs. Knowledge about these changes helps build harm reduction activities oriented to IDUs in their particular social context. PMID:16612428

  17. Initiation into Prescription Opioid Misuse among Young Injection Drug Users

    PubMed Central

    Lankenau, Stephen E.; Teti, Michelle; Silva, Karol; Bloom, Jennifer Jackson; Harocopos, Alex; Treese, Meghan

    2011-01-01

    Background Prescription opioids are the most frequently misused class of prescription drugs among young adults. Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence and fatal overdose. Descriptive data about initiation into prescription opioid misuse among young injection drug users (IDUs) are scarce. Methods An exploratory qualitative study was undertaken to describe patterns of initiation into prescription opioid misuse among IDUs aged 16 to 25 years. Those young IDUs who had misused a prescription drug at least three times in the past three months were recruited during 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analysed both quantitatively and qualitatively. Results Initiation into prescription opioid misuse was facilitated by easy access to opioids via participant’s own prescription, family, or friends, and occurred earlier than misuse of other illicit drugs, such as heroin. Nearly all transitioned into sniffing opioids, most injected opioids, and many initiated injection drug use with an opioid. Motives for transitions to sniffing and injecting opioids included obtaining a more potent high and/or substituting for heroin; access to multiple sources of opioids was common among those who progressed to sniffing and injecting opioids. Conclusion Prescription opioid misuse was a key feature of trajectories into injection drug use and/or heroin use among this sample of young IDUs. A new pattern of drug use may be emerging whereby IDUs initiate prescription opioid misuse before using heroin. PMID:21689917

  18. Impact of length of injecting career on HIV incidence among people who inject drugs.

    PubMed

    Montain, Jacqueline; Ti, Lianping; Hayashi, Kanna; Nguyen, Paul; Wood, Evan; Kerr, Thomas

    2016-07-01

    We examined the relationship between duration of injecting career and HIV seroconversion among people who inject drugs (PWID) in Vancouver, Canada. Data were derived from HIV-negative PWID enrolled in a prospective cohort study. We employed Kaplan-Meier methods and Cox regression to investigate the effect of length of time since injection drug use initiation on time to HIV seroconversion. In multivariable Cox analysis, duration of injecting career was negatively associated with time to HIV seroconversion (adjusted hazard ratio=0.82; 95% confidence interval [CI]: 0.69-0.97). Our findings highlight the need for interventions that target individuals who participate in high-risk drug use behaviors. PMID:26921723

  19. Associations Between Injection Risk and Community Disadvantage Among Suburban Injection Drug Users in Southwestern Connecticut, USA

    PubMed Central

    Barbour, Russell; Palacios, Wilson R.; Nichols, Lisa G.; Grau, Lauretta E.

    2013-01-01

    Increases in drug abuse, injection, and opioid overdoses in suburban communities led us to study injectors residing in suburban communities in southwestern Connecticut, US. We sought to understand the influence of residence on risk and injection-associated diseases. Injectors were recruited by respondent-driven sampling and interviewed about sociodemographics, somatic and mental health, injection risk, and interactions with healthcare, harm reduction, substance abuse treatment, and criminal justice systems. HIV, hepatitis B and C (HBV and HCV) serological testing was also conducted. Our sample was consistent in geographic distribution and age to the general population and to the patterns of heroin-associated overdose deaths in the suburban towns. High rates of interaction with drug abuse treatment and criminal justice systems contrasted with scant use of harm reduction services. The only factors associated with both dependent variables—residence in less disadvantaged census tracts and more injection risk—were younger age and injecting in one’s own residence. This contrasts with the common association among urban injectors of injection-associated risk behaviors and residence in disadvantaged communities. Poor social support and moderate/severe depression were associated with risky injection practices (but not residence in specific classes of census tracts), suggesting that a region-wide dual diagnosis approach to the expansion of harm reduction services could be effective at reducing the negative consequences of injection drug use. PMID:23921583

  20. Patterns of Ketamine Use Among Young Injection Drug Users†

    PubMed Central

    Lankenau, Stephen E.; Sanders, Bill

    2007-01-01

    Ketamine is a dissociative anesthetic that has emerged as an increasingly popular choice among young drug users. Recent research indicates the presence of hidden populations of young people who inject ketamine in New York and other U.S. cities. Applying an ethno-epidemiological approach, the authors recruited 40 young injection drug users (IDUs) (< 25 years old) in New York City to explore health risks associated with ketamine use. This analysis looks at the varying patterns and frequencies of ketamine injection by examining personal, social, and cultural aspects of these young people’s lives. We learned that drug-using histories, experiential dimensions, sociocultural characteristics, and associations with other young people help account for the different patterns of injecting ketamine within the sample. In particular, these findings indicate that young people who were more frequent ketamine injectors had the following characteristics: initiated injection drug use with ketamine; enjoyed the effects of ketamine, were stably housed; lived in the vicinity of New York City; and associated with others who also injected ketamine. PMID:17523582

  1. Correlates of Risky Injection Practices among Past-Year Injection Drug Users among the US General Population

    PubMed Central

    Mancha, Brent E.; Hulbert, Alicia; Rudolph, Abby E.; Martins, Silvia S.

    2011-01-01

    Background With an estimated 1 million active injection drug users (IDUs), injection drug use continues to be a public health concern in the United States. Risky injection practices have been associated with the transmission of HIV, Hepatitis B and C, as well as other skin and soft tissue infections. Methods We used data from 463 respondents, aged 18 and older, who were past-year IDUs in the 2005–2008 National Survey of Drug Use and Health (NSDUH). We investigated correlates of risky injection behavior among these recent IDUs. Results Older age (≥35 versus 18–25) was associated with reusing one’s own needle at last injection (aOR=1.80 [1.02–3.17], as were past year heroin (aOR=2.59 [1.18–5.66]) and cocaine injection (aOR=2.17 [1.13–4.15]). Past year crack cocaine use was positively associated with not cleaning needles with bleach (aOR=2.18 [1.10–4.33]). Past year cocaine injection was associated with obtaining needles in a risky manner (aOR=2.29 [1.23–4.25]). Methamphetamine injection was associated with obtaining needles in less risky ways (aOR=0.41 [0.20–0.84]). Conclusion Our findings indicate that some IDUs are continuing to engage in high risk injection behaviors. The identification of potential at-risk populations of IDUs may have implications for harm reduction interventions and HIV prevention programs. PMID:21227602

  2. Injection drug use and HIV/AIDS transmission in China.

    PubMed

    Chu, Tian Xin; Levy, Judith A

    2005-01-01

    After nearly three decades of being virtually drug free, use of heroin and other illicit drugs has re-emerged in China as a major public health problem. One result is that drug abuse, particularly heroin injection, has come to play a predominant role in fueling China's AIDS epidemic. The first outbreak of HIV among China's IDUs was reported in the border area of Yunnan province between China and Myanmar where drug trafficking is heavy. Since then drug-related HIV has spread to all 31 provinces, autonomous regions and municipalities. This paper provides an overview to HIV/AIDS transmission through injection drug use in China. It begins with a brief history of the illicit drug trade in China, followed by a discussion of the emergence of drug related AIDS, and a profile of drug users and their sexual partners who have contracted the virus or who are vulnerable to infection. It ends by summarizing three national strategies being used by China to address both drug use and AIDS as major health threats. PMID:16354561

  3. Effectiveness of HIV prevention social marketing with injecting drug users.

    PubMed

    Gibson, David R; Zhang, Guili; Cassady, Diana; Pappas, Les; Mitchell, Joyce; Kegeles, Susan M

    2010-10-01

    Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide. PMID:20724686

  4. Deportation Experiences of Women Who Inject Drugs in Tijuana, Mexico

    PubMed Central

    Robertson, Angela M.; Lozada, Remedios; Vera, Alicia; Palinkas, Lawrence A.; Burgos, José Luis; Magis-Rodriguez, Carlos; Rangel, Gudelia; Ojeda, Victoria D.

    2013-01-01

    Deportation from the United States for drug offenses is common, yet the consequences of deportation for women drug users are poorly documented. In 2008, in Tijuana, Mexico, we conducted an exploratory qualitative study of migration, deportation, and drug abuse by interviewing 12 Mexican injection-drug-using women reporting U.S. deportation. Women reported heavy drug use before and after deportation, but greater financial instability and physical danger following deportation than when in the United States. We identified an unmet need for health and social services among deported drug-using women, including HIV prevention, drug treatment, physical and mental health services, and vocational training. Binational coordination is needed to help deported women resettle in Mexico. PMID:21917563

  5. Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran

    PubMed Central

    Razzaghi, Emran M; Movaghar, Afarin Rahimia; Green, Traci Craig; Khoshnood, Kaveh

    2006-01-01

    Background In Iran, there are an estimated 200,000 injecting drug users (IDUs). Injecting drug use is a relatively new phenomenon for this country, where opium smoking was the predominant form of drug use for hundreds of years. As in many countries experiencing a rise in injecting drug use, HIV/AIDS in Iran is associated with the injection of drugs, accounting for transmission of more than two-thirds of HIV infections. This study aimed to: describe the range of characteristics of IDUs in Tehran, Iran's capital city; 2) examine the injecting-related HIV risk behaviors of IDUs, and 3) suggest necessary interventions to prevent HIV transmission among IDUs and their families and sex partners. Methods Using rapid assessment and response methods with a qualitative focus, six districts of Tehran were selected for study. A total of 81 key informants from different sectors and 154 IDUs were selected by purposeful, opportunistic and snowball sampling, then interviewed. Ethnographic observations were done for mapping and studying injecting-related HIV risk settings and behaviors. Modified content analysis methods were used to analyze the data and extract typologies of injecting drug users in Tehran. Results Evidence of injecting drug use and drug-related harm was found in 5 of 6 study districts. Several profiles of IDUs were identified: depending on their socioeconomic status and degree of stability, IDUs employed different injecting behaviors and syringe hygiene practices. The prevalence of sharing injection instruments ranged from 30–100%. Varied magnitudes of risk were evident among the identified IDU typologies in terms of syringe disinfection methods, level of HIV awareness, and personal hygiene exhibited. At the time of research, there were no active HIV prevention programs in existence in Tehran. Conclusion The recent rise of heroin injection in Iran is strongly associated with HIV risk. Sharing injection instruments is a common and complex behavior among Iranian

  6. Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review

    PubMed Central

    Reid, Savanna R

    2009-01-01

    The reuse of injecting equipment in clinical settings is well documented in Africa and appears to play a substantial role in generalized HIV epidemics. The U.S. and the WHO have begun to support large scale injection safety interventions, increased professional education and training programs, and the development and wider dissemination of infection control guidelines. Several African governments have also taken steps to control injecting equipment, including banning syringes that can be reused. However injection drug use (IDU), of heroin and stimulants, is a growing risk factor for acquiring HIV in the region. IDU is increasingly common among young adults in sub-Saharan Africa and is associated with high risk sex, thus linking IDU to the already well established and concentrated generalized HIV epidemics in the region. Demand reduction programs based on effective substance use education and drug treatment services are very limited, and imprisonment is more common than access to drug treatment services. Drug policies are still very punitive and there is widespread misunderstanding of and hostility to harm reduction programs e.g. needle exchange programs are almost non-existent in the region. Among injection drug users and among drug treatment patients in Africa, knowledge that needle sharing and syringe reuse transmit HIV is still very limited, in contrast with the more successfully instilled knowledge that HIV is transmitted sexually. These new injection risks will take on increased epidemiological significance over the coming decade and will require much more attention by African nations to the range of effective harm reduction tools now available in Europe, Asia, and North America. PMID:19715601

  7. The filter of choice: filtration method preference among injecting drug users

    PubMed Central

    2011-01-01

    Background Injection drug use syringe filters (IDUSF) are designed to prevent several complications related to the injection of drugs. Due to their small pore size, their use can reduce the solution's insoluble particle content and thus diminish the prevalence of phlebitis, talcosis.... Their low drug retention discourages from filter reuse and sharing and can thus prevent viral and microbial infections. In France, drug users have access to sterile cotton filters for 15 years and to an IDUSF (the Sterifilt®) for 5 years. This study was set up to explore the factors influencing filter preference amongst injecting drug users. Methods Quantitative and qualitative data were gathered through 241 questionnaires and the participation of 23 people in focus groups. Results Factors found to significantly influence filter preference were duration and frequency of injecting drug use, the type of drugs injected and subculture. Furthermore, IDU's rationale for the preference of one type of filter over others was explored. It was found that filter preference depends on perceived health benefits (reduced harms, prevention of vein damage, protection of injection sites), drug retention (low retention: better high, protective mechanism against the reuse of filters; high retention: filter reuse as a protective mechanism against withdrawal), technical and practical issues (filter clogging, ease of use, time needed to prepare an injection) and believes (the conviction that a clear solution contains less active compound). Conclusion It was concluded that the factors influencing filter preference are in favour of change; a shift towards the use of more efficient filters can be made through increased availability, information and demonstrations. PMID:21859488

  8. Modeling Initiation into Drug Injection among Street Youth

    ERIC Educational Resources Information Center

    Roy, Elise; Godin, Gaston; Boudreau, Jean-Francois; Cote, Philippe-Benoit; Denis, Veronique; Haley, Nancy; Leclerc, Pascale; Boivin, Jean-Francois

    2011-01-01

    This study aimed at examining the predictors of initiation into drug injection among street youth using social cognitive theory framework. A prospective cohort study based on semi-annual interviews was carried out. Psychosocial determinants referred to avoidance of initiation. Other potential predictors were: sociodemographic characteristics,…

  9. Pregnancy and Sexual Health among Homeless Young Injection Drug Users

    ERIC Educational Resources Information Center

    Hathazi, Dodi; Lankenau, Stephen E.; Sanders, Bill; Bloom, Jennifer Jackson

    2009-01-01

    Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of…

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

    PubMed

    Muñoz, Fátima; Burgos, José Luis; Cuevas-Mota, Jazmine; Teshale, Eyasu; Garfein, Richard S

    2015-01-01

    Unsafe injection practices significantly increase the risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection among injection drug users (IDUs). We examined individual and socio-environmental factors associated with unsafe injection practices in young adult IDUs in San Diego, California. Of 494 IDUs, 46.9 % reported receptive syringe sharing and 68.8 % sharing drug preparation paraphernalia in the last 3 months. Unsafe injection practices were associated with increased odds of having friends who injected drugs with used syringes, injecting with friends or sexual partners, and injecting heroin. Perceived high susceptibility to HIV and perceived barriers to obtaining sterile syringes were associated with increased odds of receptive syringe sharing, but not with sharing injection paraphernalia. Over half the IDUs reported unsafe injection practices. Our results suggest that personal relationships might influence IDUs' perceptions that dictate behavior. Integrated interventions addressing individual and socio-environmental factors are needed to promote safe injection practices in this population. PMID:24920342

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

    PubMed Central

    Muñoz, Fátima; Burgos, José Luis; Cuevas-Mota, Jazmine; Teshale, Eyasu; Garfein, Richard S.

    2014-01-01

    Unsafe injection practices significantly increase the risk of hepatitis C virus and human immunodeficiency virus (HIV) infection among injection drug users (IDUs). We examined individual and socio-environmental factors associated with unsafe injection practices in young adult IDUs in San Diego, California. Of 494 IDUs, 46.9% reported receptive syringe sharing and 68.8% sharing drug preparation paraphernalia in the last 3 months. Unsafe injection practices were associated with increased odds of having friends who injected drugs with used syringes, injecting with friends, sexual partners, and injecting heroin. Perceived high susceptibility to HIV and perceived barriers to obtaining sterile syringes were associated with increased odds of receptive syringe sharing, but not with sharing injection paraphernalia. Over half IDUs reported unsafe injection practices, and our results suggest that personal relationships might influence IDUs’ perceptions that dictate behavior. Integrated interventions addressing individual and socio-environmental factors are needed to promote safe injection practices in this population. PMID:24920342

  12. An Injectable and Drug-loaded Supramolecular Hydrogel for Local Catheter Injection into the Pig Heart

    PubMed Central

    Tseng, Cheyenne C. S.; Bastings, Maartje M. C.; Koudstaal, Stefan; Agostoni, Pierfrancesco; Chamuleau, Steven A. J.; Dankers, Patricia Y. W.

    2015-01-01

    Regeneration of lost myocardium is an important goal for future therapies because of the increasing occurrence of chronic ischemic heart failure and the limited access to donor hearts. An example of a treatment to recover the function of the heart consists of the local delivery of drugs and bioactives from a hydrogel. In this paper a method is introduced to formulate and inject a drug-loaded hydrogel non-invasively and side-specific into the pig heart using a long, flexible catheter. The use of 3-D electromechanical mapping and injection via a catheter allows side-specific treatment of the myocardium. To provide a hydrogel compatible with this catheter, a supramolecular hydrogel is used because of the convenient switching from a gel to a solution state using environmental triggers. At basic pH this ureido-pyrimidinone modified poly(ethylene glycol) acts as a Newtonian fluid which can be easily injected, but at physiological pH the solution rapidly switches into a gel. These mild switching conditions allow for the incorporation of bioactive drugs and bioactive species, such as growth factors and exosomes as we present here in both in vitro and in vivo experiments. The in vitro experiments give an on forehand indication of the gel stability and drug release, which allows for tuning of the gel and release properties before the subsequent application in vivo. This combination allows for the optimal tuning of the gel to the used bioactive compounds and species, and the injection system. PMID:26132631

  13. Multiple routes of drug administration and HIV risk among injecting drug users

    PubMed Central

    Vorobjov, Sigrid; Uusküla, Anneli; Des Jarlais, Don C.; Abel-Ollo, Katri; Talu, Ave; Rüütel, Kristi

    2011-01-01

    This study assesses relationships between drug administration routes and HIV serostatus, drug-use and sexual behaviors among current injecting drug users (IDUs) in Tallinn, Estonia. We recruited 350 IDUs for a cross-sectional risk behavior survey. Adjusted odds ratios (AORs) were calculated to explore injection risk behavior, sexual behavior and HIV serostatus associated with multiple route use. Focus groups explored reasons why injectors might use non-injecting routes of administration. Those reporting multiple drug administration routes were less likely to be HIV seropositive (AOR 0.49; 95%CI 0.25-0.97), had almost twice the odds of having more than one sexual partner (AOR 1.90; 95%CI 1.01-3.60) and of reporting having sexually transmitted diseases (AOR 2.38; 95%CI 1.02-5.59). IDUs who engage in non-injecting drug use may be reducing their risk of acquiring HIV though sharing injection equipment, but if infected may be a critical group for sexual transmission of HIV to people who do not inject drugs. PMID:22116012

  14. Implicit prejudice toward injecting drug users predicts intentions to change jobs among drug and alcohol nurses.

    PubMed

    von Hippel, William; Brener, Loren; von Hippel, Courtney

    2008-01-01

    The meaning and importance of implicit prejudice is a source of considerable debate. One way to advance this debate is to assess whether implicit prejudice can predict independent variance, beyond that predicted by explicit prejudice, in meaningful and unambiguous behaviors or behavioral intentions. In the current research, drug and alcohol nurses reported their level of stress working with injecting drug users, their job satisfaction, their explicit prejudice toward injecting drug users, and their intentions to leave drug and alcohol nursing. The nurses also completed the Single Category Implicit Association Test, which measured their implicit prejudice toward injecting drug users. Analyses revealed that implicit prejudice was a significant mediator, beyond explicit prejudice and job satisfaction, of the relation between job stress and intention to change jobs. PMID:18181783

  15. The effect of history of injection drug use and alcoholism on HIV disease progression.

    PubMed

    Lima, Viviane Dias; Kerr, Thomas; Wood, Evan; Kozai, Tsubasa; Salters, Kate A; Hogg, Robert S; Montaner, Julio S G

    2014-01-01

    The effectiveness of highly active antiretroviral therapy (HAART) in preventing disease progression can be negatively influenced by the high prevalence of substance use among patients. Here, we quantify the effect of history of injection drug use and alcoholism on virologic and immunologic response to HAART. Clinical and survey data, collected at the start of HAART and at the interview date, were based on the study Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) in British Columbia, Canada. Substance use was a three-level categorical variable, combining information on history of alcohol dependence and of injection drug use, defined as: no history of alcohol and injection drug use; history of alcohol or injection drug use; and history of both alcohol and injection drug use. Virologic response (pVL) was defined by ≥ 2 log10 copy/mL drop in a viral load. Immunologic response was defined as an increase in CD4 cell count percent of ≥ 100%. We used cumulative logit modeling for ordinal responses to address our objective. Of the 537 HIV-infected patients, 112 (21%) were characterized as having a history of both alcohol and injection drug use, 173 (32%) were nonadherent (<95%), 196 (36%) had a CD4⁺/pVL⁺ (Best) response, 180 (34%) a CD4⁺/pVL⁻ or a CD4⁻ /pVL⁺ (Incomplete) response, and 161 (30%) a CD4⁻ /pVL⁻ (Worst) response. For individuals with history of both alcohol and injection drug use, the estimated probability of non-adherence was 0.61, and (0.15, 0.25, 0.60) of Best, Incomplete and Worse responses, respectively. Screening and detection of substance dependence will identify individuals at high-risk for nonadherence and ideally prevent their HIV disease from progressing to advanced stages where HIV disease can become difficult to manage. PMID:23767757

  16. 'Safer environment interventions': a qualitative synthesis of the experiences and perceptions of people who inject drugs.

    PubMed

    McNeil, Ryan; Small, Will

    2014-04-01

    There is growing acknowledgment that social, structural, and environmental forces produce vulnerability to health harms among people who inject drugs (PWID), and safer environment interventions (SEI) have been identified as critical to mitigating the impacts of these contextual forces on drug-related harm. To date, however, SEIs have been under-theorized in the literature, and how they minimize drug-related risks across intervention types and settings has not been adequately examined. This article presents findings from a systematic review and meta-synthesis of qualitative studies reporting PWID's experiences with three types of SEIs (syringe exchange programmes, supervised injection facilities and peer-based harm reduction interventions) published between 1997 and 2012. This meta-synthesis sought to develop a comprehensive understanding of SEIs informed by the experiences of PWID. Twenty-nine papers representing twenty-one unique studies that included an aggregate of more than 800 PWID were included in this meta-synthesis. This meta-synthesis found that SEIs fostered social and physical environments that mitigated drug-related harms and increased access to social and material resources. Specifically, SEIs: (1) provided refuge from street-based drug scenes; (2) enabled safer injecting by reshaping the social and environmental contexts of injection drug use; (3) mediated access to resources and health care services; and, (4) were constrained by drug prohibition and law enforcement activities. These findings indicate that it is critical to situate SEIs in relation to the lived experiences of PWID, and in particular provide broader environmental support to PWID. Given that existing drug laws limit the effectiveness of interventions, drug policy reforms are needed to enable public health, and specifically SEIs, to occupy a more prominent role in the response to injection drug use. PMID:24561777

  17. Research fatigue among injecting drug users in Karachi, Pakistan

    PubMed Central

    2013-01-01

    Background Karachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities. It is also the epicenter of HIV epidemic in the country. Since 2004, one pilot study and four behavioral and biological surveillance rounds have been conducted in Karachi. In addition many student research projects have also focused on key risk groups including injection drug users (IDUs). As a result of this extra ordinary exposure of same kind of questions, IDUs know how to respond to high value questions related to sharing of needles or unsafe sexual practices. The purpose of the study was to explore the element of research fatigue among IDUs in Karachi, Pakistan. Methods The study was conducted on 32 spots in Karachi, selected on the basis of estimate of IDUs at each spot. A trained field worker (recovered IDU) visited each spot; observed sharing behavior of IDUs and asked questions related to practices in January 2009. Verbal consent was obtained from each respondent before asking questions. Results On average 14 IDUs were present at each spot and out of 32 selected spots, 81% were active while more than two groups were present at 69% spots. In each group three to four IDUs were present and everyone in the group was sharing. One dose of injecting narcotics was observed. Sharing of syringes, needles and distilled water was observed at 63% spots while professional injector/street doctor was present at 60% spots. Conclusion There is a need to check internal consistency in surveillance research. It is highly likely that IDUs and other risk groups know how to respond to key questions but their responses do not match with the practices. PMID:23758666

  18. Syringe Disposal Among Injection Drug Users in San Francisco

    PubMed Central

    Martinez, Alexis N.; Carpenter, Lisa; Geckeler, Dara; Colfax, Grant; Kral, Alex H.

    2011-01-01

    To assess the prevalence of improperly discarded syringes and to examine syringe disposal practices of injection drug users (IDUs) in San Francisco, we visually inspected 1000 random city blocks and conducted a survey of 602 IDUs. We found 20 syringes on the streets we inspected. IDUs reported disposing of 13% of syringes improperly. In multivariate analysis, obtaining syringes from syringe exchange programs was found to be protective against improper disposal, and injecting in public places was predictive of improper disposal. Few syringes posed a public health threat. PMID:20466956

  19. Differences in sociodemographic, drug use and health characteristics between never, former and current injecting, problematic hard-drug users in the Netherlands

    PubMed Central

    2014-01-01

    Background Injecting drug users are at increased risk for harmful effects compared to non-injecting drug users. Some studies have focused on differences in characteristics between these two groups (e.g., housing, overall health). However, no study has investigated the specific Dutch situation which in the last years has seen a decrease in homelessness among problematic hard-drug users and an increasing focus on physical health in low-threshold addiction care. The purpose of this study was to determine differences in sociodemographic, drug use and health characteristics between never-injecting (NIDUs), former-injecting (FIDUs) and current-injecting drug users (IDUs) and describe injecting practices. Methods A total of 202 problematic hard-drug users (NIDU = 64; FIDU = 76; IDU = 62) were recruited from 22 low-threshold care facilities, including drug consumption rooms, methadone maintenance treatment, heroin-assisted therapy, day shelter and/or night shelter, supported housing and day activity centres. Data were collected on-site through structured face-to-face interviews. Results Results indicate that IDUs represented a separate group of problematic hard-drug users, with distinct sociodemographic and drug use characteristics. Overall, IDUs appeared to be the group with least favourable characteristics (unstable housing/homelessness, illegal activities, polydrug use) and NIDUs appeared to have the most favourable characteristics (stable housing, help with debts, less polydrug use). The FIDU group lies somewhere in between. The three groups did not differ significantly in terms of health. Regarding injecting practices, results showed that majority of IDUs had injected drugs for over 10 years and IDUs injected heroin, cocaine, amphetamine and/or methadone in the past 6 months. Sharing syringes was not common. A quarter reported public injecting. Conclusions Unstable housing and homelessness are related to (former) injecting drug use, and stable housing is

  20. Welfare Checks, Drug Consumption, and Health: Evidence from Vancouver Injection Drug Users

    ERIC Educational Resources Information Center

    Riddell, Chris; Riddell, Rosemarie

    2006-01-01

    This paper investigates the link between welfare payments and drug use among injection drug users. The authors find an increase in the likelihood of an overdose in the days following check arrival, and in the probability of leaving the hospital against medical advice (AMA) on check day. Using the check arrival date as an instrument, we estimate…

  1. Mental Health Status, Drug Treatment Use, and Needle Sharing among Injection Drug Users

    ERIC Educational Resources Information Center

    Lundgren, Lena M.; Amodeo, Maryann; Chassler, Deborah

    2005-01-01

    This study examined the relationship among mental health symptoms, drug treatment use, and needle sharing in a sample of 507 injection drug users (IDUs). Mental health symptoms were measured through the ASI psychiatric scale. A logistic regression model identified that some of the ASI items were associated with needle sharing in an opposing…

  2. Social structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: a qualitative study

    PubMed Central

    2010-01-01

    Background Injection drug users (IDU) commonly seek manual assistance with illicit drug injections, a practice known to be associated with various health-related harms. We investigated the social structural factors that shape risks related to assisted injection and the harms that may result. Methods Twenty semi-structured qualitative interviews were conducted with IDU enrolled in the ACCESS or Vancouver Injection Drug Users Study (VIDUS) who reported requiring assistance injecting in the past six months. Audio-recorded interviews were transcribed verbatim and a thematic analysis was conducted. Results Barriers to self-injecting included a lack of knowledge of proper injecting technique, a loss of accessible veins, and drug withdrawal. The exchange of money or drugs for assistance with injecting was common. Harms experienced by IDU requiring assistance injecting included theft of the drug, missed injections, overdose, and risk of blood-borne disease transmission. Increased vulnerability to HIV/HCV infection within the context of intimate relationships was represented in participant narratives. IDU identified a lack of services available for those who require assistance injecting, with notable mention of restricted use of Vancouver's supervised injection facility. Conclusions This study documents numerous severe harms that arise from assisted injecting. Social structural factors that shape the risks related to assisted injection in the Vancouver context included intimate partner relations and social conventions requiring an exchange of goods for provision of injecting assistance. Health services for IDU who need help injecting should include targeted interventions, and supervised injection facilities should attempt to accommodate individuals who require assistance with injecting. PMID:20807442

  3. Diffusion and Controlled Localized Drug Release from an Injectable Solid Self-Assembling Peptide Hydrogel

    NASA Astrophysics Data System (ADS)

    Sun, Jessie E. P.; Stewart, Brandon; Langhans, Sigrid; Stewart, Joel P.; Pochan, Darrin J.

    2014-03-01

    We use an injectable solid peptide hydrogel (first assembled into a solid hydrogel, can shear-thin flow and immediately reheal on cessation of shear) as a drug delivery vehicle for sustained and active drug release. The triggered intramolecular peptide folding into a beta-hairpin leads to intermolecular assmebly of the peptides into the entangled and branched nanofibrillar hydrogel network responsible for its advantageous rheological properties. The hydrogel is used to encapsulate a highly effective chemotherapeutic, vincristine, with hydrophobic behavior. We show that we are able to constantly maintain drug release in low but still potent concentrations after the shear-thinning injection process. Similarly, the mechanical and morphoogical properties of the gels remains identical after injection. Characterization of the hydrogel construct is through tritiated vincristine release, TEM, confocal microscopy, and in vitro methods.

  4. Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in Northern Mexico

    PubMed Central

    Morris, Meghan D.; Lemus, Hector; Wagner, Karla D.; Martinez, Gustavo; Lozada, Remedios; Gómez, Rangel María Gudelia; Strathdee, Steffanie A.

    2012-01-01

    Aims To identify factors associated with time to initiation of (1) sex work prior to injecting drugs, (2) injection drug use, and (3) concurrent sex work and injection drug use (i.e., initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). Design Parametric survival analysis of baseline data for time to initiation event. Setting Tijuana and Ciudad Juarez situated on the Mexico-U.S. border. Participants 575 FSW-IDUs aged ≥18. Measurements Interview-administered surveys assessing context of sex work and injection drug use initiation. Findings Nearly half (n=256) initiated sex work prior to beginning to inject, a third (n=163) initiated injection first, and a quarter (n=136) initiated both sex work and injection drug use concurrently. Low education and living in Ciudad Juarez accelerated time to sex work initiation. Being from a southern Mexican state and initiating drug use with inhalants delayed the time to first injection drug use. Having an intimate partner encourage entry into sex work and first injecting drugs to deal with depression accelerated time to initiating sex work and injection concurrently. Early physical abuse accelerated time to initiating sex work and injection, and substantially accelerated time to initiation of both behaviors concurrently. Conclusions Among female sex workers who currently inject drugs in two Mexican-US border cities, nearly half appear to initiate sex work prior to beginning to inject, nearly one third initiate injection drug use before beginning sex work, and one quarter initiate both behaviors concurrently. Predictors of these three trajectories differ, and this provides possible modifiable targets for prevention. PMID:22775475

  5. Quality investigation of hydroxyprogesterone caproate active pharmaceutical ingredient and injection

    PubMed Central

    Chollet, John L.; Jozwiakowski, Michael J.

    2012-01-01

    The purpose of this study was to investigate the quality of hydroxyprogesterone caproate (HPC) active pharmaceutical ingredient (API) sources that may be used by compounding pharmacies, compared to the FDA-approved source of the API; and to investigate the quality of HPC injection samples obtained from compounding pharmacies in the US, compared to the FDA-approved product (Makena®). Samples of API were obtained from every source confirmed to be an original manufacturer of the drug for human use, which were all companies in China that were not registered with FDA. Eight of the ten API samples (80%) did not meet the impurity specifications required by FDA for the API used in the approved product. One API sample was found to not be HPC at all; additional laboratory testing showed that it was glucose. Thirty samples of HPC injection obtained from com pounding pharmacies throughout the US were also tested, and eight of these samples (27%) failed to meet the potency requirement listed in the USP monograph for HPC injection and/or the HPLC assay. Sixteen of the thirty injection samples (53%) exceeded the impurity limit setforthe FDA-approved drug product. These results confirm the inconsistency of compounded HPC Injections and suggest that the risk-benefit ratio of using an unapproved compounded preparation, when an FDA-approved drug product is available, is not favorable. PMID:22329865

  6. Injectable biopolymer based hydrogels for drug delivery applications.

    PubMed

    Atta, Sadia; Khaliq, Shaista; Islam, Atif; Javeria, Irtaza; Jamil, Tahir; Athar, Muhammad Makshoof; Shafiq, Muhammad Imtiaz; Ghaffar, Abdul

    2015-09-01

    Biopolymer based pH-sensitive hydrogels were prepared using chitosan (CS) with polyethylene glycol (PEG) of different molecular weights in the presence of silane crosslinker. The incorporated components remain undissolved in different swelling media as they are connected by siloxane linkage which was confirmed by Fourier transform infrared spectroscopy. The swelling in water was enhanced by the addition of higher molecular weight PEG. The swelling behaviour of the hydrogels against pH showed high swelling in acidic and basic pH, whereas, low swelling was examined at pH 6 and 7. This characteristic pH responsive behaviour at neutral pH made them suitable for injectable controlled drug delivery. The controlled release analysis of Cefixime (CFX) (model drug) loaded CS/PEG hydrogel exhibited that the entire drug was released in 30 min in simulated gastric fluid (SGF) while in simulated intestinal fluid (SIF), 85% of drug was released in controlled manner within 80 min. This inferred that the developed hydrogels can be an attractive biomaterial for injectable drug delivery with physiological pH and other biomedical applications. PMID:26118484

  7. The harm inside: injection during incarceration among male injection drug users in Tijuana, Mexico.

    PubMed

    Pollini, Robin A; Alvelais, Jorge; Gallardo, Manuel; Vera, Alicia; Lozada, Remedios; Magis-Rodriquez, Carlos; Strathdee, Steffanie A

    2009-07-01

    Limited access to sterile syringes and condoms in correctional facilities make these settings high risk environments for HIV transmission. Although incarceration among injection drug users (IDUs) is common, there is limited information regarding specific IDU risk behaviors inside. We examined correlates of incarceration, injection inside and syringe sharing inside among male IDUs recruited in Tijuana, Mexico, using respondent driven sampling (RDS) (n=898). An interviewer administered survey collected data on sociodemographic, behavioral and contextual characteristics. Associations with (a) history of incarceration, (b) injection inside, and (c) syringe sharing inside were identified using univariate and multiple logistic regression models with RDS adjustment. Seventy-six percent of IDUs had been incarcerated, of whom 61% injected inside. Three quarters (75%) of those who injected shared syringes. U.S. deportation [adjusted odds ratio (AOR)=1.61; 95% confidence interval (CI): 1.07, 2.43] and migration (AOR=1.81; 95% CI: 1.12, 2.95) were independently associated with incarceration. Injection inside was independently associated with recent receptive syringe sharing (AOR=2.46; 95% CI: 1.75, 3.45) and having sex with a man while incarcerated (AOR=3.59; 95% CI: 1.65, 7.83). Sharing syringes inside was independently associated with having sex with a man while incarcerated (AOR=6.18; 95% CI: 1.78, 21.49). A majority of incarcerated IDUs reported injecting and syringe sharing during incarceration, and these IDUs were more likely to engage in sex with other men. Corrections-based interventions to reduce injection and syringe sharing are urgently needed, as are risk reduction interventions for male IDUs who have sex with men while incarcerated. PMID:19386448

  8. The Harm Inside: Injection during incarceration among male injection drug users in Tijuana, Mexico

    PubMed Central

    Pollini, Robin A.; Alvelais, Jorge; Gallardo, Manuel; Vera, Alicia; Lozada, Remedios; Magis-Rodriquez, Carlos; Strathdee, Steffanie A.

    2009-01-01

    Limited access to sterile syringes and condoms in correctional facilities make these settings high risk environments for HIV transmission. Although incarceration among injection drug users (IDUs) is common, there is limited information regarding specific IDU risk behaviors inside. We examined correlates of incarceration, injection inside and syringe sharing inside among male IDUs recruited in Tijuana, Mexico, using respondent driven sampling (RDS) (n=898). An interviewer administered survey collected data on sociodemographic, behavioral and contextual characteristics. Associations with a) history of incarceration, b) injection inside, and c) syringe sharing inside were identified using univariate and multiple logistic regression models with RDS adjustment. Seventy-six percent of IDUs had been incarcerated, of whom 61% injected inside. Three quarters (75%) of those who injected shared syringes. U.S. deportation [adjusted odds ratio (AOR)=1.61; 95% confidence interval (CI): 1.07, 2.43] and migration (AOR=1.81; 95% CI: 1.12, 2.95) were independently associated with incarceration. Injection inside was independently associated with recent receptive syringe sharing (AOR=2.46; 95% CI: 1.75, 3.45) and having sex with a man while incarcerated (AOR=43.59; 95% CI: 1.65, 7.83). Sharing syringes inside was independently associated with having sex with a man while incarcerated (AOR=6.18; 95% CI: 1.78, 21.49). A majority of incarcerated IDUs reported injecting and syringe sharing during incarceration, and these IDUs were more likely to engage in sex with other men. Corrections-based interventions to reduce injection and syringe sharing are urgently needed, as are risk reduction interventions for male IDUs who have sex with men while incarcerated. PMID:19386448

  9. Prevalence of Psychiatric Disorders Among Young Injection Drug Users*

    PubMed Central

    Mackesy-Amiti, Mary E.; Donenberg, Geri R.; Ouellet, Lawrence J.

    2012-01-01

    Background Studies of individuals in treatment for substance use have found high rates of psychiatric disorders, however little is known about the mental health of drug users not in treatment. This study aimed to assess the prevalence of lifetime and recent substance use and psychiatric disorders among young injection drug users (IDU) outside of a treatment setting. Methods Participants were recruited through outreach and respondent-driven sampling. Trained interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Interviews were conducted at two field stations operated by Community Outreach Intervention Projects in Chicago. Participants were 570 young adults (18-25 years) who injected drugs in the previous 30 days. Heroin was the primary drug used in this sample. Past 12-month and lifetime substance use disorders and primary and substance-induced mental disorders were based on DSM-IV diagnostic criteria. Results Nearly all participants met the criteria for heroin dependence. Multiple substance use disorders were common; cannabis was the most common substance involved after heroin, followed by alcohol and cocaine. Major depression, alcohol dependence, antisocial personality disorder, and borderline personality disorder were highly prevalent. Other psychiatric disorders were observed at levels consistent with other young adult samples. Conclusions Young IDU experience major depression, alcohol dependence, anti-social personality disorder, and borderline personality disorder at high rates, and multiple substance use disorders are common. Anxiety disorders in this population appear to be similar in prevalence to young adults in general. PMID:22226707

  10. Examining the spatial distribution of law enforcement encounters among people who inject drugs after implementation of Mexico's drug policy reform.

    PubMed

    Gaines, Tommi L; Beletsky, Leo; Arredondo, Jaime; Werb, Daniel; Rangel, Gudelia; Vera, Alicia; Brouwer, Kimberly

    2015-04-01

    In 2009, Mexico decriminalized the possession of small amounts of illicit drugs for personal use in order to refocus law enforcement resources on drug dealers and traffickers. This study examines the spatial distribution of law enforcement encounters reported by people who inject drugs (PWID) in Tijuana, Mexico to identify concentrated areas of policing activity after implementation of the new drug policy. Mapping the physical location of law enforcement encounters provided by PWID (n = 461) recruited through targeted sampling, we identified hotspots of extra-judicial encounters (e.g., physical/sexual abuse, syringe confiscation, and money extortion by law enforcement) and routine authorized encounters (e.g., being arrested or stopped but not arrested) using point density maps and the Getis-Ord Gi* statistic calculated at the neighborhood-level. Approximately half of the participants encountered law enforcement more than once in a calendar year and nearly one third of these encounters did not result in arrest but involved harassment or abuse by law enforcement. Statistically significant hotspots of law enforcement encounters were identified in a limited number of neighborhoods located in areas with known drug markets. At the local-level, law enforcement activities continue to target drug users despite a national drug policy that emphasizes drug treatment diversion rather than punitive enforcement. There is a need for law enforcement training and improved monitoring of policing tactics to better align policing with public health goals. PMID:25300503

  11. Childhood Sexual Abuse and Age at Initiation of Injection Drug Use

    PubMed Central

    Ompad, Danielle C.; Ikeda, Robin M.; Shah, Nina; Fuller, Crystal M.; Bailey, Susan; Morse, Edward; Kerndt, Peter; Maslow, Carey; Wu, Yingfeng; Vlahov, David; Garfein, Richard; Strathdee, Steffanie A.

    2005-01-01

    Objectives. We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users. Methods. We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories. Results. The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection. Conclusions. Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with postvictimization services for children and adolescents. PMID:15798133

  12. The ethics of HIV research with people who inject drugs in Africa: a desk review.

    PubMed

    Mamotte, Nicole

    2012-03-01

    Injecting drug use is a growing problem in Africa and a growing risk factor for contracting HIV in the region. It is imperative that HIV research includes injecting drug users so that they too are able to benefit from safe and effective behavioural interventions and biomedical HIV prevention and treatment products. This article relates a critical review of the findings of a desk review of previously published literature. The article examines injecting drug use in relation to HIV-related risk and research in Kenya, Mauritius, Nigeria, South Africa and Tanzania. The ethical challenges of including people who inject drugs in HIV research in Africa are also presented. The review found injecting drug use to be on the increase in all the countries reviewed. HIV-risk behaviour among people who inject drugs, such as needle-sharing and higher-risk sexual behaviour, was also found to be widespread. Furthermore, criminalisation of drug use and strict anti-drug laws are common in the countries reviewed, while harm-reduction programmes for people who inject drugs were found to be limited. The review identified a number of ethical challenges to the involvement of people who inject drugs in HIV research in Africa. This includes the illegal status and stigma surrounding injecting drug use, which may complicate participant recruitment, enrolment and retention. In addition, a lack of funding for supportive programmes to help injecting drug users may hinder the provision of appropriate standards of prevention and care and treatment for those who seroconvert. PMID:25870892

  13. Overdose experiences among injection drug users in Bangkok, Thailand

    PubMed Central

    2010-01-01

    Background Although previous studies have identified high levels of drug-related harm in Thailand, little is known about illicit drug overdose experiences among Thai drug users. We sought to investigate non-fatal overdose experiences and responses to overdose among a community-recruited sample of injection drug users (IDU) in Bangkok, Thailand. Methods Data for these analyses came from IDU participating in the Mit Sampan Community Research Project. The primary outcome of interest was a self-reported history of non-fatal overdose. We calculated the prevalence of past overdose and estimated its relationship with individual, drug-using, social, and structural factors using multivariate logistic regression. We also assessed the prevalence of ever witnessing an overdose and patterns of response to overdose. Results These analyses included 252 individuals; their median age was 36.5 years (IQR: 29.0 - 44.0) and 66 (26.2%) were female. A history of non-fatal overdose was reported by 75 (29.8%) participants. In a multivariate model, reporting a history of overdose was independently associated with a history of incarceration (Adjusted Odds Ratio [AOR] = 3.83, 95% Confidence Interval [CI]: 1.52 - 9.65, p = 0.004) and reporting use of drugs in combination (AOR = 2.48, 95% CI: 1.16 - 5.33, p = 0.019). A majority (67.9%) reported a history of witnessing an overdose; most reported responding to the most recent overdose using first aid (79.5%). Conclusions Experiencing and witnessing an overdose were common in this sample of Thai IDU. These findings support the need for increased provision of evidence-based responses to overdose including peer-based overdose interventions. PMID:20465842

  14. Limited uptake of hepatitis C treatment among injection drug users.

    PubMed

    Mehta, Shruti H; Genberg, Becky L; Astemborski, Jacquie; Kavasery, Ravi; Kirk, Gregory D; Vlahov, David; Strathdee, Steffanie A; Thomas, David L

    2008-06-01

    We characterized hepatitis C virus (HCV) treatment knowledge, experience and barriers in a cohort of community-based injection drug users (IDUs) in Baltimore, MD. In 2005, a questionnaire on HCV treatment knowledge, experience and barriers was administered to HCV-infected IDUs. Self-reported treatment was confirmed from medical records. Of 597 participants, 71% were male, 95% African-American, 31% HIV co-infected and 94% were infected with HCV genotype 1; 70% were aware that treatment was available, but only 22% understood that HCV could be cured. Of 418 who had heard of treatment, 86 (21%) reported an evaluation by a provider that included a discussion of treatment of whom 30 refused treatment, 20 deferred and 36 reported initiating treatment (6% overall). The most common reasons for refusal were related to treatment-related perceptions and a low perceived need of treatment. Compared to those who had discussed treatment with their provider, those who had not were more likely to be injecting drugs, less likely to have health insurance, and less knowledgeable about treatment. Low HCV treatment effectiveness was observed in this IDU population. Comprehensive integrated care strategies that incorporate education, case-management and peer support are needed to improve care and treatment of HCV-infected IDUs. PMID:18165889

  15. Tobacco Use and Nicotine Dependence among HIV-Infected and Uninfected Injection Drug Users

    PubMed Central

    Marshall, Mariah M.; Kirk, Gregory D.; Caporaso, Neil E.; McCormack, Meredith C.; Merlo, Christian A.; Hague, John C.; Mehta, Shruti H.; Engels, Eric A.

    2010-01-01

    Introduction Urban U.S. populations are burdened by intersecting epidemics of HIV-infection, injection drug use, and cigarette smoking. Given the substantial morbidity attributable to tobacco in these populations, we characterized smoking behaviors, nicotine addiction, and tobacco exposure among HIV-infected and HIV-uninfected injection drug users (IDUs) in Baltimore, Maryland. Methods Smoking behaviors among participants in the ALIVE Study were assessed using interviewer-administered questionnaires. Smoking history and nicotine dependence (Fagerstrom Index scores) were compared by HIV and drug injecting status. Serum cotinine (a nicotine metabolite) was measured for a sample of participants by enzyme immunoassay. Results Among 1,052 participants (29.7% HIV-infected, 39.8% active injectors), 85.2% were current smokers and 9.3% former smokers. Smoking prevalence, age at smoking initiation, and cumulative tobacco exposure were similar by HIV status. Median Fagerstrom scores of 4 for HIV-infected and HIV-uninfected smokers indicated moderate nicotine dependence. Daily cigarette consumption was identical by HIV status (median 10 cigarettes), although HIV-infected participants were less likely to smoke 1+ pack daily compared to HIV-uninfected participants (18.0% vs. 26.9%, p=0.001). Compared to former injectors, active injectors had higher smoking prevalence (90.5% vs. 81.7%, p=0.0001), greater daily cigarette consumption (30.7% vs. 19.6% smoked 1+ pack daily, p=0.0001), and slightly higher Fagerstrom scores (median 5 vs. 4). Cotinine levels paralleled self-reported cigarette consumption. Discussion Tobacco use is extremely common among inner city IDUs. Smoking behavior and nicotine dependence did not materially differ by HIV status but were associated with active drug injection. Cessation efforts should target the dual dependence of cigarettes and drugs experienced among this population. PMID:20875704

  16. Boyfriends and injecting: the role of intimate male partners in the life of women who inject drugs in Central Java.

    PubMed

    Lazuardi, Elan; Worth, Heather; Saktiawati, Antonia Morita Iswari; Spooner, Catherine; Padmawati, Retna; Subronto, Yanri

    2012-01-01

    The international literature shows that HIV-risk behaviour for women mostly occurs in the context of intimate relationships. Power imbalances in the social, economic and cultural spheres put women at risk. This paper addresses the roles of male partners in women's engagement in drug-use behaviour and drug-related HIV-risk behaviour in Indonesia. Data were gathered through in-depth interviews with 19 women who had injected drugs in the previous month in three sites in central Java. Most of the women had male partners who also injected drugs. Results show that male partners play a significant role in the initiation of drug use, the provision of drugs, injecting behaviour and in the constitution of women injectors' social networks. These findings suggest the need to develop couple-based interventions and to facilitate women-only groups as part of HIV prevention. PMID:22468728

  17. Pregnancy and sexual health among homeless young injection drug users.

    PubMed

    Hathazi, Dodi; Lankenau, Stephen E; Sanders, Bill; Jackson Bloom, Jennifer

    2009-04-01

    Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of prenatal care, and histories of sexual victimization are described. A total of 81 lifetime pregnancies and 26 children were reported. Infrequent and ineffective use of contraception was common. While pregnancy motivated some homeless youth to establish housing, miscarriages and terminations were more frequent among youth who reported being housed. Widespread access to prenatal and medical services was reported during pregnancy, but utilization varied. Many women continued to use substances throughout pregnancy. Several youth reported childhood sexual abuse and sexual victimization while homeless. Pregnancy presents a unique opportunity to encourage positive health behaviors in a high-risk population seldom seen in a clinical setting. PMID:18692891

  18. 78 FR 44432 - New Animal Drugs; Change of Sponsor; Fentanyl; Iron Injection

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-24

    ... Sponsor; Fentanyl; Iron Injection AGENCY: Food and Drug Administration, HHS. ACTION: Final rule. SUMMARY..., NADA 099-667 for IMPOSIL (iron dextran complex) Injection and NADA 110-399 for GLEPTOSIL...

  19. Peer Norms and Sharing of Injection Paraphernalia among Puerto Rican Injection Drug Users in New York and Puerto Rico

    ERIC Educational Resources Information Center

    Andia, Jonny F.; Deren, Sherry; Robles, Rafaela R.; Kang, Sung-Yeon; Colon, Hector M.

    2008-01-01

    This study examines the influence of peer norms on sharing of injection paraphernalia (e.g., indirect sharing behaviors, including sharing of cookers, cotton, rinse water and back/front loading) among Puerto Rican injection drug users (IDUs) in Bayamon, Puerto Rico, and East Harlem, New York City. Data were collected from 873 Puerto Rican IDUs…

  20. people who inject drugs, HIV risk, and HIV testing uptake in sub-Saharan Africa.

    PubMed

    Asher, Alice K; Hahn, Judith A; Couture, Marie-Claude; Maher, Kelsey; Page, Kimberly

    2013-01-01

    Dramatic rises in injection drug use (IDU) in sub-Saharan Africa account for increasingly more infections in a region already overwhelmed by the HIV epidemic. There is no known estimate of the number of people who inject drugs (PWID) in the region, or the associated HIV prevalence in PWID. We reviewed literature with the goal of describing high-risk practices and exposures in PWID in sub-Saharan Africa, as well as current HIV prevention activities aimed at drug use. The literature search looked for articles related to HIV risk, injection drug users, stigma, and HIV testing in sub-Saharan Africa. This review found evidence demonstrating high rates of HIV in IDU populations in sub-Saharan Africa, high-risk behaviors of the populations, lack of knowledge regarding HIV, and low HIV testing uptake. There is an urgent need for action to address IDU in order to maintain recent decreases in the spread of HIV in sub-Saharan Africa. PMID:23164598

  1. Re-naming and re-gaming: Medicare's doomed attempt to reform reimbursement for injectable drugs.

    PubMed

    Kleinke, J D

    2004-01-01

    Hastily crafted provisions in the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, intended to reform the government's flawed method for reimbursing providers who administer injectable drugs, will exacerbate existing economic and clinical problems instead of resolving them. The new provisions recast Medicare's traditional drug reimbursement system; increase temptations for physicians to overuse injectable drugs; and promise to aggravate the economic problems Congress attempted to fix with the new law. Medicare can resolve these problems by reimbursing providers for injectable drugs based on their actual acquisition cost rather than on estimates embedded in a complex drug reimbursement system. PMID:15590722

  2. The rise of injecting drug use in east Africa: a case study from Kenya

    PubMed Central

    Beckerleg, Susan; Telfer, Maggie; Hundt, Gillian Lewando

    2005-01-01

    Studies on injecting drug use in East Africa are reviewed. The existingstudies document the spread of heroin injection in Kenya and Tanzania, both countries where HIV rates are high. No data from Uganda on injecting drug use was found by the authors. A case study of the growth of heroin injection in a Kenyan coastal town is presented. The need for needle-exchange programmes and other prevention services is discussed. PMID:16122382

  3. A TYPOLOGY OF DRUG-RELATED OFFENDING AMONG YOUNG HOMELESS INJECTION DRUG USERS

    PubMed Central

    Sanders, Bill; Lankenau, Stephen E.; Jackson Bloom, Jennifer; Hathaz, Dodi S.

    2011-01-01

    Research indicates a link between drug use and offending, particularly amongst high-risk individuals, such as homeless youth. The extent to which such youth interpret their offending as being related to their drug use, though, is understudied. This manuscript investigates the interpretations of drug-related offenses offered by 151 primarily white, male, homeless IDUs aged 16–29 years. Youth were asked specific questions about their drug-related offenses during in-depth interviews as part of a larger study investigating health risks surrounding drug injection between 2004 and 2006. The first section of the manuscript outlines offenses youth revealed committing either in pursuit of or after using a variety of substances. The second part of the manuscript examines the overall context (motivation, environment), and provides a seven-tiered typology of drug-related offending based on youth's interpretations, linking certain drugs to specific offenses within particular contexts. From here, some theoretical and practical implications of the findings are discussed. PMID:21423855

  4. Ten priorities for expanding access to HCV treatment for people who inject drugs in low- and middle-income countries.

    PubMed

    Ford, Nathan; Wiktor, Stefan; Kaplan, Karyn; Andrieux-Meyer, Isabelle; Hill, Andrew; Radhakrishnan, Priti; Londeix, Pauline; Forette, Chloe; Momenghalibaf, Azzi; Verster, Annette; Swan, Tracy

    2015-11-01

    Of the estimated 130-150 million people who are chronically infected with hepatitis C virus, around 90% reside in low- and middle-income countries. People who inject drugs are disproportionately affected by HCV, with a global estimated prevalence (based on serological reports of HCV antibodies) of 67%; world-wide over 10 million people who inject drugs are infected with HCV. Treatment for HCV has improved dramatically in recent years with the arrival of new direct acting antivirals (DAAs) and this is stimulating considerable efforts to scale up access to treatment. However, treatment coverage among the general population is less than 10% in most countries, and coverage for people who inject drugs is generally much lower. It is estimated that globally around 2 million people who inject drugs need treatment for HCV. The DAAs offer significant potential to rapidly expand access to treatment for HCV. While the ideal combination therapy remains to be established, key characteristics include high efficacy, tolerability, pan-genotypic activity, short treatment duration, oral therapy, affordability, limited drug-drug interactions, and availability as fixed-dose combinations and once daily treatments. This paper outlines 10 key priorities for improving access to HCV treatment for people who inject drugs: (1) affordable access to direct acting antivirals; (2) increased awareness and testing; (3) standardization of treatment; (4) simplification of service delivery; (5) integration of services; (6) peer support; (7) treatment within a framework of comprehensive prevention; (8) tracking progress; (9) dedicated funding; and (10) enabling policies. PMID:26074094

  5. Male injection drug users try new drugs following U.S. deportation to Tijuana, Mexico

    PubMed Central

    Robertson, Angela M.; Rangel, M. Gudelia; Lozada, Remedios; Vera, Alicia; Ojeda, Victoria D.

    2011-01-01

    Background Among male injection drug users (IDUs) in Tijuana, Mexico, U.S. deportation is associated with HIV transmission. Changing drug use behaviors following deportation, including the use of new drugs, may increase HIV risk but are understudied. We identify correlates of trying new drugs following male IDUs’ most recent U.S. deportation to Mexico. Methods In 2010, we recruited 328 deported male IDUs in Tijuana, Mexico. Questionnaires collected retrospective data on drug use and other HIV risk behaviors throughout migratory events. Logistic regression identified correlates of trying new drugs/combinations following their most recent deportations. Informed consent was obtained from all participants. Results Nearly one in six men (n=52, 16%) tried new drugs following their most recent deportation, including heroin (n=31), methamphetamine (n=5), and heroin/methamphetamine combined (n=17). Trying new drugs following deportation was independently associated with U.S. incarceration (adjusted odds ratio [AOR]= 3.96; 95% confidence interval [C.I.] 1.78, 8.84), increasing numbers of U.S. deportations (AOR=1.11 per deportation; C.I. 1.03, 1.20), feeling sad following deportation (AOR 2.69; C.I. 1.41, 5.14), and perceiving that one’s current lifestyle increases HIV/AIDS risk (AOR 3.91; C.I. 2.05, 7.44). Conclusions Trying new drugs following U.S. deportation may be related to the unique contexts and stressors experienced by drug-abusing migrants as they attempt to reestablish their lives in Mexico. Findings imply an unmet need for health and social programs to alleviate pre-and post-deportation stressors faced by undocumented and return migrants in the U.S.-Mexico context. PMID:21835559

  6. HIV infection among persons who inject drugs: ending old epidemics and addressing new outbreaks.

    PubMed

    Des Jarlais, Don C; Kerr, Thomas; Carrieri, Patrizia; Feelemyer, Jonathan; Arasteh, Kamyar

    2016-03-27

    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. PMID:26836787

  7. The staying safe intervention: training people who inject drugs in strategies to avoid injection-related HCV and HIV infection.

    PubMed

    Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria; Sandoval, Milagros; Cleland, Charles M; Jordan, Ashly; Hagan, Holly; Lune, Howard; Friedman, Samuel R

    2014-04-01

    This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the intervention's two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, five-session intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks. PMID:24694328

  8. THE STAYING SAFE INTERVENTION: TRAINING PEOPLE WHO INJECT DRUGS IN STRATEGIES TO AVOID INJECTION-RELATED HCV AND HIV INFECTION

    PubMed Central

    Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria; Sandoval, Milagros; Cleland, Charles M.; Jordan, Ashly; Hagan, Holly; Lune, Howard; Friedman, Samuel R.

    2014-01-01

    This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the intervention's two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, five-session intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks. PMID:24694328

  9. 'It's your life!': injecting drug users, individual responsibility and hepatitis C prevention.

    PubMed

    Fraser, Suzanne

    2004-04-01

    Health promotion materials on hepatitis C prevention and safe injecting enjoin injecting drug users to produce ethical selves through relatively rigid social and hygiene-related conduct. This article examines a sample of safe injecting and hepatitis C prevention health promotion materials, and interview data gathered from injecting drug users, to consider the ways in which the notion of individual responsibility functions within them. I argue that the primacy of the individual in western culture is indeed reflected in hepatitis C and safe injecting materials and, that for a range of reasons, injecting drug users also make use of notions of individual responsibility. The article concludes by considering the social and health implications of this individualist approach to injecting drug use and health promotion, and by suggesting ways in which effective materials which do not focus solely on the individual can be created. PMID:15068637

  10. Alcohol and HIV sexual risk behaviors among injection drug users.

    PubMed

    Arasteh, Kamyar; Des Jarlais, Don C; Perlis, Theresa E

    2008-05-01

    We analyzed data from 6341 injection drug users (IDUs) entering detoxification or methadone maintenance treatment in New York City between 1990 and 2004 to test the hypothesis that alcohol use and intoxication is associated with increased HIV sexual risk behaviors. Two types of associations were assessed: (1) a global association (i.e., the relationship between HIV sexual risk behaviors during the 6 months prior to the interview and at-risk drinking in that period, defined as more than 14 drinks per week for males or 7 drinks per week for females), and (2) an event-specific association (i.e., the relationship between HIV sexual risk behaviors during the most recent sex episode and alcohol intoxication during that episode). Sexual risk behaviors included multiple sex partners and engaging in unprotected sex. After adjusting for the effects of other variables, at-risk-drinkers were more likely to report multiple sex partners and engaging in unprotected sex with casual sex partners (both global associations). IDUs who reported both they and their casual partners were intoxicated during the most recent sex episode were more likely to engage in unprotected sex (an event-specific association). We also observed two significant interactions. Among IDUs who did not inject cocaine, moderate-drinkers were more likely to report multiple partners. Among self-reported HIV seropositive IDUs, when both primary partners were intoxicated during the most recent sex episode they were more likely to engage in unprotected sex. These observations indicate both global and event-specific associations of alcohol and HIV sexual-risk behaviors. PMID:18242009

  11. Examining non-AIDS mortality among people who inject drugs

    PubMed Central

    Mathers, Bradley M.; Degenhardt, Louisa

    2014-01-01

    Objective: To systematically review and analyse data from cohorts of people who inject drugs (PWID) to improve existing estimates of non-AIDS mortality used to calculate mortality among PWID in the Spectrum Estimates and Projection Package. Design: Systematic review and meta-analysis. Methods: We conducted an update of an earlier systematic review of mortality among PWID, searching specifically for studies providing data on non-AIDS-related deaths. Random-effects meta-analyses were performed to derive pooled estimates of non-AIDS crude mortality rates across cohorts disaggregated by sex, HIV status and periods in and out of opioid substitution therapy (OST). Within each cohort, ratios of non-AIDS CMRs were calculated and then pooled across studies for the following paired sub-groups: HIV-negative versus HIV-positive PWID; male versus female PWID; periods in OST versus out of OST. For each analysis, pooled estimates by country income group and by geographic region were also calculated. Results: Thirty-seven eligible studies from high-income countries and five from low and middle-income countries were found. Non-AIDS mortality was significantly higher in low and middle-income countries [2.74 per 100 person-years; 95% confidence interval (CI) 1.76–3.72] than in high-income countries (1.56 per 100 person-years; 95% CI 1.38–1.74). Non-AIDS CMRs were 1.34 times greater among men than women (95% CI 1.14–1.57; N = 19 studies); 1.50 times greater among HIV-positive than HIV-negative PWID (95% CI 1.15, 1.96; N = 16 studies); and more than three times greater during periods out of OST than for periods on OST (N = 7 studies). Conclusions: A comprehensive response to injecting drug must include efforts to reduce the high levels of non-AIDS mortality among PWID. Due to limitations of currently available data, including substantial heterogeneity between studies, estimates of non-AIDS mortality specific to geographic regions, country income level, or the

  12. Use of North America's first medically supervised safer injecting facility among HIV-positive injection drug users.

    PubMed

    Reddon, Hudson; Wood, Evan; Tyndall, Mark; Lai, Calvin; Hogg, Robert; Montaner, Julio; Kerr, Thomas

    2011-10-01

    The objective of this study was to examine supervised injecting facility (SIF) use among a cohort of 395 HIV-positive injection drug users (IDUs) in Vancouver, Canada. The correlates of SIF use were identified using generalized estimating equation analyses. In multivariate analyses, frequent SIF use was associated with homelessness (adjusted odds ratio [AOR] = 1.90), daily heroin injection (AOR = 1.56), and daily cocaine injection (AOR = 1.59). The reasons given for not using the SIF included a preference for injecting at home and already having a safe place to inject. The SIF services most commonly used were needle exchange and nursing services. The SIF appears to have attracted a high-risk subpopulation of HIV-positive IDUs; this coverage perhaps could be extended with the addition of HIV-specific services such as disease monitoring and the provision of antiretroviral therapy. PMID:22010805

  13. Use of North America’s first medically supervised safer injecting facility among HIV-positive injection drug users

    PubMed Central

    Reddon, Hudson; Wood, Evan; Tyndall, Mark; Lai, Calvin; Hogg, Robert; Montaner, Julio; Kerr, Thomas

    2013-01-01

    The objective of this study was to examine supervised injecting facility (SIF) use among a cohort of 395 HIV-positive injection drug users (IDUs) in Vancouver, Canada. The correlates of SIF use were identified using generalized estimating equation analyses. In multivariate analyses, frequent SIF use was associated with homelessness (adjusted odds ratio [AOR] = 1.90), daily heroin injection (AOR = 1.56), and daily cocaine injection (AOR = 1.59). The reasons given for not using the SIF included a preference for injecting at home and already having a safe place to inject. The SIF services most commonly used were needle exchange and nursing services. The SIF appears to have attracted a high-risk subpopulation of HIV-positive IDUs; this coverage perhaps could be extended with the addition of HIV- specific services such as disease monitoring and the provision of antiretroviral therapy. PMID:22010805

  14. The Cedar Project: risk factors for transition to injection drug use among young, urban Aboriginal people

    PubMed Central

    Miller, Cari L.; Pearce, Margo E.; Moniruzzaman, Akm; Thomas, Vicky; Christian, Chief Wayne; Schechter, Martin T.; Spittal, Patricia M.

    2011-01-01

    Background: Studies suggest that Aboriginal people in Canada are over-represented among people using injection drugs. The factors associated with transitioning to the use of injection drugs among young Aboriginal people in Canada are not well understood. Methods: The Cedar Project is a prospective cohort study (2003–2007) involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants’ venous blood samples were tested for antibodies to HIV and the hepatitis C virus, and drug use was confirmed using saliva screens. The primary outcomes were use of injection drugs at baseline and tranisition to injection drug use in the six months before each follow-up interview. Results: Of 605 participants, 335 (55.4%) reported using injection drugs at baseline. Young people who used injection drugs tended to be older than those who did not, female and in a relationship. Participants who injected drugs were also more likely than those who did not to have been denied shelter because of their drug use, to have been incarcerated, to have a mental illness and to have been involved in sex work. Transition to injection drug use occurred among 39 (14.4%) participants, yielding a crude incidence rate of 19.8% and an incidence density of 11.5 participants per 100 person-years. In unadjusted analysis, transition to injection drug use was associated with being female (odds ratio [OR] 1.98, 95% confidence interval (CI) 1.06–3.72), involved in sex work (OR 3.35, 95% CI 1.75–6.40), having a history of sexually transmitted infection (OR 2.01, 95% CI 1.07–3.78) and using drugs with sex-work clients (OR 2.51, 95% CI 1.19–5.32). In adjusted analysis, transition to injection drug use remained associated with involvement in sex work (adjusted OR 3.94, 95% CI 1.45–10.71). Interpretation: The initiation rate for injection drug use of 11.5 participants per 100 person-years among participants in the Cedar Project is distressing. Young

  15. Transition to injecting drug use in Iran: a systematic review of qualitative and quantitative evidence

    PubMed Central

    Rahimi-Movaghar, Afarin; Amin-Esmaeili, Masoumeh; Shadloo, Behrang; Malekinejad, Mohsen

    2015-01-01

    Background Injection drug use has been increasing over the past decade in Iran. This study aims to review the epidemiological and qualitative evidence on factors that facilitate or protect against transition to injection in Iran. Methods Five international (Medline, Web of Science, EMBASE, CINAHL, PsycINFO), one regional (IMEMR) and three Iranian (Iranmedex, Iranpsych, IranDoc) databases were searched and key experts were contacted. Two trained researchers screened documents to identify relevant studies and independently extracted data using a pre-specified protocol. A thematic analysis was applied to the qualitative data and a random effect meta-analysis model was used to determine age of first injection. Results A total of 39 documents from 31 studies met the eligibility criteria; more than 50% were conducted between 2006 and 2008. The weighted mean age of first injection was 25.8 years (95% Confidence Interval: 25.3–26.2). Overall, drug users had used drugs for 6 to 7 years before starting to inject. Heroin was the first drug of injection in the majority of cases. Factors influencing transition to injection included 1) individual (pleasure-seeking behavior and development of drug dependency), 2) social network (role of peer drug users in first injection use), and 3) environmental (the economic efficiency associated with injection and the wide availability of injectable form of drugs in the market). Conclusion Harm reduction policies in Iran have almost exclusively focused on drug injectors. However, given the extent of non-injection drug use, evidence from this study can provide insight on points of interventions for preventing transition to injection use. PMID:26210009

  16. Risk practices associated with bacterial infections among injection drug users in Denver, CO

    PubMed Central

    Phillips, Kristina T.; Stein, Michael D.

    2016-01-01

    Background There has been limited research on bacterial infections (e.g., skin and soft tissue abscesses, endocarditis) among injection drug users (IDUs), despite these infections often resulting in serious morbidity and costly medical care. Although high-risk practices that contribute to bacterial infections are not entirely clear, certain injection practices have been found to increase risk in past studies. Objectives To examine rates of bacterial infections among IDUs in Denver, CO and high-risk practices that predict skin infections. Methods Structured interviews were conducted with 51 active heroin, cocaine and methamphetamine IDUs (over 18 years). Results Among all participants, 55% reported a lifetime history of at least one skin infection and 29% reported having an infection in the last year. Those with a skin infection in the last year were significantly more likely to inject intramuscularly (OR = 1.57) and to report greater heroin injection frequency (OR = 1.08) compared to IDUs with no history of skin infections. Heroin and speedball injectors reported a higher number of past abscesses compared to methamphetamine and cocaine injectors. Conclusion Intervention strategies to reduce bacterial infections should focus on high-risk injection practices. Scientific Significance Learning about rates of bacterial infections and high-risk practices associated with these infections can benefit researchers developing risk reduction interventions for IDUs. PMID:20337504

  17. ‘Safer Environment Interventions’: A qualitative synthesis of the experiences and perceptions of people who inject drugs

    PubMed Central

    McNeil, Ryan; Small, Will

    2014-01-01

    There is growing acknowledgment that social, structural, and environmental forces produce vulnerability to health harms among people who inject drugs (PWID), and safer environment interventions (SEI) have been identified as critical to mitigating the impacts of these contextual forces on drug-related harm. To date, however, SEIs have been under-theorized in the literature, and how they minimize drug-related risks across intervention types and settings has not been adequately examined. This article presents findings from a systematic review and meta-synthesis of qualitative studies reporting PWID’s experiences with three types of SEIs (syringe exchange programmes, supervised injection facilities and peer-based harm reduction interventions) published between 1997 and 2012. This meta-synthesis seeks to develop a comprehensive understanding of SEIs informed by the experiences of PWID. Twenty-nine papers representing twenty-one unique studies that included an aggregate of more than 800 PWID were included in this meta-synthesis. This meta- synthesis found that SEIs fostered social and physical environments that mitigated drug-related harms and increased access to social and material resources. Specifically, SEIs: (1) provided refuge from street-based drug scenes; (2) enabled safer injecting by reshaping the social and environmental contexts of injection drug use; (3) mediated access to resources and health care services; and, (4) were constrained by drug prohibition and law enforcement activities. These findings indicate that it is critical to situate SEIs in relation to the lived experiences of PWID, and in particular provide broader environmental support to PWID. Given that existing drug laws limit the effectiveness of interventions, drug policy reforms are needed to enable public health, and specifically SEIs, to occupy a more prominent role in the response to injection drug use. PMID:24561777

  18. HIV Infection Among People Who Inject Drugs: The Challenge of Racial/Ethnic Disparities

    PubMed Central

    Des Jarlais, Don C.; McCarty, Dennis; Vega, William A.; Bramson, Heidi

    2013-01-01

    Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among non-Hispanic Blacks and Hispanics. A meta-analysis of international research concluded that among persons who inject drugs, racial and ethnic minorities were twice as likely to acquire an HIV infection, though there was great variation across the individual studies. To examine strategies to reduce racial/ethnic disparities among persons who inject drugs, we reviewed studies on injection drug use and its role in HIV transmission. We identified four sets of evidence-based interventions that may reduce racial ethnic disparities among persons who inject drugs: HIV counseling and testing, risk reduction services, access to anti-retroviral therapy, and drug abuse treatment. Implementation of these services, however, is insufficient in many countries, including the US. Persons who inject drugs appear to be changing drug use norms and rituals to reduce risks. The challenges are to 1) develop a validated model of how racial/ethnic disparities in HIV infection arise, persist, and are reduced or eliminated over time, and 2) implement evidence-based services on a sufficient scale to eliminate HIV transmission among all persons who inject drugs. PMID:23688094

  19. Measuring Altruistic and Solidaristic Orientations Toward Others Among People Who Inject Drugs.

    PubMed

    Friedman, Samuel R; Pouget, Enrique R; Sandoval, Milagros; Jones, Yolanda; Nikolopoulos, Georgios K; Mateu-Gelabert, Pedro

    2015-01-01

    The altruism and/or solidarity of people who inject drugs helps protect sex and drug partners from HIV. Research has been hindered by lack of measures. We developed and administered scales to assess them to 300 people who inject drugs. Altruism and Solidarity Scales were both internally consistent. Each correlated significantly with measures of helping others. These measures appear reliable and valid. They can be used to study how big events or structural interventions affect altruism and solidarity, and how altruism and solidarity are associated with changes in HIV or other risks, among people who inject drugs. PMID:26076380

  20. Rethinking risk: Gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico-U.S. border

    PubMed Central

    Syvertsen, Jennifer L.; Robertson, Angela M.; Strathdee, Steffanie A; Martinez, Gustavo; Rangel, M. Gudelia; Wagner, Karla D

    2014-01-01

    Background Studies of injection drug-using couples suggest a gendered performance of risk in which men exert greater control over drug use and render their female partners vulnerable to HIV infection and other negative health outcomes. This study assesses gender roles in injection drug use as practiced among female sex workers and their intimate male partners within a risk environment marked by rapid socioeconomic changes. Methods We draw on quantitative surveys, semi-structured interviews, and ethnographic fieldwork conducted as part of cohort study of HIV/STI risk among female sex workers and their intimate, non-commercial partners along the Mexico-U.S. border. This study employed descriptive statistics and inductive analyses of transcripts and field notes to examine practices related to drug procurement, syringe sharing, and injection assistance among couples in which both partners reported injecting drugs in the past six months. Results Among 156 couples in which both partners injected drugs (n=312), our analyses revealed that women’s roles in drug use were active and multidimensional, and both partners’ injection risk practices represented embodied forms of cooperation and compassion. Women often earned money to purchase drugs and procured drugs to protect their partners from the police. Sharing drugs and syringes and seeking injection assistance were common among couples due to drug market characteristics (e.g., the use of “black tar” heroin that clogs syringes and damages veins). Both women and men provided and received injection assistance, which was typically framed as caring for the partner in need of help. Conclusion Our mixed methods study suggests that in certain risk environments, women are more active participants in injection-related practices than has often been revealed. This participation is shaped by dynamic relationship and structural factors. Our suggestion to consider gendered injection risk as a nuanced and relational process has

  1. Undiagnosed HIV among people who inject drugs in Manipur, India.

    PubMed

    Armstrong, Gregory; Medhi, Gajendra K; Mahanta, Jagadish; Paranjape, R S; Kermode, Michelle

    2015-01-01

    Manipur is a geographically isolated state of India characterised by a high HIV prevalence among people who inject drugs (PWID). A low-to-moderate lifetime rate of HIV testing has been documented amongst PWID in Manipur. Little is known about the extent of undiagnosed HIV in this setting and whether uptake of HIV testing (and knowledge of a positive diagnosis) leads HIV-positive PWID to change their risk behaviours. The cross-sectional data (n = 821) analysed for this paper were collected in 2009 for the Integrated Behavioural and Biological Assessment (IBBA) using interviewer-administered questionnaires and the collection of de-linked blood and urine samples. Almost one-third (30.7%) of the participants tested HIV positive. The majority knew where to obtain a confidential HIV test (80.7%), however, half of the HIV-positive participants had either never had an HIV test (37.7%), or had undertaken a test without collecting the result (12.7%). Almost one-quarter (23.4%) of the HIV-positive participants and 17.4% of the HIV-negative participants had shared a needle/syringe with at least one other injector during the preceding month. Encouragingly, HIV-positive participants were significantly more likely than HIV-negative participants to use condoms with their regular sexual partners, however, there was still a high proportion of HIV-positive participants who did not use a condom at last sex with their regular (47.2%) or casual (48.0%) partners. Having taken an HIV test and collected the result was associated with a reduction in HIV-risk behaviours among HIV-positive participants, but not among HIV-negative participants. In conclusion, we found that a substantial proportion of the HIV-positive PWID in Manipur were not aware of their positive status, and risky injecting and sexual practices were commonplace. However, HIV-positive PWID appear to reduce their high-risk behaviours when they become aware of their HIV status highlighting the importance of taking HIV testing

  2. Risk, shame and the public injector: a qualitative study of drug injecting in South Wales.

    PubMed

    Rhodes, Tim; Watts, Louise; Davies, Sarah; Martin, Anthea; Smith, Josie; Clark, David; Craine, Noel; Lyons, Marion

    2007-08-01

    Drug injecting in public places is associated with elevated health harm among injecting drug users (IDUs). Yet there is little research exploring the lived experience of injecting in public places, and specifically, a need to explore the interplay of public injecting environments, risk practices and social marginalisation. We undertook 49 qualitative interviews with IDUs in South Wales, UK, in six locations. Analyses focused on injectors' narratives of injecting in public places and risk identity. Findings show how the lived experience of public injecting feeds a pervasive sense of risk and 'otherness' among street injectors, in which public injecting environments act as contextual amplifiers of social marginalisation. Injecting in public places was characterised by urgency associated with a fear of interruption, a need to maintain privacy to prevent public exposure, and an awareness or sense of shame. We argue that daily interactions involving public exposure of injecting status, combined with the negative social meanings ascribed to public places used for injection, are experienced as potentially degrading to one's sense of self. We conclude that the public injecting environment is experienced in the context of other forms of public shaming in the lives of street injectors, and is thus productive of symbolic violence. This highlights tensions between strategies seeking to create safer communities and environmental interventions seeking to reduce drug-related health harm, including recent innovations such as the 'drug consumption room' (DCR). PMID:17475383

  3. Nicolau syndrome after intramuscular injection of non-steroidal anti-inflammatory drugs (NSAID).

    PubMed

    Dadaci, Mehmet; Altuntas, Zeynep; Ince, Bilsev; Bilgen, Fatma; Tufekci, Osman; Poyraz, Necdet

    2015-01-01

    Nicolau syndrome is a rare complication of intramuscular injection that leads to local ischemic necrosis of the skin and adipose tissue. In this paper, we discuss etiologies, risk factors, and treatment options for gluteal Nicolau syndrome referring to patients treated in our hospital. Our study includes 17 women who visited our clinic with symptoms of gluteal necrosis secondary to intramuscular injection. The following variables were taken into account: injection site, drug administered, frequency of injections, the person who administered the injections, needle size, and needle tip color. Magnetic resonance images obtained in the aftermath of intramuscular injection application were carefully analyzed for presence of necrosis, cyst formation and the thickness of the gluteal fat tissue layer. Drugs that had been received in intramuscular injection were exclusively non-steroidal anti-inflammatory drugs. Mean patient BMI was 41.8 (all patients were considered as obese), and mean gluteal fat thickness was 54 mm. Standard length of needles (3.8 cm) had been used in procedures. The wounds were treated with primary closure in 11 patients and with local flap therapy in 6 patients. The observed necrosis was a consequence of misplaced gluteal injection, where drugs were injected into the adipose tissue instead of the muscle due to the extreme thickness of the fat layer, on one hand, and the inappropriate length of standard needles, on the other hand. Intramuscular injection should be avoided in obese patients whenever possible: if it is necessary, proper injection technique should be used. PMID:25725145

  4. Hemoptysis due to a mycotic pulmonary artery aneurysm in an injecting drug user.

    PubMed

    Papaioannou, Vasilios; Mikroulis, Dimitrios; Chrysafis, Ioannis; Fotakis, Stelios; Pneumatikos, Ioannis

    2014-08-01

    Infected aneurysms of the pulmonary artery are a rare consequence of injected drug use. Hemoptysis of pulmonary arterial origin is also infrequent; however, the mortality is as high as 50%. We report here a case of hemoptysis in an intravenous drug user, caused by a pulmonary artery aneurysm due to septic microemboli, originating from a groin abscess. We highlight the importance of recognizing and treating thromboembolic complications associated with deep venous thrombosis in injecting drug users. PMID:23250844

  5. Adherence to Antiretroviral Medications among Persons who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

    PubMed Central

    Feelemyer, Jonathan; Jarlais, Don Des; Arasteh, Kamyar; Uuskula, Anneli

    2014-01-01

    Adherence to antiretroviral (ART) medication is vital to reducing morbidity and mortality among HIV positive persons. People who inject drugs (PWID) are at high risk for HIV infection in transitional/low/middle income countries (TLMIC). We conducted a systematic review of studies reporting adherence to ARTs among persons with active injection drug use and/or histories of injection drug use in TLMIC. Meta-regression was performed to examine relationships between location, adherence measurements, and follow-up period. Fifteen studies were included from seven countries. Adherence levels ranged from 33% to 97%; mean weighted adherence was 72%. ART adherence was associated with different methods of measuring adherence and studies conducted in Eastern Europe and East Asia. The great heterogeneity observed precludes generalization to TLMIC as a whole. Given the critical importance of ART adherence more research is needed on ART adherence among PWID in TLMIC, including the use of standardized methods for reporting adherence to ARTs. PMID:25331268

  6. A qualitative exploration of prescription opioid injection among street-based drug users in Toronto: behaviours, preferences and drug availability

    PubMed Central

    Firestone, Michelle; Fischer, Benedikt

    2008-01-01

    Background There is evidence of a high prevalence of prescription opioid (PO) and crack use among street drug users in Toronto. The purpose of this qualitative study was to describe drug use behaviours and preferences as well as the social and environmental context surrounding the use of these drugs among young and old street-based drug injection drug users (IDUs). Methods In-depth interviews were conducted with 25 PO injectors. Topics covered included drug use history, types of drugs used, how drugs were purchased and transitions to PO use. Interviews were taped and transcribed. Content analysis was conducted to identify themes. Results Five prominent themes emerged from the interviews: 1) Combination of crack and prescription opioids, 2) First injection experience and transition to prescription opioids, 3) Drug preferences and availability, 4) Housing and income and 5) Obtaining drugs. There was consensus that OxyContin and crack were the most commonly available drugs on the streets of Toronto. Drug use preferences and behaviours were influenced by the availability of drugs, the desired effect, ease of administration and expectations around the purity of the drugs. Distinct experiences were observed among younger users as compared to older users. In particular, the initiation of injection drug use and experimentation with POs among younger users was influenced by their experiences on the street, their peers and general curiosity. Conclusion Given the current profile of street-based drug market in Toronto and the emergence of crack and POs as two predominant illicit drug groups, understanding drug use patterns and socio-economic factors among younger and older users in this population has important implications for preventive and therapeutic interventions. PMID:18928556

  7. Behavioral HIV Risk Reduction among People Who Inject Drugs: Meta-Analytic Evidence of Efficacy

    PubMed Central

    Johnson, Blair T.; Lee, I-Ching; Harman, Jennifer J.; Carey, Michael P.

    2008-01-01

    We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate behavioral HIV-risk reduction interventions targeting people who inject drugs. We included 37 RCTs evaluating 49 independent HIV-risk reduction interventions with 10,190 participants. Compared to controls, intervention participants reduced injection-and non-injection drug use, increased drug treatment entry, increased condom use, and decreased trading sex for drugs. Interventions were more successful at reducing injection drug use when participants were non-Caucasians, when content focused equivalently on drug- and sex-related risk, and when content included interpersonal skills training specific to safer needle use. Condom use outcomes improved when two intervention facilitators were used instead of one. Injection drug use outcomes did not decay, but condom use outcomes did. Behavioral interventions do reduce risk behaviors among people who inject drugs, especially when interventions target both drug- and sexual-risk behavior, and when they include certain behavioral skills components. Implications for future interventions are presented. PMID:16919744

  8. Circular Migration by Mexican Female Sex Workers Who are Injection Drug Users: Implications for HIV in Mexican Sending Communities

    PubMed Central

    Ojeda, Victoria D.; Burgos, José Luis; Hiller, Sarah P.; Lozada, Remedios; Rangel, Gudelia; Vera, Alicia; Artamonova, Irina; Rodriguez, Carlos Magis

    2013-01-01

    Background Circular migration and injection drug use increase the risk of HIV transmission in sending communities. We describe female sex workers who are injection drug users’ (FSW-IDUs) circular migration and drug use behaviors. Methods Between 2008-2010, 258 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. Results 24% of FSW-IDUs were circular migrants. HIV prevalence was 3.3% in circular migrants and 6.1% in non-circular migrants; 50% of circular and 82% of non-circular migrants were unaware of their HIV infection. Among circular migrants, 44% (n=27) consumed illicit drugs in their birthplace; 70% of these (n=20) injected drugs and one-half of injectors shared injection equipment in their birthplace. Women reporting active social relationships were significantly more likely to return home. Discussion Circular migrant FSW-IDUs exhibit multiple HIV risks and opportunities for bridging populations. Regular HIV testing and treatment and access to substance use services is critical for FSW-IDUs and their sexual/drug-using contacts. PMID:21833727

  9. Circular migration by Mexican female sex workers who are injection drug users: implications for HIV in Mexican sending communities.

    PubMed

    Ojeda, Victoria D; Burgos, José Luis; Hiller, Sarah P; Lozada, Remedios; Rangel, Gudelia; Vera, Alicia; Artamonova, Irina; Magis-Rodriguez, Carlos

    2012-02-01

    Circular migration and injection drug use increase the risk of HIV transmission in sending communities. We describe female sex workers who are injection drug users' (FSW-IDUs) circular migration and drug use behaviors. Between 2008-2010, 258 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. 24% of FSW-IDUs were circular migrants. HIV prevalence was 3.2% in circular migrants and 6.1% in non-circular migrants; 50% of circular and 75% of non-circular migrants were unaware of their HIV infection. Among circular migrants, 44% (n = 27) consumed illicit drugs in their birthplace; 74% of these (n = 20) injected drugs and one-half of injectors shared injection equipment in their birthplace. Women reporting active social relationships were significantly more likely to return home. Circular migrant FSW-IDUs exhibit multiple HIV risks and opportunities for bridging populations. Regular HIV testing and treatment and access to substance use services is critical for FSW-IDUs and their sexual/drug-using contacts. PMID:21833727

  10. Changes in sexual and drug-related risk behavior following antiretroviral therapy initiation among HIV-infected injection drug users

    PubMed Central

    Fu, Tsung-chieh; Westergaard, Ryan P.; Lau, Bryan; Celentano, David D.; Vlahov, David; Mehta, Shruti H.; Kirk, Gregory D.

    2013-01-01

    Objective To evaluate whether HAART is associated with subsequent sexual and drug-related risk behavior compensation among injection drug users (IDUs). Design A community-based cohort study of 362 HIV-infected IDUs initiating HAART in Baltimore, Maryland. Methods HAART use and risk behavior was assessed at 8316 biannual study visits (median 23). Using logistic regression with generalized estimating equations (GEE), we examined the effect of HAART initiation on changes in risk behavior while adjusting for sociodemographics, alcohol use, CD4+ cell count, year of initiation and consistency of HAART use. Results At HAART initiation, participants were a median of 44.4 years old, 71.3% men and 95.3% African–American. In multivariable analysis, HAART initiation was associated with a 75% reduction in the likelihood of unprotected sex [adjusted odds ratio (aOR) 0.25; 95% confidence interval (CI), 0.19–0.32] despite no change in overall sexual activity (aOR 0.95; 0.80–1.12). Odds of any injecting decreased by 38% (aOR 0.62; 0.51–0.75) after HAART initiation. Among the subset of persistent injectors, needle-sharing increased nearly two-fold (aOR 1.99; 1.57–2.52). Behavioral changes were sustained for more than 5 years after HAART initiation and did not differ by consistency of HAART use. Reporting specific high-risk behaviors in the year prior to initiation was a robust predictor of engaging in those behaviors subsequent to HAART. Conclusion Overall, substantial declines in sexual risk-taking and active injecting argue against significant behavioral compensation among IDUs following HAART initiation. These data also provide evidence to support identifying persons with risky pre-HAART behavior for targeted behavioral intervention. PMID:23079804

  11. Natural killer cells in highly exposed hepatitis C-seronegative injecting drug users.

    PubMed

    Mina, M M; Cameron, B; Luciani, F; Vollmer-Conna, U; Lloyd, A R

    2016-06-01

    Injecting drug use remains the major risk factor for hepatitis C (HCV) transmission. A minority of long-term injecting drug users remain seronegative and aviraemic, despite prolonged exposure to HCV - termed highly exposed seronegative subjects. Natural killer (NK) cells have been implicated in this apparent protection. A longitudinal nested, three group case-control series of subjects was selected from a prospective cohort of seronegative injecting drug users who became incident cases (n = 11), remained seronegative (n = 11) or reported transient high-risk behaviour and remained uninfected (n = 11). The groups were matched by age, sex and initial risk behaviour characteristics. Stored peripheral blood mononuclear cells were assayed in multicolour flow cytometry to enumerate natural killer cell subpopulations and to assess functional activity using Toll-like receptor ligands before measurement of activation, cytokine production and natural cytotoxicity receptor expression. Principal components were derived to describe the detailed phenotypic characteristics of the major NK subpopulations (based on CD56 and CD16 co-expression), before logistic regression analysis to identify associations with exposed, seronegative individuals. The CD56(dim) CD16(+) (P = 0.05, OR 6.92) and CD56(dim) CD16(-) (P = 0.05, OR 6.07) principal components differed between exposed, seronegative individuals and pre-infection samples of the other two groups. These included CD56(dim) CD16(+) and CD56(dim) CD16(-) subsets with CD56(dim) CD16(+) IFN-γ and TNF-α on unstimulated cells, and CD56(dim) CD16(-) CD69(+) , CD107a(+) , IFN-γ and TNF-α following TLR stimulation. The cytotoxic CD56(dim) NK subset thus distinguished highly exposed, seronegative subjects, suggesting NK cytotoxicity may contribute to protection from HCV acquisition. Further investigation of the determinants of this association and prospective assessment of protection against HCV infection are warranted. PMID:26833632

  12. Hyperthermia-induced drug delivery from thermosensitive liposomes encapsulated in an injectable hydrogel for local chemotherapy.

    PubMed

    López-Noriega, Adolfo; Hastings, Conn L; Ozbakir, Burcin; O'Donnell, Kathleen E; O'Brien, Fergal J; Storm, Gert; Hennink, Wim E; Duffy, Garry P; Ruiz-Hernández, Eduardo

    2014-06-01

    A novel drug delivery system, enabling an in situ, thermally triggered drug release is described, consisting of an injectable thermoresponsive chitosan hydrogel containing doxorubicin-loaded thermosensitive liposomes. The design, fabrication, characterization, and an assessment of in vitro bioactivity of this formulation is detailed. Combining on-demand drug delivery with in situ gelation results in a promising candidate for local chemotherapy. PMID:24436226

  13. 78 FR 17933 - Determination That BENADRYL (diphenhydramine hydrochloride) Injection and Two Other Drug Products...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ...) Injection and Two Other Drug Products Were Not Withdrawn From Sale for Reasons of Safety or Effectiveness...) has determined that the three drug products listed in this document were not withdrawn from ] sale for... or effectiveness, or if FDA determines that the listed drug was withdrawn from sale for reasons...

  14. Remaking hospital space: The health care practices of injection drug users in New York City

    PubMed Central

    Szott, Kelly

    2014-01-01

    Background Medical care has long been depicted by social scientists as a field of social control, as well as a branch of Foucauldian disciplinary power. This report focuses attention on the hospital, a highly regulated place in the United States, and examines how injection drug users (IDUs) negotiate the medical social control and institutionalized disciplinary power they encounter in this place. Methods Twenty-eight qualitative interviews were conducted in New York City with low-income people who inject drugs on a regular basis. Interview questions focused on their health and drug use and interactions with health care providers. Results A variety of practices were employed to avoid, defy and subvert medical power. Study participants reported leaving the hospital when they felt ready rather than waiting to be discharged, actively seeking the type of care they wanted and ignoring medical advice. Conclusion The hospital is not a site of total control in the narratives of IDUs, but rather a space to seek a self-determined amount and type of care. These results can re-orient providers of health care services towards understanding the productivity of the relationship between IDUs and the hospital. PMID:24418630

  15. Cognitive Behavioral Theories Used to Explain Injection Risk Behavior among Injection Drug Users: A Review and Suggestions for the Integration of Cognitive and Environmental Models

    ERIC Educational Resources Information Center

    Wagner, Karla Dawn; Unger, Jennifer B.; Bluthenthal, Ricky N.; Andreeva, Valentina A.; Pentz, Mary Ann

    2010-01-01

    Injection drug users (IDUs) are at risk for HIV and viral hepatitis, and risky injection behavior persists despite decades of intervention. Cognitive behavioral theories (CBTs) are commonly used to help understand risky injection behavior. The authors review findings from CBT-based studies of injection risk behavior among IDUs. An extensive…

  16. Boredom, depressive symptoms, and HIV risk behaviors among urban injection drug users

    PubMed Central

    German, Danielle; Latkin, Carl A.

    2013-01-01

    Boredom is closely aligned with depression, but is understood to be conceptually distinct. Little is known about boredom among active drug users and the potential association with depression and HIV risk. Current IDUs (n=845) completed a baseline behavioral survey including socio-demographic characteristics, self-reported boredom, depressive symptoms (CESD score), and HIV risk behaviors. One-third of the sample reported high boredom in the past week. In multivariate analysis, those who reported boredom were less likely to be older, African-American, have a main partner, and to be employed at least part-time. Controlling for covariates, those with high boredom were almost five times as likely to report high depressive symptoms. Co-occurrence of boredom and depressive symptoms (28%) was strongly and independently associated with a range of injection risk behaviors and sex exchange. This study demonstrates the need for more thorough understanding of mental health and HIV risk among urban drug users. PMID:22760741

  17. Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas

    PubMed Central

    Des Jarlais, Don C; Feelemyer, Jonathan P; Modi, Shilpa N.; Arasteh, Kamyar; Hagan, Holly

    2012-01-01

    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 (I2 = 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. PMID:22257753

  18. High rates of midazolam injection among drug users in Bangkok, Thailand

    PubMed Central

    2010-01-01

    Background Reports from Thailand suggest that a growing number of people who inject drugs (IDU) are now injecting midazolam, a legal benzodiazepine with potent amnestic and ventilatory depressant effects. We therefore sought to examine midazolam injection among a community-recruited sample of Thai IDU. Methods We examined the prevalence and correlates of midazolam injection among 252 IDU participating in the Mitsampan Community Research Project, Bangkok, using multivariate logistic regression. We also examined the use of midazolam in combination with other drugs. Results 252 IDU participated in this study, including 66 (26.2%) women. In total, 170 (67.5%) participants reported ever having injected midazolam, and 144 (57.1%) reported daily midazolam injection in the past six months. In multivariate analyses, a history of midazolam injection was independently associated with using drugs in combination (adjusted odds ratio [AOR] = 5.86; 95% confidence interval [CI]: 2.96-11.60), younger age (AOR = 0.43; 95%CI: 0.22-0.83), having a history of methadone treatment (AOR = 3.12, 95%CI: 1.55-6.90), and binge drug use (AOR = 2.25, 95%CI: 1.09-4.63). The drugs most commonly used in combination with midazolam were heroin (72.3%) and yaba (methamphetamine) (30.5%). Conclusion We observed a high rate of midazolam injection among Thai IDU. Midazolam injection was strongly associated with polysubstance use and binge drug use, and was most commonly used in combination with both opiates and methamphetamines. Our findings suggest that midazolam injection has become increasingly common within Thailand. Evidence-based approaches for reducing harms associated with midazolam injection are needed. PMID:20338062

  19. Epidemiology of HIV Among Injecting and Non-injecting Drug Users: Current Trends and Implications for Interventions

    PubMed Central

    Stockman, Jamila K.

    2010-01-01

    Injecting drug use is a major driver of HIV infections in Eastern Europe, the Commonwealth of Independent States, North Africa, the Middle East, and many parts of Asia and North America. We provide a global overview of the epidemiology of HIV infection among drug users and present current drug use trends that may constitute important epidemic drivers. We describe trends in ethnic disparities among injecting drug using (IDU) populations in the United States, and comment upon how these trends may now be changing. We present examples where HIV infection among non-IDUs who use cocaine, crack, and methamphetamine by other routes of administration is similar to that among IDUs, and discuss potential mechanisms of HIV spread in this overlooked population. Finally, we comment upon the potential implications of these observations for HIV interventions among IDU and non-IDU populations, taking into account different strategies that are needed in settings where HIV and/or injecting drug use has been established, or threatens to emerge. PMID:20425564

  20. Early Onset of Drug and Polysubstance Use as Predictors of Injection Drug Use Among Adult Drug Users

    PubMed Central

    Trenz, Rebecca C.; Scherer, Michael; Harrell, Paul; Zur, Julia; Sinha, Ashish; Latimer, William

    2012-01-01

    Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore Maryland. The present study used a subset (N = 651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ2 = 19.71, p < .01), cigarette (χ2 = 11.05, p < .01), marijuana (χ2 = 10.83, p < .01), and polysubstance use (χ2 = 23.48, p < .01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR = 1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR = 1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR = 2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset alcohol and polysubstance use is an important risk factor for IDU in adulthood. PMID:22172686

  1. Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities.

    PubMed

    West, Brooke S; Abramovitz, Daniela; Staines, Hugo; Vera, Alicia; Patterson, Thomas L; Strathdee, Steffanie A

    2016-02-01

    We know little about predictors of injection drug cessation and relapse among female sex workers who inject drugs (FSW-PWID) at the US-Mexico border. Among HIV-negative FSW-PWID taking part in a behavioral intervention study in Tijuana and Ciudad Juárez, Cox regression was used to identify predictors of time to first cessation of injection, which was defined as reporting not having injected drugs for a period of 4 months or longer, and among that subset, we examined predictors of time to injection relapse. Among 440 women, 84 (19%) reported ceasing injection during follow-up (median time to cessation = 9.3 months); of these, 30 (35%) reported relapse to injection (median time to relapse = 3.5 months). The rate of injection cessation was lower for women reporting trading sex prior to age 18 (adj. hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.41-1.01), ever being sexually abused (adj. HR = 0.44, 95% CI = 0.27-0.71), and a higher number of vaginal sex acts with casual clients (adj. HR = 0.99 per transaction, 95% CI = 0.98-1.00). The rate of cessation was higher for women who spent more hours on the streets on a typical day (adj. HR = 1.04/h, 95% CI = 1.01-1.08) and who lived in Tijuana vs. Ciudad Juárez (adj. HR = 2.15, 95% CI = 1.14-4.07). The rate of relapse was higher among women reporting regular drug use with clients (adj. HR = 2.17, 95% CI = 0.96-4.89) and those scoring higher on a risk injection index (adj. HR = 2.04, 95% CI = 1.15-3.61). The rate of relapse was lower for FSW-PWID with higher than average incomes (adj. HR = 0.40, 95% CI = 0.18-0.89). These findings have important implications for the scale-up of methadone maintenance treatment programs (MMTPs) in Mexico and indicate a need for gender-specific programs that address sexual abuse experiences and economic vulnerabilities faced by FSW-PWID. PMID:26696001

  2. HIV infection among injecting drug users in north-east Malaysia, 1992.

    PubMed

    Singh, S; Crofts, N

    1993-01-01

    Human immunodeficiency virus (HIV) has spread widely among injecting drug users (IDUs) in countries to the north and west of the 'Golden Triangle' region of South-East Asia; it is likely to have spread southwards to Malaysia as well. In order to assess HIV seroprevalence among IDUs in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the General Hospital in the capital city of the north-eastern Malaysian state, Kelantan. Subjects were sequential entrants to the detoxification ward, interviewed about HIV risk behaviour, and tested for antibody to HIV and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in the preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contact there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/210, 69%) among IDUs interviewed, as was unsafe injecting and unsafe sexual behaviour (20% had shared injecting equipment and 21% had had unprotected intercourse) in other states. In every locale, rates of unsafe injecting behaviour were high (55% sharing in last month), even among those who knew they were HIV infected, and rates of condom usage were low (93% of 160 sexually active IDUs had never used a condom). Syphilis was not associated with HIV infection, but with contact with Thai prostitutes.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8218462

  3. Injection drug users' and their risk networks experiences of and attitudes toward drug dealer violence in Baltimore, Maryland

    PubMed Central

    Latkin, Carl A.; Yang, Cui; Tobin, Karin E.; German, Danielle

    2012-01-01

    Background A large portion of violence associated with drug use is due to drug dealing. These analyses sought to examine injection drug users' attitudes and experiences of drug dealer violence. Methods The current study used the 18-month follow up data of STEP into Action (STEP) study, an HIV prevention intervention among drug injectors and their risk network members conducted in Baltimore, Maryland. Four scales assessed acceptability of drug dealer violence, willingness to talk to drug users about avoiding drug dealer violence, social norms about reporting drug dealer violence, and intentions to report drug dealer violence to the police. Results Many (44%) of the 373 participants reported witnessing drug dealers' acts of violence within the prior 6 months. Although the majority of participants disagreed with statements on the acceptability of dealers using violence, only a minority indicated that they would call the police if they observed dealer violence. Most participants indicated that they would be interested in talking to drug users about how to avoid violent dealers. Males were more likely to report that violence was acceptable, whereas African Americans were less likely to condone violence. Those who were homeless and had higher incomes were more likely to report witnessing drug dealer violence. Conclusions These results suggest that it may be feasible to train current and former drug users and their risk network members in methods to promote violence reduction among drug dealers. PMID:22959117

  4. Ethical Issues in HIV Prevention Research with People Who Inject Drugs

    PubMed Central

    Sugarman, Jeremy; Rose, Scott M.; Metzger, David

    2013-01-01

    Background Injection drug use continues to significantly contribute to new infections with HIV. Moreover, conducting HIV prevention research with people who inject drugs (PWIDs) can be complicated for an array of practical, social, legal and ethical reasons. It is critical that these research efforts are sensitive to the particular vulnerabilities associated with injection drug use as well as those related to being at risk for acquiring HIV so as to minimize harm to participants in research. Purpose To describe how we addressed some of these ethical challenges during the course of a large-scale multinational randomized HIV prevention trial involving PWIDs, which was successfully completed. Methods The ethical issues encountered during the life-cycle of the trial were catalogued by the principal investigator, study coordinator and ethicist working on the trial. Relevant study documents were then reviewed to provide pertinent details. The ethical issues unique to the trial were then described. Results Before implementation, the trial faced particularly complex challenges related to the vulnerability of PWIDs where HIV seroincidence rates in the population were high and legal policies and stigma regarding injection drug use was severe. Accordingly, a rapid policy assessment was commissioned and a series of community engagement activities were conducted. During the trial, in addition to using careful standard operating procedures regarding all aspects of trial conduct and extensive staff training, the trial standardized informed consent procedures and assessed them. Further, social harms were monitored along with physical harms and adverse events. Following the decision to close the study, it was critical to develop an orderly and safe process for closing it. The issue of post-trial access to the study medication and a complex intervention also surfaced for consideration. Limitations The issues described in this paper are necessarily limited to how they manifested

  5. Policy advocacy for female injecting drug users in eastern and central Europe.

    PubMed

    Zakowicz, Anna

    2010-10-01

    A key reason for hosting AIDS 2010 in Vienna was to highlight the spread of HIV through injecting drug use, something that has reached crisis proportions in many parts of Eastern Europe and the former Soviet Union. In this article, based on a presentation at the conference, Anna Zakowicz discusses the options for promoting policy advocacy for female injecting drug users (IDUs) in Central and Eastern Europe. PMID:21413621

  6. Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia

    PubMed Central

    Kruse, Gina Rae; Barbour, Russell; Heimer, Robert; Shaboltas, Alla V; Toussova, Olga V; Hoffman, Irving F; Kozlov, Andrei P

    2009-01-01

    Background The HIV epidemic in Russia has been driven by the unsafe injection of drugs, predominantly heroin and the ephedrine derived psychostimulants. Understanding differences in HIV risk behaviors among injectors associated with different substances has important implications for prevention programs. Methods We examined behaviors associated with HIV risk among 900 IDUs who inject heroin, psychostimulants, or multiple substances in 2002. Study participants completed screening questionnaires that provided data on sociodemographics, drug use, place of residence and injection- and sex-related HIV risk behaviors. HIV testing was performed and prevalence was modeled using general estimating equation (GEE) analysis. Individuals were clustered by neighborhood and disaggregated into three drug use categories: Heroin Only Users, Stimulant Only Users, and Mixed Drug Users. Results Among Heroin Only Users, younger age, front/backloading of syringes, sharing cotton and cookers were all significant predictors of HIV infection. In contrast, sharing needles and rinse water were significant among the Stimulant Only Users. The Mixed Drug Use group was similar to the Heroin Only Users with age, front/back loading, and sharing cotton significantly associated with HIV infection. These differences became apparent only when neighborhood of residence was included in models run using GEE. Conclusion The type of drug injected was associated with distinct behavioral risks. Risks specific to Stimulant Only Users appeared related to direct syringe sharing. The risks specific to the other two groups are common to the process of sharing drugs in preparation to injecting. Across the board, IDUs could profit from prevention education that emphasizes both access to clean syringes and preparing and apportioning drug with these clean syringes. However, attention to neighborhood differences might improve the intervention impact for injectors who favor different drugs. PMID:19646255

  7. Correlates of lending needles/syringes among HIV-seropositive injection drug users.

    PubMed

    Metsch, Lisa R; Pereyra, Margaret; Purcell, David W; Latkin, Carl A; Malow, Robert; Gómez, Cynthia A; Latka, Mary H

    2007-11-01

    Among HIV-positive injection drug users (IDUs), we examined the correlates of lending needles/syringes with HIV-negative and unknown status injection partners. HIV-positive IDUs (N=738) from 4 cities in the United States who reported injection drug use with other IDUs in the past 3 months participated in an audio computer-assisted self-administered interview. Eighteen percent of study participants self-reported having lent their needles to HIV-negative or unknown status injection partners. Multivariate analyses showed that 6 variables were significantly associated with this high-risk injecting practice. Older IDUs, high school graduates, and those reporting more supportive peer norms for safer drug use were less likely to lend needles/syringes. Admission to a hospital for drug treatment in the past 6 months, having injected with >1 person in the past 3 months, and having more psychiatric symptoms were all associated with more risk. These findings underscore the need for a continued prevention focus on HIV-positive IDUs that recognizes the combination of drug use, mental health factors, and social factors that might affect this high-risk injecting practice, which could be associated with HIV and hepatitis C transmission. PMID:18089987

  8. Using Mindfulness to Develop Health Education Strategies for Blood Borne Virus Prevention in Injecting Drug Use

    ERIC Educational Resources Information Center

    Treloar, Carla; Laybutt, Becky; Carruthers, Susan

    2010-01-01

    Aims: Prevention education has had limited success in reducing transmission of blood borne virus among people who inject drugs. Innovative approaches to prevention education are required. Method: This study used video recordings of injecting episodes and interviews with participants reviewing their video recordings to explore the concept of…

  9. Inability to access addiction treatment and risk of HIV infection among injection drug users recruited from a supervised injection facility†

    PubMed Central

    Milloy, M.-J.S.; Kerr, Thomas; Zhang, Ruth; Tyndall, Mark; Montaner, Julio; Wood, Evan

    2010-01-01

    Background Treatment for drug addiction is effective in reducing the harms of injection drug use, including infection with HIV and/or hepatitis C. We sought to examine the prevalence and correlates of being unable to access addiction treatment in a representative sample of injection drug users randomly recruited from a supervised injection facility. Methods Using generalized estimating equations, we determined the prevalence and factors associated with being unable to access addiction treatment. Results Between 1 July 2004 and 30 June 2006, 889 individuals completed at least one interview and were included in this analysis. At each interview, ∼20% of respondents reported trying but being unable to access any type of drug or alcohol treatment in the previous 6 months. Being unable to access treatment was independently associated with recent incarceration, daily use of heroin and borrowing used syringes. In a secondary question, the majority of individuals reported waiting lists were the reason for being unable to access treatment. Conclusion Given the independent association between inability to access addiction treatment and elevated HIV risk behavior, these results suggest expanding addiction treatment may contribute significantly to HIV prevention efforts in this population. PMID:19776079

  10. Laser-irradiated drug chromatographic analysis and laser injection of drugs to treat staphyloccocal lesions of skin

    NASA Astrophysics Data System (ADS)

    Zharov, Vladimir P.; Latyshev, Alexei S.; Kovsh, Anna I.; Razumova, Svetlana A.; Masyukova, Svetlana A.; Volnukhin, Vladimir A.

    2001-05-01

    This article deals with further development of laser drug delivery methods. In order to estimate the effect of laser- drug interactions, we carried out the chromatographic fractionation of dexamethasone, hydrocortisone, and gentamicine, both prior to and after irradiating them by pulsed Er:YAG laser radiation. The laser radiation parameters were as follows: the wavelength, pulse energy, and pulse duration were, respectively, 2.94 micrometers , 0.7 J, and 100 microsecond(s) . The total laser radiation dose administered to a 100 (mu) l sample of these drug preparations amounted to 150 J. A chromatographic analysis revealed that drug samples exposed to Er:YAG laser radiation did not show any change. The results obtained made it possible to employ pulsed Er:YAG laser radiation to perform laser-acoustic injection of the above-mentioned drug preparations to study the treatment of staphylococcal lesions in 30 guinea pigs. The perforated channel depth was measured and the injected drug solution volume was calculated. It was found that laser injection enabled one to introduce therapeutic doses of drugs, and that it expedited the healing of lesions by 3 to 4 days, as compared to the control group that received the topical application of drugs without laser irradiation.

  11. Understanding decisions made about hepatitis C treatment by couples who inject drugs.

    PubMed

    Treloar, C; Rance, J; Bryant, J; Fraser, S

    2016-02-01

    Efforts to increase the number of people having hepatitis C virus (HCV) treatment require understanding how to best deliver services to meet consumers' needs. The general health literature has examined the role that partners can play in supporting health outcomes. This study examines the experiences of couples who inject drugs in relation to knowledge of, decisions about and management of HCV treatment. This is a qualitative interview study of people who inject drugs in couples. Participants were recruited from harm reduction services in two major Australian cities. Couples were interviewed separately. Data were examined using the couple as the unit of analysis and to identify patterns of experience related to the HCV serostatus of couples. Knowledge of HCV and HCV treatment was low and variable but showed some relationship to serostatus. Decisions about HCV treatment were deeply informed by concerns regarding treatment side effects. Positive concordant couples considered 'staging' treatment to ensure that each partner could (in turn) care for the other. People with HCV in serodiscordant relationships may need specific support regarding HCV treatment information. Within positive concordant partnerships, our data indicated the need to support the HCV-positive 'carer' during their partner's treatment. Changing treatment regimens, and their anticipated lower side effect profiles, will need to be actively promoted to ensure that couples understand how these changes affect their treatment options. PMID:26305873

  12. Prevention, control and treatment of HIV-AIDS among injecting drug use in Bandung, Indonesia.

    PubMed

    Alisjahbana, Bachti; Susanto, Herman; Roesli, Rully; Yusuf, Hadi; Hinduan, Zahrotur; Mase, Johannes C; Surahman, Eri; van der Ven, Andre

    2009-07-01

    Indonesia is facing a growing HIV-epidemic that in many areas is driven by injecting drug use (IDU). IDUs underutilize health services, partly because of legal aspects which also cause that many are held in prison, where further HIV- transmission may take place. Most HIV-infected patients present with advanced HIV-AIDS and many deaths before starting antiretroviral treatment. The growing HIV-epidemic in Indonesia has socio-economical implications for individual patients as well as for the health system and for society. IMPACT, a multidisciplinary university-based program in Bandung, West-Java, integrates HIV-prevention and treatment, combining research and implementation. Biomedical, public health and sociobehavioral expertise is used for educational programs for adolescents; scaling-up HIV-testing, harm reduction strategies and care for HIV/AIDS in hospital, community and prison; and institutional as well as individual capacity building related to IDU and HIV/AIDS. It is expected that these activities can make a significant contribution to control of HIV-AIDS in the context of injecting drug use in West-Java and Indonesia as a whole. PMID:19920301

  13. Declining trends in exposures to harmful policing among people who inject drugs in Vancouver, Canada

    PubMed Central

    Landsberg, Adina; Kerr, Thomas; Milloy, Michael-John; Dong, Huiru; Nguyen, Paul; Wood, Evan; Hayashi, Kanna

    2016-01-01

    Introduction In 2006, the Vancouver Police Department (VPD) developed an organization-wide drug policy approach, which included endorsing harm reduction strategies for people who inject drugs (PWID). We sought to examine rates of potentially harmful policing exposures and associated HIV risk behaviour among PWID in Vancouver, Canada before and after the VPD policy change. Methods Data were derived from two prospective cohort studies of PWID. Multivariable generalized estimating equation models were used to examine changes in the risk of confiscation of drug use paraphernalia and physical violence by the police, as well as changes in the relationship between exposures to the two policing practices and sharing of drug use paraphernalia, before and after the policy change. Results Among 2193 participants, including 757 (34.5%) women, the rates of experiencing police confiscation of drug use paraphernalia declined from 22.3% in 2002 to 2.8% in 2014, and the rates of reporting experiencing physical violence by the police also declined from 14.1% in 2004 to 2.9% in 2014. In multivariable analyses, the post-policy change period remained independently and negatively associated with reports of confiscation of drug use paraphernalia (adjusted odds ratio (AOR): 0.25; 95% confidence interval (CI): 0.21 to 0.31) and reported physical violence by the police (AOR: 0.76; 95% CI: 0.63 to 0.91). However, experiencing both confiscation of drug use paraphernalia and physical violence by the police (AOR: 1.92; 95% CI: 1.10 to 3.33) and experiencing only confiscation of drug use paraphernalia (AOR: 1.71; 95% CI: 1.34 to 2.19) remained independently and positively associated with sharing of drug use paraphernalia during the post-policy change period. Conclusions In our study, two policing practices known to increase HIV risk among PWID have declined significantly since the local police launched an evidence-based drug policy approach. However, these practices remained independently

  14. Methadone maintenance and other factors associated with intraindividual temporal trends in injection-drug use.

    PubMed

    Shore, R E; Marmor, M; Titus, S; Des Jarlais, D C

    1996-01-01

    The objective of this study was to determine what sociodemographic, lifestyle, or drug-related characteristics predict temporal changes in self reported drug injection frequencies among HIV-seronegative injection-drug users (IDUs) who were being given HIV testing and risk reduction counseling. The 277 subjects were given 4-11 quarterly interviews including detailed history of drug use and other HIV risk factors, HIV risk reduction counseling, and venipuncture for HIV antibody testing. A regression slope of change over time in drug injection frequency was calculated for each subject, and categories were created of decreasing temporal slope, increasing slope, relapse (decrease initially, then increase), or no substantial change. Only 44% of subjects decreased their drug injection frequencies despite repetitive HIV testing and counseling. In multivariate logistic analyses, decreasing temporal trends were associated with consistent enrollment in methadone maintenance (p < .1), whereas increasing trends conversely were associated with inconsistent enrollment (p < .01) and also with an absence of crack use (p < .01). Relapses were significantly associated with needle sharing with multiple partners and a low frequency of smoking. The data suggest that methadone maintenance facilitates a positive response to HIV risk reduction counseling. However, the fact that only a minority of subjects displayed a decreasing temporal trend in drug injection frequencies emphasizes the need for improved therapeutic and counseling techniques. PMID:9017567

  15. Correlates of unsafe syringe acquisition and disposal among injection drug users in Baltimore, Maryland.

    PubMed

    Golub, Elizabeth T; Bareta, Joseph C; Mehta, Shruti H; McCall, Lisa D; Vlahov, David; Strathdee, Steffanie A

    2005-01-01

    Because multi-person syringe use is the most common vehicle for HIV and hepatitis C virus transmission among injection drug users (IDUs), safe sources of sterile syringes and safe methods of disposal are necessary to curb these epidemics. We examined syringe acquisition and disposal in a cohort of IDUs in Baltimore. Between January 1, 1998 and December 31, 2001, 1034 participants reported on syringe acquisition at 3492 visits, and 953 reported on disposal at 2569 visits. Participants were 69.9% male, 93.9% African-American, and median age was 44. Syringes were acquired exclusively from unsafe sources at 32.3% of visits, while exclusively unsafe disposal was reported at 59.3% of visits. Significant correlates of unsafe acquisition were: attending shooting galleries, anonymous sex, sharing needles, smoking crack, and emergency room visits. Significant correlates of unsafe disposal were: injecting speedball, no methadone treatment, acquiring safely, and frequent injection. Having a primary source of medical care was associated with safe acquisition, but unsafe disposal. IDUs continue to acquire safely but dispose unsafely, especially among those with a primary source of care; this suggests that messages about safe disposal are not being disseminated as widely as those about acquisition. These data suggest the need for a more active program involving pharmacists, an expanded syringe access program, and better efforts to enhance safe disposal. PMID:16419554

  16. Experiences with Policing among People Who Inject Drugs in Bangkok, Thailand: A Qualitative Study

    PubMed Central

    Hayashi, Kanna; Small, Will; Csete, Joanne; Hattirat, Sattara; Kerr, Thomas

    2013-01-01

    Background Despite Thailand's commitment to treating people who use drugs as “patients” not “criminals,” Thai authorities continue to emphasize criminal law enforcement for drug control. In 2003, Thailand's drug war received international criticism due to extensive human rights violations. However, few studies have since investigated the impact of policing on drug-using populations. Therefore, we sought to examine experiences with policing among people who inject drugs (PWID) in Bangkok, Thailand, between 2008 and 2012. Methods and Findings Between July 2011 and June 2012, semi-structured, in-depth interviews were conducted with 42 community-recruited PWID participating in the Mitsampan Community Research Project in Bangkok. Interviews explored PWID's encounters with police during the past three years. Audio-recorded interviews were transcribed verbatim, and a thematic analysis was conducted to document the character of PWID's experiences with police. Respondents indicated that policing activities had noticeably intensified since rapid urine toxicology screening became available to police. Respondents reported various forms of police misconduct, including false accusations, coercion of confessions, excessive use of force, and extortion of money. However, respondents were reluctant to report misconduct to the authorities in the face of social and structural barriers to seeking justice. Respondents' strategies to avoid police impeded access to health care and facilitated transitions towards the misuse of prescribed pharmaceuticals. The study's limitations relate to the transferability of the findings, including the potential biases associated with the small convenience sample. Conclusions This study suggests that policing in Bangkok has involved injustices, human rights abuses, and corruption, and policing practices in this setting appeared to have increased PWID's vulnerability to poor health through various pathways. Novel to this study are findings

  17. Urging others to be healthy: "intravention" by injection drug users as a community prevention goal.

    PubMed

    Friedman, Samuel R; Maslow, Carey; Bolyard, Melissa; Sandoval, Milagros; Mateu-Gelabert, Pedro; Neaigus, Alan

    2004-06-01

    "Intravention," prevention activities that are conducted by and sustained through ongoing actions of members of communities-at-risk, is an appropriate goal for HIV intervention activities. Data from 120 injection drug users in a Brooklyn, New York, neighborhood that has seen decreases in HIV prevalence among IDUs and little HIV diffusion to young adults indicate that most of them have recently (3 months) urged other people to engage in one or more self-protective actions. These data suggest that the common image of IDUs as simply being sources of social and medical problems is inaccurate. Research is needed into how to create and diffuse "communities of intravention; " and we suggest that behavioral interventions be evaluated for their success or failure at creating outward-focused health communication by participants as well as for their impact on individual risk behaviors. PMID:15237054

  18. Changes in patterns of injecting drug use in Hungary: a shift to synthetic cathinones.

    PubMed

    Péterfi, Anna; Tarján, Anna; Horváth, Gergely Csaba; Csesztregi, Tamás; Nyírády, Adrienn

    2014-01-01

    The spread of synthetic cathinone injecting is a new phenomenon observed in recent years in Hungary. Until 2010, when the first anecdotal reports on cathinone injecting appeared, injecting was associated with the use of heroin and amphetamine. In this paper we review available evidence of the changes in the drug market and a concurrent shift in patterns of injecting drug use that have been taking place in Hungary since 2010. Remarkable changes have been observed in police seizures data since 2010. While new psychoactive substances have appeared, the availability of heroin has dropped significantly. A qualitative study in 2011 revealed that these market changes correlate with changes in patterns of injecting drug use: decreasing heroin use and the appearance of mephedrone injecting were reported by treatment and needle and syringe programme (NSP) personnel. These changes are detectable in other routine epidemiological data collection systems in the following years as well (i.e. treatment, drug-related deaths, NSP clientele). Heroin-related treatment demand dropped, as did heroin-related mortality. Parallel to this, a growing number of clients appeared in treatment and in NSPs who were primarily injecting cathinones. The shift to cathinones can be observed in amphetamine and heroin injectors as well. Monitoring changes in patterns of injecting drug use are especially important because of the vulnerability of this drug-user population and the consequences of this high-risk route of drug administration. The realignment observed in Hungary is to be further investigated with regard to its determinants, changes in risk behaviour, and in treatment needs. PMID:24692417

  19. Factors associated with injection cessation, relapse and initiation in a community-based cohort of injection drug users in Chennai, India

    PubMed Central

    Mehta, Shruti H.; Sudarshi, Darshan; Srikrishnan, Aylur K.; Celentano, David D.; Vasudevan, Canjeevaram K.; Anand, Santhanam; Kumar, Muniratnam Suresh; Latkin, Carl; Solomon, Suniti; Solomon, Sunil S.

    2011-01-01

    Aims To characterize factors associated with injection cessation, relapse and initiation. Design MIDACS is a prospective cohort of injection drug users (IDUs) recruited in 2005–06 with semi-annual follow-up through 2009. Discrete-time survival models were used to characterize predictors of time to first injection cessation and relapse. Setting Chennai, India Participants 855 IDUs who reported injecting in the six months prior to baseline and had > 1 follow-up visit. Measurements Cessation was defined as the first visit where no injection drug use was reported (prior six months) and relapse as the first visit where drug injection (prior six months) was reported after first cessation. Findings All participants were male; median age was 35. Over three years, 92.7% reported cessation (incidence rate [IR]: 117 per 100 person-years). Factors positively associated with cessation included daily injection and incarceration and factors negatively associated with cessation included marriage, alcohol and homelessness. Of those who reported cessation, 24% relapsed (IR: 19.7 per 100 person-years). Factors positively associated with relapse included any education, injection in the month prior to baseline, sex with a casual partner, non-injection drug use, incarceration and homelessness. Alcohol was negatively associated with relapse. The primary reasons for cessation were medical conditions (36%) and family pressure (22%). The majority initiated with non-injection drugs, transitioning to injection after a median 4 years. Conclusions Injection drug users in Southern India demonstrate a high rate of injection cessation over three years, but relapse is not uncommon. Compensatory increases in alcohol use indicate that cessation of injection does not mean cessation of all substance use. Family pressure, concerns about general health, fear of HIV infection, and a history of non-injection drug use are important correlates of cessation. PMID:21815960

  20. Development of a risk reduction intervention to reduce bacterial and viral infections for injection drug users

    PubMed Central

    Phillips, Kristina T.; Altman, Jennifer K.; Corsi, Karen F.; Stein, Michael D.

    2016-01-01

    Bacterial infections are widespread problems among drug injectors, requiring novel preventive intervention. As part of a NIDA-funded study, we developed an intervention based on the Information-Motivation-Behavioral Skills Model, past research, injection hygiene protocols, and data collected from focus groups with 32 injectors in Denver in 2009. Qualitative responses from focus groups indicated that most participants had experienced skin abscesses and believed that bacterial infections were commonly a result of drug cut, injecting intramuscularly, and reusing needles. Access to injection supplies and experiencing withdrawal were the most frequently reported barriers to utilizing risk reduction. Implications for intervention development are discussed. PMID:23017057

  1. HIV vaccine trial willingness among injection and non-injection drug users in two urban centres, Barcelona and San Francisco.

    PubMed

    Etcheverry, M Florencia; Lum, Paula J; Evans, Jennifer L; Sanchez, Emilia; de Lazzari, Elisa; Mendez-Arancibia, Eva; Sierra, Ernesto; Gatell, José M; Page, Kimberly; Joseph, Joan

    2011-02-24

    Being able to recruit high-risk volunteers who are also willing to consider future participation in vaccine trials are critical features of vaccine preparedness studies. We described data from two cohorts of injection- and non-injection drug users in Barcelona, Spain [Red Cross centre] and in San Francisco, USA, [UFO-VAX study] at high risk of HIV/HCV infection to assess behaviour risk exposure and willingness to participate in future preventive HIV vaccine trials. We successfully identified drug-using populations that would be eligible for future HIV vaccine efficacy trials, based on reported levels of risk during screening and high levels of willingness to participate. In both groups, Red Cross and UFO-VAX respectively, HCV infection was highly prevalent at baseline (41% and 34%), HIV baseline seroprevalence was 4.2% and 1.5%, and high levels of willingness were seen (83% and 78%). PMID:21241735

  2. HIV vaccine trial willingness among injection and non-injection drug users in two urban centres, Barcelona and San Francisco

    PubMed Central

    Etcheverry, M. Florencia; Lum, Paula J.; Evans, Jennifer L.; Sanchez, Emilia; de Lazzari, Elisa; Mendez-Arancibia, Eva; Sierra, Ernesto; Gatell, José M.; Page, Kimberly; Joseph, Joan

    2013-01-01

    Being able to recruit high-risk volunteers who are also willing to consider future participation in vaccine trials are critical features of vaccine preparedness studies. We described data from two cohorts of injection- and non-injection drug users in Barcelona, Spain [Red Cross centre] and in San Francisco, USA, [UFO-VAX study] at high risk of HIV/HCV infection to assess behaviour risk exposure and willingness to participate in future preventive HIV vaccine trials. We successfully identified drug-using populations that would be eligible for future HIV vaccine efficacy trials, based on reported levels of risk during screening and high levels of willingness to participate. In both groups, Red Cross and UFO-VAX respectively, HCV infection was highly prevalent at baseline (41% and 34%), HIV baseline seroprevalence was 4.2% and 1.5%, and high levels of willingness were seen (83% and 78%). PMID:21241735

  3. Sexual Risk Taking among HIV-Positive Injection Drug Users: Contexts, Characteristics, and Implications for Prevention

    ERIC Educational Resources Information Center

    Knight, Kelly R.; Purcell, David; Dawson-Rose, Carol; Halkitis, Perry N.; Gomez, Cynthia A.

    2005-01-01

    HIV-positive injection drug users (IDUs) (N = 161) were recruited to complete a qualitative interview and a quantitative survey about sexual behavior and transmission risk. We identified two contexts in which exposure encounters occurred most commonly for HIV-positive IDUs: in intimate serodiscordant relationships and in the drug/sex economy.…

  4. Surviving in two worlds: social and structural violence of Thai female injecting drug users.

    PubMed

    Haritavorn, Niphattra

    2014-01-01

    Thai females injecting drugs are ensnared in a web of problems arising from forms of prejudice that magnify their vulnerability. They are vulnerable, at risk, and exposed to a high degree of social suffering. This paper aims to elucidate how social production and structural violence combine to shape the lives of these women. Using a qualitative methodology, two focus groups with 5 key informants and in-depth interviews involving a total of 35 women injecting drugs were conducted in Bangkok. The findings reveal that the structural environment that directly impacts upon these women's lives becomes the reason for their suffering. The structural environment puts these women at risk of violence in numerous social settings in which these women engage as well as generating tension at a subjective level (i.e. the habitus) of these women. Thai female injecting drug users are trapped in a difficult tension between the demands for being Thai women seeking to exist in the masculine world of drug use but at the same time meeting Thai society's expectations of womanhood. Unequal gender relations are manifest in the everyday violence that women face in the drug community, culminating in the essential nature of women being questioned, undermined and threatened. Living in the drug community, women are subjected to violence and harassment, and gendered brutality by intimate partners. In conclusion, the social suffering that Thai female injecting drug users find themselves confronting is confined to dilemmas cause by tensions between drug use and the overriding gender habitus. PMID:24183342

  5. Immediate impact of Hurricane Sandy on people who inject drugs in New York City

    PubMed Central

    Pouget, Enrique R.; Sandoval, Milagros; Nikolopoulos, Georgios K.; Friedman, Samuel R.

    2015-01-01

    Over the 8 months following Hurricane Sandy, of October 2012, we interviewed 300 people who inject drugs in New York City. During the week after the storm 28% rescued others or volunteered with aid groups; 60% experienced withdrawal; 27% shared drug injection or preparation equipment or injected with people they normally would not inject with; 70% of those in opioid maintenance therapy could not obtain sufficient doses; and 43% of HIV-positive participants missed HIV medication doses. Though relatively brief, a hurricane can be viewed as a Big Event that can alter drug environments and behaviors, and may have lasting impact. The study’s limitations are noted and future needed research is suggested. PMID:25775259

  6. Associations of Body Mass Index with Sexual Risk-Taking and Injection Drug Use among US High School Students

    PubMed Central

    Lowry, Richard; Robin, Leah; Kann, Laura; Galuska, Deborah A.

    2014-01-01

    The purpose of this study was to determine if body mass index (BMI) is associated with behaviors that may increase risk for HIV and other sexually transmitted diseases (STDs) among US high school students. We analyzed nationally representative data from the 2005–2011 national Youth Risk Behavior Surveys (YRBS) to examine associations of BMI categories with sexual risk behaviors and injection drug use among sexually active high school students, using sex-stratified logistic regression models. Controlling for race/ethnicity and grade, among female and male students, both underweight (BMI < 5th percentile) and obesity (BMI ≥ 95th percentile) were associated with decreased odds of being currently sexually active (i.e., having had sexual intercourse during the past 3 months). However, among sexually active female students, obese females were more likely than normal weight females to have had 4 or more sex partners (odds ratio, OR = 1.59), not used a condom at last sexual intercourse (OR = 1.30), and injected illegal drugs (OR = 1.98). Among sexually active male students, overweight (85th percentile ≤ BMI < 95th percentile) was associated with not using a condom at last sexual intercourse (OR = 1.19) and obesity was associated with injection drug use (OR = 1.42). Among sexually active students, overweight and obesity may be indicators of increased risk for HIV and other STDs. PMID:25105024

  7. Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand

    PubMed Central

    2011-01-01

    Background Despite Thailand's official reclassification of drug users as "patients" deserving care and not "criminals," the Thai government has continued to rely heavily on punitive responses to drug use such as "boot camp"-style compulsory "treatment" centers. There is very little research on experiences with compulsory treatment centers among people who use drugs. The work reported here is a first step toward filling that gap. Methods We examined experiences of compulsory drug treatment among 252 Thai people who inject drugs (IDU) participating in the Mitsampan Community Research Project in Bangkok. Multivariate logistic regression was used to identify factors independently associated with a history of compulsory treatment experience. Results In total, 80 (31.7%) participants reported a history of compulsory treatment. In multivariate analyses, compulsory drug detention experience was positively associated with current spending on drugs per day (adjusted odds ratio [AOR] = 1.86; 95%CI: 1.07 - 3.22) and reporting drug planting by police (AOR = 1.81; 95%CI: 1.04 - 3.15). Among those with compulsory treatment experience, 77 (96.3%) reported injecting in the past week, and no difference in intensity of drug use was observed between those with and without a history of compulsory detention. Conclusion These findings raise concerns about the current approach to compulsory drug detention in Thailand. Exposure to compulsory drug detention was associated with police abuse and high rates of relapse into drug use, although additional research is needed to determine the precise impact of exposure to this form of detention on future drug use. More broadly, compulsory "treatment" based on a penal approach is not consistent with scientific evidence on addressing drug addiction and should be phased out in favor of evidence-based interventions. PMID:22014093

  8. Drug-related harm among people who inject drugs in Thailand: summary findings from the Mitsampan Community Research Project

    PubMed Central

    2013-01-01

    Background For decades, Thailand has experienced high rates of illicit drug use and related harms. In response, the Thai government has relied on drug law enforcement to address this problem. Despite these efforts, high rates of drug use persist, and Thailand has been contending with an enduring epidemic of human immunodeficiency virus (HIV) among people who inject drugs (IDU). Methods In response to concerns regarding drug-related harm in Thailand and a lack of research focused on the experiences and needs of Thai IDU, the Mitsampan Community Research Project was launched in 2008. The project involved administering surveys capturing a range of behavioral and other data to community-recruited IDU in Bangkok in 2008 and 2009. Results In total, 468 IDU in Bangkok were enrolled in the project. Results revealed high rates of midazolam injection, non-fatal overdose and incarceration. Syringe sharing remained widespread among this population, driven primarily by problems with access to syringes and methamphetamine injection. As well, reports of police abuse were common and found to be associated with high-risk behavior. Problems with access to evidence-based drug treatment and HIV prevention programs were also documented. Although compulsory drug detention centers are widely used in Thailand, data suggested that these centers have little impact on drug use behaviors among IDU in Bangkok. Conclusions The findings from this project highlight many ongoing health and social problems related to illicit drug use and drug policies in Bangkok. They also suggest that the emphasis on criminal justice approaches has resulted in human rights violations at the hands of police, and harms associated with compulsory drug detention and incarceration. Collectively, the findings indicate the urgent need for the implementation of evidence-based policies and programs in this setting. PMID:24099081

  9. Epidemiology of HIV/AIDS, hepatitis B, hepatitis C, and tuberculosis among minority injection drug users.

    PubMed Central

    Estrada, Antonio L.

    2002-01-01

    OBJECTIVE: This article reviews the literature on the impact of HIV/AIDS, hepatitis B and C viruses (HBV, HCV), and tuberculosis on minority drug injectors in the United States. OBSERVATIONS: Injection drug use is a key factor in the transmission of blood-borne pathogens, and HIV disease is exacerbated by tuberculosis infection. Minority drug injectors are disproportionately represented in the national statistics on these infections. Behavioral epidemiologic studies show that both injection-related risk factors years of injecting drugs, type of drug injected, direct and indirect sharing of injection paraphernalia) and sex-related risk factors (lack of condom use, multiple sexual partners, survival sex) are conducive to the spread of HIV, HBV, and HCV. CONCLUSIONS: Two issues must be addressed to halt the spread of HIV infection and hepatitis B and C. The capacity of syringe-exchange programs to refer participants to drug treatment programs and facilitate access to health and social services must be increased. Culturally appropriate behavioral interventions targeting risk behaviors among ethnic and racial minorities, especially women, must be developed and put in place. PMID:12435836

  10. Rapid assessment and response to injecting drug use in Madras, south India.

    PubMed

    Kumar; Mudaliar; Thyagarajan; Kumar; Selvanayagam; Daniels

    2000-03-01

    HIV infection among injecting drug users (IDUs) is preventable, and in order to develop appropriate interventions, an assessment was carried out at Madras, South India using the Rapid Assessment and Response Guide on Injecting Drug Use developed by WHO. Data were collected with multiple methods from multiple sources using the principles of triangulation and induction. A total of 100 IDUs were interviewed. These interviews were complemented by focus groups and observations. A community advisory board ensured community ownership and participation. Findings showed that heroin, buprenorphine, diazepam and avil were the drugs most commonly injected. The use of pharmaceutical preparations as a 'cocktail' was also prevalent. Drug injectors interviewed were males, and most (81%) were from low-income groups living in slums. Direct (69%) as well as indirect sharing (94%) was common. Such unhygienic injecting practices, and the lack of access to sterile water, contribute to the high incidence of adverse health consequences. Compared with the buprenorphine injectors, heroin injectors were more likely to share injecting equipment (P=0.0022), inject more frequently (P=0.0013), have more drug using network members (P=0.0104), frequent 'shooting' locations (P=0.002), use the dealer's place to inject (P=0.0317), and face threats of arrest (P=0.0023). Many buprenorphine injectors managed their life without serious crises, and seemed to adopt a 'natural' harm reduction response. Sexual risk behaviour was prevalent among opioid users, and a history of commercial sex was associated with daily alcohol use (P=0.0221). The assessment led to an action plan which was presented and endorsed in an advocacy meeting by key stake-holders and decision-makers. The critical importance of implementing quality, accessible, community-oriented, and effective HIV interventions with the capacity to reach the majority of IDUs is discussed. Public health responses to injecting drug use must target changes

  11. International epidemiology of HIV and AIDS among injecting drug users.

    PubMed

    Des Jarlais, D C; Friedman, S R; Choopanya, K; Vanichseni, S; Ward, T P

    1992-10-01

    HIV/AIDS and iv drug use (IVDU) are of significant multinational scope and growing. Supporting increased IVDU in many countries are countries' geographical proximity to illicit drug trafficking distribution routes, law enforcement efforts which increase the demand for more efficient drug distribution and consumption, and countries' infrastructural and social modernization. Given the failures of intensified law enforcement efforts to thwart the use and proliferation of illegal drugs, countries with substantial IVDU should look away from preventing use to preventing HIV transmission within drug user populations. With HIV seroprevalence rates rapidly reaching 40-50% in some developing country IVDU groups, a variety of prevention programs is warranted. Such programs should be supported and implemented while prevention remains feasible. This paper examines the variation in HIV seroprevalence among IVD users, rapid HIV spread among users, HIV among IVDUs in Bangkok, emerging issues in HIV transmission among IVDUs, non-AIDS manifestations of HIV infection among IVDUs, prevention programs and effectiveness, and harm reduction. PMID:1466837

  12. Socio-demographic factors, health risks and harms associated with early initiation of injection among people who inject drugs in Tallinn, Estonia: evidence from cross-sectional surveys

    PubMed Central

    Vorobjov, Sigrid; Des Jarlais, Don C.; Abel-Ollo, Katri; Talu, Ave; Rüütel, Kristi; Uusküla, Anneli

    2012-01-01

    Aim To explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia. Methods IDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation. Results A total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (n=156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity. Conclusions Our results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs. PMID:23036651

  13. Interaction of injectable neurotropic drugs with the red cell membrane.

    PubMed

    Reinhart, Walter H; Lubszky, Szabina; Thöny, Sandra; Schulzki, Thomas

    2014-10-01

    The normal red blood cell (RBC) shape is a biconcave discocyte. An intercalation of a drug in the outer half of the membrane lipid bilayer leads to echinocytosis, an intercalation in the inner half to stomatocytosis. We have used the shape transforming capacity of RBCs as a model to analyse the membrane interaction potential of various neurotropic drugs. Chlorpromazine, clomipramine, citalopram, clonazepam, and diazepam induced a reversible stomatocytosis, phenytoin induced echinocytosis, while the anticonvulsants levetiracetam, valproic acid and phenobarbital had no effect. This diversity of RBC shape transformations suggests that the pharmacological action is not linked to the membrane interaction. We conclude that this simple RBC shape transformation assay could be a useful tool to screen for potential drug interactions with cell membranes. PMID:24997296

  14. Prevention of HIV Infection among Injection Drug Users in Resource-Limited Settings

    PubMed Central

    Vlahov, David; Robertson, Angela M.; Strathdee, Steffanie A.

    2011-01-01

    Injection drug use contributes to considerable global morbidity and mortality associated with human immunodeficiency virus (HIV) infection and AIDS and other infections due to blood-borne pathogens through the direct sharing of needles, syringes, and other injection equipment. Of ~16 million injection drug users (IDUs) worldwide, an estimated 3 million are HIV infected. The prevalence of HIV infection among IDUs is high in many countries in Asia and eastern Europe and could exacerbate the HIV epidemic in sub- Saharan Africa. This review summarizes important components of a comprehensive program for prevention of HIV infection in IDUs, including unrestricted legal access to sterile syringes through needle exchange programs and enhanced pharmacy services, treatment for opioid dependence (i.e., methadone and buprenorphine treatment), behavioral interventions, and identification and treatment of noninjection drug and alcohol use, which accounts for increased sexual transmission of HIV. Evidence supports the effectiveness of harm-reduction programs over punitive drug-control policies. PMID:20397939

  15. An injectable hybrid nanoparticle-in-oil-in-water submicron emulsion for improved delivery of poorly soluble drugs

    NASA Astrophysics Data System (ADS)

    Wang, Shuo; Wang, Hua; Liang, Wenquan; Huang, Yongzhuo

    2012-04-01

    Poor drugability problems are commonly seen in a class of chemical entities with poor solubility in water and oil, and moreover, physicochemical instability of these compounds poses extra challenges in design of dosage forms. Such problems contribute a significant high failure rate in new drug development. A hybrid nanoparicle-in-oil-in-water (N/O/W) submicron emulsion was proposed for improved delivery of poorly soluble and unstable drugs (e.g., dihydroartemisinin (DHA)). DHA is known for its potent antimalarial effect and antitumor activity. However, its insolubility and instability impose big challenges for formulations, and so far, no injectable dosage forms are clinically available yet. Therefore, an injectable DHA N/O/W system was developed. Unlike other widely-explored systems (e.g., liposomes, micelles, and emulsions), in which low drug load and only short-term storage are often found, the hybrid submicron emulsion possesses three-fold higher drug-loading capacity than the conventional O/W emulsion. Of note, it can be manufactured into a freeze-drying form and can render its storage up to 6 months even in room temperature. The in vivo studies demonstrated that the PK profiles were significantly improved, and this injectable system was effective in suppressing tumor growth. The strategy provides a useful solution to effective delivery of such a class of drugs.

  16. The influence of the perceived consequences of refusing to share injection equipment among injection drug users: Balancing competing risks

    PubMed Central

    Wagner, Karla D.; Lankenau, Stephen E.; Palinkas, Lawrence A.; Richardson, Jean L.; Chou, Chih-Ping; Unger, Jennifer B.

    2011-01-01

    Injection drug users (IDUs) are at risk for HIV and other bloodborne pathogens through receptive syringe sharing (RSS) and receptive paraphernalia sharing (RPS). Research into the influence of the perceived risk of HIV infection on injection risk behavior has yielded mixed findings. One explanation may be that consequences other than HIV infection are considered when IDUs are faced with decisions about whether or not to share equipment. We investigated the perceived consequences of refusing to share injection equipment among 187 IDUs recruited from a large syringe exchange program in Los Angeles, California, assessed their influence on RSS and RPS, and evaluated gender differences. Two sub-scales of perceived consequences were identified: structural/external consequences and social/internal consequences. In multiple linear regression, the perceived social/internal consequences of refusing to share were associated with both RSS and RPS, after controlling for other psychosocial constructs and demographic variables. Few statistically significant gender differences emerged. Assessing the consequences of refusing to share injection equipment may help explain persistent injection risk behavior, and may provide promising targets for comprehensive intervention efforts designed to address both individual and structural risk factors. PMID:21498004

  17. Recent trends in benzodiazepine use by injecting drug users in Victoria and Tasmania.

    PubMed

    Fry, Craig L; Bruno, Raimondo B

    2002-12-01

    To address the lack of data on patterns of benzodiazepine use among injecting drug users (IDU) in Victoria and Tasmania, convenience samples of 152 Melbourne and 100 Hobart IDU were recruited from needle and syringe programme outlets and administered a structured survey on patterns of benzodiazepine use, injection-related health problems and drug use history. Most respondents had used benzodiazepines during the preceding 6 months, and more than one-third (Melbourne 36%, 95% CI, 28-44; Hobart 37%, 95% CI, 27-47) had injected benzodiazepines during this period. Diazepam was the preferred benzodiazepine for those using orally, while intravenous benzodiazepine users preferred to inject temazepam. Benzodiazepine injection for Melbourne IDU was related to greater levels of injection-related health problems. Patterns of benzodiazepine use amongst Melbourne and Hobart IDU are different to that in other Australian jurisdictions, with available data suggesting that prevalence of injection may be increasing. Ongoing monitoring of benzodiazepine injection, together with in-depth studies of supply characteristics and health impacts in jurisdictions where significant trends are detected is needed. Consideration of regulatory, supply, education and training options for the prevention of benzodiazepine injection is also indicated. PMID:12537706

  18. Injecting Practices and Knowledge of the Associated Risk among 16-19-Year-Old Injecting Drug Users in Plymouth, UK

    ERIC Educational Resources Information Center

    Trudgeon, Helen; Evans, David

    2010-01-01

    There has been significant research into the harms associated with injecting drugs and about the use of needle exchange programmes (NEPs) by adult injecting drug users (IDUs) in the United Kingdom. However, very limited research has been conducted investigating the knowledge, experiences and beliefs of IDUs under 18 years old, who due to their age…

  19. Denial of Prescription Analgesia Among People Who Inject Drugs in a Canadian Setting

    PubMed Central

    Voon, Pauline; Callon, Cody; Nguyen, Paul; Dobrer, Sabina; Montaner, Julio S.G.; Wood, Evan; Kerr, Thomas

    2015-01-01

    Introduction and Aims Despite the high prevalence of pain among people who inject drugs (PWID), clinicians may be reluctant to prescribe opioid-based analgesia to those with a history of drug use or addiction. We sought to examine the prevalence and correlates of PWID reporting being denied prescription analgesia (PA). We also explored reported reasons for and actions taken after being denied PA. Design and Methods Using data from two prospective cohort studies of PWID in Vancouver, Canada, multivariate logistic regression was used to identify the prevalence and correlates of reporting being denied PA. Descriptive statistics were used to characterize reasons for denials and subsequent actions. Results Approximately two thirds (66.5%) of our sample of 462 active PWID reported having ever been denied PA. We found that reporting being denied PA was significantly and positively associated with having ever been enrolled in methadone maintenance treatment (MMT) (adjusted odds ratio [AOR]=1.76, 95%CI: 1.11–2.80) and daily cocaine injection (AOR=2.38, 95%CI: 1.00–5.66). The most commonly reported reason for being denied PA was being accused of drug-seeking (44.0%). Commonly reported actions taken after being denied PA included buying the requested medication off the street (40.1%) or obtaining heroin to treat pain (32.9%) Discussion and Conclusions These findings highlight the clinical challenges of addressing perceived pain control needs and the need for strategies to prevent high-risk methods of self-managing pain, such as obtaining diverted medications or illicit substances for pain. Such strategies may include integrated pain management guidelines within MMT and other substance use treatment programs. PMID:25521168

  20. Establishment of drug-resistant HBV small-animal models by hydrodynamic injection

    PubMed Central

    Cheng, Junjun; Han, Yanxing; Jiang, Jian-Dong

    2014-01-01

    In antiviral therapy of hepatitis B virus (HBV) infection, drug resistance remains a huge obstacle to the long-term effectiveness of nucleoside/tide analogs (NAs). Primary resistance mutation (rtM204V) contributes to lamivudine (LAM)-resistance, and compensatory mutations (rtL180M and rtV173L) restore viral fitness and increase replication efficiency. The evaluation of new anti-viral agents against drug-resistant HBV is limited by the lack of available small-animal models. We established LAM-resistance HBV replication mice models based on clinical LAM-resistant HBV mutants. Double (rtM204V+rtL180M) or triple (rtM204V+rtL180M+rtV173L) lamivudine-resistant mutations were introduced into HBV expression vector, followed by hydrodynamic injection into tail vein of NOD/SCID mice. Viremia was detected on days 5, 9, 13 and 17 and liver HBV DNA was detected on day 17 after injection. The serum and liver HBV DNA levels in LAM-resistant model carrying triple mutations are the highest among the models. Two NAs, LAM and entecavir (ETV), were used to test the availability of the models. LAM and ETV inhibited viral replication on wild-type model. LAM was no longer effective on LAM-resistant models, but ETV retains a strong activity. Therefore, these models can be used to evaluate anti-viral agents against lamivudine-resistance, affording new opportunities to establish other drug-resistant HBV small-animal models. PMID:26579395

  1. Socio-demographic correlates of injection drug use among male drug users: a cross sectional study in Nepal.

    PubMed

    Neupane, Sanjeev Raj; Mishra, Shiva Raj; Adhikari, Samaj; Poudyal, Amod Kumar

    2014-12-01

    Drug abuse is one of the major public health problems in Nepal. The objective of this study is to explore the factors responsible for the injecting drug use in Nepal. A cross sectional study was conducted among drug users in Pokhara sub metropolitan city in Nepal. Taking prevalence of 20% at 95% confidence interval and 20% non-response rate, 448 samples were calculated for face to face interviews. Most of the study participants were >24 year's age. Sixty-one percentage of the participants were unemployed. The largest percentage belonged to Gurung/Rai/Pun (37%) ethnic groups, and had completed secondary level of education (47.5%). In the logistic regression analysis occupation, motivating factors for drug use, ever been to custody, age at first drug use, age at first sex, money spent on drugs, ever been rehabilitated and age of the respondents showed a statistically significant association with injecting drug use status. The respondents having business [Adjusted Odds ratio (aOR) 4.506, 95% CI (1.677-12.104)], service [aOR 2.698, 95% CI (a1.146-6.355], having tragedy/turmoil [aOR 3.867, 95% CI (1.596-9.367)], family problem [aOR 2.010, 95% CI (2.010-53.496)], had sex at >19 years [aOR 1.683, 95% CI (1.017-2.785)], rehabilitated >2 times [aOR 4.699, 95% CI (1.401-15.763)], >24 years age group [aOR 1.741, 95% CI (1.025-2.957)] had higher odds of having injecting habits. Having money spent on drugs >3,000 NRs (300 USD) [aOR 0.489, 95%CI (0.274-0.870), not been to custody (aOR 0.330, 95%CI (0.203-0.537)] and having curiosity for drug use [aOR 0.147, 95% CI (0.029-0.737)] were found to be protective for injecting drug use. This study recommends the harm reduction program specifically focused on drug users of occupational groups like business, service and the youths through public health actions to stop transiting them to injecting drug use. PMID:24705679

  2. Impact of a positive hepatitis C diagnosis on homeless injecting drug users: a qualitative study

    PubMed Central

    Tompkins, Charlotte NE; Wright, Nat MJ; Jones, Lesley

    2005-01-01

    Background Increasing numbers of injecting drug users are presenting to primary care and a growing number of general practices are specifically providing care for homeless people. Injecting drug users are at the greatest risk of hepatitis C infection and homeless drug misusers, because of their drug-taking behaviour and patterns, have been identified as being at greater risk of harm of blood-borne diseases than the general population. However, little work has been conducted with injecting drug users or homeless people who have hepatitis C and little is known about how the virus may affect them. Aim To explore the impact of a positive hepatitis C diagnosis on homeless injecting drug users. Design of study This study employed qualitative research. In-depth interviews allowed the exploration of the impact of a potentially life-threatening diagnosis within the context of a person's expressed hierarchy of needs. Setting A primary care centre for homeless people in the north of England. Method In-depth interviews about the impact of a positive hepatitis C diagnosis on their lives were conducted with 17 homeless injecting drug users who had received a positive hepatitis C diagnosis. The interviews were audiotaped, transcribed, and analysed using the framework approach. Results Receiving a positive diagnosis for hepatitis C resulted in feelings of shock, devastation, disbelief, anger, and questioning. A positive diagnosis had lasting social, emotional, psychological, behavioural, and physical effects on homeless injecting drug users, even years after the initial diagnosis. Most responders were diagnosed by a doctor in primary care or by hospital staff; however, not all had sought testing and a number were tested while inpatients and were unaware that blood had been taken for hepatitis C virus serology. Conclusions The implications for clinical policy and primary care practice are discussed, including the issues of patient choice, confidentiality, and pre- and post

  3. Reductions in HIV/STI Incidence and Sharing of Injection Equipment among Female Sex Workers Who Inject Drugs: Results from a Randomized Controlled Trial

    PubMed Central

    Strathdee, Steffanie A.; Abramovitz, Daniela; Lozada, Remedios; Martinez, Gustavo; Rangel, Maria Gudelia; Vera, Alicia; Staines, Hugo; Magis-Rodriguez, Carlos; Patterson, Thomas L.

    2013-01-01

    Background We evaluated brief combination interventions to simultaneously reduce sexual and injection risks among female sex workers who inject drugs (FSW-IDUs) in Tijuana and Ciudad Juarez, Mexico during 2008–2010, when harm reduction coverage was expanding rapidly in Tijuana, but less so in Juarez. Methods FSW-IDUs ≥18 years reporting sharing injection equipment and unprotected sex with clients within the last month participated in a randomized factorial trial comparing four brief, single-session conditions combining either an interactive or didactic version of a sexual risk intervention to promote safer sex in the context of drug use, and an injection risk intervention to reduce sharing of needles/injection paraphernalia. Women underwent quarterly interviews and testing for HIV, syphilis, gonorrhea, Chlamydia and Trichomonas, blinding interviewers and assessors to assignment. Poisson regression with robust variance estimation and repeated measures ordinal logistic regression examined effects on combined HIV/STI incidence and receptive needle sharing frequency. Findings Of 584 initially HIV-negative FSW-IDUs, retention was ≥90%. After 12 months, HIV/STI incidence decreased >50% in the interactive vs. didactic sex intervention (Tijuana:AdjRR:0.38,95% CI:0.16–0.89; Juarez: AdjRR:0.44,95% CI:0.19–0.99). In Juarez, women receiving interactive vs. didactic injection risk interventions decreased receptive needle-sharing by 85% vs. 71%, respectively (p = 0.04); in Tijuana, receptive needle sharing declined by 95%, but was similar in active versus didactic groups. Tijuana women reported significant increases in access to syringes and condoms, but Juarez women did not. Interpretation After 12 months in both cities, the interactive sexual risk intervention significantly reduced HIV/STI incidence. Expanding free access to sterile syringes coupled with brief, didactic education on safer injection was necessary and sufficient for achieving robust, sustained

  4. Barriers to antiretroviral treatment access for injecting drug users living with HIV in Chennai, South India.

    PubMed

    Chakrapani, Venkatesan; Velayudham, Jaikumar; Shunmugam, Murali; Newman, Peter A; Dubrow, Robert

    2014-01-01

    India's National AIDS Control Organization provides free antiretroviral treatment (ART) to people living with HIV (PLHIV), including members of marginalized groups such as injecting drug users (IDUs). To help inform development of interventions to enhance ART access, we explored barriers to free ART access at government ART centers for IDUs living with HIV in Chennai by conducting three focus groups (n = 19 IDUs) and four key informant interviews. Data were explored using framework analysis to identify categories and derive themes. We found interrelated barriers at the family and social, health-care system, and individual levels. Family and social level barriers included lack of family support and fear of societal discrimination, as well as unmet basic needs, including food and shelter. Health-care system barriers included actual or perceived unfriendly hospital environment and procedures such as requiring proof of address and identity from PLHIV, including homeless IDUs; provider perception that IDUs will not adhere to ART, resulting in ART not being initiated; actual or perceived inadequate counseling services and lack of confidentiality; and lack of effective linkages between ART centers, needle/syringe programs, and drug dependence treatment centers. Individual-level barriers included active drug use, lack of self-efficacy in ART adherence, low motivation to initiate ART stemming from a fatalistic attitude, and inadequate knowledge about ART. These findings indicate that to facilitate IDUs gaining access to ART, systemic changes are needed, including steps to make the environment and procedures at government ART centers more IDU-friendly and steps to decrease HIV- and drug use-related stigma and discrimination faced by IDUs from the general public and health-care providers. Housing support for homeless IDUs and linkage of IDUs with drug dependence treatment are also essential. PMID:24283220

  5. Fatal case of extensively drug-resistant Mycobacterium tuberculosis Beijing genotype infection in an injecting drug user, Athens, Greece, 2012.

    PubMed

    Leuow, K; Papaventsis, D; Kourkoundi, S; Ioannidis, P; Karabela, S; Tsikrika, S; Marinou, I; Papavasileiou, A; Stone, M; Drobniewski, F; Paparisos, V; Vogiatzakis, E

    2013-01-01

    We present the first fatal case of extensively drug-resistant tuberculosis (XDR-TB) in an injecting drug user (IDU) in Athens, Greece, co-infected with human immunodeficiency virus and hepatitis C virus and discuss the implications for public health. Despite immediate initiation of treatment, the patient's condition gradually deteriorated and he died 16 days after hospital admission because of multiple organ failure. The contact tracing investigation revealed no further infections among the patient's contacts. PMID:23557942

  6. A repertoire of peptide tags for controlled drug release from injectable noncovalent hydrogel.

    PubMed

    Wieduwild, Robert; Lin, Weilin; Boden, Annett; Kretschmer, Karsten; Zhang, Yixin

    2014-06-01

    A repertoire of conjugable tags for controlling the release of drugs from biomaterials is highly interesting for the development of combinatorial drug administration techniques. This paper describes such a system of 11 peptide tags derived from our previous work on a physical hydrogel system cross-linked through peptide-heparin interactions. The release kinetics of the tags correlate well with their affinity to heparin and obey Fick's second law of diffusion, with the exception of the ATIII peptide, which displays a stable release profile close to a zero-order reaction. A system for release experiments over seven months was built, using the hydrogel matrix as a barrier between the reservoirs of tagged compounds and supernatant. The gel matrix can be injected without affecting the releasing properties. A tagged cyclosporin A derivative was also tested, and its release was monitored by measuring its biological activity. This work represents a design of biomaterials with an integral system of drug delivery, where both the assembly process of the matrix and affinity capture/release of tagged compounds are based on the noncovalent interaction of heparin with one class of peptides. PMID:24825401

  7. U.S. Drug Use and Migration experiences of Mexican Female Sex Workers who are injection Drug Users

    PubMed Central

    Ojeda, Victoria D.; Burgos, José Luis; Rangel, María Gudelia; Lozada, Remedios; Vera, Alicia

    2013-01-01

    Objective To describe U.S.-based drug/sex behaviors and correlates of lifetime U.S. drug use by Mexican female sex workers who inject drugs (FSW-IDUs). Methods Between 2008–2010, 315 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. Results Twenty-seven percent (n=85) of FSW-IDUs were U.S. migrants; of these, 46% (n=39) were deportees. One-half of U.S.-migrant FSW-IDUs consumed illicit drugs in the U.S., and two-thirds of these injected drugs in the U.S. Among U.S. injectors, over 75% ever received or shared used injection equipment. The majority (92%) of U.S.-migrant FSW-IDUs never obtained U.S. drug treatment services. HIV prevalence was 4% among U.S.-migrant and 5% among non-U.S. migrant FSW-IDUs; 100% of U.S.-migrant and 75% of non-U.S. migrant FSW-IDUs were unaware of their HIV status. Conclusions Binational coordination to improve access to substance use treatment and HIV testing services in Mexico and the U.S. among marginalized binational migrants may be critical to containing HIV transmission. PMID:23698687

  8. ‘On the same level’: facilitators’ experiences running a drug user-led safer injecting education campaign

    PubMed Central

    2013-01-01

    Background Unsafe injection practices play a major role in elevated rates of morbidity and mortality among people who inject drugs (IDU). There is growing interest in the direct involvement of IDU in interventions that seek to address unsafe injecting. This study describes a drug user-led safer injecting education campaign, and explores facilitators’ experiences delivering educational workshops. Methods We conducted semi-structured qualitative interviews with 8 members of the Injection Support (IS) Team who developed and facilitated a series of safer injecting education workshops. Interviews explored facilitator’s perceptions of the workshops, experiences being a facilitator, and perspectives on the educational campaign. Interviews were transcribed verbatim and a thematic analysis was conducted. Results IS Team facilitators described how the workshop’s structure and content enabled effective communication of information about safer injecting practices, while targeting the unsafe practices of workshop participants. Facilitators’ identity as IDU enhanced their ability to relate to workshop participants and communicate educational messages in language accessible to workshop participants. Facilitators reported gaining knowledge and skills from their involvement in the campaign, as well as positive feelings about themselves from the realization that they were helping people to protect their health. Overall, facilitators felt that this campaign provided IDU with valuable information, although facilitators also critiqued the campaign and suggested improvements for future efforts. Conclusions This study demonstrates the feasibility of involving IDU in educational initiatives targeting unsafe injecting. Findings illustrate how IDU involvement in prevention activities improves relevance and cultural appropriateness of interventions while providing individual, social, and professional benefits to those IDU delivering education. PMID:23497293

  9. HIV and HCV discordant injecting partners and their association to drug equipment sharing.

    PubMed

    De, Prithwish; Cox, Joseph; Boivin, Jean-Francois; Platt, Robert W; Jolly, Ann M; Alexander, Paul E

    2009-01-01

    Our objective was to examine the association between HIV and HCV discordant infection status and the sharing of drug equipment by injection drug users (IDUs). IDUs were recruited from syringe exchange and methadone treatment programmes in Montreal, Canada. Characteristics of participants and their injecting partners were elicited using a structured questionnaire. Among 159 participants and 245 injecting partners, sharing of syringes and drug preparation equipment did not differ between concordant or discordant partners, although HIV-positive subjects did not share with HIV-negative injectors. Sharing of syringes was positively associated with discordant HIV status (OR=1.85) and negatively with discordant HCV status (OR=0.65), but both results were not statistically significant. Sharing of drug preparation equipment was positively associated with both discordant HIV (OR=1.61) and HCV (OR=1.18) status, but both results were non-significant. Factors such as large injecting networks, frequent mutual injections, younger age, and male gender were stronger predictors of equipment sharing. In conclusion, IDUs do not appear to discriminate drug equipment sharing partners based at least on their HCV infection status. The results warrant greater screening to raise awareness of infection status, post-test counselling to promote status disclosure among partners, and skill-building to avoid equipment sharing between discordant partners. PMID:19172434

  10. The association between neighborhood residential rehabilitation and injection drug use in Baltimore, Maryland, 2000-2011

    PubMed Central

    Linton, Sabriya L.; Jennings, Jacky M.; Latkin, Carl A.; Kirk, Gregory D.; Mehta, Shruti H.

    2014-01-01

    This study utilized multilevel cross-classified models to longitudinally assess the association between neighborhood residential rehabilitation and injection drug use. We also assessed whether relocating between neighborhoods of varying levels of residential rehabilitation was associated with injection drug use. Residential rehabilitation was categorized into three groups (e.g. low, moderate, high), and lagged one visit to ensure temporality. After adjusting for neighborhood and individual-level factors, residence in a neighborhood with moderate residential rehabilitation was associated with a 23% reduction in injection drug use [AOR=0.77; 95% CI (0.67,0.87)]; residence in a neighborhood with high residential rehabilitation was associated with a 26% reduction in injection drug use [AOR=0.74; 95% CI (0.61,0.91)]. Continuous residence within neighborhoods with moderate/high rehabilitation, and relocating to neighborhoods with moderate/high rehabilitation, were associated with a lower likelihood of injection drug use. Additional studies are needed to understand the mechanisms behind these relationships. PMID:24840154

  11. Global Epidemiology of HIV Among Women and Girls Who Use or Inject Drugs: Current Knowledge and Limitations of Existing Data

    PubMed Central

    Larney, Sarah; Mathers, Bradley M.; Poteat, Tonia; Kamarulzaman, Adeeba; Degenhardt, Louisa

    2016-01-01

    Background Women and girls who use and inject drugs are a critical population at risk of HIV. In this article, we review data on the epidemiology of drug use and injection among women globally and HIV prevalence among women and girls who use and inject drugs. Results Women and girls comprise one-third of people who use and inject drugs globally. There is substantial variation in HIV prevalence in this population, between and within countries. There is a pronounced lack of data examining HIV risk among particularly vulnerable subpopulations of women who use and inject drugs, including women who have sex with women, transgender women, racial and ethnic minority women, and young women. Women who use and inject drugs experience stigma and discrimination that affect access to services, and high levels of sexual risk exposures. Conclusions There are significant gaps in our understanding of the epidemiology of drug use and injecting among women and girls and HIV risk and prevalence in this population. Women are frequently underrepresented in studies of drug use and HIV risk and prevalence among people who inject drugs, limiting our understanding of possible sex differences in this population. Most research originates from developed countries and may not be generalizable to other settings. A great deal of work is needed to improve understanding of HIV among particularly vulnerable subpopulations, such as transgender women who use drugs. Better data are critical to efforts to advocate for the needs of women and girls who use and inject drugs. PMID:25978476

  12. Sericin/Dextran Injectable Hydrogel as an Optically Trackable Drug Delivery System for Malignant Melanoma Treatment.

    PubMed

    Liu, Jia; Qi, Chao; Tao, Kaixiong; Zhang, Jinxiang; Zhang, Jian; Xu, Luming; Jiang, Xulin; Zhang, Yunti; Huang, Lei; Li, Qilin; Xie, Hongjian; Gao, Jinbo; Shuai, Xiaoming; Wang, Guobin; Wang, Zheng; Wang, Lin

    2016-03-01

    Severe side effects of cancer chemotherapy prompt developing better drug delivery systems. Injectable hydrogels are an effective site-target system. For most of injectable hydrogels, once delivered in vivo, some properties including drug release and degradation, which are critical to chemotherapeutic effects and safety, are challenging to monitor. Developing a drug delivery system for effective cancer therapy with in vivo real-time noninvasive trackability is highly desired. Although fluorescence dyes are used for imaging hydrogels, the cytotoxicity limits their applications. By using sericin, a natural photoluminescent protein from silk, we successfully synthesized a hydrazone cross-linked sericin/dextran injectable hydrogel. This hydrogel is biodegradable and biocompatible. It achieves efficient drug loading and controlled release of both macromolecular and small molecular drugs. Notably, sericin's photoluminescence from this hydrogel is directly and stably correlated with its degradation, enabling long-term in vivo imaging and real-time monitoring of the remaining drug. The hydrogel loaded with Doxorubicin significantly suppresses tumor growth. Together, the work demonstrates the efficacy of this drug delivery system, and the in vivo effectiveness of this sericin-based optical monitoring strategy, providing a potential approach for improving hydrogel design toward optimal efficiency and safety of chemotherapies, which may be widely applicable to other drug delivery systems. PMID:26900631

  13. Injecting and sexual risk correlates of HBV and HCV seroprevalence among new drug injectors

    PubMed Central

    Neaigus, Alan; Gyarmathy, V. Anna; Miller, Maureen; Frajzyngier, Veronica M.; Zhao, Mingfang; Friedman, Samuel R.; Des Jarlais, Don C.

    2007-01-01

    We examine injecting and sexual risk correlates of hepatitis B (HBV) and hepatitis C (HCV) seroprevalence among new injecting drug users (IDUs) (age 18–30 years, injecting ≤6 years). Participants were interviewed/serotested (HIVab, HBVcAb, HCVab) in New York City, 2/1999–2/2003. Gender-stratified, multivariate logistic regression was conducted. Participants (N=259) were: 68% male; 81% white. Women were more likely to test HCV seropositive (42% vs. 27%) and men HBV seropositive (24% vs. 12%); HIV seroprevalence was low (3%). Among both men and women, HBV seropositivity was associated with ever selling sex, and HCV seropositivity with ever having had infected (HIV, HBV or HCV) sex partners (among those ever sharing injecting equipment). Among women only, HBV seropositivity was associated with ever having had infected sex partners (regardless of ever sharing injecting equipment), and HCV seropositivity with ≥300 lifetime drug injections. Among men only, HCV seropositivity was associated with ≥40 lifetime number of sex partners (among those never sharing injecting equipment). In this new IDU sample, HBV and HCV seroprevalence differed by gender and were considerably higher than HIV seroprevalence. Early interventions, targeting injecting and sexual risks and including HBV vaccination, are needed among new IDUs to prevent HBV, HCV and, potentially, HIV epidemics. PMID:17289298

  14. Spatial distribution and antitumor activities after intratumoral injection of fragmented fibers with loaded hydroxycamptothecin.

    PubMed

    Wei, Jiaojun; Luo, Xiaoming; Chen, Maohua; Lu, Jinfu; Li, Xiaohong

    2015-09-01

    There was only a small percentage of drug delivered to tumors after systemic administration, and solid tumors also have many barriers to prevent drug penetration within tumors. In the current study, intratumoral injection of drug-loaded fiber fragments was proposed to overcome these barriers, allowing drug accumulation at the target site to realize the therapeutic efficacy. Fragmented fibers with hydroxycamptothecin (HCPT) loaded were constructed by cryocutting of aligned electrospun fibers, and the fiber lengths of 5 (FF-5), 20 (FF-20), and 50μm (FF-50) could be easily controlled by adjusting the slice thickness. Fragmented fibers were homogeneously dispersed into 2% sodium alginate solution, and could be smoothly injected through 26G1/2 syringe needles. FF-5, FF-20 and FF-50 fiber fragments indicated similar release profiles except a lower burst release from FF-50. In vitro viability tests showed that FF-5 and FF-20 fiber fragments caused higher cytotoxicity and apoptosis rates than FF-50. After intratumoral injection into murine H22 subcutaneous tumors, fragmented fibers with longer lengths indicated a higher accumulation into tumors and a better retention at the injection site, but showed less apparent diffusion within tumor tissues. In addition to the elimination of invasive surgery, HCPT-loaded fiber fragments showed superior in vivo antitumor activities and fewer side effects than intratumoral implantation of drug-loaded fiber mats. Compared with FF-5 and FF-50, FF-20 fiber fragments indicated optimal spatial distribution of HCPT within tumors and achieved the most significant effects on the animal survival, tumor growth inhibition and tumor cell apoptosis induction. It is suggested that the intratumoral injection of drug-loaded fiber fragments provided an efficient strategy to improve patient compliance, allow the retention of fragmented fibers and spatial distribution of drugs within tumor tissues to achieve a low systemic toxicity and an optimal

  15. Injecting Drug Users and Their Health Seeking Behavior: A Cross-Sectional Study in Dhaka, Bangladesh

    PubMed Central

    Biswas, Tuhin; Bhuiyan, Faiz Ahmed; Islam, Md. Serajul; Rahman, Mohammad Mizanur; Nessa, Hurun

    2015-01-01

    Introduction and Aim. Injecting drug users (IDUs) are amongst the most vulnerable people to acquisition of HIV/AIDS. This study aims to collect information on IDUs and their health seeking behavior in Bangladesh. Design and Methods. A cross-sectional study was conducted among 120 IDUs attending a drug rehabilitation center in Dhaka, Bangladesh. Data were collected on sociodemographics, drug use, health seeking behavior, knowledge of injecting drugs, and sexual behavior. Results. The mean ± SD and median (IQR) age of the participants were 32.5 ± 21.3 and 33 (27–38) years, respectively, with only 9.2% females. Injection buprenorphine was the drug of choice for 40% of participants, and 58% of the participants first started drug use with smoking cannabis. 73.3% of participants shared needles sometimes and 57.5% were willing to use the needle exchange programs. 60% of the participants had no knowledge about the diseases spread by injection. Condom use during the last intercourse with regular partners was 11.7% and with any partners 15.8%. Conclusion. IDUs in Bangladesh are a high-risk group for HIV/AIDS due to lack of knowledge and risky behaviors. Education and interventions specifically aimed at IDUs are needed, because traditional education may not reach IDUs or influence their behavior. PMID:25692067

  16. Managing la malilla: Exploring drug treatment experiences among injection drug users in Tijuana, Mexico, and their implications for drug law reform

    PubMed Central

    Syvertsen, Jennifer; Pollini, Robin A.; Lozada, Remedios; Vera, Alicia; Rangel, Gudelia; Strathdee, Steffanie A.

    2012-01-01

    Background In August 2009, Mexico reformed its drug laws and decriminalized small quantities of drugs for personal use; offenders caught three times will be mandated to enter drug treatment. However, little is known about the quality or effectiveness of drug treatment programs in Mexico. We examined injection drug users’ (IDUs) experiences in drug treatment in Tijuana, Mexico, with the goal of informing program planning and policy. Methods We examined qualitative and quantitative data from Proyecto El Cuete, a multi-phased research study on HIV risk among IDUs in Tijuana. Phase I consisted of 20 in-depth interviews and Phase II employed respondent-driven sampling to recruit 222 IDUs for a quantitative survey. We also reviewed national drug policy documents, surveillance data, and media reports to situate drug users’ experiences within the broader sociopolitical context. Results Participants in the qualitative study were 50% male with a mean age of 32; most injected heroin (85.0%) and methamphetamine (60.0%). The quantitative sample was 91.4% male with a mean age of 35; 98.2% injected heroin and 83.7% injected heroin and methamphetamine together. The majority of participants reported receiving treatment: residential treatment was most common, followed by methadone; other types of services were infrequently reported. Participants’ perceptions of program acceptability and effectiveness were mixed. Mistreatment emerged as a theme in the qualitative interviews and was reported by 21.6% of Phase II participants, primarily physical (72.0%) and verbal (52.0%) abuse. Conclusions Our results point to the need for political, economic, and social investment in the drug treatment system before offenders are sentenced to treatment under the revised national drug law. Resources are needed to strengthen program quality and ensure accountability. The public health impact of the new legislation that attempts to bring drug treatment to the forefront of national drug policy

  17. 77 FR 71006 - Sodium Nitrite Injection and Sodium Thiosulfate Injection Drug Products Labeled for the Treatment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-28

    ... and cardiac symptoms due to lack of adequate oxygen in body tissues. The approved Sodium Nitrite.... Cyanide antidotes carry serious risks and some unapproved drug products may lack Boxed Warnings and other... blood. Methemoglobin is an oxidized form of hemoglobin that has a decreased affinity for...

  18. Drug injection rates and needle-exchange use in New York City, 1991-1996.

    PubMed

    Marmor, M; Shore, R E; Titus, S; Chen, X; Des Jarlais, D C

    2000-09-01

    Objectives included (1) to develop methods for identifying injection drug users with accelerating injection habits so they might be referred to counseling and treatment and (2) to investigate behavioral correlates of accelerating injection habits, including syringe-exchange program utilization. Data on drug use, enrollment in methadone maintenance, and demographic variables were obtained from 328 subjects who were seronegative for human immunodeficiency virus (HIV) who attended anywhere from 4 to 11 quarterly study visits for interview, HIV pretest counseling and risk reduction counseling, and blood donation for HIV antibody testing. Subjects were recalled 2 weeks after each study visit to receive their results and post-test counseling. We characterized subjects according to their patterns of drug injection as accelerating, decelerating, or stable, using intraindividual regression analyses and categorization rules, and by syringe-exchange use as consistent users, sporadic users, or nonusers. The present subjects included 52% with decelerating, 29% with stable, and 19% with accelerating rates of drug injection. There were 128 subjects (39%) who were categorized as consistent users of syringe-exchange programs, 84 (25%) were categorized as sporadic users, and 116 (35%) were categorized as nonusers. All syringe-exchange groups showed significantly decelerating drug injection. Rates of decline were significantly less, however, among consistent syringe-exchange users than sporadic or nonusers of syringe exchanges. Categorical analysis also showed significant differences among groups, with 30% of consistent syringe-exchange program users having accelerating rates of drug injection compared to 9% of nonusers and 17% of sporadic users. That consistent syringe-exchange users included a larger proportion of individuals whose drug habits were accelerating than did sporadic users or nonusers of syringe exchanges suggests a need for improved identification and counseling of

  19. Injecting Drug Use Among Mexican Female Sex Workers on the US-Mexico Border.

    PubMed

    Cepeda, Alice; Nowotny, Kathryn M; Valdez, Avelardo

    2015-01-01

    Both injecting drug users (IDU) and sex workers are at great risk of contracting and transmitting HIV. Therefore, IDU sex workers could be at especially high risk. The recent increase of HIV infection in Mexico has caused increased attention to sex work. We identify the correlates of injecting drug use including socio-demographic, work history, and sexual and non-injecting drug use risk behaviors among Mexican female sex workers. There is a high risk profile for IDUs compared to never injectors including a high prevalence of lifetime STI infection (54.2%). Revealed is an environment composed of high-risk networks that may have serious binational public health implications. PMID:26211392

  20. Injectable and pH-Responsive Silk Nanofiber Hydrogels for Sustained Anticancer Drug Delivery.

    PubMed

    Wu, Hongchun; Liu, Shanshan; Xiao, Liying; Dong, Xiaodan; Lu, Qiang; Kaplan, David L

    2016-07-13

    Silk is useful as a drug carrier due to its biocompatibility, tunable degradation, and outstanding capacity in maintaining the function of drugs. Injectable silk hydrogels could deliver doxorubicin (DOX) for localized chemotherapy for breast cancer. To improve hydrogel properties, thixotropic silk nanofiber hydrogels in an all-aqueous solution were prepared and used to locally deliver DOX. The silk hydrogels displayed thixotropic capacity, allowing for easy injectability followed by solidification in situ. The hydrogels were loaded with DOX and released the drug over eight weeks with pH- and concentration-dependent release kinetics. In vitro and in vivo studies demonstrated that DOX-loaded silk hydrogels had good antitumor response, outperforming the equivalent dose of free DOX administered intravenously. Thixotropic silk hydrogels provide improved injectability to support sustained release, suggesting promising applications for localized chemotherapy. PMID:27315327

  1. High HIV burden among people who inject drugs in 15 Indian cities

    PubMed Central

    Lucas, Gregory M.; Solomon, Sunil S.; Srikrishnan, Aylur K.; Agrawal, Alok; Iqbal, Syed; Laeyendecker, Oliver; McFall, Allison M.; Kumar, Muniratnam S.; Ogburn, Elizabeth; Celentano, David D.; Solomon, Suniti; Mehta, Shruti H.

    2015-01-01

    Background Injecting drug use has historically been the principal driver of the HIV epidemic in the Northeast states of India. However, recent data indicate growing numbers of people who inject drugs (PWID) in North and Central Indian cities. Methods We conducted face-to-face surveys among PWID in 7 Northeast and 8 North/Central Indian cities using respondent-driven sampling. We used a rapid HIV testing protocol to identify seropositive individuals and multi-assay algorithm to identify those with recent infection. We used multi-level regression models that incorporated sampling weights and had random intercepts for site to assess risk factors for prevalent and incident (recent) HIV infection. Results We surveyed 14,481 PWID from 15 Indian cities between January and December 2013. Participants reported high rates of needle/syringe sharing. The median (site range) estimated HIV prevalence and incidence were 18.1% (5.9, 44.9) and 2.9 per 100 person-years (0, 12.4), respectively. HIV prevalence was higher in Northeast sites while HIV incidence was higher in North/Central sites. The odds of prevalent HIV were over 3-fold higher in women than men. Other factors associated with HIV prevalence or incidence included duration since first injection, injection of pharmaceutical drugs, and needle/syringe sharing. Conclusions The burden of HIV infection is high among PWID in India, and may be increasing in cities where injecting drug use is emerging. Women who inject drugs were at substantially higher risk for HIV than men, a situation that may be mediated by dual injection-related and sexual risks. PMID:25715105

  2. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users.

    PubMed Central

    Molitor, F; Truax, S R; Ruiz, J D; Sun, R K

    1998-01-01

    Morbidity, mortality, and drug treatment data suggest that methamphetamine use is on the rise. Based on research findings of the sexual behaviors of methamphetamine-using injection drug users, we chose to examine the relationship between methamphetamine use during sex and risky sexual behaviors and human immunodeficiency virus (HIV) seropositivity among clients of publicly funded HIV testing sites in California who reported never injecting drugs. We found that among gay, bisexual, and heterosexual men and heterosexual women, users of methamphetamines reported more sexual partners than non-methamphetamine users. Among heterosexuals, a greater percentage of methamphetamine users than nonusers participated in anal intercourse. Methamphetamine use was independently related to decreased condom use during vaginal and anal intercourse, prostitution, and sex with known injection drug users. In addition, methamphetamine users were more likely to have had a sexually transmitted disease. When controlling for race or ethnicity; age; exposure to possibly infected blood or blood products; and the use of cocaine, alcohol, or marijuana during sex, methamphetamine-using bisexual men were more likely to test positive for HIV than those reporting no history of methamphetamine use. Our data suggest that noninjection methamphetamine use is related to increased, unprotected sexual activity and the risk of contracting sexually transmitted diseases, including HIV. PMID:9499742

  3. Syndemic vulnerability, sexual and injection risk behaviors, and HIV continuum of care outcomes in HIV-positive injection drug users

    PubMed Central

    Mizuno, Yuko; Purcell, David W.; Knowlton, Amy R.; Wilkinson, James D.; Gourevitch, Marc N.; Knight, Kelly R.

    2015-01-01

    Limited investigations have been conducted on syndemics and HIV continuum of care outcomes. Using baseline data from a multi-site, randomized controlled study of HIV-positive injection drug users (n=1052), we examined whether psychosocial factors co-occurred, and whether these factors were additively associated with behavioral and HIV continuum of care outcomes. Experiencing one type of psychosocial problem was significantly (p<0.05) associated with an increased odds of experiencing another type of problem. Persons with 3 or more psychosocial problems were significantly more likely to report sexual and injection risk behaviors and were less likely to be adherent to HIV medications. Persons with 4 or more problems were less likely to be virally suppressed. Reporting any problems was associated with not currently taking HIV medications. Our findings highlight the association of syndemics not only with risk behaviors, but also with outcomes related to the continuum of care for HIV-positive persons. PMID:25249392

  4. Injection site infections and injuries in men who inject image- and performance-enhancing drugs: prevalence, risks factors, and healthcare seeking.

    PubMed

    Hope, V D; McVeigh, J; Marongiu, A; Evans-Brown, M; Smith, J; Kimergård, A; Parry, J V; Ncube, F

    2015-01-01

    People who inject drugs are vulnerable to infections and injuries at injection sites, but these have rarely been studied in those injecting image- and performance-enhancing drugs (IPEDs). This study examined the factors associated with reported symptoms of injection site infections and injuries in IPED injectors. Of the 366 male IPED injectors surveyed, 42% reported ever having redness, swelling and tenderness (36% in the preceding year), and 6·8% had ever had an abscess or open wound at an injection site. Having these symptoms was associated with a range of factors related to drug use and healthcare utilization. One sixth (17%) of those reporting redness, tenderness and swelling had ever sought treatment, as had the majority (76%) of those reporting an abscess, sore or open wound. Most common sources of advice were emergency clinics and General Practitioners. Interventions are needed to support access to appropriate injecting equipment and provide targeted harm reduction advice. PMID:24713416

  5. Temporal differences in gamma-hydroxybutyrate overdoses involving injecting drug users versus recreational drug users in Helsinki: a retrospective study

    PubMed Central

    2012-01-01

    Background Gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) have been profiled as 'party drugs' used mainly at dance parties and in nightclubs on weekend nights. The purpose of this study was to examine the frequency of injecting drug use among GHB/GBL overdose patients and whether there are temporal differences in the occurrence of GHB/GBL overdoses of injecting drug and recreational drug users. Methods In this retrospective study, the ambulance and hospital records of suspected GHB- and GBL overdose patients treated by the Helsinki Emergency Medical Service from January 1st 2006 to December 31st 2007 were reviewed. According to the temporal occurrence of the overdose, patients were divided in two groups. In group A, the overdose occurred on a Friday-Saturday or Saturday-Sunday night between 11 pm-6 am. Group B consisted of overdoses occurring on outside this time frame. Results Group A consisted of 39 patient contacts and the remaining 61 patient contacts were in group B. There were statistically significant differences between the two groups in (group A vs. B, respectively): history of injecting drug abuse (33% vs. 59%, p = 0.012), reported polydrug and ethanol use (80% vs. 62%, p = 0.028), the location where the patients were encountered (private or public indoors or outdoors, 10%, 41%, 41% vs. 25%, 18%, 53%, p = 0.019) and how the knowledge of GHB/GBL use was obtained (reported by patient/bystanders or clinical suspicion, 72%, 28% vs. 85%, 10%, p = 0.023). Practically all (99%) patients were transported to emergency department after prehospital care. Conclusion There appears to be at least two distinct groups of GHB/GBL users. Injecting drug users represent the majority of GHB/GBL overdose patients outside weekend nights. PMID:22296777

  6. Characteristics of hepatitis C infection in injecting drug users in Zadar County, Croatia.

    PubMed

    Medić, Alan; Dzelalija, Boris; Sonicki, Zdenko; Zekanović, Drazen

    2008-09-01

    The aim of the study was to determine additional risk factors that could increase the prevalence of hepatitis C (HCV) infection among injecting drug users (IDU). The study included 327 heroin addicts registered in Zadar County, Croatia. The participants were divided into two groups according to their HCV status. HCV-positive and HCV-negative study participants were compared. HCV-positive group started injecting heroin at earlier age (median 18.5 years) than HCV-negative group (median 20.0 years) (p = 0.032) and had been injecting heroin for a significantly longer period (median 5 years vs. median 4 years, respectively; p < 0.001). IDUs in HCV-positive group shared their injecting equipment significantly more often than IDUs in HCV-negative group (p < 0.001; chi2 = 32.7). The main reasons for starting drugs were curiosity, psychological reasons (depression and/or neurosis), and peer or partner pressure in HCV-positive group, and fun, curiosity, and peer pressure in HCV-negative group (p = 0.051; chi2 = 23.6). Earlier onset of heroin use, longer heroin use, sharing injection equipment, curiosity, and psychological problems as reasons for starting drugs were associated with higher prevalence of HCV infection among injecting heroin users in Zadar County. PMID:18982740

  7. Injectable polyanhydride granules provide controlled release of water-soluble drugs with a reduced initial burst.

    PubMed

    Tabata, Y; Domb, A; Langer, R

    1994-01-01

    A method for preparing polyanhydride granules of an injectable size was developed. The resulting granules permitted a nearly constant release of low-molecular-weight, water-soluble drugs without an initial burst. The polyanhydrides used were poly(fatty acid dimer), poly(sebacic acid), and their copolymers. The dyes acid orange 63 and p-nitroaniline were used as model compounds for drugs. Polymer degradation and drug release for disks and variously sized granules of copolymers containing drugs, prepared by a water-in-oil (W/O) emulsion method, were compared with those for devices prepared by the usual compression method. In the W/O emulsion method, a mixture of aqueous drug solution and polymer-chloroform solution was emulsified by probe sonication to prepare a very fine W/O emulsion. The powder obtained by freeze-drying of the W/O emulsion was pressed into circular disks. In the compression method, the drug was mechanically mixed with the polymer, and the mixture was compressed into circular disks. The resulting disks were ground to prepare granules of different sizes. The granules encapsulated more than 95% of the drug, irrespective of the preparation method. Both methods were effective in preparing polymer disks capable of controlled drug release without any initial burst. However, as the granule size decreased to an injectable size (diameter, < 150 microns), a large difference in the drug release profile was observed between the two preparation methods. The injectable granules obtained by the W/O emulsion method showed nearly constant drug release without any large initial burst, in contrast to those prepared by the compression method, irrespective of the drug type.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8138910

  8. Prevalence of skin problems and leg ulceration in a sample of young injecting drug users

    PubMed Central

    2014-01-01

    Background Drug users suffer harm from the injecting process, and clinical services are reporting increasing numbers presenting with skin-related problems such as abscesses and leg ulcers. Skin breakdown can lead to long-term health problems and increased service costs and is often the first indication of serious systemic ill health. The extent of skin problems in injecting drug users has not previously been quantified empirically, and there is a dearth of robust topical literature. Where skin problems have been reported, this is often without clear definition and generic terms such as ‘soft tissue infection’ are used which lack specificity. The aim of this study was to identify the range and extent of skin problems including leg ulceration in a sample of injecting drug users. Definitions of skin problems were developed and applied to descriptions from drug users to improve rigour. Methods Data were collected in needle exchanges and methadone clinics across Glasgow, Scotland, from both current and former drug injectors using face-to-face interviews. Results Two hundred participants were recruited, of which 74% (n = 148) were males and 26% (n = 52) were females. The age range was 21–44 years (mean 35 years). Just under two thirds (64%, n = 127) were currently injecting or had injected within the last 6 months, and 36% (n = 73) had previously injected and had not injected for more than 6 months. Sixty per cent (n = 120) of the sample had experienced a skin problem, and the majority reported more than one problem. Most common were abscesses, lumps, track marks and leg ulcers. Fifteen per cent (n = 30) of all participants reported having had a leg ulcer. Conclusions This is an original empirical study which demonstrated unique findings of a high prevalence of skin disease (60%) and surprisingly high rates of leg ulceration (15%). Skin disease in injecting drug users is clearly widespread. Leg ulceration in particular is a chronic recurring

  9. "Single-use" needles and syringes for the prevention of HIV infection among injection drug users.

    PubMed

    Des Jarlais, D C

    1998-01-01

    Providing single-use injection equipment to persons who inject illicit drugs would appear to be an effective method for reducing HIV transmission. However, interviews with manufacturers, syringe exchange program staff, and drug users revealed numerous difficulties with such a technologic solution. All designs for such equipment can be defeated and should probably be called difficult-to-reuse equipment. There are problems with consumer acceptance of difficult-to-reuse equipment and with safe disposal of large amounts of biohazardous waste. Despite these problems, it would be useful to conduct additional research, particularly on the potential for placing difficult-to-reuse equipment into shooting galleries. PMID:9663624

  10. [Drug injection method risky for transmission of blood-borne diseases: are we careful enough?].

    PubMed

    Bravo Portela, M J; Ortiz Castro, A; Galván Reyes, J; Barrio Anta, G; de la Fuente de Hoz, L

    1998-01-01

    In the last 20 years, research on the determinants of the HIV epidemic among drug users has focused mainly on studies of risk behaviour for drug injection. Studies involving human behaviour present special methodological problems. This paper presents a review of 1) the most important features that make this field different from the study of blood-borne diseases in other populations, and 2) the basic variables used in epidemiology to analyse injecting risk behaviour. Alternatives to improve research planning and results are proposed based on collaborating with other disciplines and improving the methodological resources of epidemiology. PMID:9810835

  11. Intradermal needle-free powdered drug injection by a helium-powered device.

    PubMed

    Liu, John; Hogan, N Catherine; Hunter, Ian W

    2012-01-01

    We present a new method for needle-free powdered drug injection via a bench-top gas-powered device. This injector provides an alternative method of vaccine delivery to address the cold chain problem--the cost and risk of transporting temperature sensitive vaccines to developing countries. The device houses interchangeable nozzle inserts to vary orifice geometries and is capable of delivering polymer beads (1-5 µm diameter) into the dermal layer of porcine tissue. Results for injection shape and injection depth versus nozzle orifice diameter demonstrate the device's controllability. PMID:23366327

  12. Injecting Drug Users Retention in Needle-Exchange Program and its Determinants in Iran Prisons

    PubMed Central

    Shahbazi, Mohammad; Farnia, Marzieh; Moradi, Ghobad; Karamati, Mohammadreza; Paknazar, Fatemeh; Mirmohammad Khani, Majid

    2015-01-01

    Background: Participation and to stay in a health program depends on many factors. One of these programs is Needle Exchange Program (NEP) in prisons. Objectives: The current study aimed to evaluate the retention of injecting drug prisoners and find the related factors in Iran. Patients and Methods: This cohort study analyzed data about injecting drug male prisoners who were participated in NEP in three Iranian prisons. Data was collected from October 2009 to June 2010. A proper approach of survival analyses including Kaplan-Meier method, Log-Rank test, and Cox Proportional Hazard Model were used to evaluate Injecting Drug Users (IDUs) retention in NEP and its determinants. Results: Out of 320 prisoners, 167 were from Isfahan Central Prison, 82 from Tehran-Ghezel-Hesar Prison, and 71 from Hamadan Central Prison. Two-hundred and fifty prisoners (78.4%) had history of drug injection; and drug injection was the most common choice for 115 persons (35.9%). Participants were followed up for 29 weeks, the mean (SD) time of retention in the program was 24.1 (0.6) weeks. There was a significant relationship between age, number of used needles per week, duration of addiction, age of addiction onset, as well as imprisonment age, main method of drug use, type of main using drug, Hepatitis B Virus (HBV) infection, job status, reason of arrestment, history of involvement in harm reduction programs, and the length of retention (P < 0.05). There was also significant relationship between the history of using harm reduction services (P = 0.007), tattooing (P = 0.01), longer durations of addiction (P = 0.048), and retention. Conclusions: Tattooing and longer duration of addiction were two important factors that significantly increased retention in the program. In contrast, history of using harm reduction services was the factor that decreased persistence. The risk of quitting the program may decrease about 68% in those who did not involve in harm reduction programs. PMID:26405681

  13. Eligibility of persons who inject drugs for treatment of hepatitis C virus infection

    PubMed Central

    Arain, Amber; Robaeys, Geert

    2014-01-01

    In this decade, an increase is expected in end-stage liver disease and hepatocellular carcinoma, most commonly caused by hepatitis C virus (HCV) infection. Although people who inject drugs (PWID) are the major source for HCV infection, they were excluded from antiviral treatments until recently. Nowadays there is incontrovertible evidence in favor of treating these patients, and substitution therapy and active substance use are no longer contraindications for antiviral treatment. The viral clearance in PWID after HCV antiviral treatment with interferon or pegylated interferon combined with ribavirin is comparable to the viral clearance in non-substance users. Furthermore, multidisciplinary approaches to delivering treatment to PWID are advised, and their treatment should be considered on an individualized basis. To prevent the spread of HCV in the PWID community, recent active PWID are eligible for treatment in combination with needle exchange programs and substitution therapy. As the rate of HCV reinfection is low after HCV antiviral treatment, there is no need to withhold HCV treatment due to concerns about reinfection alone. Despite the advances in treatment efficacies and data supporting their success, HCV assessment of PWID and initiation of antiviral treatment remains low. However, the proportion of PWID assessed and treated for HCV is increasing, which can be further enhanced by understanding the barriers to and facilitators of HCV care. Removing stigmatization and implementing peer support and group treatment strategies, in conjunction with greater involvement by nurse educators/practitioners, will promote greater treatment seeking and adherence by PWID. Moreover, screening can be facilitated by noninvasive methods for detecting HCV antibodies and assessing liver fibrosis stages. Recently, HCV clearance has become a major endpoint in the war against drugs for the Global Commission on Drug Policy. This review highlights the most recent evidence concerning

  14. Sexual Practices of Female Sex Workers Who Inject Drugs in Osogbo, Nigeria.

    PubMed

    Adelekan, Ademola Lukman; Omoregie, Philomena Imade; Edoni, Elizabeth Ronami

    2014-01-01

    Female sex workers (FSWs) who inject drugs have higher risks of HIV infection due to injection drug use and the array of sexual practices employed. This study, therefore, is designed to determine sexual practices of FSWs who inject drug in Osogbo, Nigeria. This study was a cross-sectional descriptive mixed-methods design. Twenty-seven FSWs who inject drug were selected from 11 brothels by snowball sampling and interviewed with a semistructured questionnaire and in-depth interview guide. The mean age of respondents was 26.2 ± 7.5. Many of the respondents were aware of the magnitude of HIV and some were sex workers first before turning to be drug users. Some of the respondents had ever tested for HIV and few had ever been treated for STI more than once. Some respondents were willing to have male clients who do not wear a condom in exchange for accepting more money in return. Many of the respondents reported use of condom, regular talking of herbs, and good personal hygiene as ways of protecting themselves from HIV. Respondents have relatively high numbers of sexual partners. Involving sex workers directly in HIV prevention campaigns will encourage them to look after their health and to access services that could help them. PMID:27350958

  15. The effect of methadone maintenance on positive outcomes for opiate injection drug users

    PubMed Central

    Corsi, Karen F; Lehman, Wayne K; Booth, Robert E

    2009-01-01

    This study examined outcome variables for 160 opiate injection drug users (IDUs) who entered methadone maintenance between baseline and 6 month follow-up. Outcome variables of interest included drug use, productivity and HIV risk behaviors. Participants were recruited through street outreach in Denver, Colorado from 2000 through 2004 using targeted sampling. The sample was primarily male, 48% White, averaged 39 years of age and had been injecting drugs for an average of nearly 20 years. Significant improvements were found in univariate tests. Logistic regression revealed that spending more time in treatment was a significant predictor of positive outcomes on drug use and HIV risk behaviors. The results underscore the importance of retaining IDUs in methadone maintenance in order to maximize their treatment success. Results from this study show that time in treatment can affect many aspects of the participant’s life in a positive way, including reduction of HIV risk. PMID:19150202

  16. Responsibility attribution of HIV infection and coping among injection drug users in Malaysia.

    PubMed

    Chou, Chih-Chin; Chronister, Julie; Chou, Chih-Hung; Tan, Sooyin; Macewicz, Thomas

    2013-01-01

    This study explored responsibility attribution (RA) of HIV/AIDS infection (i.e., how an individual perceives the cause of their HIV/AIDS infection) and its relationship to coping styles among injection drug users (IDUs) with HIV/AIDS. In addition, this study investigated whether self-esteem, social support, and religiosity mediate the relationship between RA and coping styles of IDUs with HIV/AIDS. Participants were 201 adult IDUs with HIV/AIDS participating in the National Drug Rehabilitation Center in Malaysia. Five measures were used to assess the above constructs. Cluster analysis, analysis of variance, and mediation analyses were conducted. Results of this study indicated that IDUs with HIV/AIDS in Malaysia can be classified into four homogenous attribution groups: external, fatalistic, internal, and indeterminate. Mediator analyses revealed that combination of self-esteem, social support, and religiosity mediate the relationship between RA and coping behaviors. Clinicians working with IDUs with HIV/AIDS need to address the role of RA, self-esteem, religiosity, and social support as these psychosocial constructs are linked to coping with HIV/AIDS. Future researchers should investigate whether enhancing self-esteem, social support, and religiosity can promote active problem-solving coping and reduce the use of avoidance coping behaviors. PMID:23713718

  17. Risk Factors Associated with Unsafe Injection Practices at the First Injection Episode among Intravenous Drug Users in France: Results from PrimInject, an Internet Survey

    PubMed Central

    Guichard, Anne; Guignard, Romain; Lert, France; Roy, Elise

    2015-01-01

    Background. New drug use patterns may increase the risk of human immunodeficiency virus and hepatitis infections. In France, new injection patterns among youths with diverse social backgrounds have emerged, which may explain the persistently high rates of hepatitis C virus infection. This study explores factors associated with injection risk behaviours at first injection among users who began injecting in the post-2000 era. Methods. A cross-sectional study was conducted on the Internet from October 2010 to March 2011, through an online questionnaire. Multivariate logistic regression identified the independent correlates of needle sharing and equipment (cooker/cotton filter) sharing. Results. Among the 262 respondents (mean age 25 years), 65% were male. Both risk behaviours were positively associated with initiation before 18 years of age (aOR 3.7 CI 95% 1.3–10.6 and aOR 3.0 CI 95% 1.3–7.0) and being injected by another person (aOR 3.1 CI 95% 1.0–9.9 and aOR 3.0 CI 95% 1.3–7.1). Initiation at a party was an independent correlate of equipment sharing (aOR 2.6 95% CI 1.0–6.8). Conclusions. Results suggest a need for innovative harm reduction programmes targeting a variety of settings and populations, including youths and diverse party scenes. Education of current injectors to protect both themselves and those they might initiate into injection is critically important. PMID:26504609

  18. Injection drug users and the provision of hepatitis C-related services in a nationwide sample of drug treatment programs.

    PubMed

    Vassilev, Zdravko P; Strauss, Shiela M; Astone, Janetta; Des Jarlais, Don C

    2004-01-01

    Drug treatment facilities are important sites for providing targeted prevention and health services to injection drug users (IDUs) who are infected with the hepatitis C virus (HCV). A nationwide survey was conducted to examine whether differences exist in the HCV-related services provided by drug treatment programs that have varying proportions of IDUs among their patients. The results indicate that, overall, drug treatment programs with a greater proportion of IDUs offer significantly more HCV services as compared to programs with a smaller proportion of IDUs. However, important components of hepatitis C-related care, such as universal basic education and counseling about HCV and extensive HCV-antibody testing, are not yet being provided by all programs with a large proportion of IDUs among their patient populations. PMID:15255228

  19. Differential Risk Factors for HIV Drug and Sex Risk-Taking Among Non-treatment-seeking Hospitalized Injection Drug Users

    PubMed Central

    Crooks, Denise; Tsui, Judith; Anderson, Bradley; Dossabhoy, Shernaz; Herman, Debra; Liebschutz, Jane M.; Stein, Michael D.

    2016-01-01

    Injection drug users (IDUs) are at increased risk of contracting HIV. From a clinical trial assessing an intervention to enhance the linkage of hospitalized patients to opioid treatment after discharge, we conducted multivariate analysis of baseline data from hospitalized IDUs with a history of opioid dependence (n = 104) to identify differences in factors predicting HIV drug and sex risk behaviors. Factors significantly associated with HIV drug risk were being non-Hispanic Caucasian and recent cocaine use. Being female, binge drinking, and poorer mental health were significantly associated with higher sex risk. Because factors predicting HIV sex risk behaviors differ from those predicting HIV drug risk, interventions aimed at specific HIV risks should have different behavioral and substance use targets. PMID:25063229

  20. Gender Differences in Planning Ability and Hepatitis C Virus among People who Inject Drugs

    PubMed Central

    Scheidell, Joy D.; Khan, Maria R.; Clifford, Lisa M.; Dunne, Eugene M.; Keen, Larry D.; Latimer, William W.

    2015-01-01

    Hepatitis C virus (HCV) is primarily spread through risky injection practices, including sharing needles, cookers, cottons, rinse water, and the practice of backloading. An important aspect of harm reduction for people who inject drugs (PWID) is to identify factors that contribute to safer injection. Planning ability may influence risky injection practices and gender differences in factors that drive injection practices indicate a need to examine associations between planning and injection behaviors in men versus women. Data from the NEURO-HIV Epidemiologic Study was restricted to those who had ever injected in their lifetime (n=456). Impaired planning ability was assessed with the Tower of London and defined as a standardized total excess moves score below the 10th percentile. We used logistic regression to estimate the gender-specific adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations between impaired planning, each injection practice, and biologically-confirmed HCV. Impaired planning ability was associated with sharing needles (AOR=2.93, 95% CI: 1.33, 6.47), cookers (AOR=3.13, 95% CI: 1.22, 8.02), cottons (AOR=2.89, 95% CI: 1.23, 6.78), rinse water (AOR=2.43, 95% CI: 1.15, 5.14), and backloading (AOR=2.68, 95% CI: 1.26, 5.70) and HCV (AOR=3.42, 95% CI: 1.03, 11.38) among men. Planning ability was not significantly associated with the injection behaviors or HCV among women, suggesting other factors likely contribute to risky injection practices. Interventions to promote harm reduction among PWID should ascertain and strengthen planning ability. Women may have additional barriers to practicing safe injection beyond impaired planning abilities, which should also be addressed. PMID:25863005

  1. Preliminary Results in the Application of Ultrasound during the Injection of Drugs

    NASA Astrophysics Data System (ADS)

    Muelas, H. Ruben Dario; Pazos-Ospina, J. F.; Casanova, G. Gonzalo Fernando; Ealo, Joao L.

    During the injection of drugs into the brain a phenomenon known as backflow is presented, whereby the injected drug flows along the needle track rather than spread inside the target tissue. This backflow is a major problem because it produces an inadequate distribution of the drug. Previous studies have shown that backflow is dependent on some parameter such as the geometry of the needle, insertion speed and flow rate at which the infusate is injected. Also, this phenomenon is reduced when a radial compressive stress exists in the needle-tissue interface. In view of this, in this paper we propose an experimental setup to evaluate the effect of using ultrasonic wavefronts on the drug delivery distribution. A needle of 0.36 mm of diameter is coupled to a linear actuator which moves the needle at a speed of 0.5 mm/s in a phantom tissue sample of agarose gel. A single disk-like ultrasonic transducer with a through hole at its center to allow the insertion of the needle is used to generate the acoustic field. At the same time, a pump system injects a tracer inside the sample and makes visible the amount of liquid that is returned by effect of backflow. A numerical model of the acoustic field inside the sample is presented. Also, preliminary results with and without the application of ultrasound are discussed

  2. HIV Infection among People Who Inject Drugs: The Challenge of Racial/Ethnic Disparities

    ERIC Educational Resources Information Center

    Des Jarlais, Don C.; McCarty, Dennis; Vega, William A.; Bramson, Heidi

    2013-01-01

    Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that…

  3. Depression as Measured by the Beck Depression Inventory-II among Injecting Drug Users

    ERIC Educational Resources Information Center

    Johnson, Mark E.; Neal, David B.; Brems, Christiane; Fisher, Dennis G.

    2006-01-01

    This study conducts a confirmatory factor analysis of the Beck Depression Inventory-II (BDI-II) with a sample of 598 individuals who reported recent injecting drug use. Findings indicate that out of four models tested, the best model for this sample is a three-factor solution (somatic, affective, and cognitive) previously reported by Buckley,…

  4. Sex workers’ non-commercial male partners who inject drugs report higher risk sexual behaviors

    PubMed Central

    Robertson, Angela M.; Syvertsen, Jennifer L.; Palinkas, Lawrence A.; Vera, Alicia; Rangel, Gudelia; Martinez, Gustavo; Strathdee, Steffanie A

    2014-01-01

    Female sex workers (FSWs) are less likely to use condoms with non-commercial male partners than clients. We compare non-commercial male partners who do and do not inject drugs in Tijuana and Ciudad Juárez, Mexico. Sexual risk behaviors were more prevalent among injectors, who could promote HIV/STI transmission in this region. PMID:24275732

  5. Predictors of Hospitalization for Injection Drug Users Seeking Care for Soft Tissue Infections

    PubMed Central

    Baernstein, Amy; Binswanger, Ingrid; Bradley, Katharine; Merrill, Joseph O.

    2007-01-01

    BACKGROUND Soft tissue infections (STIs) from injection drug use are a common cause of Emergency Department visits, hospitalizations, and operating room procedures, yet little is known about factors that may predict the need for these costly medical services. OBJECTIVE To describe a cohort of injection drug users seeking Emergency Department care for STIs and to identify risk factors associated with hospitalization. We hypothesized that participants who delayed seeking care would be hospitalized more often than those who did not. DESIGN Cohort study using in-person structured interviews and medical record review. Logistic regression assessed the association between hospital admission and delay in seeking care as well as other demographic, clinical, and psychosocial factors. PARTICIPANTS Injection drug users who sought Emergency Department care for STIs from May 2001 to March 2002. RESULTS Of the 136 participants, 55 (40%) were admitted to the hospital. Delay in seeking care was not associated with hospital admission. Participants admitted for their infection were significantly more likely to be living in a shelter (P = .01) and to report being hospitalized 2 or more times in the past year (P < .01). CONCLUSIONS We identified a subpopulation of injection drug users, mostly living in shelters, who were hospitalized frequently in the past year and who were more likely to be hospitalized for their current infections compared to others. As members of this subpopulation can be easily identified and located, they may benefit from interventions to reduce the health care utilization resulting from these infections. PMID:17356973

  6. HIV risk behaviors and alcohol intoxication among injection drug users in Puerto Rico.

    PubMed

    Matos, Tomás D; Robles, Rafaela R; Sahai, Hardeo; Colón, Hector M; Reyes, Juan C; Marrero, C Amalia; Calderón, José M; Shepard, Elizabeth W

    2004-12-01

    This paper reports results of an analysis of the association between alcohol intoxication and injection and sexual HIV risk behaviors among 557 Hispanic heroin and cocaine injectors, not in treatment, who were recruited in poor communities in Puerto Rico. Subjects were part of a longitudinal prevention-intervention study aimed at reducing drug use and HIV risk behaviors. Participants reported a high prevalence of co-occurring conditions, particularly symptoms of severe depression (52%) and severe anxiety (37%), measured by Beck's Depression Index and Beck's Anxiety Index, respectively. Alcohol intoxication during the last 30 days was reported by 18% of participants. Associations were found between alcohol intoxication and both injection and sexual risk behaviors. In the bivariate analysis, subjects reporting alcohol intoxication were more likely to inject three or more times per day, pool money to buy drugs, share needles, and share cotton. They were also significantly more likely to have a casual or paying sex partner and to have unprotected sex with these partners. After adjustment, sharing needles and cotton, having sex with a paying partner or casual partner, and exchanging sex for money or drugs were significantly related to alcohol intoxication. HIV prevention programs, to be effective, must address alcohol intoxication and its relation to injection and sexual risk behaviors as a central issue in HIV prevention among drug injectors. PMID:15561474

  7. Gender Differences in Sexual Practices and Beliefs among Rural Injection Drug Users in Treatment.

    ERIC Educational Resources Information Center

    Zagumny, Matthew J.; Holt, Tamala Ray

    1999-01-01

    Survey examines gender differences in sexual practices and beliefs about condom use among rural injecting drug users admitted to treatment programs. Results indicate that Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome knowledge was extremely limited for both males and females in this sample, suggesting that basic HIV/AIDS…

  8. Persistent Bacillus cereus Bacteremia in 3 Persons Who Inject Drugs, San Diego, California, USA.

    PubMed

    Schaefer, Gabrielle; Campbell, Wesley; Jenks, Jeffrey; Beesley, Cari; Katsivas, Theodoros; Hoffmaster, Alex; Mehta, Sanjay R; Reed, Sharon

    2016-09-01

    Bacillus cereus is typically considered a blood culture contaminant; however, its presence in blood cultures can indicate true bacteremia. We report 4 episodes of B. cereus bacteremia in 3 persons who inject drugs. Multilocus sequence typing showed that the temporally associated infections were caused by unrelated clones. PMID:27533890

  9. Persistent Bacillus cereus Bacteremia in 3 Persons Who Inject Drugs, San Diego, California, USA

    PubMed Central

    Schaefer, Gabrielle; Campbell, Wesley; Jenks, Jeffrey; Beesley, Cari; Katsivas, Theodoros; Hoffmaster, Alex; Mehta, Sanjay R.

    2016-01-01

    Bacillus cereus is typically considered a blood culture contaminant; however, its presence in blood cultures can indicate true bacteremia. We report 4 episodes of B. cereus bacteremia in 3 persons who inject drugs. Multilocus sequence typing showed that the temporally associated infections were caused by unrelated clones. PMID:27533890

  10. A Randomized Trial of Employment-Based Reinforcement of Cocaine Abstinence in Injection Drug Users

    ERIC Educational Resources Information Center

    Silverman, Kenneth; Wong, Conrad J.; Needham, Mick; Diemer, Karly N.; Knealing, Todd; Crone-Todd, Darlene; Fingerhood, Michael; Nuzzo, Paul; Kolodner, Kenneth

    2007-01-01

    High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs…

  11. Sustained release of active chemotherapeutics from injectable-solid β-hairpin peptide hydrogel.

    PubMed

    Sun, Jessie E P; Stewart, Brandon; Litan, Alisa; Lee, Seung Joon; Schneider, Joel P; Langhans, Sigrid A; Pochan, Darrin J

    2016-05-26

    MAX8 β-hairpin peptide hydrogel is a solid, preformed gel that can be syringe injected due to shear-thinning properties and can recover solid gel properties immediately after injection. This behavior makes the hydrogel an excellent candidate as a local drug delivery vehicle. In this study, vincristine, a hydrophobic and commonly used chemotherapeutic, is encapsulated within MAX8 hydrogel and shown to release constantly over the course of one month. Vincristine was observed to be cytotoxic in vitro at picomolar to nanomolar concentrations. The amounts of drug released from the hydrogels over the entire time-course were in this concentration range. After encapsulation, release of vincristine from the hydrogel was observed for four weeks. Further characterization showed the vincristine released during the 28 days remained biologically active, well beyond its half-life in bulk aqueous solution. This study shows that vincristine-loaded MAX8 hydrogels are excellent candidates as drug delivery vehicles, through sustained, low, local and effective release of vincristine to a specific target. Oscillatory rheology was employed to show that the shear-thinning and re-healing, injectable-solid properties that make MAX8 a desirable drug delivery vehicle are unaffected by vincristine encapsulation. Rheology measurements also were used to monitor hydrogel nanostructure before and after drug encapsulation. PMID:26906463

  12. Individual and Network Interventions With Injection Drug Users in 5 Ukraine Cities

    PubMed Central

    Lehman, Wayne E. K.; Latkin, Carl A.; Dvoryak, Sergey; Brewster, John T.; Royer, Mark S.; Sinitsyna, Larisa

    2011-01-01

    Objectives. We evaluated the effects of an individual intervention versus a network intervention on HIV-related injection and sexual risk behaviors among street-recruited opiate injection drug users in 5 Ukraine cities. Methods. Between 2004 and 2006, 722 opiate injection drug users were recruited to participate in interventions that were either individually based or based on a social network model in which peer educators intervened with their network members. Audio computer-assisted self-interview techniques were used to interview participants at baseline and follow-up. Results. Multiple logistic analyses controlling for baseline injection and sexual risks revealed that both peer educators and network members in the network intervention reduced injection-related risk behaviors significantly more than did those in the individually based intervention and that peer educators increased condom use significantly more than did those in the individual intervention. Individual intervention participants, however, showed significantly greater improvements than did network members with respect to reductions in sexual risk behaviors. Conclusions. Social network interventions may be more effective than individually based interventions in changing injection risk behaviors among both peer educators and network members. The effectiveness of network interventions in changing sexual risk behaviors is less clear, probably owing to network composition and inhibitions regarding discussing sexual risk behaviors. PMID:20395584

  13. Severe illness and death among injecting drug users in Scotland: a case-control study.

    PubMed

    Taylor, A; Hutchinson, S; Lingappa, J; Wadd, S; Ahmed, S; Gruer, L; Taylor, T H; Roy, K; Gilchrist, G; McGuigan, C; Penrice, G; Goldberg, D

    2005-04-01

    Between April and September 2000, 60 injecting drug users in Scotland died or were hospitalized with severe illness. Laboratory investigations suggested that Clostridium novyi and other bacteria were important aetiological agents. To determine associated environmental/behavioural factors a case-control study was undertaken with 19 'definite' and 32 'probable' cases in Glasgow, Scotland. For every deceased case (n=19), up to three proxy individuals were interviewed. Three controls were identified for each case. Multivariate logistic regression analyses compared (i) all cases and controls; (ii) definite cases and matched controls; (iii) probable cases and matched controls. In all three analyses injecting into muscle or skin and injecting most of the time with a filter used by someone else were the variables most strongly associated with illness. Comparing only muscle-injecting cases and controls, cases were significantly more likely to have injected larger amounts of heroin per average injection than were controls. The findings make an important epidemiological contribution to the understanding of the public health and clinical implications of the contamination of illicit drugs by histotoxic clostridia. PMID:15816144

  14. Epidemiology of Drug Use and HIV-Related Risk Behaviors among People Who Inject Drugs in Mwanza, Tanzania

    PubMed Central

    Tan, Annabel Xulin; Kapiga, Saidi; Khoshnood, Kaveh; Bruce, R. Douglas

    2015-01-01

    Heroin trafficking and consumption has increased steadily over the past decade in Tanzania, but limited information regarding HIV and drug use exists for the city of Mwanza. Our study investigates the epidemiology of drug use, and HIV risk behaviors among drug users in the northwestern city of Mwanza. Using a combination of targeted sampling and participant referral, we recruited 480 participants in Mwanza between June and August 2014. The sample was 92% male. Seventy-nine (16.4%) participants reported injecting heroin, while 434 (90.4%) reported smoking heroin. Unstable housing and cohabitation status were the only socioeconomic characteristics significantly associated with heroin injection. More than half of heroin injectors left syringes in common locations, and half reported sharing needles and syringes. Other risk behaviors such as lack of condom use during sex, and the use of illicit drugs during sex was widely reported as well. Among the study sample, there was poor awareness of health risks posed by needle/syringe sharing and drug use. Our results show that heroin use and HIV risk related behaviors are pressing problems that should not be ignored in Mwanza. Harm reduction programs are urgently needed in this population. PMID:26701616

  15. Spatial distribution and characteristics of injecting drug users (IDU) in five Northeastern states of India

    PubMed Central

    2011-01-01

    Background Injecting drugs is the major driving force of human immunodeficiency virus (HIV) epidemic in Northeastern India. We have assessed the spatial distribution of locations where injecting drug users (IDU) congregate, as well as the risk behaviour and key characteristics of IDUs to develop new strategies strengthening intervention measures for HIV prevention in this region. Methods Locations of IDUs congregation for buying and injecting drugs were identified through Key Informants (KI). Verification of the location and its characteristics were confirmed through field visits. We also conducted semi-structured and structured interviews with IDUs to learn more about their injecting behaviour and other characteristics. Results Altogether, 2462 IDU locations were identified in 5 states. The number of IDU locations was found to be greater in the states bordering Myanmar. Private houses, parks, abandoned buildings, pharmacies, graveyards, and isolated places were the most frequently chosen place for injecting drugs. Many injecting locations were visited by IDUs of varying ages, of which about 10-20% of locations were for females. In some locations, female IDUs were also involved in sex work. Sharing of needle and syringes was reported in all the states by large proportion of IDUs, mainly with close friends. However, even sharing with strangers was not uncommon. Needle and syringes were mainly procured from pharmacies, drug peddlers and friends. Lack of access to free sterile needles and syringes, and inconsistent supplies from intervention programs, were often given as the cause of sharing or re-use of needles and syringes by IDUs. Most of the IDUs described a negative attitude of the community towards them. Conclusion We highlight the injection of drugs as a problem in 5 Northeastern India states where this is the major driving force of an HIV epidemic. Also highlighted are the large numbers of females that are unrecognized as IDUs and the association between drug

  16. Social Network Structure and HIV Infection Among Injecting Drug Users in Lithuania: Gatekeepers as Bridges of Infection

    PubMed Central

    Caplinskiene, Irma; Caplinskas, Saulius; Latkin, Carl A.

    2014-01-01

    The aim of the study was to assess—while controlling for individual risk characteristics—how certain social network structural characteristics (degree, eigenvector, and betweenness centrality) are related to HIV infections. Injecting drug users (N = 299) in Vilnius, Lithuania were recruited using incentivized chain referral sampling for a cross-sectional study. Sociometric social links were established between participants, and UCINET was used to calculate network measures. HIV prevalence was 10 %, and all except two knew they were infected. Of the five variables that remained significant in the final multivariate model, one showed temporal cumulative infection risk (more years since first drug injecting), three reflected informed altruism (always using condoms, less distributive syringe sharing and having not more than one sex partner), and one pointed to the importance of social network structure (betweenness centrality, indicating bridge populations). Loess regression indicates that betweenness may have the highest impact on HIV prevalence (about 60 vs. 20 % estimated HIV prevalence for the highest betweenness centrality values vs. highest age values). This analysis contributes to existing evidence showing both potential informed altruism (or maybe social desirability bias) in connection with HIV infection, and a link between HIV infection risk and the role of bridges within the social network of injecting drug user populations. These findings suggest the importance of harm reduction activities, including confidential testing and counseling, and of social network interventions. PMID:24469223

  17. Social network structure and HIV infection among injecting drug users in Lithuania: gatekeepers as bridges of infection.

    PubMed

    Gyarmathy, V Anna; Caplinskiene, Irma; Caplinskas, Saulius; Latkin, Carl A

    2014-03-01

    The aim of the study was to assess-while controlling for individual risk characteristics-how certain social network structural characteristics (degree, eigenvector, and betweenness centrality) are related to HIV infections. Injecting drug users (N = 299) in Vilnius, Lithuania were recruited using incentivized chain referral sampling for a cross-sectional study. Sociometric social links were established between participants, and UCINET was used to calculate network measures. HIV prevalence was 10 %, and all except two knew they were infected. Of the five variables that remained significant in the final multivariate model, one showed temporal cumulative infection risk (more years since first drug injecting), three reflected informed altruism (always using condoms, less distributive syringe sharing and having not more than one sex partner), and one pointed to the importance of social network structure (betweenness centrality, indicating bridge populations). Loess regression indicates that betweenness may have the highest impact on HIV prevalence (about 60 vs. 20 % estimated HIV prevalence for the highest betweenness centrality values vs. highest age values). This analysis contributes to existing evidence showing both potential informed altruism (or maybe social desirability bias) in connection with HIV infection, and a link between HIV infection risk and the role of bridges within the social network of injecting drug user populations. These findings suggest the importance of harm reduction activities, including confidential testing and counseling, and of social network interventions. PMID:24469223

  18. Evidence for a substantial role of sharing of injecting paraphernalia other than syringes/needles to the spread of hepatitis C among injecting drug users.

    PubMed

    Mathei, C; Shkedy, Z; Denis, B; Kabali, C; Aerts, M; Molenberghs, G; Van Damme, P; Buntinx, F

    2006-08-01

    In industrialized countries, transmission of hepatitis C occurs primarily through injecting drug use. Transmission of hepatitis C in injecting drug users is mainly associated with the sharing of contaminated syringes/needles, although evidence for risk of hepatitis C infection through sharing of other injecting paraphernalia is increasing. In this paper, the independent effects of sharing paraphernalia other than syringes/needles have been estimated. The prevalence and force of infection were modelled using three serological data sets from drug users in three centres in Belgium as a function of the sharing behaviour. It was found that sharing of materials other than syringes/needles indeed seemed to contribute substantially to the spread of hepatitis C among injecting drug users. PMID:16901287

  19. Spatial Epidemiology of HIV among Injection Drug Users in Tijuana, Mexico

    PubMed Central

    Brouwer, Kimberly C.; Rusch, Melanie L.; Weeks, John R.; Lozada, Remedios; Vera, Alicia; Magis-Rodríguez, Carlos; Strathdee, Steffanie A.

    2012-01-01

    The northwest border city of Tijuana is Mexico’s fifth largest and is experiencing burgeoning drug use and human immunodeficiency virus (HIV) epidemics. Since local geography influences disease risk, we explored the spatial distribution of HIV among injection drug users (IDUs). From 2006–2007, 1056 IDUs were recruited using respondent-driven sampling, and then followed for eighteen months. Participants underwent semi-annual surveys, mapping, and testing for HIV, tuberculosis, and syphilis. Using Average Nearest Neighbor and Getis-Ord Gi* statistics, locations where participants lived, worked, bought and injected drugs were compared with HIV status and environmental and behavioral factors. Median age was thirty-seven years; 85 percent were male. Females had higher HIV prevalence than males (10.2 percent vs. 3.4 percent; p=0.001). HIV cases at baseline (n=47) most strongly clustered by drug injection sites (Z-Score −6.173; p < 0.001), with a 16 km2 hotspot near the Mexico/U.S. border, encompassing the red-light district. Spatial correlates of HIV included syphilis infection, female gender, younger age, increased hours on the street per day, and higher number of injection partners. Almost all HIV seroconverters injected within a 2.5 block radius of each other immediately prior to seroconversion. Only history of syphilis infection and female gender were strongly associated with HIV in the area where incident cases injected. Directional trends suggested a largely static epidemic until July–December 2008, when HIV spread to the southeast, possibly related to intensified violence and policing that spiked in the latter half of 2008. While clustering allows for targeting interventions, the dynamic nature of epidemics suggests the importance of mobile treatment and harm reduction programs. PMID:23606753

  20. Spatial Epidemiology of HIV among Injection Drug Users in Tijuana, Mexico.

    PubMed

    Brouwer, Kimberly C; Rusch, Melanie L; Weeks, John R; Lozada, Remedios; Vera, Alicia; Magis-Rodríguez, Carlos; Strathdee, Steffanie A

    2012-01-01

    The northwest border city of Tijuana is Mexico's fifth largest and is experiencing burgeoning drug use and human immunodeficiency virus (HIV) epidemics. Since local geography influences disease risk, we explored the spatial distribution of HIV among injection drug users (IDUs). From 2006-2007, 1056 IDUs were recruited using respondent-driven sampling, and then followed for eighteen months. Participants underwent semi-annual surveys, mapping, and testing for HIV, tuberculosis, and syphilis. Using Average Nearest Neighbor and Getis-Ord Gi* statistics, locations where participants lived, worked, bought and injected drugs were compared with HIV status and environmental and behavioral factors. Median age was thirty-seven years; 85 percent were male. Females had higher HIV prevalence than males (10.2 percent vs. 3.4 percent; p=0.001). HIV cases at baseline (n=47) most strongly clustered by drug injection sites (Z-Score -6.173; p < 0.001), with a 16 km(2) hotspot near the Mexico/U.S. border, encompassing the red-light district. Spatial correlates of HIV included syphilis infection, female gender, younger age, increased hours on the street per day, and higher number of injection partners. Almost all HIV seroconverters injected within a 2.5 block radius of each other immediately prior to seroconversion. Only history of syphilis infection and female gender were strongly associated with HIV in the area where incident cases injected. Directional trends suggested a largely static epidemic until July-December 2008, when HIV spread to the southeast, possibly related to intensified violence and policing that spiked in the latter half of 2008. While clustering allows for targeting interventions, the dynamic nature of epidemics suggests the importance of mobile treatment and harm reduction programs. PMID:23606753

  1. Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug

    PubMed Central

    Tempalski, Barbara; Cooper, Hannah L.; Friedman, Samuel R.; Des Jarlais, Don C.; Brady, Joanne; Gostnell, Karla

    2009-01-01

    Background Scientific consensus holds that if, at the outset of the HIV/AIDS epidemic, injection drug users (IDUs) had had better access to sterile syringes, much of the epidemic among IDUs in the U.S. could have been prevented. In the context of preventing infectious diseases, 100% syringe coverage—that is, one sterile syringe per injector for each injection—is a public health goal. Notably, we know little about variations in syringe coverage within the U.S. and elsewhere, or about the social and political factors that might determine this coverage. Methods Using data from Holmberg (AJPH, 1996), the 1990 United States Census, the 2000 Beth Israel National Syringe Exchange Survey (n=72), and estimates of IDUs in metropolitan areas (MSAs); (Friedman et al., 2004), we explore the impact of (1) political factors (ACT UP, outreach, early syringe exchange programme (SEP) presence, men who have sex with men (MSM) per capita, drug arrests, and police per capita); (2) local resources for SEPs; and (3) indicators of socioeconomic inequality on SEP coverage. We define “syringe coverage” as the ratio of syringes distributed at SEPs to the number of syringes heroin injectors need in a year. We calculated the number of syringes heroin injectors need in a year by multiplying an estimate of the number of IDUs in each MSA by an estimate of the average number of times heroin injectors inject heroin per year (2.8 times per day times 365 days). In this analysis, the sample was limited to 35 MSAs in which the primary drug of choice among injectors was heroin. Results SEP coverage varies greatly across MSAs, with an average of 3 syringes distributed per 100 injection events (std dev = 0.045; range: 2 syringes per 10 injection events, to 3 syringes per 10,000 injection events). In bivariate regression analyses, a 1 unit difference in the proportion of the population that was MSM per 1,000 was associated with a difference of 0.002 in SEP coverage (p=0.052); early SEP presence was

  2. Reducing HIV-related risk behaviors among injection drug users in residential detoxification.

    PubMed

    Booth, Robert E; Campbell, Barbara K; Mikulich-Gilbertson, Susan K; Tillotson, Carrie J; Choi, Dongseok; Robinson, James; Calsyn, Donald A; Mandler, Raul N; Jenkins, Lindsay M; Thompson, Laetitia L; Dempsey, Catherine L; Liepman, Michael R; McCarty, Dennis

    2011-01-01

    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. PMID:20652630

  3. Reducing HIV-Related Risk Behaviors Among Injection Drug Users in Residential Detoxification

    PubMed Central

    Booth, Robert E.; Campbell, Barbara K.; Mikulich-Gilbertson, Susan K.; Tillotson, Carrie J.; Choi, Dongseok; Robinson, James; Calsyn, Donald A.; Mandler, Raul N.; Jenkins, Lindsay M.; Thompson, Laetitia L.; Dempsey, Catherine L.; Liepman, Michael R.; McCarty, Dennis

    2010-01-01

    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. PMID:20652630

  4. Explaining the Geographical Variation of HIV Among Injection Drug Users in the United States

    PubMed Central

    Ciccarone, D.; Bourgois, P.

    2005-01-01

    Distinct physical and chemical types of street heroin exist worldwide, but their impact on behavior and disease acquisition is not well understood or documented. This article presents a hypothesis to explain the unequal diffusion of HIV among injection drug users in the United States by examining the distribution and use of one type of heroin—“Mexican black tar.” Drawing on ethnographic, clinical, epidemiological, and laboratory data, we suggest that the chemical properties of black tar heroin promote the following safer injection practices: (1) the rinsing of syringes with water to prevent clogging; (2) the heating of cookers to promote dissolution; and (3) a rapid transition from venous injection to subcutaneous or intramuscular injections. PMID:14677781

  5. Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015.

    PubMed

    Giese, Coralie; Igoe, Derval; Gibbons, Zorina; Hurley, Caroline; Stokes, Siobhan; McNamara, Sinead; Ennis, Orla; O'Donnell, Kate; Keenan, Eamon; De Gascun, Cillian; Lyons, Fiona; Ward, Mary; Danis, Kostas; Glynn, Ronan; Waters, Allison; Fitzgerald, Margaret

    2015-01-01

    In February 2015, an outbreak of recently acquired HIV infections among people who inject drugs (PWID) was identified in Dublin, following similar outbreaks in Greece and Romania in 2011. We compared drug and risk behaviours among 15 HIV cases and 39 controls. Injecting a synthetic cathinone, snow blow, was associated with recent HIV infection (AOR: 49; p=0.003). Prevention and control efforts are underway among PWID in Dublin, but may also be needed elsewhere in Europe. PMID:26537764

  6. HIV Prevention and Rehabilitation Models for Women Who Inject Drugs in Russia and Ukraine

    PubMed Central

    Skipalska, Halyna; Suvorova, Svetlana; Sukovatova, Olga; Zakharov, Konstantin; Hodgdon, Sara

    2012-01-01

    Women who inject drugs require gender-specific approaches to drug rehabilitation, modification of risk behaviors, and psychosocial adaptation. Improved outcomes have been demonstrated when the specific needs of women's subpopulations have been addressed. Special services for women include prenatal care, child care, women-only programs, supplemental workshops on women-focused topics, mental health services, and comprehensive programs that include several of the above components. To address the special needs of women injecting drug user (IDU) subpopulations, such as HIV-positive pregnant women and women with young children, recently released female prisoners, and street-involved girls and young women, HealthRight International and its local partners in Russia and Ukraine have developed innovative service models. This paper presents each of these models and discusses their effectiveness and implementation challenges specific to local contexts in Russia and Ukraine. PMID:23304535

  7. HIV Prevention and Rehabilitation Models for Women Who Inject Drugs in Russia and Ukraine.

    PubMed

    Yorick, Roman; Skipalska, Halyna; Suvorova, Svetlana; Sukovatova, Olga; Zakharov, Konstantin; Hodgdon, Sara

    2012-01-01

    Women who inject drugs require gender-specific approaches to drug rehabilitation, modification of risk behaviors, and psychosocial adaptation. Improved outcomes have been demonstrated when the specific needs of women's subpopulations have been addressed. Special services for women include prenatal care, child care, women-only programs, supplemental workshops on women-focused topics, mental health services, and comprehensive programs that include several of the above components. To address the special needs of women injecting drug user (IDU) subpopulations, such as HIV-positive pregnant women and women with young children, recently released female prisoners, and street-involved girls and young women, HealthRight International and its local partners in Russia and Ukraine have developed innovative service models. This paper presents each of these models and discusses their effectiveness and implementation challenges specific to local contexts in Russia and Ukraine. PMID:23304535

  8. Syringe access for the prevention of blood borne infections among injection drug users

    PubMed Central

    Stancliff, Sharon; Agins, Bruce; Rich, Josiah D; Burris, Scott

    2003-01-01

    Background Approximately one-third of acquired immunodeficiency syndrome cases in the United States are associated with the practice of sharing of injection equipment and are preventable through the once-only use of syringes, needles and other injection equipment. Discussion Sterile syringes may be obtained legally by 4 methods depending on the state. They may be purchased over the counter, prescribed, obtained at syringe exchange programs or furnished by authorized agencies. Each of these avenues has advantages and disadvantages; therefore, legal access through all means is the most likely way to promote the use of sterile syringes. Summary By assisting illicit drug injectors to obtain sterile syringes the primary care provider is able to reduce the incidence of blood borne infections, and educate patients about safe syringe disposal. The provider is also able to initiate discussion about drug use in a nonjudgmental manner and to offer care to patients who are not yet ready to consider drug treatment. PMID:14633286

  9. Photoacoustic imaging to detect rat brain activation after cocaine hydrochloride injection

    NASA Astrophysics Data System (ADS)

    Jo, Janggun; Yang, Xinmai

    2011-03-01

    Photoacoustic imaging (PAI) was employed to detect small animal brain activation after the administration of cocaine hydrochloride. Sprague Dawley rats were injected with different concentrations (2.5, 3.0, and 5.0 mg per kg body) of cocaine hydrochloride in saline solution through tail veins. The brain functional response to the injection was monitored by photoacoustic tomography (PAT) system with horizontal scanning of cerebral cortex of rat brain. Photoacoustic microscopy (PAM) was also used for coronal view images. The modified PAT system used multiple ultrasonic detectors to reduce the scanning time and maintain a good signal-to-noise ratio (SNR). The measured photoacoustic signal changes confirmed that cocaine hydrochloride injection excited high blood volume in brain. This result shows PAI can be used to monitor drug abuse-induced brain activation.

  10. Social Support and HIV-Related Injection Risk among Puerto Rican Migrant and Nonmigrant Injection Drug Users Recruited in New York City

    ERIC Educational Resources Information Center

    Mino, Milton; Deren, Sherry; Yeon-Kang, Sung

    2006-01-01

    This study compared the associations between social support and HIV injection risk among Puerto Rican migrant (n = 221) and nonmigrant (n = 340) injection drug users in New York City. Practical and emotional support scales were developed from 8 items and examined by migrant status as predictors of risk. Bivariate and regression analysis were…

  11. Injection drug users' perspectives on placing HIV prevention and other clinical services in pharmacy settings.

    PubMed

    Lutnick, Alexandra; Case, Patricia; Kral, Alex H

    2012-04-01

    In their role as a source of sterile syringes, pharmacies are ideally situated to provide additional services to injection drug users (IDUs). Expanding pharmacy services to IDUs may address the low utilization rates of healthcare services among this population. This qualitative study of active IDUs in San Francisco explored perspectives on proposed health services and interventions offered in pharmacy settings, as well as facilitators and barriers to service delivery. Eleven active IDUs participated in one-on-one semistructured interviews at a community field site and at a local syringe exchange site between February and May 2010. Results revealed that most had reservations about expanding services to pharmacy settings, with reasons ranging from concerns about anonymity to feeling that San Francisco already offers the proposed services in other venues. Of the proposed health services, this group of IDUs prioritized syringe access and disposal, clinical testing and vaccinations, and provision of methadone. Pharmacists' and pharmacy staff's attitudes were identified as a major barrier to IDUs' comfort with accessing services. The findings suggest that although IDUs would like to see some additional services offered within pharmacy settings, this is contingent upon pharmacists and their staff receiving professional development trainings that cultivate sensitivity towards the needs and experiences of IDUs. PMID:22231488

  12. Circumstances, Pedagogy and Rationales for Injection Initiation Among New Drug Injectors

    PubMed Central

    Harocopos, Alex; Kobrak, Paul; Jost, John J.; Clatts, Michael C.

    2010-01-01

    Injection drug use is especially risky for new injectors. To understand the social and environmental contexts in which risks occur, we interviewed individuals who had initiated injection within the past 3 years (n = 146, 69.2% male) about the circumstances and rationales for their initial injection events. Respondents typically initiated injection due to tolerance (49.3%) and/or for experimentation (61.1%). Most (86.2%) did not possess the technical skills required to self-inject, and relied on the assistance of someone older (58.5%). While low levels of syringe sharing (5.8%) were reported, a majority of respondents (60.5%) engaged in at least one type of behavioral risk. Female injectors were more likely than male injectors to rely on another individual (95.5 vs. 82.2%), often a sex partner (40.5 vs. 7.2%), for assistance. The diversity seen in early injection practices highlights the need for tailored prevention messages to reach this population prior to the onset of injection risk. PMID:20127155

  13. Correlates of unprotected sexual intercourse among women who inject drugs or who have sexual partners who inject drugs in St Petersburg, Russia

    PubMed Central

    Abdala, Nadia; Hansen, Nathan B; Toussova, Olga V; Krasnoselskikh, Tatiana V; Verevochkin, Sergei; Kozlov, Andrei P; Heimer, Robert

    2014-01-01

    Objectives To assess risk for unintended pregnancy, this study describes the correlates of unprotected sexual intercourse (UPSI) among women who inject illicit drugs or who have sexual partners who inject drugs in St Petersburg, Russia. Methods Data from a cross-sectional survey and biological test results collected between 2005 and 2008 from 202 Russian women (143 drug injectors and 59 non-drug injectors) were analysed. Multivariate regression was used to investigate the correlates of UPSI occurring at the women’s last sexual act. Independent variables included socio-demographics, age at sexual debut, first sexual encounter perceived as involuntary, number of pregnancies and number of children for which the participant is the primary caretaker, heavy sporadic drinking (i.e. consuming more than five drinks in 2 hours at least twice a month), at-risk drinking per the Alcohol Use Disorder Identification Test (AUDIT-C) score, and sexually transmitted infections (HIV-1, syphilis serology, Chlamydia trachomatis and Neisseria gonorrheae). Results Sixty-seven percent of women reported UPSI at last intercourse. UPSI was independently associated with heavy sporadic drinking [odds ratio (OR) 2.8, 95% CI 1.2–6.6] and having been pregnant (OR 2.25, 95% CI 1.1–4.6). Conclusions Despite the high risk for HIV acquisition or transmission and unintended pregnancy, condom use among the study population is low. Programmes to investigate and improve contraceptive use, including condom use, among this vulnerable group of women are needed. Such programmes may require identifying and targeting female reproductive health concerns and problem drinking, particularly heavy sporadic drinking, rather than conventional measures of alcohol misuse. PMID:23377534

  14. Intracerebroventricular injection of adiponectin regulates locomotor activity in rats.

    PubMed

    Miyatake, Yumiko; Shiuchi, Tetsuya; Ueta, Tomoyo; Taniguchi, Yasuko; Futami, Akari; Sato, Fukiko; Kitamura, Tadahiro; Tsutsumi, Rie; Harada, Nagakatsu; Nakaya, Yutaka; Sakaue, Hiroshi

    2015-01-01

    Enhancing exercise motivation is the best way to prevent obesity and diabetes. In this study, we examined whether adiponectin affects locomotion activity in Wister and Spontaneously-Running Tokushima-Shikoku (SPORTS) rats using two types of behavioral assays: home cage and wheel running activity. SPORTS rats were established from an original line from Wister strain that had shown high level of wheel running activity in our laboratory. Injection of adiponectin into the lateral ventricle of Wister rats and SPORTS rats decreased home cage activity, but no change was observed in the food intake and oxygen consumption. This result indicates the possibility that adiponectin can reduce non-exercise activity thermogenesis (NEAT) and physical activity via the central nervous system. In contrast, injection of adiponectin did not change wheel running activity in SPORTS rats. We produced hypothalamus-destructed model rat using monosodium glutamate (MSG) to elucidate the regulation site of adiponectin. Injection of adiponectin into MSG-treated SPORTS rats did not change amount of home cage activity and food intake, suggesting that adiponectin action on home cage activity was in the hypothalamic area. These results suggest that adiponectin regulates locomotion activity through mediobasal hypothalamus. PMID:26399348

  15. Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research.

    PubMed

    Friedman, Samuel R; Tempalski, Barbara; Brady, Joanne E; West, Brooke S; Pouget, Enrique R; Williams, Leslie D; Des Jarlais, Don C; Cooper, Hannah L F

    2016-06-01

    This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action. PMID:27198555

  16. Promethazine Misuse among Methadone Maintenance Patients and Community-Based Injection Drug Users

    PubMed Central

    Shapiro, Brad J.; Lynch, Kara L.; Toochinda, Tab; Lutnick, Alexandra; Cheng, Helen Y.; Kral, Alex H.

    2013-01-01

    Objective Promethazine has been reported to be misused in conjunction with opioids in several settings. Promethazine misuse by itself or in conjunction with opioids may have serious adverse health effects. To date, no prevalence data for the nonmedical use of promethazine has been reported. This study examines the prevalence and correlates of promethazine use in two different populations in San Francisco, California, USA: methadone maintenance clinic patients and community-based injection drug users (IDUs). Methods We analyzed urine samples for the presence of promethazine and reviewed the clinical records for 334 methadone maintenance patients at the county methadone clinic. Separately, we used targeted sampling methods to recruit and survey 139 community-based opioid IDUs about their use of promethazine. We assessed prevalence and factors associated with promethazine use with bivariate and multivariate statistics. Results The prevalence of promethazine positive urine samples among the methadone maintenance patients was 26 percent. Only 15 percent of promethazine positive patients had an active prescription for promethazine. Among IDUs reporting injection of opiates in the community-based survey, 17 percent reported having used promethazine in the past month; 24 percent of the IDUs who reported being enrolled in methadone treatment reported using promethazine in the past month. Conclusions The finding that one quarter of methadone maintenance patients in a clinic or recruited in community settings have recently used promethazine provides compelling evidence of significant nonmedical use of promethazine in this patient population. Further research is needed to establish the extent and nature of nonmedical use of promethazine. PMID:23385449

  17. Harmful microinjecting practices among a cohort of injection drug users in Vancouver Canada

    PubMed Central

    Rachlis, Beth; Lloyd-Smith, Elisa; Small, Will; Tobin, Diane; Stone, Dave; Li, Kathy; Wood, Evan; Kerr, Thomas

    2013-01-01

    Objectives We sought to identify factors associated with harmful microinjecting practices in a longitudinal cohort of IDU. Methods Using data from the Vancouver Injection Drug Users Study (VIDUS) between January 2004 and December 2005, generalized estimating equations (GEE) logistic regression was performed to examine sociodemographic and behavioral factors associated with four harmful microinjecting practices (frequent rushed injecting, frequent syringe borrowing, frequently injecting with a used water capsule, frequently injecting alone). Results In total, 620 participants were included in the present analysis. Our study included 251 (40.5%) women and 203 (32.7%) self-identified Aboriginal participants. The median age was 31.9 (interquartile range: 23.4–39.3). GEE analyses found that each harmful microinjecting practice was associated with a unique profile of sociodemographic and behavioral factors. Discussion We observed high rates of harmful microinjecting practices among IDU. The present study describes the epidemiology of harmful microinjecting practices and points to the need for strategies that target higher risk individuals including the use of peer-driven programs and drug-specific approaches in an effort to promote safer injecting practices. PMID:20509739

  18. Injection drug users trained by overdose prevention programs: Responses to witnessed overdoses

    PubMed Central

    Lankenau, Stephen E.; Wagner, Karla D.; Silva, Karol; Kecojevic, Aleksander; Iverson, Ellen; McNeely, Miles; Kral, Alex H.

    2012-01-01

    In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPP), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when responding to a drug overdose. IDUs (n=30) trained by two OPPs in Los Angeles were interviewed in 2010–11 about responses to their most recently witnessed drug overdose using an instrument containing both open and closed-ended questions. Among the 30 witnessed overdose events, the victim recovered in 29 cases while the outcome was unknown in one case. Participants responded to overdoses using a variety of techniques taught by OPP. Injecting the victim with naloxone was the most common recommended response while other recommended responses included stimulating the victim with knuckles, calling 911, and giving rescue breathing. Barriers preventing participants from employing recommended response techniques in certain circumstances included prior successes using folk remedies to revive a victim, concerns over attracting police to the scene, and issues surrounding access to or use of naloxone. Practical solutions, such as developing booster sessions to augment OPP, are encouraged to increase the likelihood that trained participants respond to a drug overdose with the full range of recommended techniques. PMID:22847602

  19. Narrating the social relations of initiating injecting drug use: transitions in self and society.

    PubMed

    Rhodes, Tim; Bivol, Stela; Scutelniciuc, Otilia; Hunt, Neil; Bernays, Sarah; Busza, Joanna

    2011-11-01

    Few studies have explored drug injectors' accounts of their initiation of others into injecting. There also lacks research on the social relations of initiating injecting drug use in transitional society. We draw upon analyses of 42 audio-recorded semi-structured interviews with current and recent injecting drug users, conducted in 2009 in the Republic of Moldova, a transitional society of south-eastern Europe. A thematic analysis informed by narrative theory was undertaken, focusing on accounts of self-initiation and the initiation of others. We also reflect upon the potential of peer efforts to dissuade would-be injectors from initiating. Findings emphasise initiation into injecting as a symbolic identity transition, enabled through everyday social relations. In turn, our analysis locates the drug transitions of the self inside an account of societal transition. We find that personal narratives of self transition are made sense of, and presented, in relation to broader narratives of social transition and change. Furthermore, we explore how narratives of self-initiation, and especially the initiation of others, serve to negotiate initiation as a moral boundary crossing. Self-initiation is located inside an account of transitioning social values. In looking back, initiation is depicted as a feature of a historically situated aberration in normative values experienced by the 'transition generation'. Accounts of the initiation of others (which a third of our sample describe) seek to qualify the act as acceptable given the circumstances. These accounts also connect the contingency of agency with broader narratives of social condition. Lastly, the power of peers to dissuade others from initiating injection was doubted, in part because most self-initiations were accomplished as a product of agency enabled by environment as well as in the face of peer attempts to dissuade. PMID:21903372

  20. Electron beam injection during active experiments. I - Electromagnetic wave emissions

    NASA Technical Reports Server (NTRS)

    Winglee, R. M.; Kellogg, P. J.

    1990-01-01

    The wave emissions produced in Echo 7 experiment by active injections of electron beams were investigated to determine the properties of the electromagnetic and electrostatic fields for both the field-aligned and cross-field injection in such experiments and to evaluate the sources of free energy and relative efficiencies for the generation of the VLF and HF emissions. It is shown that, for typical beam energies in active experiments, electromagnetic effects do not substantially change the bulk properties of the beam, spacecraft charging, and plasma particle acceleration. Through simulations, beam-generated whistlers; fundamental z-mode and harmonic x-mode radiation; and electrostatic electron-cyclotron, upper-hybrid, Langmuir, and lower-hybrid waves were identified. The characteristics of the observed wave spectra were found to be sensitive to both the ratio of the electron plasma frequency to the cyclotron frequency and the angle of injection relative to the magnetic field.

  1. Drug-Related Arrest Rates and Spatial Access to Syringe Exchange Programs in New York City Health Districts: Combined Effects on the Risk of Injection-Related Infections among Injectors

    PubMed Central

    Jarlais, Don C Des; Tempalski, Barbara; Bossak, Brian H; Ross, Zev; Friedman, Samuel R

    2011-01-01

    Drug-related law enforcement activities may undermine the protective effects of syringe exchange programs (SEPs) on local injectors’ risk of injection-related infections. We explored the spatial overlap of drug-related arrest rates and access to SEPs over time (1995-2006) in New York City health districts, and used multilevel models to investigate the relationship of these two district-level exposures to the odds of injecting with an unsterile syringe. Districts with better SEP access had higher arrest rates, and arrest rates undermined SEPs’ protective relationship with unsterile injecting. Drug-related enforcement strategies targeting drug users should be de-emphasized in areas surrounding SEPs. PMID:22047790

  2. At-risk drinking and injection and sexual risk behaviors of HIV-positive injection drug users entering drug treatment in New York City.

    PubMed

    Arasteh, Kamyar; Des Jarlais, Don C

    2009-08-01

    We analyzed data from 1253 HIV-positive injection drug users (IDUs) entering detoxification or methadone maintenance treatment in New York City between 1990 and 2004 to assess HIV risk behaviors and their association with at-risk drinking (defined as more than 14 drinks per week for males or 7 drinks per week for females) and intoxication. Most (81%) of the participants were male, 50% were Hispanic, and 36% African American. The average age of respondents was 40 years. Injection risk behaviors that were examined were distributive sharing of needles/syringes and distributive sharing of needles/syringes with multiple IDUs. Sexual risk behaviors included multiple sex partners, engaging in unprotected sex, and among women, engaging in trade sex. After adjusting for the effects of other variables, at-risk drinking among cocaine injectors was associated with distributive sharing of needles/syringes. At-risk drinkers were also more likely to engage in unprotected sex with a casual partner. Finally, among cocaine injectors alcohol intoxication during the most recent sex episode was associated with unprotected sex with a casual partner. These observations indicate that among HIV-positive IDUs at-risk drinking is associated with higher rates of injection and sexual risk behaviors and that alcohol intoxication is related to unprotected sex. PMID:19591610

  3. The role of social networks and geography on risky injection behaviors of young persons who inject drugs

    PubMed Central

    Boodram, Basmattee; Mackesy-Amiti, Mary-Ellen; Latkin, Carl

    2016-01-01

    Background Little is known about young persons who inject drugs (PWID), who are increasingly from suburban communities and predominantly non-Hispanic white. Methods We conducted a cross-sectional personal network (egocentric) and geographic study of young PWID and their drug-using, sexual, and support network members in 2012-13 in metropolitan Chicago, Illinois, U.S. Results We enrolled 164 young (median age=26), mostly male (65%), non-Hispanic white PWID (71%), with a self-reported HCV prevalence of 13%. Many (59%) reported multiple residences (i.e., were transient) in the past year, 45% of whom reported living in both urban and suburban places (i.e., were cross-over transients). In multivariable analyses that adjusted for participant and network member characteristics, (1) large injection networks were more common among homeless participants; and (2) syringe sharing was (a) highest among cross-over transients compared to suburban (OR = 4.19 95% CI 1.69 – 10.35) and urban only residents (OR = 2.91 95% CI 1.06 – 8.03), (b) higher among HCV-unknown compared HCV-negative participants (OR = 4.62 95% CI 1.69-10.35), (c) more likely with network members who were cross-over transients compared to urban (OR = 4.94, 95% CI 2.17 – 11.23) and (d) less likely with network members with HCV-unknown compared to HCV-negative status (OR = 0.4 95% CI 0.19 – 0.84). Conclusions We identified homelessness as a significant risk factor for large networks and cross-over transience as a significant risk factor for syringe sharing. Further research is needed to understand the role of geographic factors promoting higher risk among these crossover transient PWID. PMID:26169447

  4. The role of harm reduction in controlling HIV among injecting drug users

    PubMed Central

    Wodak, Alex; McLeod, Leah

    2012-01-01

    Injecting drug users (IDU) now account for one in 10 new HIV infections world wide. Yet it has been known since the early 1990s that HIV among IDU can be effectively, safely and cost-effectively controlled by the early and vigorous implementation of a comprehensive package of strategies known as ’harm reduction’. This concept means that decreasing drug-related harms is accorded an even higher priority than reduction of drug consumption. Strategies required involve: explicit and peer-based education about the risk of HIV from sharing injecting equipment; needle syringe programmes; drug treatment (including especially opiate substitution treatment) and community development. Many countries experiencing or threatened by an HIV epidemic among IDU have now adopted harm reduction but often implementation has been too little and too late. Although coverage is slowly improving in many countries, HIV is still spreading faster among IDU than harm reduction programmes while coverage in correctional centres lags far behind community settings. The scientific debate about harm reduction is now over. National and international support for harm reduction is growing while almost all the major UN organizations responsible for drug policy now support harm reduction. Only a small number of countries, led by the USA, are still vehemently opposed to harm reduction. Excessive reliance on drug law enforcement remains the major barrier to increased adoption of harm reduction. Sometimes zealous drug law enforcement undermines harm reduction. A more balanced approach to drug law enforcement is required with illicit drug use recognized primarily as a health and social problem. PMID:18641473

  5. Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugs

    PubMed Central

    Jozaghi, Ehsan; Jackson, Asheka

    2015-01-01

    Background: Research predicting the public health and fiscal impact of Supervised Injection Facilities (SIFs), across different cities in Canada, has reported positive results on the reduction of HIV cases among People Who Inject Drugs (PWID). Most of the existing studies have focused on the outcomes of Insite, located in the Vancouver Downtown Eastside (DTES). Previous attention has not been afforded to other affected areas of Canada. The current study seeks to address this deficiency by assessing the cost-effectiveness of opening a SIF in Saskatoon, Saskatchewan. Methods: We used two different mathematical models commonly used in the literature, including sensitivity analyses, to estimate the number of HIV infections averted due to the establishment of a SIF in the city of Saskatoon, Saskatchewan. Results: Based on cumulative cost-effectiveness results, SIF establishment is cost-effective. The benefit to cost ratio was conservatively estimated to be 1.35 for the first two potential facilities. The study relied on 34% and 14% needle sharing rates for sensitivity analyses. The result for both sensitivity analyses and the base line estimates indicated positive prospects for the establishment of a SIF in Saskatoon. Conclusion: The opening of a SIF in Saskatoon, Saskatchewan is financially prudent in the reduction of tax payers’ expenses and averting HIV infection rates among PWID PMID:26029896

  6. Epidemiology of hepatitis C virus infection among injecting drug users in Australia.

    PubMed Central

    Crofts, N; Jolley, D; Kaldor, J; van Beek, I; Wodak, A

    1997-01-01

    STUDY OBJECTIVE: To review the epidemiology of hepatitis C virus (HCV) infection among injecting drug users (IDUs) in Australia, and consider needs for further research and prevention policies and programmes. DESIGN: (1) Review of the results of surveillance for HCV; (2) review of published literature on prevalence, incidence, and risk factors for HCV among IDUs; and (3) reconstruction of incidence rates from prevalence studies of HCV in IDUs. SETTING AND PARTICIPANTS: Field and clinic based studies of IDUs in Australia. MAIN RESULTS: HCV has been present at high prevalences (of the order of 60-70%) in populations of Australian IDUs since at least 1971. Duration of injecting and main drug injected were the main predictors of seropositivity, the latter possibly a surrogate for frequency of injecting and both together as surrogate for cumulative numbers of times injected. Risk of infection begins with first injection and continues as long as injecting does. Current incidence is approximately 15 per 100 person years, and up to 40 per 100 person years in some subpopulations. Incidence may have decreased through the 1980s as a result of behaviour change in relation to HIV, as it has for hepatitis B, but not significantly so. CONCLUSIONS: Control of HCV infection in Australia will depend on effectiveness of measures to control HCV spread among IDUs. This will be a greater challenge than the control of HIV in this population has been. Needs identified include improved surveillance, especially for recently acquired infection, better understanding of exact transmission modes, and urgent improvement in prevention strategies. PMID:9519134

  7. Hepatitis C Avoidance in Injection Drug Users: A Typology of Possible Protective Practices

    PubMed Central

    McGowan, Catherine; Harris, Magdalena; Rhodes, Tim

    2013-01-01

    Introduction Hepatitis C virus (HCV) represents a serious public health concern. People who inject drugs (PWID) are at particular risk and nearly half (45%) of PWID in England may be infected. HCV prevention interventions have only had moderate impact on the prevalence of HCV in this population. Using qualitative methods, we sought to detail the protective practices potentially linked to HCV avoidance among PWID, and explore the motivations for these. Methods The study used a life history approach allowing participants to detail their lived experience both before and during the course of their injecting careers. Thirty-seven participants were recruited from drug services in London, and from referrals within local injecting networks. A baseline and follow-up in-depth qualitative interview was carried out with each participant, and for half, a third interview was also undertaken. All underwent testing for HCV antibody. Analyses focused on developing a descriptive typology of protective practices potentially linked to HCV avoidance. Results Practices were deemed to be protective against HCV if they could be expected a priori to reduce the number of overall injections and/or the number of injections using shared injecting equipment. Participants reported engaging in various protective practices which fell into three categories identified through thematic analysis: principles about injecting, preparedness, and flexibility. Conclusions All participants engaged in protective practices irrespective of serostatus. It is important to consider the relative importance of different motivations framing protective practices in order to formulate harm reduction interventions which appeal to the situated concerns of PWID, especially given that these protective practices may also help protect against HIV and other blood borne infections. PMID:24194855

  8. HIV prevention among injecting drug users: responses in developing and transitional countries.

    PubMed Central

    Ball, A L; Rana, S; Dehne, K L

    1998-01-01

    OBJECTIVE: Human immunodeficiency virus (HIV) infection associated with injecting drug use has been reported in at least 98 countries and territories worldwide. There is evidence that new epidemics are emerging in different regions, including Eastern Europe, Latin American, and the eastern Mediterranean. The authors provide a global overview of the situation of HIV infection associated with injecting drug use and responses that have been implemented in various developing and transitional countries. METHODS: Although there has been extensive documentation of the extent and nature of of HIV infection associated with injecting drug use in many developed countries and the various interventions implemented in those countries, there is very limited information on the situation in developing and transitional countries. This chapter brings together information from a broad range of sources, including published literature; "gray" or "fugitive" literature; data collected by the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations International Drug Control Programme (UNDCP); personal communications; and direct observation by the authors. The authors have traveled extensively to a wide range of developing and transitional countries and have accessed information not readily available to the international research community. RESULTS: A wide range of HIV prevention strategies targeting injecting drug users (IDUs) has been implemented in developing countries and countries in transition. Interventions include opioid substitution pharmacotherapy, needle syringe exchange and distribution, condom and bleach distribution, outreach to IDUs, peer education programs, and social network interventions. In some communities, completely new models of intervention and service delivery have developed in response to specific local needs and limitations. CONCLUSIONS: Although empirical data may currently be lacking to demonstrate the

  9. Social Network-Related Risk Factors for Bloodborne Virus Infections Among Injection Drug Users Receiving Syringes through Secondary Exchange

    PubMed Central

    Cox, Joseph; Boivin, Jean-François; Platt, Robert W.; Jolly, Ann M.

    2007-01-01

    Secondary syringe exchange (SSE) refers to the exchange of sterile syringes between injection drug users (IDUs). To date there has been limited examination of SSE in relation to the social networks of IDUs. This study aimed to identify characteristics of drug injecting networks associated with the receipt of syringes through SSE. Active IDUs were recruited from syringe exchange and methadone treatment programs in Montreal, Canada, between April 2004 and January 2005. Information on each participant and on their drug-injecting networks was elicited using a structured, interviewer-administered questionnaire. Subjects’ network characteristics were examined in relation to SSE using regression models with generalized estimating equations. Of 218 participants, 126 were SSE recipients with 186 IDUs in their injecting networks. The 92 non-recipients reported 188 network IDUs. Networks of SSE recipients and non-recipients were similar with regard to network size and demographics of network members. In multivariate analyses adjusted for age and gender, SSE recipients were more likely than non-recipients to self-report being HIV-positive (OR = 3.56 [1.54–8.23]); require or provide help with injecting (OR = 3.74 [2.01–6.95]); have a social network member who is a sexual partner (OR = 1.90 [1.11–3.24]), who currently attends a syringe exchange or methadone program (OR = 2.33 [1.16–4.70]), injects daily (OR = 1.77 [1.11–2.84]), and shares syringes with the subject (OR = 2.24 [1.13–4.46]). SSE is associated with several injection-related risk factors that could be used to help focus public health interventions for risk reduction. Since SSE offers an opportunity for the dissemination of important prevention messages, SSE-based networks should be used to improve public health interventions. This approach can optimize the benefits of SSE while minimizing the potential risks associated with the practice of secondary exchange. PMID:18038211

  10. Unexpectedly high injection drug use, HIV and hepatitis C prevalence among female sex workers in the Republic of Mauritius.

    PubMed

    Johnston, Lisa Grazina; Corceal, Sewraz

    2013-02-01

    Female sex workers (FSW) often have a disproportionately high prevalence of HIV infection and they, along with their clients, are considered a core group contributing to the transmission of HIV in many countries. In 2010, females who reported having vaginal/anal/oral sex in the last 6 months with a male in exchange for money or gifts, aged ≥15 years, and living in Mauritius were recruited into a survey using respondent driven sampling. Consenting females (n = 299) completed a behavioral questionnaire and provided venous blood for HIV, HCV and HBV testing. HIV seroprevalence among FSW was 28.9 % and 43.8 % were infected with HCV; among HIV seropositive FSW, 88.2 % were also infected with HCV. Almost 40 % of FSW reported injecting drugs sometime in their lives and 30.5 % of all FSW reported doing so in the previous 3 months. Among those who ever injected drugs, 82.5 % did so in the past 3 months and among those 60 % reported injecting drugs at least once a day. Among FSW who ever injected drugs, 17.5 % reported sharing a needle at last injection. Regression analyses found injection drug use behaviors to be positively associated with HIV seroprevalence. These findings indicate that FSW, especially those who inject drugs, are at high risk for HIV and HCV infection and transmission and illustrates the need for gender responsive HIV and injection drug use prevention and treatment models that respond to the unique situations that affect this population. PMID:22851154

  11. Activated carbon injection - a mercury control success story

    SciTech Connect

    2008-07-01

    Almost 100 full-scale activated carbon injection (ACI) systems have been ordered by US electric utilities. These systems have the potential to remove over 90% of the mercury in flue, at a cost below $10,000 per pound of mercury removal. Field trials of ACI systems arm outlined. 1 fig.

  12. Understanding the association between injecting and sexual risk behaviors of injecting drug users in Manipur and Nagaland, India

    PubMed Central

    2012-01-01

    Background In India, as in rest of the world, HIV prevention programs have focused on HIV transmission through unsafe injecting practices with less attention on sexual risk behaviors among injecting drug users (IDUs). This study examines the sexual risk taking behaviors of IDUs associated with their pattern of drug use in India. Methods Data were obtained from the behavioral tracking survey conducted in 2009 among 1712 IDUs in two districts each of Manipur and Nagaland states in Northeastern part of India. Sexual risk behaviors among IDUs were assessed in terms of multiple sex partners, sex with a paid female partner in the last 12 months and inconsistent condom use with any female partner. Results More than one-fourth (27%) in Manipur and almost one in two (47%) IDUs reported having had sex with two or more female partners in the past 12 months. In Manipur where heroin is commonly used, the odds of having multiple sex partners were higher among non-heroin users than heroin users (42% vs. 23%, Adjusted Odds Ratio (AOR): 1.7, 95% Confidence Interval (CI): 1.1-2.6) and who shared needles/syringes in the last one month than who did not share (46% vs. 26%, AOR: 2.2, CI: 1.2-4.0). In Nagaland, where Spasmoproxyvon (SP, a synthetic opioid analgesic that contains dextropropoxyphene, dicyclomine hydrochloride and paracetamol) is most common, regular injectors as compared to occasional injectors were more likely to report multiple sex partners (67% vs. 42%, AOR: 2.7, CI: 1.8-4.1) and sex with paid partners (13% vs. 3%, AOR: 6.0, CI: 3.0-12.1). Sharing of needles/syringes was positively associated with multiple sex partners (51% vs. 44%, AOR: 1.6, CI: 1.2-2.2), and inconsistent condom use (93% vs. 80%, AOR: 3.0, CI: 1.8-5.1). Conclusions IDUs with unsafe injecting practices also engage in risky sexual practices magnifying the risk of HIV infection. There is a need to focus on prevention of sexual transmission among high-risk IDUs, particularly in areas where

  13. The Impact of Legalizing Syringe Exchange Programs on Arrests Among Injection Drug Users in California

    PubMed Central

    Bluthenthal, Ricky N.; Lorvick, Jennifer; Anderson, Rachel; Flynn, Neil; Kral, Alex H.

    2007-01-01

    Legislation passed in 2000 allowed syringe exchange programs (SEPs) in California to operate legally if local jurisdictions declare a local HIV public health emergency. Nonetheless, even in locales where SEPs are legal, the possession of drug paraphernalia, including syringes, remained illegal. The objective of this paper is to examine the association between the legal status of SEPs and individual arrest or citation for drug paraphernalia among injection drug users (IDUs) in California from 2001 to 2003. Using data from three annual cross-sections (2001-03) of IDUs attending 24 SEPs in 16 California counties (N = 1,578), we found that overall, 14% of IDUs in our sample reported arrest or citation for paraphernalia in the 6 months before the interview. Further analysis found that 17% of IDUs attending a legal SEP (defined at the county level) reported arrest or citation for drug paraphernalia compared to 10% of IDUs attending an illegal SEP (p = 0.001). In multivariate analysis, the adjusted odds ratio of arrest or citation for drug paraphernalia was 1.6 [95% confidence interval (CI) = 1.2, 2.3] for IDUs attending legal SEPs compared to IDUs attending illegal SEPs, after controlling for race/ethnicity, age, homelessness, illegal income, injection of amphetamines, years of injection drug use, frequency of SEP use, and number of needles received at last visit. IDUs attending SEPs with legal status may be more visible to police, and hence, more subject to arrest or citation for paraphernalia. These findings suggest that legislative efforts to decriminalize the operation of SEPs without concurrent decriminalization of syringe possession may result in higher odds of arrest among SEP clients, with potentially deleterious implications for the health and well-being of IDUs. More comprehensive approaches to removing barriers to accessing sterile syringes are needed if our public health goals for reducing new HIV/HCV infections are to be obtained. PMID:17265133

  14. Systemic barriers accessing HIV treatment among people who inject drugs in Russia: a qualitative study

    PubMed Central

    Sarang, Anya; Rhodes, Tim; Sheon, Nicolas

    2013-01-01

    Achieving ‘universal access’ to antiretroviral HIV treatment (ART) in lower income and transitional settings is a global target. Yet, access to ART is shaped by local social condition and is by no means universal. Qualitative studies are ideally suited to describing how access to ART is socially situated. We explored systemic barriers to accessing ART among people who inject drugs (PWID) in a Russian city (Ekaterinburg) with a large burden of HIV treatment demand. We undertook 42 in-depth qualitative interviews with people living with HIV with current or recent experience of injecting drug use. Accounts were analysed thematically, and supplemented here with an illustrative case study. Three core themes were identified: ‘labyrinthine bureaucracy’ governing access to ART; a ‘system Catch 22’ created by an expectation that access to ART was conditional upon treated drug use in a setting of limited drug treatment opportunity; and ‘system verticalization’, where a lack of integration across HIV, tuberculosis (TB) and drug treatment compromised access to ART. Taken together, we find that systemic factors play a key role in shaping access to ART with the potential adverse effects of reproducing treatment initiation delay and disengagement from treatment. We argue that meso-level systemic factors affecting access to ART for PWID interact with wider macro-level structural forces, including those related to drug treatment policy and the social marginalization of PWID. We note the urgent need for systemic and structural changes to improve access to ART for PWID in this setting, including to simplify bureaucratic procedures, foster integrated HIV, TB and drug treatment services, and advocate for drug treatment policy reform. PMID:23197431

  15. Continuing HIV Risk in New York City Injection Drug Users: The Association of Syringe Source and Syringe Sharing

    PubMed Central

    Jenness, Samuel M.; Hagan, Holly; Liu, Kai-Lih; Wendel, Travis; Murrill, Christopher S.

    2016-01-01

    Sterile syringe access is an important means to reduce HIV risk, but many injection drug users (IDU) who obtain syringes from sterile sources continue to share syringes. We examined the factors associated with continuing syringe sharing in New York City. We recruited 500 active IDU in 2005 through respondent-driven sampling. In multiple logistic regression, not obtaining all syringes in the past year exclusively from sterile sources was associated with increased syringe sharing. Ensuring adequate syringe availability as well as engaging and retaining nonusers and inconsistent users in sterile syringe services may increase sterile syringe access and decrease syringe sharing. PMID:21303239

  16. Factors that help injecting drug users to access and benefit from services: A qualitative study

    PubMed Central

    Neale, Joanne; sheard, Laura; Tompkins, Charlotte NE

    2007-01-01

    Background International research shows that injecting drug users (IDUs) can encounter many barriers when they try to access drug treatment and other services. However, the existing literature is mostly quantitative and does not consider the kinds of factors that injectors themselves identify as enabling them to access and benefit from services. Responding to this gap in knowledge, our paper explores IDUs' own suggestions for improving service engagement and their reports of other factors enabling them to seek help. Methods Semi-structured qualitative interviews were conducted with 75 current illicit drug injectors in three geographically diverse areas of West Yorkshire, England. Recruitment was through needle exchange programmes, with additional snowball sampling to ensure inclusivity of gender, ethnicity and primary drug injected. Transcribed data were analysed thematically using Framework. Results Although participants were often satisfied with current access to services, they made three broad suggestions for improving engagement. These were: providing more services (more providers and more forms of support); better operation of existing services (including better communication systems and more flexibility around individual needs); and staffing-related improvements (particularly, less judgemental and more understanding staff attitudes). Other factors identified as important enablers of help seeking were: having supporting relationships (particularly with family members); personal circumstances/life events (especially becoming a parent); and an injector's state of mind (such as feeling motivated and positive). Conclusion A range of practical suggestions for improving IDUs' access to drug treatment and other services are identified. PMID:17971204

  17. Recruiting and Retaining Mobile Young Injection Drug Users in a Longitudinal Study

    PubMed Central

    Lankenau, Stephen E.; Sanders, Bill; Hathazi, Dodi; Jackson Bloom, Jennifer

    2011-01-01

    Longitudinal studies that research homeless persons or transient drug users face particular challenges in retaining subjects. Between 2005 and 2006, 101 mobile young injection drug users were recruited in Los Angeles into a 2-year longitudinal study. Several features of ethnographic methodology, including fieldwork and qualitative interviews, and modifications to the original design, such as toll-free calls routed directly to ethnographer cell phones and wiring incentive payments, resulted in retention of 78% of subjects for the first follow-up interview. Longitudinal studies that are flexible and based upon qualitative methodologies are more likely to retain mobile subjects while also uncovering emergent research findings. PMID:20222779

  18. A stability-indicating HPLC method for medroxyprogesterone acetate in bulk drug and injection formulation.

    PubMed

    Burana-Osot, Jankana; Ungboriboonpisal, Sooksri; Sriphong, Lawan

    2006-03-18

    A stability-indicating HPLC assay method has been developed and validated for medroxyprogesterone acetate (MPA) in bulk drug and injectable suspension. An isocratic RP-HPLC was achieved on a Hichrom C(18) column (150 mm x 4.6mm i.d., 5 microm) utilizing a mobile phase of methanol 0.020 M acetate buffer pH 5 (65:35, v/v) and a photodiode array detector at 245 nm. The stress testing of MPA was carried out under acidic and alkaline hydrolysis, and oxidation conditions. MPA was well resolved from its degradation products, a main related substance (megestrol acetate) and two preservatives (methyl paraben and propyl paraben) with the resolution >or=2. The proposed method was validated for selectivity, linearity, accuracy, precision and solution stability. The method was found to be suitable for the quality control of MPA in bulk drug and injections as well as the stability-indicating studies. PMID:16242876

  19. Social support and recovery among Mexican female sex workers who inject drugs

    PubMed Central

    Hiller, Sarah; Syvertsen, Jennifer; Lozada, Remedios; Ojeda, Victoria D.

    2013-01-01

    This qualitative study describes social support that female sex workers who inject drugs (FSW-IDUs) receive and recovery efforts in the context of relationships with family and intimate partners. We conducted thematic analysis of in-depth interviews with 47 FSW-IDUs enrolled in an intervention study to reduce injection/sexual risk behaviors in Tijuana, Mexico. FSW-IDUs received instrumental and emotional social support, which positively and negatively influenced recovery efforts. Participants reported how some intimate partners provided conflicting positive and negative support during recovery attempts. Problematic support (i.e., well-intended support with unintended consequences) occurred in strained family relationships, limiting the positive effects of support. Mexican drug treatment programs should consider addressing social support in recovery curricula through evidence-based interventions that engage intimate partners, children and family to better reflect socio-cultural and contextual determinants of substance abuse. PMID:23375570

  20. Symbiotic Goals and the Prevention of Blood-Borne Viruses Among Injection Drug Users

    PubMed Central

    Friedman, Samuel R.; Sandoval, Milagros; Mateu-Gelabert, Pedro; Meylakhs, Peter; Des Jarlais, Don C.

    2011-01-01

    A positive-deviance control–case life history study of injection drug users (IDUs) in New York City who had injected drugs for 8–15 years compared 21 IDUs who were antibody negative for both HIV and hepatitis C with 3 infected with both viruses and 11 infected with hepatitis C virus but not HIV. Eligible subjects were referred from other research studies and from community organizations that conduct testing for HIV and hepatitis C virus. Data were collected during 2005–2008 and were analyzed using life history and grounded theory approaches. They support grounded hypotheses that IDUs who are able to attain symbiotic goals like avoiding withdrawal and maintaining social support are assisted thereby in remaining uninfected with HIV or hepatitis C. These hypotheses should be tested using cohort studies and prevention trials to see if helping IDUs attain symbiotic goals reduces infection risk. The study’s limitations are noted. PMID:21303250

  1. Injection of Xenopus eggs before activation, achieved by control of extracellular factors, improves plasmid DNA replication after activation.

    PubMed

    Wangh, L J

    1989-05-01

    Injection of molecular probes into unfertilized Xenopus eggs requires suppression of activation. But the unfertilized egg is poised for activity, and pricking, like sperm penetration, triggers the start of the first cell cycle. Methods of suppressing activation generally rely on introduction of drugs into the cell, but some of these techniques are irreversible. I report here that injection without activation can also be accomplished by simply limiting extracellular free Ca2+ to 1-2 microM. The site of injection heals, but the cortex does not contract. Gentle modification of the vitelline envelope, which causes it to become tougher, improves the rate of healing to about 100%. Healed eggs are stable for hours and can be activated when needed. Injection of a plasmid derived from type 1 bovine papilloma virus revealed that replication occurs only after activation, but preloading the DNA markedly increased the efficiency of first-round replication. DNA interaction with the unactivated egg cytoplasm may therefore be required for efficient replication of exogenous DNA. The new procedures described here are likely to be of general utility. PMID:2559091

  2. Drug Network Characteristics and HIV Risk Among Injection Drug Users in Russia: The roles of Trust, Size, and Stability

    PubMed Central

    Odinokova, Veronika A.; Heimer, Robert; Grau, Lauretta E.; Lyubimova, Alexandra; Safiullina, Liliya; Levina, Olga S.; Niccolai, Linda M.

    2011-01-01

    We investigated the influence of drug network characteristics including trust, size, and stability on HIV risk behaviors and HIV testing among injection drug users (IDUs) in St. Petersburg, Russia. Overall, male and female IDUs who reported having high levels of trust in their drug networks were significantly more likely to share syringes than those with lower levels of trust (OR [95% CI]) 2.87 [1.06, 7.81] and 4.89 [1.05, 21.94], respectively). Male and female IDUs in larger drug networks were more likely to share syringes than those in smaller networks (4.21 [1.54, 11.51] and 4.80 [1.20, 19.94], respectively). Characteristics that were significantly associated with not having been HIV tested included drug network instability among men and larger network size among women. High trust, large size, and instability were positively and significantly associated with syringe sharing and not having been HIV tested. Effectiveness of interventions in Russia to reduce the risk of HIV infection may be enhanced if network characteristics are addressed. PMID:20872063

  3. Police Victimization Among Persons Who Inject Drugs Along the U.S.–Mexico Border

    PubMed Central

    Pinedo, Miguel; Burgos, José Luis; Zúñiga, María Luisa; Perez, Ramona; Macera, Caroline A.; Ojeda, Victoria D.

    2015-01-01

    Objective: Problematic policing practices are an important driver of HIV infection among persons who inject drugs (PWID) in the U.S.–Mexico border region. This study identifies factors associated with recent (i.e., past 6 months) police victimization (e.g., extortion, physical and sexual violence) in the border city of Tijuana, Mexico. Method: From 2011 to 2013, 733 PWID (62% male) were recruited in Tijuana and completed a structured questionnaire. Eligible participants were age 18 years or older, injected illicit drugs within the past month, and spoke Spanish or English. Multivariable logistic regression analyses identified correlates of recent experiences of police victimization (e.g., bribes, unlawful confiscation, physical and sexual violence). Results: Overall, 56% of PWID reported a recent police victimization experience in Tijuana. In multivariable logistic regression analyses, factors independently associated with recent police victimization included recent injection of methamphetamine (adjusted odds ratio [AOR] = 1.62; 95% CI [1.18, 2.21]) and recently received injection assistance by a “hit doctor” (AOR = 1.56; 95% CI [1.03, 2.36]). Increased years lived in Tijuana (AOR = 0.98 per year; 95% CI [0.97, 0.99]) and initiating drug use at a later age (AOR = 0.96 per year; 95% CI [0.92, 0.99]) were inversely associated with recent police victimization. Conclusions: Physical drugusing markers may increase PWID susceptibility to police targeting and contribute to experiences of victimization. Interventions aimed at reducing police victimization events in the U.S.–Mexico border region should consider PWID’s drug-using behaviors. Reducing problematic policing practices may be a crucial public health strategy to reduce HIV risk among PWID in this region. PMID:26402356

  4. Severe Community-Acquired Bloodstream Infection with Acinetobacter ursingii in Person who Injects Drugs

    PubMed Central

    Salzer, Helmut J.F.; Rolling, Thierry; Schmiedel, Stefan; Klupp, Eva-Maria; Lange, Christoph

    2016-01-01

    We report a community-acquired bloodstream infection with Acinteobacter ursingii in an HIV-negative woman who injected drugs. The infection was successfully treated with meropenem. Species identification was performed by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Improved identification of Acinetobacter spp. by using this method will help identify clinical effects of this underdiagnosed pathogen. PMID:26689082

  5. Outbreak of wound botulism in people who inject drugs, Norway, October to November 2013.

    PubMed

    MacDonald, E; Arnesen, T M; Brantsaeter, A B; Gerlyng, P; Grepp, M; Hansen, B Å; Jonsrud, K; Lundgren, B; Mellegård, H; Møller-Stray, J; Rønning, K; Vestrheim, D F; Vold, L

    2013-01-01

    In October and November 2013, four cases of wound botulism were confirmed in people who inject drugs (PWID) in Norway. Two additional cases are suspected. Because of the international distribution pathways for heroin – the likely source of the outbreak – healthcare workers and public health authorities in other countries should remain vigilant for wound botulism in PWID. This outbreak serves as a reminder that countries should ensure access to botulinum antitoxin in case of outbreak situations. PMID:24229788

  6. Hepatitis-C virus infection among injecting drug users in Lahore, Pakistan: A cross sectional study

    PubMed Central

    Akhtar, Abdul Majeed; Majeed, Sadia; Jamil, Muhammad; Rehman, Abdul; Majeed, Sufia

    2016-01-01

    Objectives: To determine the prevalence and risk factors of hepatitis C virus among injecting drugs users, furthermore different genotypes of HCV infection and their effect on viral load were also found and subsequently most prevalent subtype was predicted. Methods: All samples were processed for Anti-HCV antibody detection through ELISA by using third generation ELISA Kit. The Anti-HCV positive serum samples were stored for RT-PCR to estimate the viral load and genotypes of HCV for study. Injecting drug users selected from in and around Lahore Metropolitan from July 2012 to August 2013 was included. The data analysis was completed by using SPSS version 16. A p-value of < 0.05 was considered to be significant. Results: A total of 241 Injecting drug users were enrolled and screened for Anti HCV in the study. Prevalence of HCV infection in IDUs from Lahore was found to be 36.09%. Education (p=0.000), low socioeconomic status (p=0.011), Blood transfusion (0.003), any tattoo on the body (p=0.002), use of injectable drugs with reused syringes (p=0.000) and sharing of syringes (p=0.001) in groups was significantly associated with HCV infection. Some utensils were also significantly associated with HCV status. The most common subtype of HCV genotype was 3a (n=65) followed by 2a (n=15) and 1a (n=6). Conclusion: The study reveals that IDUs with reused syringes status and sharing of syringes in group had more chances to get HCV infection. The viral load in IDUs infected with different subtypes of genotype was significantly associated. PMID:27182243

  7. Determinants of HIV risk among men who have homosexual sex and inject drugs.

    PubMed

    Crofts, N; Marcus, L; Meade, J; Sattler, G; Wallace, J; Sharp, R

    1995-01-01

    Men with histories of both homosexual contact and injecting drug use (IDU) are at increased risk of HIV infection over men who have only one such risk. Despite this, their special needs and circumstances have been neglected by AIDS prevention programmes. A survey of a wide spectrum of homosexual male IDUs was carried out in Melbourne and Sydney in 1993 to inform the development of specific policy and programmes for HIV prevention in these subcultures. Of 169 men, self-reported HIV prevalence was 27%. Decreasing compliance with safe sex guidelines (as measured by numbers of casual partners, participation in anal intercourse and use of condoms) was associated with HIV seropositivity, increased age, and increased participation in sex work; having a regular male partner was not protective against unsafe sexual behaviour, no matter the length of the relationship. A substantial proportion (15%) reported inconsistent condom use during anal sex with more than two partners in the preceding month: they were slightly more likely to be engaging in sex work, less 'stable' and more likely to be HIV infected. Sexual risk was not strongly associated with unsafe injecting, which was in general safe. Men who both have homosexual sex and inject drugs are groups at high risk of HIV, more from unsafe sex than from shared injecting equipment; men who believed themselves to be HIV infected were continuing to have sex in such a way that would allow transmission. These are clearly groups in need of priority targeted interventions. PMID:8652699

  8. New cases of HIV among people who inject drugs in Hungary: False alarm or early warning?

    PubMed

    Rácz, József; Gyarmathy, V Anna; Csák, Róbert

    2016-01-01

    Between 2009 and the first quarter of 2014, only one case of HIV (contracted outside Hungary) was detected among PWIDs in Hungary. However, more recent evidence suggests increased sharing of injecting paraphernalia among PWIDs. This is linked to the emergence of new designer drugs that require frequent injection, alongside funding cuts to the Hungarian needle exchange program (NEP) which has reduced access to sterile injecting equipment. During the past five years in Hungary, drug use has become increasingly discussed in moral as opposed to public health terms, and drug consumption has been re-criminalized. The largest NEP in Hungary was closed because of political pressure and government funding for regular HCV/HIV testing/counselling and seroprevalence studies among PWIDs has been stopped. This paper describes the detection of two new cases of HIV infection in PWIDs attending two NEPs in Budapest in May 2014. These new cases may indicate an unfolding HIV outbreak among PWIDs-similar to those reported in Greece and Romania. Yet the question remains: If no further HIV cases are detected, is this because there are no new cases or because there are no testing facilities for PWID? PMID:26251353

  9. Population Size Estimates for Men who Have Sex with Men and Persons who Inject Drugs.

    PubMed

    Oster, Alexandra M; Sternberg, Maya; Lansky, Amy; Broz, Dita; Wejnert, Cyprian; Paz-Bailey, Gabriela

    2015-08-01

    Understanding geographic variation in the numbers of men who have sex with men (MSM) and persons who inject drugs (PWID) is critical to targeting and scaling up HIV prevention programs, but population size estimates are not available at generalizable sub-national levels. We analyzed 1999-2010 National Health and Nutrition Examination Survey data on persons aged 18-59 years. We estimated weighted prevalence of recent (past 12 month) male-male sex and injection drug use by urbanicity (the degree to which a geographic area is urban) and US census region and calculated population sizes. Large metro areas (population ≥1,000,000) had higher prevalence of male-male sex (central areas, 4.4% of men; fringe areas, 2.5%) compared with medium/small metro areas (1.4%) and nonmetro areas (1.1%). Injection drug use did not vary by urbanicity and neither varied by census region. Three-quarters of MSM, but only half of PWID, resided in large metro areas. Two-thirds of MSM and two-thirds of PWID resided in the South and West. Efforts to reach MSM would benefit from being focused in large metro areas, while efforts to reach PWID should be delivered more broadly. These data allow for more effective allocation of funds for prevention programs. PMID:26115985

  10. Laser-induced microjet injection into preablated skin for more effective transdermal drug delivery

    NASA Astrophysics Data System (ADS)

    Jang, Hun-jae; Hur, Eugene; Kim, Yoonkwan; Lee, Seol-Hoon; Kang, Nae G.; Yoh, Jack J.

    2014-11-01

    A breakthrough in the efficient transdermal delivery of drug via the laser-driven microjet is reported. A single source of laser beam is split into two: one beam ablates a targeted spot on a skin and another beam drives the injector for fast microjet ejection into a preablated spot. This combined ablation and microjet injection scheme using a beam splitter utilizes 1∶4 laser energy sharing between generation of the microhole via ablation and the microjet which is generated using the Er:YAG laser beam at a 2940-nm wavelength and 150-μs pulse duration. A careful analysis of the injection mechanism is carried out by studying the response of the elastic membrane that separates a driving water unit for bubble expansion from a drug unit for a microjet ejection. The efficiency of the present delivery scheme is evaluated by the abdominal porcine skin test using the fluorescein isothiocyanate staining and the confocal microscopy for quantitative delivery confirmation. The depth of penetration and the injected volume of the drug are also confirmed by polyacrylamide gel tests.

  11. Laser-induced microjet injection into preablated skin for more effective transdermal drug delivery.

    PubMed

    Jang, Hun-Jae; Hur, Eugene; Kim, Yoonkwan; Lee, Seol-Hoon; Kang, Nae G; Yoh, Jack J

    2014-11-01

    A breakthrough in the efficient transdermal delivery of drug via the laser-driven microjet is reported. A single source of laser beam is split into two: one beam ablates a targeted spot on a skin and another beam drives the injector for fast microjet ejection into a preablated spot. This combined ablation and microjet injection scheme using a beam splitter utilizes laser energy sharing between generation of the microhole via ablation and the microjet which is generated using the Er:YAG laser beam at a 2940-nm wavelength and pulse duration. A careful analysis of the injection mechanism is carried out by studying the response of the elastic membrane that separates a driving water unit for bubble expansion from a drug unit for a microjet ejection. The efficiency of the present delivery scheme is evaluated by the abdominal porcine skin test using the fluorescein isothiocyanate staining and the confocal microscopy for quantitative delivery confirmation. The depth of penetration and the injected volume of the drug are also confirmed by polyacrylamide gel tests. PMID:25408959

  12. Substance Abuse Treatment, HIV/AIDS, and the Continuum of Response for People Who Inject Drugs

    PubMed Central

    Kresina, Thomas F.; Lubran, Robert; Clark, H. Westley; Cheever, Laura W.

    2012-01-01

    The continuum of response (CoR) to HIV/AIDS is a framework for implementation of HIV prevention, care, and treatment programs based on a national strategic plan for HIV/AIDS services. The CoR for people who inject drugs (PWID) is an important extension of the developed CoR to HIV/AIDS. The CoR-PWID employs stakeholders who together plan, develop, pilot, and provide a full range of services that address the various prevention, care/support, and treatment needs of people, families, and communities infected or affected by HIV/AIDS and injection drug use. The CoR-PWID comprises a broad range of services that include but are not limited to the World Health Organization priority interventions for HIV/AIDS prevention, treatment, and care in the health sector and the package of essential interventions for the prevention, treatment, and care of HIV for people who inject drugs. Implementation of these well-defined, essential prevention, care/support, and treatment services, in addition to locally defined needed services, in a coordinated fashion is important to clients, their families, and communities. The CoR-PWID is, therefore, a necessary framework essential for service development for countries that address HIV/AIDS in populations of PWID. PMID:23243517

  13. Sharing of Needles and Syringes among Men Who Inject Drugs: HIV Risk in Northwest Bangladesh

    PubMed Central

    Pasa, M. Kamal; Alom, Kazi Robiul; Bashri, Zubaida; Vermund, Sten H.

    2016-01-01

    Introduction Injection drug use is prevalent in northwestern Bangladesh. We sought to explore the context of needle/syringe sharing among persons who inject drugs (PWID), examining risk exposures to blood-borne infections like the human immunodeficiency virus (HIV) and hepatitis in a region where these dual epidemics are likely to expand. Methods We used a qualitative research approach to learn about injection practices, conducting 60 in-depth interviews among PWID. We then conducted 12 focus group discussions (FGDs) that generated a checklist of salient issues, and followed up with personal observations of typical days at the drug-use venues. Content and interpretative frameworks were used to analyze qualitative information and socio-demographic information, using SPSS software. Results We found that needle/syringe-sharing behaviours were integrated into the overall social and cultural lives of drug users. Sharing behaviours were an central component of PWID social organization. Sharing was perceived as an inherent element within reciprocal relationships, and sharing was tied to beliefs about drug effects, economic adversity, and harassment due to their drug user status. Carrying used needles/syringes to drug-use venues was deemed essential since user-unfriendly needle-syringe distribution schedules of harm reduction programmes made it difficult to access clean needles/syringes in off-hours. PWID had low self-esteem. Unequal power relationships were reported between the field workers of harm reduction programmes and PWID. Field workers expressed anti-PWID bias and judgmental attitudes, and also had had misconceptions about HIV and hepatitis transmission. PWID were especially disturbed that no assistance was forthcoming from risk reduction programme staff when drug users manifested withdrawal symptoms. Conclusion Interventions must take social context into account when scaling up programmes in diverse settings. The social organization of PWID include values that

  14. The potential for bridging: HIV status awareness and risky sexual behaviour of injection drug users who have non-injecting permanent partners in Ukraine

    PubMed Central

    Mazhnaya, Alyona; Andreeva, Tatiana I; Samuels, Steve; DeHovitz, Jack; Salyuk, Tetyana; McNutt, Louise-Anne

    2014-01-01

    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−. PMID:24560341

  15. A situational picture of HIV/AIDS and injection drug use in Vinnitsya, Ukraine

    PubMed Central

    Barcal, Katerina; Schumacher, Joseph E; Dumchev, Kostyantyn; Moroz, Larisa Vasiliyevna

    2005-01-01

    Background New and explosive HIV epidemics are being witnessed in certain countries of Eastern Europe, including Ukraine, as well as a rapid and dramatic increase in the supply, use, and negative public health consequences of illicit drugs. A majority of registered HIV cases in Ukraine occur among injection drug users (IDUs), large numbers of whom report HIV risk behaviors such as needle sharing. The purpose of this study was to apply the World Health Organization's Rapid Assessment and Response on Injection Drug Use (IDU-RAR) guide to create a situational picture in the Vinnitsya Oblast, Ukraine, a region with very scarce information about the HIV/AIDS and injection drug use (IDU) epidemics. Methods The IDU-RAR uses a combination of qualitative data collection techniques commonly employed in social science and evaluation research to quickly depict the extent and nature of the given health problem and propose locally relevant recommendations for improvement. The investigators focused their assessment on the contextual factors, drug use, and intervention and policy components of the IDU-RAR. A combination of network and block sampling techniques was used. Data collection methods included direct observation, review of existing data, structured and unstructured interviews, and focus group discussions. Key informants and locations were visited until no new information was being generated. Results The number of registered HIV cases in Vinnitsya has increased from 3 (1987–1995) to 860 (1999–10/2004), 57 of whom have already died. Ten percent of annual admissions to the area's Regional Narcological Dispensary were for opiate disorders, and the number of registered IDUs rose by 20% from 1999 to 2000. The level of HIV/AIDS awareness is generally poor among the general population but high among high-risk populations. Both HIV/AIDS and injection drug use carry a strong stigma in the community, even among medical professionals. There was very little evidence of primary HIV

  16. Hepatitis-B Infections among the Injection Drug Abusers: An Emerging Risk in Public Health, Bangladesh.

    PubMed

    Hossain, K J; Nandi, A K

    2015-10-01

    The objective of the study was to determine the incidence of Hepatitis-B (HBV) infection among the injection drugs abusers (IDUs). The research work was a cross-sectional study. A total of 400 IDUs were selected from July 2012 to June 2013 at the Outpatient Department of the Central Drug Addiction Treatment Center, Tejgaon, Dhaka, Bangladesh. They were selected consecutively following the purposive sampling method on the basis of defined selection criteria. Research instruments were a pre-tested interviewer questionnaire and blood specimen. Results showed that 79.70%(315) of the IDUs were found literate and 20.3%(85) illiterate. In present occupation, majority of them 60.5%(242) had no work and 39.5%(158) specific occupation. The mean age of them was 27.9±6.4 years. In marital status, 46.5%(186) were unmarried, 20.7%(83) married after addiction and 30.3%(121) married before addiction. Majority of the IDUs 75.2%(289) started their addiction with cannabis. In addition to injection drugs use, all of them were multiple drug abusers. In response to the sharing of needle, 35.7%(143) of the IDUs shared needle uncommonly and 64.3%(257) did not shared it at all. Ninety-three percent (372) of them were heterosexual and polygamous having extramarital sex with multiple partners. The quality of sex-partners was wife, friends, brothel & hotel based sex sellers and street sex sellers. Majority of IDUs {82.0%(328)} did not use condom at all and 15.5(62) sold blood several times in their lifetime. Seven percent {7.0%(28)} injection drug abusers had been suffering from hepatitis-B virus (HBV) infection. HBV infection was found to be significantly (p≥0.05) associated with the quality of sex partners and number of sex partners, and age and marital status. There is no significant association with sharing of needle particularly occasional sharing of needle. Altering the behaviors of IDUs, especially their sexual lifestyles, drug habit, using of disposable syringe without sharing of

  17. Community reentry challenges after release from prison among people who inject drugs in St. Petersburg, Russia

    PubMed Central

    Cepeda, Javier A.; Vetrova, Marina V.; Lyubimova, Alexandra I.; Levina, Olga S.; Heimer, Robert; Niccolai, Linda M.

    2016-01-01

    Purpose Little is known about the context of the post-release risk environment among formerly incarcerated people who inject drugs (PWID) in Russia. The purpose of this paper is to explore these challenges as they relate to reentry, relapse to injection opioid use, and overdose. Design/methodology/approach The authors conducted 25 in-depth semi-structured interviews among PWID living in St Petersburg, Russia who had been incarcerated within the past two years. Participants were recruited from street outreach (n = 20) and a drug treatment center (n = 5). Findings Emergent themes related to the post-release environment included financial instability, negative interactions with police, return to a drug using community, and reuniting with drug using peers. Many respondents relapsed to opioid use immediately after release. Those whose relapse occurred weeks or months after their release expressed more motivation to resist. Alcohol or stimulant use often preceded the opioid relapse episode. Among those who overdosed, alcohol use was often reported prior to overdosing on opioids. Practical implications Future post-release interventions in Russia should effectively link PWID to social, medical, and harm reduction services. Particular attention should be focussed on helping former inmates find employment and overdose prevention training prior to leaving prison that should also cover the heightened risk of concomitant alcohol use. Originality/value In addition to describing a syndemic involving the intersection of incarceration, injection drug use, poverty, and alcohol abuse, the findings can inform future interventions to address these interrelated public health challenges within the Russian setting. PMID:26277925

  18. Attitudes toward Methadone among Out-of-Treatment Minority Injection Drug Users: Implications for Health Disparities

    PubMed Central

    Zaller, Nickolas D.; Bazazi, Alexander R.; Velazquez, Lavinia; Rich, Josiah D.

    2009-01-01

    Injection drug use (IDU) continues to be a significant public health issue in the U.S. and internationally, and there is evidence to suggest that the burden of injection drug use and associated morbidity and mortality falls disproportionately on minority communities. IDU is responsible for a significant portion of new and existing HIV/AIDS cases in many parts of the world. In the U.S., the prevalence of HIV and hepatitis C virus is higher among populations of African-American and Latino injection drug users (IDUs) than among white IDUs. Methadone maintenance therapy (MMT) has been demonstrated to effectively reduce opiate use, HIV risk behaviors and transmission, general mortality and criminal behavior, but opiate-dependent minorities are less likely to access MMT than whites. A better understanding of the obstacles minority IDUs face accessing treatment is needed to engage racial and ethnic disparities in IDU as well as drug-related morbidity and mortality. In this study, we explore knowledge, attitudes and beliefs about methadone among 53 out-of-treatment Latino and African-American IDUs in Providence, RI. Our findings suggest that negative perceptions of methadone persist among racial and ethnic minority IDUs in Providence, including beliefs that methadone is detrimental to health and that people should attempt to discontinue methadone treatment. Additional potential obstacles to entering methadone therapy include cost and the difficulty of regularly attending a methadone clinic as well as the belief that an individual on MMT is not abstinent from drugs. Substance use researchers and treatment professionals should engage minority communities, particularly Latino communities, in order to better understand the treatment needs of a diverse population, develop culturally appropriate MMT programs, and raise awareness of the benefits of MMT. PMID:19440415

  19. Physical Violence Among a Prospective Cohort of Injection Drug Users: A Gender-Focused Approach

    PubMed Central

    Marshall, Brandon D.L.; Fairbairn, Nadia; Li, Kathy; Wood, Evan; Kerr, Thomas

    2008-01-01

    Although dramatically heightened rates of violence have been observed among injection drug users (IDU), little is known about the gender differences associated with violence among this population. Employing a risk environment framework, we performed an analysis of the factors associated with experiencing violence among participants enrolled in a prospective cohort study of IDU during the years 1996-2005 using generalized estimating equations (GEE). Among 1114 individuals, 291 (66%) of females and 470 (70%) of males reported experiencing violence during the study period. In multivariate analyses, mental illness, frequent alcohol use, frequent crack use, homelessness, Downtown Eastside residency, and requiring help injecting were positively associated with experiencing violence for both sexes (all p < 0.05). For females, binge drug use (AOR = 1.30) and drug dealing (AOR = 1.42) were positively associated with violence, while younger age (AOR = 1.02), frequent heroin injection (AOR = 1.24), and incarceration (AOR = 1.50) were significant for males. Women were more likely to be attacked by acquaintances, partners, and sex trade clients, while men were more likely to experience violence from strangers and the police. These findings indicate that susceptibility to violence among IDU is structured by environmental factors such as homelessness and drug-related factors such as frequent alcohol use and involvement in drug economies. Furthermore, important gender differences with respect to the predictors and characteristics of violent attacks do exist. These findings indicate an urgent need for the development of comprehensive programs and structural interventions that take a gender-focused approach to violence among IDU. PMID:18487025

  20. Ready-to-use injectable calcium phosphate bone cement paste as drug carrier.

    PubMed

    Vorndran, E; Geffers, M; Ewald, A; Lemm, M; Nies, B; Gbureck, U

    2013-12-01

    Current developments in calcium phosphate cement (CPC) technology concern the use of ready-to-use injectable cement pastes by dispersing the cement powder in a water-miscible solvent, such that, after injection into the physiological environment, setting of cements occurs by diffusion of water into the cement paste. It has also been demonstrated recently that the combination of a water-immiscible carrier liquid combined with suitable surfactants facilitates a discontinuous liquid exchange in CPC, enabling the cement setting reaction to take place. This paper reports on the use of these novel cement paste formulations as a controlled release system of antibiotics (gentamicin, vancomycin). Cement pastes were applied either as a one-component material, in which the solid drugs were physically dispersed, or as a two-component system, where the drugs were dissolved in an aqueous phase that was homogeneously mixed with the cement paste using a static mixing device during injection. Drug release profiles of both antibiotics from pre-mixed one- and two-component cements were characterized by an initial burst release of ∼7-28%, followed by a typical square root of time release kinetic for vancomycin. Gentamicin release rates also decreased during the first days of the release study, but after ∼1 week, the release rates were more or less constant over a period of several weeks. This anomalous release kinetic was attributed to participation of the sulfate counter ion in the cement setting reaction altering the drug solubility. The drug-loaded cement pastes showed high antimicrobial potency against Staphylococcus aureus in an agar diffusion test regime, while other cement properties such as mechanical performance or phase composition after setting were only marginally affected. PMID:23954526

  1. Non-injection and Injection Drug Use and STI/HIV Risk in the United States: The Degree to which Sexual Risk Behaviors versus Sex with an STI-Infected Partner Account for Infection Transmission among Drug Users

    PubMed Central

    Khan, Maria; Berger, Amanda; Hemberg, Jordana; O’Neill, Allison; Dyer, Typhanye Penniman; Smyrk, Kristina

    2012-01-01

    We used the National Longitudinal Study of Adolescent Health (N=14,322) to measure associations between non-injection crack-cocaine and injection drug use and sexually transmitted infection including HIV (STI/HIV) risk among young adults in the United States and to identify factors that mediate the relationship between drug use and infection. Respondents were categorized as injection drug users, non-injection crack-cocaine users, or non-users of crack-cocaine or injection drugs. Non-injection crack-cocaine use remained an independent correlate of STI (adjusted prevalence ratio (APR): 1.63, 95% confidence interval (CI): 1.10–2.42) and sexual risk behaviors including multiple partnerships and inconsistent condom use. Injection drug use was strongly associated with STI (APR: 2.66, 95% CI: 1.18–5.99); this association appeared to be mediated by sex with STI-infected partners rather than by sexual risk behaviors. The results underscore the importance of sexual risk reduction among all drug users including IDUs, who face high sexual as well as parenteral transmission risk. PMID:22890684

  2. High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors

    PubMed Central

    Smith, Maria Elisa; Robinowitz, Natanya; Chaulk, Patrick; Johnson, Kristine E.

    2014-01-01

    Objectives Abscesses and chronic wounds are common among injection drug users (IDUs) though chronic wounds have been understudied. We assess the risk factors associated with both acute and chronic wounds within a community-based population of IDUs frequenting the Baltimore City Needle Exchange Program (BNEP). Methods We performed a cross-sectional study of BNEP clients ≥18 years who completed an in-person survey regarding active or prior wounds including abscesses (duration <8 weeks) and chronic wounds (duration ≥8 weeks), injection practices, and skin care. Factors associated with wounds were analyzed using univariate and multivariate logistic regression. Results Of the 152 participants, 63.2% were men, 49.3% were Caucasian, 44.7% were African American, 34.9% had any type of current wound, 17.8% had an active abscess, and 19.7% had a current chronic wound. Abscesses were more common in women (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.10–5.97); and those reporting skin-popping (OR, 5.38; 95% CI, 1.85–15.67). In a multivariate model, risk factors for an abscess included injecting with a family member/partner (AOR, 4.06; 95% CI, 0.99–16.58). In a multivariable analysis of current chronic wounds, cleaning skin with alcohol prior to injection was protective (AOR, 0.061; 95% CI, 0.0064–0.58). Conclusions Abscesses and chronic wounds were prevalent among a sample of IDUs in Baltimore. Abscesses were associated with injection practices, and chronic wounds appeared linked to varying skin and tool cleaning practices. There is a pressing need for wound-related education and treatment efforts among IDUs who are at greatest risk for skin-related morbidity. PMID:25469653

  3. Delivering care to injection drug users coinfected with HIV and hepatitis C virus.

    PubMed

    Taylor, Lynn E

    2005-04-15

    Injection drug use has fueled the epidemic of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection in the United States. Nevertheless, drug dependence is among the main reasons that coinfected persons are not being treated for HCV infection. This report describes the development and progress of an HIV clinic program (funded by the Ryan White Comprehensive AIDS Resources Emergency Act) to deliver care for HCV infection to HIV-seropositive injection drug users. To optimize safety and adherence, pegylated interferon is directly administered to patients in the context of integrated addiction, psychiatric, and HIV and HCV therapy. Ribavirin is packed weekly in pill boxes for patients to take at home. Thus far, adherence to weekly visits for treatment with interferon has been 99%. No one has had to stop treatment for HCV infection because of ongoing drug use, addiction relapse or exacerbation, or psychiatric complications. Presented here is a work in progress, rather than a finished research project or definitive model of care. PMID:15768348

  4. Perceived risk of HIV infection among deported male injection drug users in Tijuana, Mexico.

    PubMed

    Pinedo, Miguel; Burgos, José Luis; Robertson, Angela M; Vera, Alicia; Lozada, Remedios; Ojeda, Victoria D

    2014-01-01

    Deported injection drug users (IDUs) in Mexico may be vulnerable to HIV infection following expulsion from the USA. We examined factors associated with HIV risk perception among a sample of deportees in Tijuana. From January to April 2010, 313 male IDUs who reported ever being deported from the USA completed a questionnaire. Overall, 35% (N=110) of deportees perceived HIV risk. In multivariate logistic regression analyses, factors independently associated with HIV risk perception included ever having a steady female partner in Tijuana post-deportation (adjusted odds ratio [AOR]: 2.26; 95% confidence interval [CI]: 1.01-5.07) and years spent in a US prison (AOR: 1.29 per year; 95% CI: 1.13-1.48). Conversely, years of drug injection use (AOR: 0.95 per year; 95% CI: 0.91-0.99), ever witnessing family members use drugs prior to first migration trip (AOR: 0.24; 95% CI: 0.09-0.65), years of residence in the USA (AOR: 0.91 per year; 95% CI: 0.84-0.98) and being a Tijuana native (AOR: 0.40; 95% CI: 0.16-0.99) were negatively associated with HIV risk perception. US-Mexico border cities that receive deported migrants should target HIV prevention interventions to specific subgroups, including drug-using male deportees. Interventions should consider migrant's time in the USA, the role of their social networks, and reducing missed opportunities for HIV testing/education. PMID:24650124

  5. A Qualitative Exploration of Gender in the Context of Injection Drug Use in Two US–Mexico Border Cities

    PubMed Central

    Cruz, Michelle Firestone; Mantsios, Andrea; Ramos, Rebeca; Case, Patricia; Brouwer, Kimberly C.; Ramos, Maria Elena; Fraga, Wendy Davila; Latkin, Carl A.; Miller, Cari L.; Strathdee, Steffanie A.

    2009-01-01

    Injection drug use is of increasing concern along the U.S.–Mexico border where Tijuana and Ciudad (Cd.) Juarez are located. We conducted a qualitative study to explore the context of drug use, with a focus on gender differences. In-depth interviews were conducted with 10 male and 10 female injection drug users (IDUs) in Tijuana and 15 male and 8 female IDUs in Cd. Juarez. Topics included types of drugs used, injection settings, access to sterile needles and environmental influences. Interviews were taped, transcribed and translated. Content analysis was conducted to identify themes. Several themes emerged with respect to gender: (a) how drugs were obtained; (b) where drugs were used; (c) relationship dynamics surrounding drug use; and (d) sex in exchange for money or drugs. Men reported buying and injecting in shooting galleries and other locations, whereas women tended to buy and inject drugs with people they knew and trusted. All men reported having shared syringes in shooting galleries, often with strangers. In these two cities, venue-based interventions may be more appropriate for male IDUs, whereas personal network interventions may be more appropriate among female IDUs. PMID:16865542

  6. Participant and Staff Experiences in a Peer-Delivered HIV Intervention with Injection Drug Users

    PubMed Central

    Kostick, Kristin M.; Weeks, Margaret; Mosher, Heather

    2015-01-01

    We explore ethical issues faced by investigators as they conduct research as part of a peer-delivered HIV/AIDS risk reduction program for injection drug users (IDUs). Staff and participant experiences in peer-delivered interventions among IDUs have come under scrutiny by ethics researchers because of their potential to inadvertently and negatively impact participant rehabilitation due to continued engagement with drug-using networks during the course of outreach. This study explores whether enhanced communication of participant concerns and experiences with clinic and research staff helps to reduce inadvertent malfeasance in peer-delivered drug treatment interventions. Results contribute to the development of patient support infrastructure in peer-delivered risk reduction programs involving IDUs. PMID:24572079

  7. Drug injection into fat tissue with a laser based microjet injector

    NASA Astrophysics Data System (ADS)

    Han, Tae-hee; Hah, Jung-moo; Yoh, Jack J.

    2011-05-01

    We have investigated a new micro drug jet injector using laser pulse energy. An infrared laser beam of high energy (˜3 J/pulse) is focused inside a driving fluid in a small chamber. The pulse then induces various energy releasing processes, and generates fast microjets through a micronozzle. The elastic membrane of this system plays an important role in transferring mechanical pressure and protecting drug from heat release. In this paper, we offer the sequential images of microjet generation taken by a high speed camera as an evidence of the multiple injections via single pulse. Furthermore, we test the proposed system to penetrate soft animal tissues in order to evaluate its feasibility as an advanced transdermal drug delivery method.

  8. Vietnamese-speaking injecting drug users in Melbourne: the need for harm reduction programs.

    PubMed

    Louie, R; Krouskos, D; Gonzalez, M; Crofts, N

    1998-06-01

    While research on aspects of injecting drug use (IDU), including injecting and sexual risks for HIV transmission, has been progressing in 'mainstream' Australian populations, there has been little among non-English speaking background (NESB) communities in Australia, particularly the South-East Asian communities, of which the Vietnamese is the largest. This exploratory study employed and trained peer workers to recruit and interview IDUs of Vietnamese origin in Melbourne on a wide range of subjects related to risks associated with their drug using, as an initial assessment of risk-taking behaviours for blood-borne viruses among Vietnamese-speaking IDUs. A finger-prick blood sample was taken where possible to measure antibody status to HIV, HBV and HCV. The profile which emerged was not dissimilar to that of their English-speaking counterparts prior to the benefit of currently available harm-reduction programs. A relatively isolated group whose social world often related only to other Vietnamese-speaking drug users, they were engaging in unsafe sex and unsafe injecting and were unfamiliar with procedures for cleaning injecting equipment and where they could seek out information and services, including needle exchanges. This study has identified an urgent need not only to promote currently available information and services to this group, but also to provide culturally relevant education and other harm-reduction measures needed to prevent transmission of HIV, other BBVs and STDs. The study has highlighted the lack of responsiveness of mainstream health services to the needs of Vietnamese-speaking IDUs. PMID:9659777

  9. High dead-space syringe use among people who inject drugs in Tijuana, Mexico

    PubMed Central

    Rafful, Claudia; Zule, William; González-Zúñiga, Patricia E.; Werb, Dan; Elena Medina-Mora, María; Magis-Rodriguez, Carlos; Strathdee, Steffanie A.

    2015-01-01

    Background High dead-space syringes (HDSS) are believed to confer an elevated risk of acquiring HIV and other blood-borne infections. Objectives We identified prevalence and correlates of HDSS use among injection drug users (IDU) in Tijuana, Mexico, where syringe purchase and possession is legal without a prescription. Methods Beginning in 2011, IDU who reported being 18 years or older, who injected drugs within the last month were recruited into a prospective study. At baseline and semi-annually, 557 IDU underwent HIV-testing and interviewer-administered surveys. Logistic regression was used to identify correlates of using HDSS. Results Of 557 IDU, 40% had ever used HDSS, mostly because no other syringe type was available (72%), or because they were easier to get (20%). Controlling for sex and age at first injection, use of HDSS was associated with cocaine as the first drug injected (Adjusted Odds Ratio [AOR]:2.68; Confidence Interval 95% [CI]:1.15-6.22), having been stopped or arrested by police (AOR:1.84; 95% CI:1.11-3.07), being deported from the US (AOR:1.64; 95%CI:1.06-2.53), and believing it is illegal to carry syringes (AOR:1.78; 95%CI:1.01-3.15). Conclusion Use of HDSS is surprisingly common among IDU in Tijuana. Efforts are needed to expand coverage of low-dead space syringes through existing syringe exchange programs. Education is required to increase awareness of the harms associated with HDSS, and to inform IDU that syringe possession is legal across Mexico. PMID:25695145

  10. Hepatitis C and HIV in injecting drug users in Armenia, Colombia.

    PubMed

    Berbesi-Fernández, Dedsy; Segura-Cardona, Ángela; Montoya-Vélez, Liliana; Castaño-Perez, Guillermo A

    2015-01-01

    A constant and progressive increase in the availability of heroin in Colombia in recent decades and the intravenous use  of this drug have established the need to prevent a possible epidemic of HIV and hepatitis C. This research determined the sero-prevalence of hepatitis C and HIV according to sociodemographic characteristics and risk behaviors in people who inject drugs in Armenia, Colombia. This is a cross-sectional study on 265 users captured through respondent-driven sampling after informed consent. Sero-prevalence of hepatitis C was 22.3 % [95% CI 12.3 % -23.5 %]; for HIV infection, it was 2.6 % [95% CI 0.4 to 6.0]; 67.5% reported injecting for more than two years, 35 % shared needles and syringes, and 12.4 % had used a condom during their last sexual intercourse. Users who did not purchase syringes in drugstores in the last six months are 2.7 times [95% CI 1.32 to 5.48] more likely to contract hepatitis C; daily injection frequency was higher in HIV- positive cases [OR 2.87; 95% CI 0.55 to 15.9] but nonsignificant. One fourth of respondents are infected with HIV or hepatitis C, either as a single infection or co-infection. This study identified risk practices such as sharing needles and low condom use in the last six months, worldwide documented and discussed risk factors. This research is a first step in the search for strategies to prevent the spread of HIV infection and hepatitis C in networks of injecting drug users. PMID:26706807

  11. Hepatitis C genotype distribution and homology among geographically disparate injecting drug users in Afghanistan.

    PubMed

    Sanders-Buell, Eric; Rutvisuttinunt, Wiriya; Todd, Catherine S; Nasir, Abdul; Bradfield, Andrea; Lei, Esther; Poltavee, Kultida; Savadsuk, Hathairat; Kim, Jerome H; Scott, Paul T; de Souza, Mark; Tovanabutra, Sodsai

    2013-07-01

    Hepatitis C virus (HCV) prevalence is high among injecting drug users in Afghanistan, but transmission dynamics are poorly understood. Samples from HCV-infected injecting drug users were sequenced to determine circulating genotypes and potential transmission linkages. Serum samples were obtained from injecting drug user participants in Hirat, Jalalabad, and Mazar-i-Sharif between 2006 and 2008 with reactive anti-HCV rapid tests. Specimens with detected HCV viremia were amplified and underwent sequence analysis. Of 113 samples evaluated, 25 samples (35.2%) were only typeable in NS5B, nine samples (12.7%) were only typeable in CE1, and 37 samples (52.1%) were genotyped in both regions. Of those with typeable HCV, all were Afghan males with a mean age of 31.1 (standard deviation [SD] ± 8.0) years and mean duration of injecting of 3.9 (SD ± 4.3) years. Most reported residence outside Afghanistan in the last decade (90.1%) and prior incarceration (76.8%). HCV genotypes detected were: 1a, (35.2%, n = 25), 3a (62.0%, n = 44), and 1b (2.8%, n = 2). Cluster formation was detected in NS5B and CE1 and were generally from within the same city. All participants within clusters reported being a refugee in Iran compared to 93.5% of those outside clusters. Only 22.2% (4/11) of those within clusters had been refugees in Pakistan and these four individuals had also been refugees in Iran. Predominance of genotype 3a and the association between HCV viremia and having been a refugee in Iran potentially reflects migration between Afghanistan and Iran among IDUs from Mazar-i-Sharif and Hirat and carry implications for harm reduction programs for this migratory population. PMID:23918535

  12. Incident syphilis infection among people who inject drugs in Tijuana, Mexico.

    PubMed

    Pines, Heather A; Rusch, Melanie L; Vera, Alicia; Rangel, Gudelia; Magis-Rodriguez, Carlos; Strathdee, Steffanie A

    2015-12-01

    Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via respondent-driven sampling and followed for 18 months. At semi-annual visits, participants were tested for syphilis and completed surveys, which collected information on socio-demographics, sexual behaviours, substance use and injection behaviours. Poisson regression was used to estimate syphilis incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Twenty-one participants acquired syphilis during follow-up (IR = 1.57 per 100 person-years, 95% CI: 1.02-2.41). In a multivariate analysis, syphilis incidence was higher among women (IRR = 3.90, 95% CI: 1.37-11.09), HIV-positive participants (IRR = 4.60, 95% CI: 1.58-13.39) and those who reported ever exchanging sex for drugs, money, or other goods (IRR = 2.74, 95% CI: 0.97-7.76), while syphilis incidence was lower among those living in Tijuana for a longer duration (IRR = 0.95 per year, 95% CI: 0.91-1.00) and those reporting at least daily injection drug use (past 6 months) (IRR = 0.22, 95% CI: 0.09-0.54). Our findings suggest interventions that address the destabilising conditions associated with migration and integrate sexual and drug-related risk reduction strategies may help reduce syphilis incidence among PWID along the Mexico-US border. PMID:25614523

  13. FACTORS ASSOCIATED WITH EMPLOYMENT AMONG A COHORT OF INJECTION DRUG USERS

    PubMed Central

    Richardson, Lindsey; Wood, Evan; Li, Kathy; Kerr, Thomas

    2015-01-01

    Introduction and Aims One of the most substantial costs of drug use is lost productivity and social functioning, including holding of a regular job. However, little is known about employment patterns of injection drug users (IDU). We sought to identify factors that were associated with legal employment among IDU. Design and Methods We describe the employment patterns of participants of a longitudinal cohort study of IDU in Vancouver, Canada. We then use generalised estimating equations (GEE) to determine statistical associations between legal employment and various intrinsic, acquired, behavioural and circumstantial factors. Results From 1 June 1999 to 30 November 2003, 330 (27.7%) of 1190 participants reported having a job at some point during follow up. Employment rates remain somewhat stable throughout the study period (9–12.4%). Factors positively and significantly associated with legal employment in multivariate analysis were male gender (adjusted odds ratio [AOR] = 2.78) and living outside the Downtown Eastside (AOR = 1.85). Factors negatively and significantly associated with legal employment included older age (AOR = 0.97); Aboriginal ethnicity (AOR = 0.72); HIV-positive serostatus (AOR = 0.32); HCV-positive serostatus (AOR = 0.46); daily heroin injection (AOR = 0.73); daily crack use (AOR = 0.77); public injecting (AOR = 0.50); sex trade involvement (AOR = 0.49); recent incarceration (AOR = 0.56); and unstable housing (AOR = 0.57). Discussion and Conclusions Our results suggest a stabilising effect of employment for IDU and socio-demographic, drug use and risk-related barriers to employment. There is a strong case to address these barriers and to develop innovative employment programming for high-risk drug users. PMID:20565522

  14. Fluorescent blue lights, injecting drug use and related health risk in public conveniences: findings from a qualitative study of micro-injecting environments.

    PubMed

    Parkin, Stephen; Coomber, Ross

    2010-07-01

    This paper presents findings relating to injecting drug users' experiences and opinions of public toilets illuminated with fluorescent blue lights and presents an empirical assessment of the intended deterrent effect of such installations. Data analysis identified that blue lights deterred less than half the sample interviewed. Furthermore over half (18/31) of the sample were prepared to inject in conditions specifically designed to deter injecting practice. Of these, 11 respondents were completely undeterred and 7 individuals were only partially deterred by blue light environments. These findings are discussed within the interpretative frameworks of Pierre Bourdieu's theory of habitus and symbolic violence. The authors conclude that fluorescent blue lights contribute towards the development of situated resistance by injecting drug users within a public injecting habitus; a resistance that produces and reproduces drug-related harm and is a behaviour that opposes the symbolic violence of harm reduction intervention. The paper concludes with suggestions for theory-driven practical intervention that may seek to disrupt the harmful elements of the public injecting habitus. PMID:20167527

  15. Estimating hidden populations: a new method of calculating the prevalence of drug-injecting and non-injecting female street prostitution.

    PubMed

    Bloor, M; Leyland, A; Barnard, M; McKeganey, N

    1991-11-01

    This paper outlines a new method we have developed for estimating the prevalence of streetworking prostitution and the proportions of female street-working prostitutes who are injecting drug users. This method is based on the capture/recapture approach and involves distinguishing new fieldwork contacts from repeat field work contacts. The size of the overall population can be modelled from records of the increasing ratio of repeat to new fieldwork contacts. The method may have a relevance beyond a concern with prostitution and drug injecting, and may be of value in estimating other hidden populations. PMID:1777742

  16. Law Enforcement Practices Associated with HIV Infection Among Injection Drug Users in Odessa, Ukraine

    PubMed Central

    Dvoryak, Sergey; Sung-Joon, Min; Brewster, John T.; Wendt, William W.; Corsi, Karen F.; Semerik, Oleg Y.; Strathdee, Steffanie A.

    2013-01-01

    Despite HIV prevention efforts over the past 10 years in Odessa, Ukraine, HIV rates among injection drug users (IDUs) remain high. We explored whether IDUs’ experiences with the police and court system in Odessa were associated with HIV serostatus, after controlling for other factors. Qualitative methods, including semi-structured interviews with the police and members of court (N = 19), and focus groups with IDUs (N = 42), were employed to aid in developing a survey instrument for a larger quantitative phase and to assist in interpreting the findings from the quantitative phase, which included 200 participants who were interviewed and tested for HIV. Overall, 55 % tested positive for HIV. Negative experiences with the police were noted by 86 % and included having preloaded syringes taken (66 %), rushed injections due to fear of the police (57 %), police planting drugs (18 %), paying police to avoid arrest (61 %) and threatened by the police to inform on other IDUs (23 %). HIV positive participants were more likely than those who were negative to report these experiences. In a multiple logistic regression, the most significant correlate of HIV infection was rushed injections due to fear of the police. Police actions in Odessa may be contributing to the continued escalation of HIV among IDUs, underscoring the need for structural interventions. PMID:23754613

  17. Increased risk for hepatitis C associated with solvent use among Canadian Aboriginal injection drug users

    PubMed Central

    2010-01-01

    Background Solvent abuse is a particularly serious issue affecting Aboriginal people. Here we examine the association between solvent use and socio-demographic variables, drug-related risk factors, and pathogen prevalence in Aboriginal injection drug users (IDU) in Manitoba, Canada. Methods Data originated from a cross-sectional survey of IDU from December 2003 to September 2004. Associations between solvent use and variables of interest were assessed by multiple logistic regression. Results A total of 266 Aboriginal IDU were included in the analysis of which 44 self-reported recent solvent use. Hepatitis C infection was 81% in solvent-users, compared to 55% in those reporting no solvent use. In multivariable models, solvent-users were younger and more likely to be infected with hepatitis C (AOR: 3.5; 95%CI: 1.3,14.7), to have shared needles in the last six months (AOR: 2.6; 95%CI:1.0,6.8), and to have injected talwin & Ritalin (AOR: 10.0; 95%CI: 3.8,26.3). Interpretation High hepatitis C prevalence, even after controlling for risky injection practices, suggests that solvent users may form closed networks of higher risk even amongst an already high-risk IDU population. Understanding the social-epidemiological context of initiation and maintenance of solvent use is necessary to address the inherent inequalities encountered by this subpopulation of substance users, and may inform prevention strategies for other marginalized populations. PMID:20642835

  18. Design and synthesis of HIV-1 protease inhibitors for a long-acting injectable drug application.

    PubMed

    Kesteleyn, Bart; Amssoms, Katie; Schepens, Wim; Hache, Geerwin; Verschueren, Wim; Van De Vreken, Wim; Rombauts, Klara; Meurs, Greet; Sterkens, Patrick; Stoops, Bart; Baert, Lieven; Austin, Nigel; Wegner, Jörg; Masungi, Chantal; Dierynck, Inge; Lundgren, Stina; Jönsson, Daniel; Parkes, Kevin; Kalayanov, Genadiy; Wallberg, Hans; Rosenquist, Asa; Samuelsson, Bertil; Van Emelen, Kristof; Thuring, Jan Willem

    2013-01-01

    The design and synthesis of novel HIV-1 protease inhibitors (PIs) (1-22), which display high potency against HIV-1 wild-type and multi-PI-resistant HIV-mutant clinical isolates, is described. Lead optimization was initiated from compound 1, a Phe-Phe hydroxyethylene peptidomimetic PI, and was directed towards the discovery of new PIs suitable for a long-acting (LA) injectable drug application. Introducing a heterocyclic 6-methoxy-3-pyridinyl or a 6-(dimethylamino)-3-pyridinyl moiety (R(3)) at the para-position of the P1' benzyl fragment generated compounds with antiviral potency in the low single digit nanomolar range. Halogenation or alkylation of the metabolic hot spots on the various aromatic rings resulted in PIs with high stability against degradation in human liver microsomes and low plasma clearance in rats. Replacing the chromanolamine moiety (R(1)) in the P2 protease binding site by a cyclopentanolamine or a cyclohexanolamine derivative provided a series of high clearance PIs (16-22) with EC(50)s on wild-type HIV-1 in the range of 0.8-1.8 nM. PIs 18 and 22, formulated as nanosuspensions, showed gradual but sustained and complete release from the injection site over two months in rats, and were therefore identified as interesting candidates for a LA injectable drug application for treating HIV/AIDS. PMID:23177258

  19. Weight loss associated with HIV seroconversion among injection-drug users.

    PubMed

    Marmor, M; Titus, S; Harrison, C; Cord-Cruz, E A; Shore, R E; Vogler, M; Krasinski, K; Mildvan, D; Des Jarlais, D C

    1996-08-15

    To describe symptoms associated with human immunodeficiency virus (HIV) seroconversion, we studied a cohort of 366 injection-drug users (IDUs) with a study design that included recall every 3 months to collect symptom histories using a structured questionnaire. Eleven HIV seroconversions were observed in 621.5 person years at risk (PYAR), equivalent to 1.8 seroconversions/100 PYAR. Cox regression analysis showed age < or = 35 years to be a significant risk factor for HIV seroconversion after controlling for gender, race, and the frequency of drug injection. An embedded case-control analysis then compared symptom histories of HIV seroconverters with those of age-(+/- 5 years) and visit number-matched controls who remained HIV seronegative for > or = 3 months longer than the HIV-seroconverters. Multivariate case-control analysis adjusted for injection frequency yielded significant associations of HIV seroconversion with histories of weight loss > or = 4.5 kg (seven of 11 cases; odds ratio [OR] = 11.6, 95% confidence interval [CI] 3.1, 43.1) and oral ulcers (three of 11 cases; OR = 7.6, 95% CI = 1.2, 48.2) in the 3 months before the subjects' first HIV-seropositive study visit. We conclude that histories of recent symptoms reported by HIV-seroconverting IDUs differ from those reported by non-HIV-seroconverting IDUs, and weight loss may be particularly common among IDUs experiencing primary HIV infection. PMID:8757430

  20. An overview of anthrax infection including the recently identified form of disease in injection drug users

    PubMed Central

    Hicks, Caitlin W.; Sweeney, Daniel A.; Cui, Xizhong; Li, Yan

    2012-01-01

    Purpose Bacillus anthracis infection (anthrax) can be highly lethal. Two recent outbreaks related to contaminated mail in the USA and heroin in the UK and Europe and its potential as a bioterrorist weapon have greatly increased concerns over anthrax in the developed world. Methods This review summarizes the microbiology, pathogenesis, diagnosis, and management of anthrax. Results and conclusions Anthrax, a gram-positive bacterium, has typically been associated with three forms of infection: cutaneous, gastrointestinal, and inhalational. However, the anthrax outbreak among injection drug users has emphasized the importance of what is now considered a fourth disease form (i.e., injectional anthrax) that is characterized by severe soft tissue infection. While cutaneous anthrax is most common, its early stages are distinct and prompt appropriate treatment commonly produces a good outcome. However, early symptoms with the other three disease forms can be nonspecific and mistaken for less lethal conditions. As a result, patients with gastrointestinal, inhalational, or injectional anthrax may have advanced infection at presentation that can be highly lethal. Once anthrax is suspected, the diagnosis can usually be made with gram stain and culture from blood or tissue followed by confirmatory testing (e.g., PCR). While antibiotics are the mainstay of anthrax treatment, use of adjunctive therapies such as anthrax toxin antagonists are a consideration. Prompt surgical therapy appears to be important for successful management of injectional anthrax. PMID:22527064

  1. Institutional ethical review and ethnographic research involving injection drug users: a case study.

    PubMed

    Small, Will; Maher, Lisa; Kerr, Thomas

    2014-03-01

    Ethnographic research among people who inject drugs (PWID) involves complex ethical issues. While ethical review frameworks have been critiqued by social scientists, there is a lack of social science research examining institutional ethical review processes, particularly in relation to ethnographic work. This case study describes the institutional ethical review of an ethnographic research project using observational fieldwork and in-depth interviews to examine injection drug use. The review process and the salient concerns of the review committee are recounted, and the investigators' responses to the committee's concerns and requests are described to illustrate how key issues were resolved. The review committee expressed concerns regarding researcher safety when conducting fieldwork, and the investigators were asked to liaise with the police regarding the proposed research. An ongoing dialogue with the institutional review committee regarding researcher safety and autonomy from police involvement, as well as formal consultation with a local drug user group and solicitation of opinions from external experts, helped to resolve these issues. This case study suggests that ethical review processes can be particularly challenging for ethnographic projects focused on illegal behaviours, and that while some challenges could be mediated by modifying existing ethical review procedures, there is a need for legislation that provides legal protection of research data and participant confidentiality. PMID:24581074

  2. Institutional Ethical Review and Ethnographic Research Involving Injection Drug Users: A Case Study

    PubMed Central

    Small, Will; Maher, Lisa; Kerr, Thomas

    2014-01-01

    Ethnographic research among people who inject drugs (PWID) involves complex ethical issues. While ethical review frameworks have been critiqued by social scientists, there is a lack of social science research examining institutional ethical review processes, particularly in relation to ethnographic work. This case study describes the institutional ethical review of an ethnographic research project using observational fieldwork and in-depth interviews to examine injection drug use. The review process and the salient concerns of the review committee are recounted, and the investigators’ responses to the committee’s concerns and requests are described to illustrate how key issues were resolved. The review committee expressed concerns regarding researcher safety when conducting fieldwork and the investigators were asked to liaise with the police regarding the proposed research. An ongoing dialogue with the institutional review committee regarding researcher safety and autonomy from police involvement, as well as formal consultation with a local drug user group and solicitation of opinions from external experts, helped to resolve these issues. This case study suggests that ethical review processes can be particularly challenging for ethnographic projects focused on illegal behaviours, and that while some challenges could be mediated by modifying existing ethical review procedures, there is a need for legislation that provides legal protection of research data and participant confidentiality. PMID:24581074

  3. Measuring altruistic & solidaristic orientations towards others among people who inject drugs

    PubMed Central

    Friedman, Samuel R.; Pouget, Enrique R.; Sandoval, Milagros; Jones, Yolanda; Nikolopoulos, Georgios; Mateu-Gelabert, Pedro

    2015-01-01

    Background Past research has found that HIV+ people who inject drugs (PWID) have high levels of consistent condom use in their partnerships with non-IDUs and in other behavioral expressions of what could be altruism or solidarity. Such research on PWID has been hindered by lack of appropriate measures of altruism and solidarity. Yet such measures may help us understand how people who inject drugs react when structural interventions or Big Events such as economic or political crises take place, and thus may also have major implications for HIV and other epidemics. Methods After considerable formative ethnography and pilot testing, we developed scales to assess altruistic and solidaristic orientations towards other drug users and non-drug users. We administered these scales to 300 PWID (56% male; 72% nonwhite; 98% income < $20,000) who were referred to our storefront location by a large respondent-driven sampling (RDS) project. Scale reliabilities were assessed using Cronbach's alpha; scale validity was assessed using Pearson's correlations with criterion variables. Results The 13-item Altruism Scale and the 9-item Solidarity Scale were both internally consistent (alpha = 0.91, 0.83, respectively). Each scale was correlated with how many hours participants help other people, local organizations, or the community in general during an average week (r = 0.33, p < 0.001; and 0.34, p < 0.001, respectively) and with bringing food or other necessities to others after the Hurricane Sandy emergency (r = 0.48, p < 0.001; and 0.41, p < 0.001, respectively). Conclusion These measures seem to be reliable and valid. They can be useful for a variety of studies of PWID and perhaps other people who use drugs. They can help us study both how (and if) Big Events or structural interventions affect altruism and solidarity among PWID and how (and if) altruism and solidarity are associated with changes in HIV or other risks among PWID. PMID:26076380

  4. [Apply association rules to analysis adverse drug reactions of shuxuening injection based on spontaneous reporting system data].

    PubMed

    Yang, Wei; Xie, Yan-Ming; Xiang, Yong-Yang

    2014-09-01

    This research based on the analysis of spontaneous reporting system (SRS) data which the 9 601 case reports of Shuxuening injection adverse drug reactions (ADR) in national adverse drug reaction monitoring center during 2005-2012. Apply to the association rules to analysis of the relationship between Shuxuening injection's ADR and the characteristics of ADR reports were. We found that ADR commonly combination were "nausea + breath + chills + vomiting", "nausea + chills + vomiting + palpitations", and their confidence level were 100%. The ADR and the case reports information commonly combination were "itching, and glucose and sodium chloride Injection, and generally ADR report, and normal dosage", "palpitation, and glucose and sodium chloride injection, and normal dosage, and new report", "chills, and generally ADR report, and normal dosage, and 0.9% sodium chloride injection", and their confidence level were 100% too. The results showed that patients using Shuxuening injection occurred most of ADRs were systemic damage, skin and its accessories damage, digestive system damage, etc. And most of cases were generally and new reports, and patients with normal dosage. The ADR's occurred had little related with solvent. It is showed that the Shuxuening injection occurred of ADR mainly related to drug composition. So Shuxuening injection used in clinical need to closely observation, and focus on the ADR reaction, and to do a good job of drug risk management. PMID:25532406

  5. Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial

    PubMed Central

    Strathdee, Steffanie A.; Ricketts, Erin P.; Huettner, Steven; Cornelius, Lee; Bishai, David; Havens, Jennifer R.; Beilenson, Peter; Rapp, Charles; Lloyd, Jacqueline J.; Latkin, Carl A.

    2007-01-01

    We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p = 0.03). In a multivariate “intention to treat’ model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional ‘as treated’ analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment. PMID:16364566

  6. Modeling hepatitis C virus transmission among people who inject drugs: Assumptions, limitations and future challenges

    PubMed Central

    Scott, Nick; Hellard, Margaret; McBryde, Emma Sue

    2016-01-01

    The discovery of highly effective hepatitis C virus (HCV) treatments has led to discussion of elimination and intensified interest in models of HCV transmission. In developed settings, HCV disproportionally affects people who inject drugs (PWID), and models are typically used to provide an evidence base for the effectiveness of interventions such as needle and syringe programs, opioid substitution therapy and more recently treating PWID with new generation therapies to achieve specified reductions in prevalence and / or incidence. This manuscript reviews deterministic compartmental S-I, deterministic compartmental S-I-S and network-based transmission models of HCV among PWID. We detail typical assumptions made when modeling injecting risk behavior, virus transmission, treatment and re-infection and how they correspond with available evidence and empirical data. PMID:26305706

  7. HIV risk, health, and social characteristics of sexual minority female injection drug users in Baltimore

    PubMed Central

    German, Danielle; Latkin, Carl A.

    2015-01-01

    Female injection drug users {IDU} who report sex with women are at increased risk for HIV and social instability, but it is important to assess whether these disparities also exist according to sexual minority identity rather than behaviorally defined categories. Within a sample of current IDU in Baltimore, about 17% of female study participants (n=307) identified as gay/lesbian/bisexual. In controlled models, sexual minorities were three times as likely to report sex exchange behavior and four times as likely to report a recent STI. Injection risk did not differ significantly, but sexual minority women reported higher prevalence of socio-economic instability, negative health indicators, and fewer network financial, material, and health support resources. There is a need to identify and address socio-economic marginalization, social support, and health issues among female IDUs who identify as lesbian or bisexual. PMID:25504312

  8. Recurrent deep venous thrombosis in an HIV-positive and injecting drug user woman.

    PubMed

    Dos Santos, Vitorino Modesto; Teles, Ludmila Thommen; Leão, Carlos Eduardo Silva; Lopes, Jânio Wagner Pinheiro; Fastudo, Custodio Abel; Lima, Regina Lucas Machada

    2012-01-01

    We report a case of recurrent deep venous thrombosis in a 44-year-old woman, intravenous drug user and HIV-infected, who injected cocaine in the groins and veins of the dorsum of the feet. She suffered several episodes of deep venous thrombosis and soft-tissue infections in the lower limbs. Images of Doppler ultrasound scan revealed thrombosis in the right popliteal vein with partial recanalization and calcified thrombi in the territory of the right femoral vein. After use of heparin and oral anticoagulation, her clinical evolution was uneventful, and she was asymptomatic at the occasion of the hospital discharge. This report calls for better awareness about injections in the groins and superficial femoral veins, which are part of the deep venous system. Thrombosis related to HIV infection is highlighted. PMID:22529454

  9. Modeling hepatitis C virus transmission among people who inject drugs: Assumptions, limitations and future challenges.

    PubMed

    Scott, Nick; Hellard, Margaret; McBryde, Emma Sue

    2016-02-17

    The discovery of highly effective hepatitis C virus (HCV) treatments has led to discussion of elimination and intensified interest in models of HCV transmission. In developed settings, HCV disproportionally affects people who inject drugs (PWID), and models are typically used to provide an evidence base for the effectiveness of interventions such as needle and syringe programs, opioid substitution therapy and more recently treating PWID with new generation therapies to achieve specified reductions in prevalence and / or incidence. This manuscript reviews deterministic compartmental S-I, deterministic compartmental S-I-S and network-based transmission models of HCV among PWID. We detail typical assumptions made when modeling injecting risk behavior, virus transmission, treatment and re-infection and how they correspond with available evidence and empirical data. PMID:26305706

  10. Will "Combined Prevention" Eliminate Racial/Ethnic Disparities in HIV Infection among Persons Who Inject Drugs in New York City?

    PubMed

    Des Jarlais, Don; Arasteh, Kamyar; McKnight, Courtney; Feelemyer, Jonathan; Hagan, Holly; Cooper, Hannah; Campbell, Aimee; Tross, Susan; Perlman, David

    2015-01-01

    It has not been determined whether implementation of combined prevention programming for persons who inject drugs reduce racial/ethnic disparities in HIV infection. We examine racial/ethnic disparities in New York City among persons who inject drugs after implementation of the New York City Condom Social Marketing Program in 2007. Quantitative interviews and HIV testing were conducted among persons who inject drugs entering Mount Sinai Beth Israel drug treatment (2007-2014). 703 persons who inject drugs who began injecting after implementation of large-scale syringe exchange were included in the analyses. Factors independently associated with being HIV seropositive were identified and a published model was used to estimate HIV infections due to sexual transmission. Overall HIV prevalence was 4%; Whites 1%, African-Americans 17%, and Hispanics 4%. Adjusted odds ratios were 21.0 (95% CI 5.7, 77.5) for African-Americans to Whites and 4.5 (95% CI 1.3, 16.3) for Hispanics to Whites. There was an overall significant trend towards reduced HIV prevalence over time (adjusted odd ratio = 0.7 per year, 95% confidence interval (0.6-0.8). An estimated 75% or more of the HIV infections were due to sexual transmission. Racial/ethnic disparities among persons who inject drugs were not significantly different from previous disparities. Reducing these persistent disparities may require new interventions (treatment as prevention, pre-exposure prophylaxis) for all racial/ethnic groups. PMID:25965957

  11. Will "Combined Prevention" Eliminate Racial/Ethnic Disparities in HIV Infection among Persons Who Inject Drugs in New York City?

    PubMed Central

    Des Jarlais, Don; Arasteh, Kamyar; McKnight, Courtney; Feelemyer, Jonathan; Hagan, Holly; Cooper, Hannah; Campbell, Aimee; Tross, Susan; Perlman, David

    2015-01-01

    It has not been determined whether implementation of combined prevention programming for persons who inject drugs reduce racial/ethnic disparities in HIV infection. We examine racial/ethnic disparities in New York City among persons who inject drugs after implementation of the New York City Condom Social Marketing Program in 2007. Quantitative interviews and HIV testing were conducted among persons who inject drugs entering Mount Sinai Beth Israel drug treatment (2007–2014). 703 persons who inject drugs who began injecting after implementation of large-scale syringe exchange were included in the analyses. Factors independently associated with being HIV seropositive were identified and a published model was used to estimate HIV infections due to sexual transmission. Overall HIV prevalence was 4%; Whites 1%, African-Americans 17%, and Hispanics 4%. Adjusted odds ratios were 21.0 (95% CI 5.7, 77.5) for African-Americans to Whites and 4.5 (95% CI 1.3, 16.3) for Hispanics to Whites. There was an overall significant trend towards reduced HIV prevalence over time (adjusted odd ratio = 0.7 per year, 95% confidence interval (0.6–0.8). An estimated 75% or more of the HIV infections were due to sexual transmission. Racial/ethnic disparities among persons who inject drugs were not significantly different from previous disparities. Reducing these persistent disparities may require new interventions (treatment as prevention, pre-exposure prophylaxis) for all racial/ethnic groups. PMID:25965957

  12. A qualitative study of the perceived effects of blue lights in washrooms on people who use injection drugs

    PubMed Central

    2013-01-01

    Background Blue lights are sometimes placed in public washrooms to discourage injection drug use. Their effectiveness has been questioned and concerns raised that they are harmful but formal research on the issue is limited to a single study. We gathered perceptions of people who use injection drugs on the effects of blue lights with the aim of informing harm reduction practice. Methods We interviewed 18 people in two Canadian cities who currently or previously used injection drugs to better understand their perceptions of the rationale for and consequences of blue lights in public washrooms. Results Participants described a preference for private places to use injection drugs, but explained that the need for an immediate solution would often override other considerations. While public washrooms were in many cases not preferred, their accessibility and relative privacy appear to make them reasonable compromises in situations involving urgent injecting. Participants understood the aim of blue lights to be to deter drug use. The majority had attempted to inject in a blue-lit washroom. While there was general agreement that blue lights do make injecting more difficult, a small number of participants were entirely undeterred by them, and half would use a blue-lit washroom if they needed somewhere to inject urgently. Participants perceived that, by making veins less visible, blue lights make injecting more dangerous. By dispersing public injection drug use to places where it is more visible, they also make it more stigmatizing. Despite recognizing these harms, more than half of the participants were not opposed to the continued use of blue lights. Conclusions Blue lights are unlikely to deter injection drugs use in public washrooms, and may increase drug use-related harms. Despite recognizing these negative effects, people who use injection drugs may be reluctant to advocate against their use. We attempt to reconcile this apparent contradiction by interpreting blue

  13. Expanded syringe exchange programs and reduced HIV infection among new injection drug users in Tallinn, Estonia

    PubMed Central

    2011-01-01

    Background Estonia has experienced an HIV epidemic among intravenous drug users (IDUs) with the highest per capita HIV prevalence in Eastern Europe. We assessed the effects of expanded syringe exchange programs (SEP) in the capital city, Tallinn, which has an estimated 10,000 IDUs. Methods SEP implementation was monitored with data from the Estonian National Institute for Health Development. Respondent driven sampling (RDS) interview surveys with HIV testing were conducted in Tallinn in 2005, 2007 and 2009 (involving 350, 350 and 327 IDUs respectively). HIV incidence among new injectors (those injecting for < = 3 years) was estimated by assuming (1) new injectors were HIV seronegative when they began injecting, and (2) HIV infection occurred at the midpoint between first injection and time of interview. Results SEP increased from 230,000 syringes exchanged in 2005 to 440,000 in 2007 and 770,000 in 2009. In all three surveys, IDUs were predominantly male (80%), ethnic Russians (>80%), and young adults (mean ages 24 to 27 years). The proportion of new injectors decreased significantly over the years (from 21% in 2005 to 12% in 2009, p = 0.005). HIV prevalence among all respondents stabilized at slightly over 50% (54% in 2005, 55% in 2007, 51% in 2009), and decreased among new injectors (34% in 2005, 16% in 2009, p = 0.046). Estimated HIV incidence among new injectors decreased significantly from 18/100 person-years in 2005 and 21/100 person-years in 2007 to 9/100 person-years in 2009 (p = 0.026). Conclusions In Estonia, a transitional country, a decrease in the HIV prevalence among new injectors and in the numbers of people initiating injection drug use coincided with implementation of large-scale SEPs. Further reductions in HIV transmission among IDUs are still required. Provision of 70 or more syringes per IDU per year may be needed before significant reductions in HIV incidence occur. PMID:21718469

  14. Drugscapes and the Role of Place and Space in Injection Drug Use-Related HIV Risk Environments

    PubMed Central

    Tempalski, Barbara; McQuie, Hilary

    2013-01-01

    Although considerable research has been conducted to identify the behavioural characteristics that predispose individuals to inject drugs or become infected with HIV via injection drug use, much less research has been conducted on structural and policy determinants, cultural norms, stigma, and ecological factors which may affect drug use risk behaviour, users’ networks and HIV rates associated with drug use across geographic areas. For programme planners, whether official or grassroots, an understanding of place-based characteristics can help better identify risk environments to injection drug use-related HIV, and determine how to facilitate actions regarding public policy and harm reduction to aid in the reduction of risk. As such, we consider in this commentary the importance of geographic place and the socio-spatial and political processes related to place that may help determine where IDU-related HIV risk environments occur. PMID:18554896

  15. Injection Drug User Quality of Life Scale (IDUQOL): Findings from a content validation study

    PubMed Central

    Hubley, Anita M; Palepu, Anita

    2007-01-01

    Background Quality of life studies among injection drug users have primarily focused on health-related measures. The chaotic life-style of many injection drug users (IDUs), however, extends far beyond their health, and impacts upon social relationships, employment opportunities, housing, and day to day survival. Most current quality of life instruments do not capture the realities of people living with addictions. The Injection Drug Users' Quality of Life Scale (IDUQOL) was developed to reflect the life areas of relevance to IDUs. The present study examined the content validity of the IDUQOL using judgmental methods based on subject matter experts' (SMEs) ratings of various elements of this measure (e.g., appropriateness of life areas or items, names and descriptions of life areas, instructions for administration and scoring). Methods Six SMEs were provided with a copy of the IDUQOL and its administration and scoring manual and a detailed content validation questionnaire. Two commonly used judgmental measures of inter-rater agreement, the Content Validity Index (CVI) and the Average Deviation Mean Index (ADM), were used to evaluate SMEs' agreement on ratings of IDUQOL elements. Results A total of 75 elements of the IDUQOL were examined. The CVI results showed that all elements were endorsed by the required number of SMEs or more. The ADM results showed that acceptable agreement (i.e., practical significance) was obtained for all elements but statistically significant agreement was missed for nine elements. For these elements, SMEs' feedback was examined for ways to improve the elements. Open-ended feedback also provided suggestions for other revisions to the IDUQOL. Conclusion The results of the study provided strong evidence in support of the content validity of the IDUQOL and direction for the revision of some IDUQOL elements. PMID:17663783

  16. Characterization of Occult Hepatitis B Infection Among Injecting Drug Users in Tehran, Iran

    PubMed Central

    Asli, Maryam; Kandelouei, Tahmineh; Rahimyan, Koroush; Davoodbeglou, Foad; Vaezjalali, Maryam

    2016-01-01

    Background Hepatitis B virus (HBV) infection is a major health problem worldwide. Objectives The aim of this study was to investigate the frequency of occult hepatitis B infection (OBI) and its associated risk factors, together with the molecular characterization of the virus in injecting drug users of Tehran. Patients and Methods The study consisted of 229 injecting drug users. Serum samples were collected and tested for the presence of hepatitis B core antibody (HBcAb) and hepatitis B surface antigen (HBsAg) by an enzyme-linked immunosorbent assay (ELISA). HBV B virus DNA was extracted from the serum samples, and a fragment of the S gene was amplified using the nested polymerase chain reaction. The genotype, subgenotypes, subtype, and S gene mutation of HBV were determined by direct sequencing. A phylogenetic tree was constructed using the neighbor-joining method. Results Sixty-four (28%) participants were HBcAb positive, 59 cases were HBcAb positive and HBsAg negative, and 5 cases were HBsAg positive. Hepatitis B DNA was found in three HBsAg-positive cases. Thirteen of 59 (22%) individuals were hepatitis B DNA positive. The phylogenetic tree of hepatitis B DNA showed the existence of genotype D. The only significant correlation was between sharing a syringe and OBI. Conclusions In comparison with the rate of HBcAb positivity reported in other Iranian studies, the rate was higher in the present study. There were a few variations, genotypes, and subtypes among the infected injecting drug users. Further investigations are needed to unravel the molecular characterization of OBI. PMID:27226802

  17. A cluster of Bacillus cereus bacteremia cases among injection drug users

    PubMed Central

    Benusic, Michael A; Press, Natasha M; Hoang, Linda MN; Romney, Marc G

    2015-01-01

    Bacillus cereus is a ubiquitous spore-forming organism that is infrequently implicated in extraintestinal infections. The authors report three cases of B cereus bacteremia among injection drug users presenting within one month to an urban tertiary care hospital. Treatment with intravenous vancomycin was successful in all three cases. While temporal association suggested an outbreak, molecular studies of patient isolates using pulsed-field gel electrophoresis did not suggest a common source. A review of the association of B cereus infections with heroin use and treatment of this pathogen is provided. PMID:26015795

  18. Big Events in Greece and HIV Infection Among People Who Inject Drugs

    PubMed Central

    Nikolopoulos, Georgios K.; Sypsa, Vana; Bonovas, Stefanos; Paraskevis, Dimitrios; Malliori-Minerva, Melpomeni; Hatzakis, Angelos; Friedman, Samuel R.

    2015-01-01

    Big Events are processes like macroeconomic transitions that have lowered social well-being in various settings in the past. Greece has been hit by the global crisis and experienced an HIV outbreak among people who inject drugs. Since the crisis began (2008), Greece has seen population displacement, inter-communal violence, cuts in governmental expenditures, and social movements. These may have affected normative regulation, networks, and behaviors. However, most pathways to risk remain unknown or unmeasured. We use what is known and unknown about the Greek HIV outbreak to suggest modifications in Big Events models and the need for additional research. PMID:25723309

  19. Human immunodeficiency virus among people who inject drugs: is risk increasing in Europe?

    PubMed

    Hedrich, D; Kalamara, E; Sfetcu, O; Pharris, A; Noor, A; Wiessing, L; Hope, V; Van de Laar, M

    2013-01-01

    In most European Union (EU)/European Economic Area (EEA) countries, between 2010 and 2012, reports of new human immunodeficiency virus (HIV) diagnoses among people who inject drugs have been stable or declining. HIV outbreaks in Greece and Romania, first reported in 2011, continue and economic conditions hinder provision of effective response coverage. When measured against some established thresholds, prevention coverage remains inadequate in at least one-third of EU/EEA countries. Urgent consideration to scale up prevention efforts is merited. PMID:24308980

  20. A cluster of Bacillus cereus bacteremia cases among injection drug users.

    PubMed

    Benusic, Michael A; Press, Natasha M; Hoang, Linda Mn; Romney, Marc G

    2015-01-01

    Bacillus cereus is a ubiquitous spore-forming organism that is infrequently implicated in extraintestinal infections. The authors report three cases of B cereus bacteremia among injection drug users presenting within one month to an urban tertiary care hospital. Treatment with intravenous vancomycin was successful in all three cases. While temporal association suggested an outbreak, molecular studies of patient isolates using pulsed-field gel electrophoresis did not suggest a common source. A review of the association of B cereus infections with heroin use and treatment of this pathogen is provided. PMID:26015795

  1. Agents of change: peer mentorship as HIV prevention among HIV-positive injection drug users.

    PubMed

    Mackenzie, Sonja; Pearson, Charles; Frye, Victoria; Gómez, Cynthia A; Latka, Mary H; Purcell, David W; Knowlton, Amy R; Metsch, Lisa R; Tobin, Karin E; Valverde, Eduardo E; Knight, Kelly R

    2012-04-01

    This paper presents a qualitative investigation of peer mentoring among HIV seropositive injection drug users in a randomized controlled trial, the INSPIRE study. Qualitative analyses of 68 in-depth open-ended interviews conducted in 2005 in Baltimore, New York, Miami, and San Francisco revealed that these individuals conceptualized themselves as change agents through the identity of peer mentor at the three related domains of individual, interpersonal, and community-level change. Implications for program development and future research of peer mentoring as a mechanism for HIV prevention are discussed. This study was funded by the Centers for Disease Control and Prevention and Health Resources and Services Administration (HRSA). PMID:22428820

  2. Could Education Contribute to Reduce Prevalence of HIV among Injecting Drug Users? A Case Study of IDUs from the Rehabilitation Center for Drugs Users

    ERIC Educational Resources Information Center

    Rajbhandari, Mani Man Singh

    2008-01-01

    This study primarily focuses on Injecting Drug Users (IDUs) from the Narconon Nepal for drugs rehabilitation and prevention center. The study attempt to explore the changing behavior of IDUs from the education received from the rehabilitation center which contributes to reduce the prevalence of HIV among IDUs. The data were collected through semi…

  3. Social and Structural Factors Associated with HIV Infection among Female Sex Workers Who Inject Drugs in the Mexico-US Border Region

    PubMed Central

    Strathdee, Steffanie A.; Lozada, Remedios; Martinez, Gustavo; Vera, Alicia; Rusch, Melanie; Nguyen, Lucie; Pollini, Robin A.; Uribe-Salas, Felipe; Beletsky, Leo; Patterson, Thomas L.

    2011-01-01

    Background FSWs who inject drugs (FSW-IDUs) can acquire HIV through high risk sexual and injection behaviors. We studied correlates of HIV infection among FSW-IDUs in northern Mexico, where sex work is quasi-legal and syringes can be legally obtained without a prescription. Methods FSW-IDUs>18 years old who reported injecting drugs and recent unprotected sex with clients in Tijuana and Ciudad Juarez underwent surveys and HIV/STI testing. Logistic regression identified correlates of HIV infection. Results Of 620 FSW-IDUs, prevalence of HIV, gonorrhea, Chlamydia, trichomonas, syphilis titers ≥1∶8, or any of these infections was 5.3%, 4%, 13%, 35%, 10% and 72%, respectively. Compared to other FSW-IDUs, HIV-positive women were more likely to: have syphilis titers ≥1∶8 (36% vs. 9%, p<0.001), often/always inject drugs with clients (55% vs. 32%, p = 0.01), and experience confiscation of syringes by police (49% vs. 28%, p = 0.02). Factors independently associated with HIV infection were syphilis titers ≥1∶8, often/always injecting with clients and police confiscation of syringes. Women who obtained syringes from NEPs (needle exchange programs) within the last month had lower odds of HIV infection associated with active syphilis, but among non-NEP attenders, the odds of HIV infection associated with active syphilis was significantly elevated. Conclusions Factors operating in both the micro-social environment (i.e., injecting drugs with clients) and policy environment (i.e., having syringes confiscated by police, attending NEPs) predominated as factors associated with risk of HIV infection, rather than individual-level risk behaviors. Interventions should target unjustified policing practices, clients' risk behaviors and HIV/STI prevention through NEPs. PMID:21541349

  4. Hepatitis C Virus Phylogenetic Clustering Is Associated with the Social-Injecting Network in a Cohort of People Who Inject Drugs

    PubMed Central

    Sacks-Davis, Rachel; Daraganova, Galina; Aitken, Campbell; Higgs, Peter; Tracy, Lilly; Bowden, Scott; Jenkinson, Rebecca; Rolls, David; Pattison, Philippa; Robins, Garry; Grebely, Jason; Barry, Alyssa; Hellard, Margaret

    2012-01-01

    It is hypothesized that social networks facilitate transmission of the hepatitis C virus (HCV). We tested for association between HCV phylogeny and reported injecting relationships using longitudinal data from a social network design study. People who inject drugs were recruited from street drug markets in Melbourne, Australia. Interviews and blood tests took place three monthly (during 2005–2008), with participants asked to nominate up to five injecting partners at each interview. The HCV core region of individual isolates was then sequenced and phylogenetic trees were constructed. Genetic clusters were identified using bootstrapping (cut-off: 70%). An adjusted Jaccard similarity coefficient was used to measure the association between the reported injecting relationships and relationships defined by clustering in the phylogenetic analysis (statistical significance assessed using the quadratic assignment procedure). 402 participants consented to participate; 244 HCV infections were observed in 238 individuals. 26 genetic clusters were identified, with 2–7 infections per cluster. Newly acquired infection (AOR = 2.03, 95% CI: 1.04–3.96, p = 0.037, and HCV genotype 3 (vs. genotype 1, AOR = 2.72, 95% CI: 1.48–4.99) were independent predictors of being in a cluster. 54% of participants whose infections were part of a cluster in the phylogenetic analysis reported injecting with at least one other participant in that cluster during the study. Overall, 16% of participants who were infected at study entry and 40% of participants with newly acquired infections had molecular evidence of related infections with at least one injecting partner. Likely transmission clusters identified in phylogenetic analysis correlated with reported injecting relationships (adjusted Jaccard coefficient: 0.300; p<0.001). This is the first study to show that HCV phylogeny is associated with the injecting network, highlighting the importance of the injecting network in HCV

  5. Pilot experiments on the actions of drugs injected into the human corpus cavernosum penis.

    PubMed Central

    Brindley, G. S.

    1986-01-01

    Seven drugs that are known to relax smooth muscle (phenoxybenzamine, phentolamine, thymoxamine, imipramine, verapamil, papaverine, naftidrofuryl) caused erection when injected intracavernosally. Salbutamol, hydralazine, lignocaine and bupivacaine caused tumidity but not erection. Metaraminol and guanethidine caused shrinkage followed by tumidity. Neostigmine, atropine, propranolol and idazoxan had no effect in the doses tried. It is argued that the seven drugs that cause erection do so by relaxing vascular and trabecular smooth muscle within the cavernosal space, and that the two that cause shrinkage of the penis do so by constricting vascular and trabecular smooth muscle within the cavernosal space. It is argued that muscarinic and beta-adrenergic transmission play no important part in erectile mechanisms within the corpora cavernosa. Papaverine, phenoxybenzamine and metaraminol, given intracavernosally, are already used therapeutically. Uses are suggested for thymoxamine, phentolamine, verapamil and guanethidine. PMID:3801762

  6. Time Varying Apparent Volume of Distribution and Drug Half-Lives Following Intravenous Bolus Injections

    PubMed Central

    Wesolowski, Carl A.; Wesolowski, Michal J.; Babyn, Paul S.

    2016-01-01

    We present a model that generalizes the apparent volume of distribution and half-life as functions of time following intravenous bolus injection. This generalized model defines a time varying apparent volume of drug distribution. The half-lives of drug remaining in the body vary in time and become longer as time elapses, eventually converging to the terminal half-life. Two example fit models were substituted into the general model: biexponential models from the least relative concentration error, and gamma variate models using adaptive regularization for least relative error of clearance. Using adult population parameters from 41 studies of the renal glomerular filtration marker 169Yb-DTPA, simulations of extracellular fluid volumes of 5, 10, 15 and 20 litres and plasma clearances of 40 and 100 ml/min were obtained. Of these models, the adaptively obtained gamma variate models had longer times to 95% of terminal volume and longer half-lives. PMID:27403663

  7. Prevalence and Correlates of Former Injection Drug Use Among Young Non-injecting Heroin Users in Chicago

    PubMed Central

    Broz, Dita; Ouellet, Lawrence J.

    2013-01-01

    Non-injecting heroin users (NIHU) 16–30 years-old were street recruited in Chicago between 2002–2005 to examine factors associated with having ever injected. Participants completed computerized self-administered interviews and provided specimens for HIV and hepatitis serotesting. Of 689 NIHU, 51.2% were non-Hispanic Black, 64.4% were male, and the median age was 25 years. Former injection was reported by 17.9%; of those, 66.7% injected <10 times. Multivariable analysis identified individual and social factors that place young NIHU at increased risk of injection. Targeted interventions are necessary to prevent transitions to injection and reduce transmission of HIV and viral hepatitis infections. PMID:20380556

  8. Perceived risk of HIV infection among deported male injection drug users in Tijuana, Mexico

    PubMed Central

    Pinedo, Miguel; Burgos, José Luis; Robertson, Angela M.; Vera, Alicia; Lozada, Remedios; Ojeda, Victoria D.

    2014-01-01

    Deported injection drug users (IDUs) in Mexico may be vulnerable to HIV infection following expulsion from the U.S. We examined factors associated with HIV risk perception among a sample of deportees in Tijuana. From January to April 2010, 313 male IDUs who reported ever being deported from the U.S. completed a questionnaire. Overall, 35% (N=110) of deportees perceived HIV risk. In multivariate logistic regression analyses, factors independently associated with HIV risk perception included: ever having a steady female partner in Tijuana post-deportation (Adjusted Odds Ratio (AOR): 2.26; 95% Confidence Interval (CI): 1.01-5.07) and years spent in a U.S. prison (AOR: 1.29 per year; 95% CI: 1.13-1.48). Conversely, years of drug injection use (AOR: 0.95 per year; 95% CI: 0.91-0.99), ever witnessing family members use drugs prior to first migration trip (AOR: 0.24; 95% CI: 0.09-0.65), years of residence in the United States (AOR: 0.91 per year; 95% CI: 0.84-0.98) and being a Tijuana-native (AOR: 0.40; 95% CI: 0.16-0.99) were negatively associated HIV risk perception. U.S.-Mexico border cities that receive deported migrants should target HIV prevention interventions to specific subgroups, including drug-using male deportees. Interventions should consider migrant's time in the U.S., the role of their social networks, and reducing missed opportunities for HIV testing/education. PMID:24650124

  9. Active ultrasound pattern injection system (AUSPIS) for interventional tool guidance.

    PubMed

    Guo, Xiaoyu; Kang, Hyun-Jae; Etienne-Cummings, Ralph; Boctor, Emad M

    2014-01-01

    Accurate tool tracking is a crucial task that directly affects the safety and effectiveness of many interventional medical procedures. Compared to CT and MRI, ultrasound-based tool tracking has many advantages, including low cost, safety, mobility and ease of use. However, surgical tools are poorly visualized in conventional ultrasound images, thus preventing effective tool tracking and guidance. Existing tracking methods have not yet provided a solution that effectively solves the tool visualization and mid-plane localization accuracy problem and fully meets the clinical requirements. In this paper, we present an active ultrasound tracking and guiding system for interventional tools. The main principle of this system is to establish a bi-directional ultrasound communication between the interventional tool and US imaging machine within the tissue. This method enables the interventional tool to generate an active ultrasound field over the original imaging ultrasound signals. By controlling the timing and amplitude of the active ultrasound field, a virtual pattern can be directly injected into the US machine B mode display. In this work, we introduce the time and frequency modulation, mid-plane detection, and arbitrary pattern injection methods. The implementation of these methods further improves the target visualization and guiding accuracy, and expands the system application beyond simple tool tracking. We performed ex vitro and in vivo experiments, showing significant improvements of tool visualization and accurate localization using different US imaging platforms. An ultrasound image mid-plane detection accuracy of ±0.3 mm and a detectable tissue depth over 8.5 cm was achieved in the experiment. The system performance is tested under different configurations and system parameters. We also report the first experiment of arbitrary pattern injection to the B mode image and its application in accurate tool tracking. PMID:25337784

  10. Active Ultrasound Pattern Injection System (AUSPIS) for Interventional Tool Guidance

    PubMed Central

    Guo, Xiaoyu; Kang, Hyun-Jae; Etienne-Cummings, Ralph; Boctor, Emad M.

    2014-01-01

    Accurate tool tracking is a crucial task that directly affects the safety and effectiveness of many interventional medical procedures. Compared to CT and MRI, ultrasound-based tool tracking has many advantages, including low cost, safety, mobility and ease of use. However, surgical tools are poorly visualized in conventional ultrasound images, thus preventing effective tool tracking and guidance. Existing tracking methods have not yet provided a solution that effectively solves the tool visualization and mid-plane localization accuracy problem and fully meets the clinical requirements. In this paper, we present an active ultrasound tracking and guiding system for interventional tools. The main principle of this system is to establish a bi-directional ultrasound communication between the interventional tool and US imaging machine within the tissue. This method enables the interventional tool to generate an active ultrasound field over the original imaging ultrasound signals. By controlling the timing and amplitude of the active ultrasound field, a virtual pattern can be directly injected into the US machine B mode display. In this work, we introduce the time and frequency modulation, mid-plane detection, and arbitrary pattern injection methods. The implementation of these methods further improves the target visualization and guiding accuracy, and expands the system application beyond simple tool tracking. We performed ex vitro and in vivo experiments, showing significant improvements of tool visualization and accurate localization using different US imaging platforms. An ultrasound image mid-plane detection accuracy of ±0.3 mm and a detectable tissue depth over 8.5 cm was achieved in the experiment. The system performance is tested under different configurations and system parameters. We also report the first experiment of arbitrary pattern injection to the B mode image and its application in accurate tool tracking. PMID:25337784

  11. The Washington Needle Depot: fitting healthcare to injection drug users rather than injection drug users to healthcare: moving from a syringe exchange to syringe distribution model.

    PubMed

    Small, Dan; Glickman, Andrea; Rigter, Galen; Walter, Thia

    2010-01-01

    Needle exchange programs chase political as well as epidemiological dragons, carrying within them both implicit moral and political goals. In the exchange model of syringe distribution, injection drug users (IDUs) must provide used needles in order to receive new needles. Distribution and retrieval are co-existent in the exchange model. Likewise, limitations on how many needles can be received at a time compel addicts to have multiple points of contact with professionals where the virtues of treatment and detox are impressed upon them. The centre of gravity for syringe distribution programs needs to shift from needle exchange to needle distribution, which provides unlimited access to syringes. This paper provides a case study of the Washington Needle Depot, a program operating under the syringe distribution model, showing that the distribution and retrieval of syringes can be separated with effective results. Further, the experience of IDUs is utilized, through paid employment, to provide a vulnerable population of people with clean syringes to prevent HIV and HCV. PMID:20047690

  12. The Washington Needle Depot: fitting healthcare to injection drug users rather than injection drug users to healthcare: moving from a syringe exchange to syringe distribution model

    PubMed Central

    2010-01-01

    Needle exchange programs chase political as well as epidemiological dragons, carrying within them both implicit moral and political goals. In the exchange model of syringe distribution, injection drug users (IDUs) must provide used needles in order to receive new needles. Distribution and retrieval are co-existent in the exchange model. Likewise, limitations on how many needles can be received at a time compel addicts to have multiple points of contact with professionals where the virtues of treatment and detox are impressed upon them. The centre of gravity for syringe distribution programs needs to shift from needle exchange to needle distribution, which provides unlimited access to syringes. This paper provides a case study of the Washington Needle Depot, a program operating under the syringe distribution model, showing that the distribution and retrieval of syringes can be separated with effective results. Further, the experience of IDUs is utilized, through paid employment, to provide a vulnerable population of people with clean syringes to prevent HIV and HCV. PMID:20047690

  13. A mimic of soft tissue infection: intra-arterial injection drug use producing hand swelling and digital ischemia

    PubMed Central

    Foster, Sean D.; Lyons, Michael S.; Runyan, Christopher M.; Otten, Edward J.

    2015-01-01

    BACKGROUND: Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identifying complications of intra-arterial injection can be difficult, as clinical manifestations overlap with other more common conditions such as cellulitis and soft tissue infection, and a history of injection drug use is frequently not disclosed. METHODS: A 37-year-old male patient presented with 24 hours of right hand pain, erythema and swelling. Despite classic “track marks”, he denied a history of injection drug use, and vascular insults were not initially considered. After failing to respond to three days of aggressive treatment for suspected deep-space infection, an arteriogram demonstrated findings consistent with digital ischemia of embolic etiology. RESULTS: As a result of the delay in diagnosis, the lesion was not amenable to reperfusion and the patient required amputation of the distal digit. CONCLUSION: Practitioners should be alert to the possibility of intra-arterial injection and resulting complications when evaluating unusual extremity infections or unexplained ischemic symptoms, even in the absence of a definite history of injection drug use. PMID:26401188

  14. Propacetamol-Induced Injection Pain Is Associated with Activation of Transient Receptor Potential Vanilloid 1 Channels.

    PubMed

    Schillers, Florian; Eberhardt, Esther; Leffler, Andreas; Eberhardt, Mirjam

    2016-10-01

    Propacetamol (PPCM) is a prodrug of paracetamol (PCM), which was generated to increase water solubility of PCM for intravenous delivery. PPCM is rapidly hydrolyzed by plasma esterases to PCM and diethylglycine and shares some structural and metabolic properties with lidocaine. Although PPCM is considered to be comparable to PCM regarding its analgesic properties, injection pain is a common side effect described for PPCM but not PCM. Injection pain is a frequent and unpleasant side effect of numerous drugs in clinical use, and previous reports have indicated that the ligand gated ion channels transient receptor potential ankyrin 1 (TRPA1) and transient receptor potential vanilloid 1 (TRPV1) can mediate this effect on sensory neurons. This study aimed to investigate molecular mechanisms by which PPCM, in contrast to PCM, causes injection pain. Therefore, human TRPV1 and TRPA1 receptors were expressed in human embryonic kidney 293 cells and investigated by means of whole-cell patch clamp and ratiometric calcium imaging. PPCM (but not PCM) activated TRPV1, sensitized heat-induced currents, and caused an increase in intracellular calcium. In TRPA1-expressing cells however, both PPCM and PCM evoked calcium responses but failed to induce inward currents. Intracutaneous injection of PPCM, but not of PCM, in human volunteers induced an intense and short-lasting pain and an increase in superficial blood flow, indicating activation of nociceptive C fibers and subsequent neuropeptide release. In conclusion, activation of human TRPV1 by PPCM seems to be a relevant mechanism for induction of pain upon intracutaneous injection and thus also for pain reported as an adverse side effect upon intravenous administration. PMID:27457427

  15. Factorial design studies of antiretroviral drug-loaded stealth liposomal injectable: PEGylation, lyophilization and pharmacokinetic studies

    NASA Astrophysics Data System (ADS)

    Sudhakar, Beeravelli; Krishna, Mylangam Chaitanya; Murthy, Kolapalli Venkata Ramana

    2016-01-01

    The aim of the present study was to formulate and evaluate the ritonavir-loaded stealth liposomes by using 32 factorial design and intended to delivered by parenteral delivery. Liposomes were prepared by ethanol injection method using 32 factorial designs and characterized for various physicochemical parameters such as drug content, size, zeta potential, entrapment efficiency and in vitro drug release. The optimization process was carried out using desirability and overlay plots. The selected formulation was subjected to PEGylation using 10 % PEG-10000 solution. Stealth liposomes were characterized for the above-mentioned parameters along with surface morphology, Fourier transform infrared spectrophotometer, differential scanning calorimeter, stability and in vivo pharmacokinetic studies in rats. Stealth liposomes showed better result compared to conventional liposomes due to effect of PEG-10000. The in vivo studies revealed that stealth liposomes showed better residence time compared to conventional liposomes and pure drug solution. The conventional liposomes and pure drug showed dose-dependent pharmacokinetics, whereas stealth liposomes showed long circulation half-life compared to conventional liposomes and pure ritonavir solution. The results of statistical analysis showed significance difference as the p value is (<0.05) by one-way ANOVA. The result of the present study revealed that stealth liposomes are promising tool in antiretroviral therapy.

  16. Sterile syringe access and disposal among injection drug users newly enrolled in methadone maintenance treatment: a cross-sectional survey

    PubMed Central

    McNeely, Jennifer; Arnsten, Julia H; Gourevitch, Marc N

    2006-01-01

    Background We sought to assess injection practices, means of acquiring and disposing of syringes, and utilization and knowledge of harm reduction resources among injection drug users (IDUs) entering methadone maintenance treatment (MMT). Methods Interviews with 100 consecutive patients, including 35 IDUs, entering a MMT program in the Bronx, NY. Results Utilization of unsafe syringe sources was reported by 69% of IDUs in our sample. Most (80%) IDUs reused syringes, and syringe sharing was also common. Fewer than half knew that non-prescription pharmacy purchase of syringes was possible. The most common means of disposing of injecting equipment were the trash (63%) and syringe exchange programs (49%). Conclusions These findings indicate that drug users entering treatment under-utilize sanctioned venues to obtain sterile syringes or safely dispose of used injection equipment. Programs providing services to drug users should adopt a proactive stance to address the safety and health issues faced by injectors. PMID:16503997

  17. Estimating the variability in the risk of infection for hepatitis C in the Glasgow injecting drug user population.

    PubMed

    Sutton, A J; McDonald, S A; Palmateer, N; Taylor, A; Hutchinson, S J

    2012-12-01

    Glasgow (Scotland's largest city) has a high prevalence of injecting drug use and has one of the highest prevalences of hepatitis C virus (HCV) infection in injecting drug users (IDUs) in Western Europe. HCV prevalence data from surveys of Glasgow's IDUs from 1990 to 2007 were utilized and a model was applied that described the prevalence of HCV as a function of the rate (force) of infection. Force-of-infection estimates for HCV that may vary over time and injecting career length over a range of variables were investigated. New initiates to injecting were found to be at increased risk of HCV infection, with being recruited from a street location and reporting injecting in prison leading to a significant increase in the risk of infection in new initiates. These results indicate areas of importance for the planning of public health measures that target the IDU population. PMID:22459739

  18. Bisexual Behavior Among Male Injection Drug Users in New York City.

    PubMed

    Reilly, Kathleen H; Neaigus, Alan; Wendel, Travis; Marshall, David M; Hagan, Holly

    2016-02-01

    Drug using men who have sex with men and women (MSMW) may be at high risk for HIV infection and transmitting HIV to sex partners. In 2012, injection drug users (IDUs) were sampled in New York City for the National HIV Behavioral Surveillance cross-sectional study using respondent-driven sampling. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95 % confidence intervals (95 %CI) to determine correlates of bisexual behavior in the past 12 months. Of 333 participants, 47(14.1 %) reported MSMW. Variables independently associated (p < 0.05) with MSMW included bisexual sexual identity (vs. "straight") (adjusted odds ratio (aOR) 92.6; 95 % CI 18.9, 454.5), Bronx residence [vs. Manhattan (aOR 8.4; 95 %CI 1.6,43.7)], past 12 month behaviors of having sex with ≥3 sex partners (aOR 18.1; 95 % CI 3.3,98.4), "sold" sex (aOR 8.5; 95 % CI 2.3, 31.5), "bought" sex (aOR 0.2; 95 % CI 0.1, 0.9), and injection methamphetamine use (aOR 20.5; 95 % CI 3.0, 139.7). MSM IDUs are an important subgroup to consider for HIV interventions, as they may not be reached through HIV prevention programming aimed at MSM. PMID:26607927

  19. Portraying persons who inject drugs recently infected with hepatitis C accessing antiviral treatment: a cluster analysis.

    PubMed

    Bamvita, Jean-Marie; Roy, Elise; Zang, Geng; Jutras-Aswad, Didier; Artenie, Andreea Adelina; Levesque, Annie; Bruneau, Julie

    2014-01-01

    Objectives. To empirically determine a categorization of people who inject drug (PWIDs) recently infected with hepatitis C virus (HCV), in order to identify profiles most likely associated with early HCV treatment uptake. Methods. The study population was composed of HIV-negative PWIDs with a documented recent HCV infection. Eligibility criteria included being 18 years old or over, and having injected drugs in the previous 6 months preceding the estimated date of HCV exposure. Participant classification was carried out using a TwoStep cluster analysis. Results. From September 2007 to December 2011, 76 participants were included in the study. 60 participants were eligible for HCV treatment. Twenty-one participants initiated HCV treatment. The cluster analysis yielded 4 classes: class 1: Lukewarm health seekers dismissing HCV treatment offer; class 2: multisubstance users willing to shake off the hell; class 3: PWIDs unlinked to health service use; class 4: health seeker PWIDs willing to reverse the fate. Conclusion. Profiles generated by our analysis suggest that prior health care utilization, a key element for treatment uptake, differs between older and younger PWIDs. Such profiles could inform the development of targeted strategies to improve health outcomes and reduce HCV infection among PWIDs. PMID:25349730

  20. Infections with spore-forming bacteria in persons who inject drugs, 2000-2009.

    PubMed

    Palmateer, Norah E; Hope, Vivian D; Roy, Kirsty; Marongiu, Andrea; White, Joanne M; Grant, Kathie A; Ramsay, Colin N; Goldberg, David J; Ncube, Fortune

    2013-01-01

    Since 2000 in the United Kingdom, infections caused by spore-forming bacteria have been associated with increasing illness and death among persons who inject drugs (PWID). To assess temporal and geographic trends in these illnesses (botulism, tetanus, Clostridium novyi infection, and anthrax), we compared rates across England and Scotland for 2000-2009. Overall, 295 infections were reported: 1.45 per 1,000 PWID in England and 4.01 per 1,000 PWID in Scotland. The higher rate in Scotland was mainly attributable to C. novyi infection and anthrax; rates of botulism and tetanus were comparable in both countries. The temporal and geographic clustering of cases of C. novyi and anthrax into outbreaks suggests possible contamination of specific heroin batches; in contrast, the more sporadic nature of tetanus and botulism cases suggests that these spores might more commonly exist in the drug supply or local environment although at varying levels. PWID should be advised about treatment programs, injecting hygiene, risks, and vaccinations. PMID:23260795

  1. Syringe Sharing and HIV Incidence Among Injection Drug Users and Increased Access to Sterile Syringes

    PubMed Central

    Small, Will; Buchner, Chris; Zhang, Ruth; Li, Kathy; Montaner, Julio; Wood, Evan

    2010-01-01

    Objectives. We assessed the effects of syringe exchange program (SEP) policy on rates of HIV risk behavior and HIV incidence among injection drug users. Methods. Using a multivariate generalized estimating equation and Cox regression methods, we examined syringe borrowing, syringe lending, and HIV incidence among a prospective cohort of 1228 injection drug users in Vancouver, British Columbia. Results. We observed substantial declines in rates of syringe borrowing (from 20.1% in 1998 to 9.2% in 2003) and syringe lending (from 19.1% in 1998 to 6.8% in 2003) following SEP policy change. These declines coincided with a statistically significant increase in the proportion of participants accessing sterile syringes from nontraditional SEP sources (P < .001). In multivariate analyses, the period following the change in SEP policy was independently associated with a greater than 40% reduction in syringe borrowing (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI] = 0.49, 0.65) and lending (AOR = 0.52; 95% CI = 0.45, 0.60), as well as declining HIV incidence (adjusted hazard ratio = 0.13; 95% CI = 0.06, 0.31). Conclusions. Widespread syringe distribution appears to be a more effective SEP policy than do more restrictive SEP policies that limit syringe access. Efforts should be made to ensure that SEP policies and program design serve to maximize rather than hinder syringe access. PMID:20558797

  2. Evaluation of drug-induced tissue injury by measuring alanine aminotransferase (ALT) activity in silkworm hemolymph

    PubMed Central

    2012-01-01

    Background Our previous studies suggest silkworms can be used as model animals instead of mammals in pharmacologic studies to develop novel therapeutic medicines. We examined the usefulness of the silkworm larvae Bombyx mori as an animal model for evaluating tissue injury induced by various cytotoxic drugs. Drugs that induce hepatotoxic effects in mammals were injected into the silkworm hemocoel, and alanine aminotransferase (ALT) activity was measured in the hemolymph 1 day later. Results Injection of CCl4 into the hemocoel led to an increase in ALT activity. The increase in ALT activity was attenuated by pretreatment with N-acetyl-L-cysteine. Injection of benzoic acid derivatives, ferric sulfate, sodium valproate, tetracycline, amiodarone hydrochloride, methyldopa, ketoconazole, pemoline (Betanamin), N-nitroso-fenfluramine, and D-galactosamine also increased ALT activity. Conclusions These findings indicate that silkworms are useful for evaluating the effects of chemicals that induce tissue injury in mammals. PMID:23137391

  3. Quality of life, depression, anxiety and suicidal ideation among men who inject drugs in Delhi, India

    PubMed Central

    2013-01-01

    Background Mental disorders such as depression, anxiety and suicide represent an important public health problem in India. Elsewhere in the world a high prevalence of symptoms of common mental disorders have been found among people who inject drugs (PWID). Research in India has largely overlooked symptoms of common mental disorders among this high risk group. This paper reports on the results of a survey examining quality of life, depression, anxiety and suicidal ideation among adult males who inject drugs living in Delhi. Methods Participants (n = 420) were recruited from needle and syringe programs using time location sampling and were interviewed using an interviewer-administered questionnaire. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts and attempts within the past 12 months. Results The mean length of injecting career was 20.9 years indicating a sample of chronic injecting drug users, of whom only one-third (38%) were born in Delhi. The level of illiteracy was very high (62%), and just 2% had completed class 12. Scavenging / rag picking was the main form of income for 48%, and many were homeless (69%). One-third (33%) had been beaten up at least twice during the preceding 6 months, and many either never (45%) or rarely (27%) attended family events. We found a high prevalence of depressive (84%, cut-off ≥10) and anxiety (71%, cut-off score of ≥3) symptoms. Fifty-three percent thought about killing themselves in the past 12 months, and 36% had attempted to kill themselves. Conclusions Our findings revealed a socially excluded population of PWID in Delhi who have minimal education and are often homeless, leaving them vulnerable to physical violence, poverty, poor health, imprisonment and disconnection from family. The high prevalence of psychological distress found in this study has implications for

  4. Correlates of Injection Drug Use among Female Sex Workers in Two Mexico-U.S. Border Cities

    PubMed Central

    Strathdee, Steffanie A.; Philbin, Morgan M.; Semple, Shirley J.; Pu, Minya; Orozovich, Prisci; Martinez, Gustavo; Lozada, Remedios; Fraga, Miguel; de la Torre, Adela; Staines, Hugo; Magis-Rodríguez, Carlos; Patterson, Thomas L.

    2008-01-01

    Objective: To characterize the overlap between injection drug use and sex work by women in Tijuana and Cd. Juarez, situated on the Mexico-U.S. border. Methods: FSWs aged ≥18 years who were not knowingly HIV-positive and reported having unprotected sex with ≥1 client in the prior two months underwent interviews and testing for HIV, syphilis gonorrhea and Chlamydia. Logistic regression identified factors associated with injecting drugs within the last month. Results: Of 924 FSWs, 18.0% had ever injected drugs. Among FSW-IDUs (N=114), prevalence of HIV, syphilis titers >1:8, gonorrhea and Chlamydia was significantly higher at 12.3%, 22.7%, 15.2% and 21.2% compared to 4.8%, 13.1%, 5.2% and 11.9% among other FSWs (N=810). FSW-IDUs also had more clients in the past six months (median: 300 vs. 240, p=0.02). Factors independently associated with injecting drugs in the past month included living in Tijuana, being younger, being married/common-law, longer duration in the sex trade, speaking English, earning less for sex without condoms, often using drugs before sex, and knowing other FSWs who injected drugs. Conclusions: FSW-IDUs had higher STI levels, engaged in riskier behaviors and were more vulnerable to having unsafe sex with clients compared to other FSWs, indicating that this subgroup is an important bridge population requiring focused prevention. PMID:17714888

  5. Short-Term Cessation of Sex Work and Injection Drug Use: Evidence from a Recurrent Event Survival Analysis

    PubMed Central

    Gaines, Tommi L.; Urada, Lianne; Martinez, Gustavo; Goldenberg, Shira M.; Rangel, Gudelia; Reed, Elizabeth; Patterson, Thomas L.; Strathdee, Steffanie A.

    2015-01-01

    Objective This study quantitatively examined the prevalence and correlates of short-term sex work cessation among female sex workers who inject drugs (FSW-IDUs) and determined whether injection drug use was independently associated with cessation. Methods We used data from FSW-IDUs (n=467) enrolled into an intervention designed to increase condom use and decrease sharing of injection equipment but was not designed to promote sex work cessation. We applied a survival analysis that accounted for quit-re-entry patterns of sex work over 1-year stratified by city, Tijuana and Ciudad Juarez, Mexico. Results Overall, 55% of participants stopped sex work at least once during follow-up. Controlling for other characteristics and intervention assignment, injection drug use was inversely associated with short-term sex work cessation in both cities. In Ciudad Juarez, women receiving drug treatment during follow-up had a 2-fold increase in the hazard of stopping sex work. In both cities, income from sources other than sex work, police interactions and healthcare access were independently and significantly associated with shorter-term cessation. Conclusions Short-term sex work cessation was significantly affected by injection drug use. Expanded drug treatment and counseling coupled with supportive services such as relapse prevention, job training, and provision of alternate employment opportunities may promote longer-term cessation among women motivated to leave the sex industry. PMID:25644589

  6. Potential impact of vaccination on the hepatitis C virus epidemic in injection drug users

    PubMed Central

    Hahn, Judith A.; Wylie, Dennis; Dill, Jesse; Sanchez, Maria S.; Lloyd-Smith, James O.; Page-Shafer, Kimberly; Getz, Wayne M.

    2010-01-01

    Background Hepatitis C virus (HCV) causes significant morbidity and mortality in injecting drug users (IDU) worldwide. HCV vaccine candidates have shown promise for reducing the infectivity of acute infection and averting chronic infection, yet the impact of varying levels of vaccine efficacy and vaccine delivery strategies on the HCV epidemic in IDU have not been explored. Methods We utilized extensive data on injecting behavior collected in the UFO Study of young IDU in San Francisco to construct a stochastic individual-based model that reflects heterogeneous injecting risk behavior, historical HCV trends, and existing information on viral dynamics and vaccine characteristics. Results Our modeled HCV rate closely paralleled observed HCV incidence in San Francisco, with estimated incidence of 59% per person year (ppy) early in the epidemic, and 27% ppy after risk reduction was introduced. Chronic HCV infection, the clinically relevant state of HCV infection that leads to liver disease and hepatocellular cancer, was estimated at 22% ppy (±3%) early in the epidemic and 14% ppy (±2%) after risk reduction was introduced. We considered several scenarios, and highlight that a vaccine with 50% to 80% efficacy targeted to high-risk or sero-negative IDU at a high vaccination rate could further reduce chronic HCV incidence in IDU to 2–7% ppy 30 years after its introduction. Conclusions Our results underscore the importance of further efforts to develop both HCV vaccines and optimal systems of delivery to IDU populations. PMID:20445816

  7. Route of Nicotine Administration Influences In Vivo Dopamine Neuron Activity: Habituation, Needle Injection, and Cannula Infusion

    PubMed Central

    Dong, Yu; Zhang, Tianxiang; Li, Wei; Doyon, William; Dani, John A.

    2010-01-01

    Mesolimbic dopamine (DA) systems play a critical role in tobacco addiction driven by nicotine. Nicotine activates midbrain DA neurons and, consequently, elevates DA concentrations in targets, especially in the nucleus accumbens (NAc) of the ventral striatum. The route of drug administration influences the impact of addictive drugs. Here, we examine whether the nature of the administration alters DA neuron activity and DA concentrations in the NAc. Using unhabituated naïve freely moving rats, microdialysis measurements showed that nicotine administered via needle injection caused greater DA release in the NAc than the same dose administered via an implanted chronic cannula. After habituation to the needle injections, however, there was no significant difference in DA signaling between the needle and cannula routes of administration. Consistent with these microdialysis results after habituation, our in vivo tetrode unit recordings showed no significant difference in midbrain DA neuron activity in response to nicotine delivered by needle or cannula as long as predictive cues were avoided. PMID:19714495

  8. Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California

    PubMed Central

    Wagner, Karla D.; Armenta, Richard F.; Roth, Alexis M.; Maxwell, Jane C.; Cuevas-Mota, Jazmine; Garfein, Richard S.

    2014-01-01

    Background Use of synthetic cathinones (SC) and cannabimimetics (i.e., “THC homologues” [TH]) is associated with adverse health effects. We investigated the epidemiology of synthetic drug use among a cohort of injection drug users (IDUs) in San Diego, California. Methods We used logistic regression analysis to identify correlates of SC and TH use among 485 IDUs enrolled from June 2012 to September 2013. Results Seven percent of participants reported ever using SC and 30% reported ever using TH. In multivariate logistic regression, age and recent hospitalization were significantly associated with odds of SC use (Adjusted Odds Ratio [AOR] 0.93, 95% Confidence Interval [C.I.] 0.90, 0.97; and AOR 2.34 95% C.I. 1.00, 5.49, respectively) and TH use (AOR 0.96, 95% C.I. 0.94, 0.98; and AOR 2.62, 95% C.I. 1.47, 4.68, respectively). Use of methamphetamine (AOR 9.35, 95% C.I. 1.20, 72.79) and club drugs in the past six months (AOR 3.38, 95% C.I. 1.17, 9.76) were significantly associated with SC use. Being on probation/parole (AOR 2.42, 95% C.I. 1.44,4.07), initiating injection drug use with stimulants (AOR 1.89 95% C.I. 1.13, 3.16), and past six-month marijuana (AOR 9.22, 95% C.I. 4.49, 18.96) and prescription drug use (AOR 1.98, 95% C.I. 1.20, 3.27) were significantly associated with TH use. Conclusions A considerable proportion of IDU use synthetic drugs and may experience harms associated with their use. Findings have implications for criminal justice system management. Prevention efforts should emphasize the risks associated with rapidly changing synthetic formulations, and the potential harms associated with polydrug use. PMID:24916748

  9. 32 CFR 637.7 - Drug enforcement activities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... CRIMINAL INVESTIGATIONS MILITARY POLICE INVESTIGATION Investigations § 637.7 Drug enforcement activities... initial, interim and final military police reports concerning drug investigations will be provided to...

  10. 32 CFR 637.7 - Drug enforcement activities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... CRIMINAL INVESTIGATIONS MILITARY POLICE INVESTIGATION Investigations § 637.7 Drug enforcement activities... initial, interim and final military police reports concerning drug investigations will be provided to...

  11. 32 CFR 637.7 - Drug enforcement activities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... CRIMINAL INVESTIGATIONS MILITARY POLICE INVESTIGATION Investigations § 637.7 Drug enforcement activities... initial, interim and final military police reports concerning drug investigations will be provided to...

  12. Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the need for a multiregion approach.

    PubMed

    Deren, Sherry; Gelpí-Acosta, Camila; Albizu-García, Carmen E; González, Ángel; Des Jarlais, Don C; Santiago-Negrón, Salvador

    2014-11-01

    High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast-Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions. PMID:25211722

  13. Addressing the HIV/AIDS Epidemic Among Puerto Rican People Who Inject Drugs: The Need for a Multiregion Approach

    PubMed Central

    Deren, Sherry; Gelpí-Acosta, Camila; Albizu-García, Carmen E.; González, Ángel; Des Jarlais, Don C.; Santiago-Negrón, Salvador

    2014-01-01

    High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast–Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions. PMID:25211722

  14. Developing a Brief Scale to Measure HIV Transmission Risk Among Injecting Drug Users

    PubMed Central

    Shahesmaeili, Armita; Haghdoost, Ali Akbar; Soori, Hamid

    2015-01-01

    Background: One of the main concerns of policymakers is to measure the impact of harm reduction programs and different interventions on the risk of HIV transmission among Injecting Drug Users (IDUs). Looking simultaneously at multiple factors and conditions that affect the risk of HIV transmission may provide policymakers a better insight into the mixed nature of HIV transmission. Objectives: The present study aimed to design a simple, brief, and multi-dimensional scale for measuring HIV transmission risk among IDUs. Patients and Methods: From October 2013 to March 2014, we conducted face-to-face interviews with 147 IDUs. Eligible participants were individuals 18 years or older who had injected drugs at least once during the last year and had not participated in similar studies within the 2 months before the interview. To design a scale for measuring HIV transmission risk, we specified 11 items, which address different dimensions of HIV risk taking behaviors/situations based on experts’ opinion. We applied exploratory factor analysis (EFA) with principal component extraction to develop scales. Eigen values greater than 1 were used as a criterion for factor extraction. Results: We extracted 7 items based on first factor, which were accounted for 21% of the variations. The final scale contained 7 items: 4 items were related to injecting practice and 3 items related to sexual behaviors. The Cronbach’s α coefficient was 0.66, acceptable for such a brief scale. Conclusions: Applying a simple and brief scale that incorporates the different dimensions of HIV transmission risk may provide policymakers and harm reductionists with a better understanding of HIV transmission in this key group and may be advantageous for evaluating intervention programs. PMID:26870713

  15. The social structural production of HIV risk among injecting drug users.

    PubMed

    Rhodes, Tim; Singer, Merrill; Bourgois, Philippe; Friedman, Samuel R; Strathdee, Steffanie A

    2005-09-01

    There is increasing appreciation of the need to understand how social and structural factors shape HIV risk. Drawing on a review of recently published literature, we seek to describe the social structural production of HIV risk associated with injecting drug use. We adopt an inclusive definition of the HIV 'risk environment' as the space, whether social or physical, in which a variety of factors exogenous to the individual interact to increase vulnerability to HIV. We identify the following factors as critical in the social structural production of HIV risk associated with drug injecting: cross-border trade and transport links; population movement and mixing; urban or neighbourhood deprivation and disadvantage; specific injecting environments (including shooting galleries and prisons); the role of peer groups and social networks; the relevance of 'social capital' at the level of networks, communities and neighbourhoods; the role of macro-social change and political or economic transition; political, social and economic inequities in relation to ethnicity, gender and sexuality; the role of social stigma and discrimination in reproducing inequity and vulnerability; the role of policies, laws and policing; and the role of complex emergencies such as armed conflict and natural disasters. We argue that the HIV risk environment is a product of interplay in which social and structural factors intermingle but where political-economic factors may play a predominant role. We therefore emphasise that much of the most needed 'structural HIV prevention' is unavoidably political in that it calls for community actions and structural changes within a broad framework concerned to alleviate inequity in health, welfare and human rights. PMID:15955404

  16. Patterns of Drug Use, Risky Behavior, and Health Status Among Persons Who Inject Drugs Living in San Diego, California: A Latent Class Analysis

    PubMed Central

    Roth, Alexis M.; Armenta, Richard A.; Wagner, Karla D.; Roesch, Scott C.; Bluthenthal, Ricky N.; Cuevas-Mota, Jazmine; Garfein, Richard S.

    2015-01-01

    Background Among persons who inject drugs (PWID), polydrug use (the practice of mixing multiple drugs/alcohol sequentially or simultaneously) increases risk for HIV transmission and unintentional overdose deaths. Research has shown local drug markets influence drug use practices. However, little is known about the impact of drug mixing in markets dominated by black tar heroin and methamphetamine, such as the western United States. Methods Data were collected through an ongoing longitudinal study examining drug use, risk behavior, and health status among PWID. Latent class analysis (LCA) was used to identify patterns of substance use (heroin, methamphetamine, prescription drugs, alcohol, and marijuana) via multiple administration routes (injecting, smoking, and swallowing). Logistic regression was used to identify behaviors and health indicators associated with drug use class. Results The sample included 511 mostly white (51.5%) males (73.8%), with mean age of 43.5 years. Two distinct classes of drug users predominated: methamphetamine by multiple routes (51%) and heroin by injection (49%). In multivariable logistic regression, class membership was associated with age, race, and housing status. PWID who were HIV-seropositive and reported prior sexually transmitted infections had increased odds of belonging to the methamphetamine class. Those who were HCV positive and reported previous opioid overdose had an increased odds of being in the primarily heroin injection class (all P-values < .05). Conclusion Risk behaviors and health outcomes differed between PWID who primarily inject heroin vs. those who use methamphetamine. The findings suggest that in a region where PWID mainly use black tar heroin or methamphetamine, interventions tailored to sub-populations of PWID could improve effectiveness. PMID:25313832

  17. Transmitted Drug Resistance Mutations in Antiretroviral-Naïve Injection Drug Users with Chronic HIV-1 Infection in Iran

    PubMed Central

    Memarnejadian, Arash; Menbari, Shahoo; Vahabpour, Rouhollah; Aghasadeghi, Mohammad Reza; Mostafavi, Ehsan; Abdi, Mohammad

    2015-01-01

    The growing incidence and transmission of drug resistant HIV-1 strains due to widespread use of antiretroviral therapy (ART) can jeopardize the success of first-line ART. While there is a known moderate prevalence of transmitted drug resistance (TDR) among newly infected Iranians, no data exist about the rate of these primary resistance mutations among the ART-naïve, chronically infected individuals who are, in fact, the main candidates for ART initiation. To address this issue, we collected blood samples from 40 ART-naïve injection drug-users (IDUs) with chronic HIV-1 infection (seroconversion time ranging from 2 to 9 years) living in Sanandaj, Iran, followed by sequencing of the protease and reverse-transcriptase regions from their HIV-1 genome. Phylogenetic analyses of the sequenced regions revealed that all samples were CRF35_AD. Transmitted resistance mutations were interpreted as surveillance drug-resistant mutations (SDRMs) based on the world health organization (WHO) algorithm. The frequency of SDRMs to any class of antiretroviral drugs was 15%, which included mutations to nucleoside reverse transcriptase inhibitors (NRTIs, 10%), with M41L and M184V as the most common (5%), and non-nucleoside reverse transcriptase inhibitors (NNRTIs, 5%), with K103N as the only detected mutation (5%). Although not in the WHO SDRMs list, several minor protease inhibitor resistant mutations listed in the International Antiviral Society-USA panel were identified, of which M36I, H69K, L89M/V/I (each one 100%) and K20R/T (92.5%) can be considered as polymorphic signatures for CRF35_AD.The relatively high rate of TDR mutations in our study raises concerns about the risk of treatment failure in chronically infected IDUs of Sanandaj city. These results suggest that routine resistance testing should be considered before the therapy initiation in this area. Additional surveillance studies are required to generalize this deduction to other cities of Iran. PMID:25962088

  18. Transmitted Drug Resistance Mutations in Antiretroviral-Naïve Injection Drug Users with Chronic HIV-1 Infection in Iran.

    PubMed

    Memarnejadian, Arash; Menbari, Shahoo; Mansouri, Seyed Ali; Sadeghi, Leila; Vahabpour, Rouhollah; Aghasadeghi, Mohammad Reza; Mostafavi, Ehsan; Abdi, Mohammad

    2015-01-01

    The growing incidence and transmission of drug resistant HIV-1 strains due to widespread use of antiretroviral therapy (ART) can jeopardize the success of first-line ART. While there is a known moderate prevalence of transmitted drug resistance (TDR) among newly infected Iranians, no data exist about the rate of these primary resistance mutations among the ART-naïve, chronically infected individuals who are, in fact, the main candidates for ART initiation. To address this issue, we collected blood samples from 40 ART-naïve injection drug-users (IDUs) with chronic HIV-1 infection (seroconversion time ranging from 2 to 9 years) living in Sanandaj, Iran, followed by sequencing of the protease and reverse-transcriptase regions from their HIV-1 genome. Phylogenetic analyses of the sequenced regions revealed that all samples were CRF35_AD. Transmitted resistance mutations were interpreted as surveillance drug-resistant mutations (SDRMs) based on the world health organization (WHO) algorithm. The frequency of SDRMs to any class of antiretroviral drugs was 15%, which included mutations to nucleoside reverse transcriptase inhibitors (NRTIs, 10%), with M41L and M184V as the most common (5%), and non-nucleoside reverse transcriptase inhibitors (NNRTIs, 5%), with K103N as the only detected mutation (5%). Although not in the WHO SDRMs list, several minor protease inhibitor resistant mutations listed in the International Antiviral Society-USA panel were identified, of which M36I, H69K, L89M/V/I (each one 100%) and K20R/T (92.5%) can be considered as polymorphic signatures for CRF35_AD.The relatively high rate of TDR mutations in our study raises concerns about the risk of treatment failure in chronically infected IDUs of Sanandaj city. These results suggest that routine resistance testing should be considered before the therapy initiation in this area. Additional surveillance studies are required to generalize this deduction to other cities of Iran. PMID:25962088

  19. Hepatitis C virus risk behaviors within the partnerships of young injecting drug users

    PubMed Central

    Hahn, Judith A.; Evans, Jennifer L.; Davidson, Peter J.; Lum, Paula J.; Page, Kimberly

    2010-01-01

    Aims Young injection drug users (IDU) are at high risk for hepatitis C virus (HCV). We sought to determine whether perceiving one's injecting partner to be HCV positive was associated with decreased odds of engaging in receptive needle/syringe sharing (RNS) or ancillary equipment sharing (AES) with that partner. Design We conducted a cross-sectional study from 2003 to 2007 in San Francisco (n=212 participants) to examine whether perceived partner HCV status was associated with RNS and AES within injecting partnerships (n=492 partnerships) of young (under age 30) IDU who are HCV antibody negative. Findings RNS and AES (in the absence of RNS) occurred in 23% and 66% of injecting partnerships in the prior month. The odds of engaging in RNS were significantly lower for relationships in which the participant reported that his/her partner was HCV positive (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25-0.95). This association was attenuated when adjusted for reusing one's own needle/syringe (adjusted OR 0.57; 95% CI 0.28-1.15). The odds of engaging in AES were lower for participants who did not know the HCV status of their partner, only among non-sexual partnerships (OR 0.47; 95% CI 0.29-0.76). Conclusions Because perceiving one's partner to be HCV positive was associated with decreased RNS, increased HCV testing and partner disclosure may be warranted. AES was common and was decreased only among non-sexual partnerships in which the HCV status of the partner was not known. This suggests that interventions to reduce AES in young IDU must be widespread. PMID:20491725

  20. Cigarette Smoking and Quit Attempts Among Injection Drug Users in Tijuana, Mexico

    PubMed Central

    2013-01-01

    Introduction: Injection drug use and cigarette smoking are major global health concerns. Limited data exist regarding cigarette smoking behavior and quit attempts among injection drug users (IDUs) in low- and middle-income countries to inform the development of cigarette smoking interventions. We conducted a cross-sectional study to describe cigarette smoking behavior and quit attempts among IDUs in Tijuana, Mexico. Methods: IDUs were recruited through community outreach and administered in-person interviews. Multivariable Poisson regression models were constructed to determine prevalence ratios (PRs) for quit attempts. Results: Of the 670 participants interviewed, 601 (89.7%) were current smokers. Of these, median number of cigarettes smoked daily was 10; 190 (31.6%) contemplated quitting smoking in the next 6 months; 132 (22.0%) had previously quit for ≥1 year; and 124 (20.6%) had made a recent quit attempt (lasting ≥1 day during the previous 6 months). In multivariable analysis, recent quit attempts were positively associated with average monthly income (≥3,500 pesos [US$280] vs. <1,500 pesos [US$120]; PR = 2.30; 95% CI = 1.57–3.36), smoking marijuana (PR = 1.38; 95% CI = 1.01–2.90), and smoking heroin (PR = 1.85; 95% CI = 1.23–2.78), and they were negatively associated with number of cigarettes smoked daily (PR = 0.96; 95% CI = 0.94–0.98). Conclusions: One out of 5 IDUs attempted to quit cigarette smoking during the previous 6 months. Additional research is needed to improve the understanding of the association between drug use patterns and cigarette smoking quit attempts, including the higher rate of quit attempts observed among IDUs who smoke marijuana or heroin compared with IDUs who do not smoke these substances. PMID:23873979

  1. Injecting drug users in Scotland, 2006: Listing, number, demography, and opiate-related death-rates.

    PubMed

    King, Ruth; Bird, Sheila M; Overstall, Antony; Hay, Gordon; Hutchinson, Sharon J

    2013-06-01

    Using Bayesian capture-recapture analysis, we estimated the number of current injecting drug users (IDUs) in Scotland in 2006 from the cross-counts of 5670 IDUs listed on four data-sources: social enquiry reports (901 IDUs listed), hospital records (953), drug treatment agencies (3504), and recent Hepatitis C virus (HCV) diagnoses (827 listed as IDU-risk). Further, we accessed exact numbers of opiate-related drugs-related deaths (DRDs) in 2006 and 2007 to improve estimation of Scotland's DRD rates per 100 current IDUs. Using all four data-sources, and model-averaging of standard hierarchical log-linear models to allow for pairwise interactions between data-sources and/or demographic classifications, Scotland had an estimated 31700 IDUs in 2006 (95% credible interval: 24900-38700); but 25000 IDUs (95% CI: 20700-35000) by excluding recent HCV diagnoses whose IDU-risk can refer to past injecting. Only in the younger age-group (15-34 years) were Scotland's opiate-related DRD rates significantly lower for females than males. Older males' opiate-related DRD rate was 1.9 (1.24-2.40) per 100 current IDUs without or 1.3 (0.94-1.64) with inclusion of recent HCV diagnoses. If, indeed, Scotland had only 25000 current IDUs in 2006, with only 8200 of them aged 35+ years, the opiate-related DRD rate is higher among this older age group than has been appreciated hitherto. There is counter-balancing good news for the public health: the hitherto sharp increase in older current IDUs had stalled by 2006. PMID:23730265

  2. Prevalence and determinants of hepatitis C virus infection among female drug injecting sex workers in Glasgow

    PubMed Central

    Taylor, Avril; Hutchinson, Sharon J; Gilchrist, Gail; Cameron, Sheila; Carr, Susan; Goldberg, David J

    2008-01-01

    Background Few studies of the prevalence of hepatitis C virus (HCV) infection have focussed on women who work as street sex workers to finance their drug use. Methods The investigators report the survey findings of such a population in Glasgow. All women attending the health and social care drop-in centre, situated in Glasgow's "Red Light Area", during a four-week period in 1999 were invited to participate in a survey involving the provision of a saliva sample for anonymous HCV testing and the self-completion of a questionnaire seeking demographic, sexual and injecting practice data. Results Of the 223 women who attended, 51% agreed to participate. Of the 98 women who provided a sufficient saliva sample, 64% (95% CI: 54%–74%) tested HCV antibody positive; 98% of those who tested positive had ever injected drugs. Adjusting for the 85% sensitivity of the saliva test, the HCV antibody prevalence among IDU sex workers sampled was 81%; a rate which is considerably higher than those recorded, contemporaneously, among Glasgow IDUs generally. Two factors were independently associated with HCV antibody positivity in saliva: ever shared needles and syringes (adjusted OR 5.7, 95% CI 2–16) and number of times imprisoned (adjusted OR 7.3, 95% CI 1.4–39, for more than five times compared to zero times). Conclusion Women who engage in street sex work to finance their drug habit are a particularly desperate, chaotic and vulnerable population. This study demonstrates that their HCV infection risk may be greater than that for other IDUs. Those responsible for designing interventions to prevent HCV infection among IDUs should consider the special needs of this group. PMID:18355407

  3. Cost and performance of activated carbon injection for mercury control

    SciTech Connect

    2006-08-15

    Activated carbon injection (ACI) is one technology being developed to absorb mercury from mercury emitted from coal-fired power plants. In 2003/04, the USDOE and NETL selected 14 projects to test and evaluate mercury control technologies. While field testing is still ongoing, DOE/NETL recently completed an economic analysis of mercury control for six test sites spanning three ACI variations - conventional powdered activated carbon (PAC), brominated PAC and conventional PAC combined with a sorbent enhancement additive (SEA) applied to the coal. To evaluate the progress of the field testing program and discern the performance of ACI, a data adjustment methodology was developed to account for baseline methane capture. This data were used to perform economic analyses to achieve low, mid and high levels of mercury control. The costs are given in the article. Full details are available on the DOE/NETL website, www.netl.doe.gov. 2 figs., 1 photo.

  4. [Epidemiology of hepatitis C and human immunodeficiency virus infections among injecting drug users in Hungary--what's next?].

    PubMed

    Gyarmathy, V Anna; Rácz, József

    2010-03-01

    The prevalence of hepatitis C virus infection (HCV) is currently about 35% among injecting drug users in Budapest, Hungary, and it is under 20% outside of the capital, and no verified case of human immunodeficiency virus (HIV) have been detected so far. Mathematical models describe that the co-occurrence of HIV and HCV among injecting drug users is such under an HCV prevalence of about 35% the probability of an HIV epidemic is low, but above this threshold an, HIV epidemic is to be expected. According to these models, there is a looming probability of an HIV epidemic among injecting drug users in Hungary, especially in Budapest. There are four ways to prevent or delay such an epidemic: 1. substitution treatment programs; 2. legal access to injecting equipment; 3. free and confidential HIV and HCV counseling and rapid testing; and 4. hygienic injecting environment. In order to avoid a predicted HIV epidemic, epidemiological pattern of HCV among injecting drug users in Hungary requires both a comprehensive prevention response and the systematic monitoring of the epidemiological situation. The success of the prevention programs depends on two factors: 1. wide access; and 2. regular financial support from the government. PMID:20178967

  5. Multimodal assessment of spatial distribution of drug-tracer uptake by brain tissue after intra-arterial injections

    NASA Astrophysics Data System (ADS)

    Singh-Moon, Rajinder; Chaudhuri, Durba; Wang, Mei; Straubinger, Robert; Bigio, Irving J.; Joshi, Shailendra

    2014-02-01

    It is challenging to track the rapid changes in drug concentrations after intra-arterial (IA) administration to elucidate the pharmacokinetics of this method of drug delivery. Traditional pharmacokinetic parameters (such as protein binding) that are highly relevant to intravenous (IV) administration do not seem to apply to IA injections. Regional drug delivery is affected by the biomechanics of drug injection, resting blood flow, and local tissue extraction. In-vivo and ex-vivo, optical methods for spatial mapping of drug deposition can assist in visualizing drug distributions and aid in the screening of potential drugs and carrier candidates. We present a multimodal approach for the assessment of drug distribution in postmortem tissue specimens using diffuse reflectance spectroscopy, multispectral imaging, and confocal microscopy and demonstrate feasibility of distinguishing route of administration advantages of liposome-dye conjugate delivery. The results of this study suggest that insight on drug dynamics gained by this aggregated approach can be used to help screen and/or optimize potential drug candidates and drug delivery protocols.

  6. The Everyday Violence of Hepatitis C Among Young Women Who Inject Drugs in San Francisco.

    PubMed

    Bourgois, Philippe; Prince, Bridget; Moss, Andrew

    2004-09-01

    A theoretical understanding of the gendered contours of structural, everyday and symbolic violence suggests that young addicted women are particularly vulnerable to the infectious diseases caused by injection drug use-especially hepatitis C. Participant-observation fieldwork among heroin and speed addicts in San Francisco's Haight Ashbury neighborhood reveals that extreme levels of violence against women are normalized in the common sense of street-youth drug culture. Physical, sexual and emotional violence, as well as the pragmatics of income generation, including drug and resource sharing in the moral economy of street addicts, oblige most young homeless women to enter into relationships with older men. These relationships are usually abusive and economically parasitical to the women. Sexual objectification and a patriarchal romantic discourse of love and moral worth leads to the misrecognition of gender power inequities by both the men and women who are embroiled in them, as well as by many of the public services and research projects designed to help or control substance abusers. Despite deep epistemological, theoretical and logistical gulfs between quantitative and qualitative methods, applied public health research and the interventions they inform can benefit from the insights provided by a theoretical and cross-methodological focus on how social power contexts shape the spread of infectious disease and promote disproportional levels of social suffering in vulnerable populations. PMID:16685288

  7. Injecting drug use: A vector for the introduction of new hepatitis C virus genotypes.

    PubMed

    Ruta, Simona; Cernescu, Costin

    2015-10-14

    Hepatitis C virus (HCV) genotypes' monitoring allows real-time insight into the dynamic changes that occur in the global epidemiological picture of HCV infection. Intravenous drug use is currently the primary driver for HCV transmission in developed and developing countries. The distribution of HCV genotypes/subtypes differs significantly between people who inject drugs (PWID) and the general population. HCV genotypes that previously exhibited a limited geographical distribution (3a, 4) are becoming more prevalent in this high-risk group. Immigration from HCV-endemic countries and the evolving networks of HCV transmission in PWID influence HCV genotypes distribution in Europe. Social vulnerabilities (e.g., unemployment, homelessness, and limited access to social and healthcare insurances systems) are important triggers for illicit drug use, which increases the associated risks of HCV infection and the frequent emergence of less prevalent genotypes. Genotype/subtype determination bears important clinical consequences in the progression of liver disease, susceptibility to antiviral therapies and the emergence of resistance-associated variants. An estimated half of the chronically HCV-infected PWID are unaware of their infection, and only one in ten of those diagnosed enter treatment. Nevertheless, PWID exhibit high response rates to new antiviral regimens, and the level of HCV reinfection is unexpectedly low. The focus of the healthcare system must be on the early detection and treatment of infection, to avoid late presentations that are associated with high levels of viremia and liver fibrosis, which may diminish the therapeutic success rate. PMID:26478672

  8. The Everyday Violence of Hepatitis C Among Young Women Who Inject Drugs in San Francisco

    PubMed Central

    Bourgois, Philippe; Prince, Bridget; Moss, Andrew

    2005-01-01

    A theoretical understanding of the gendered contours of structural, everyday and symbolic violence suggests that young addicted women are particularly vulnerable to the infectious diseases caused by injection drug use—especially hepatitis C. Participant-observation fieldwork among heroin and speed addicts in San Francisco’s Haight Ashbury neighborhood reveals that extreme levels of violence against women are normalized in the common sense of street-youth drug culture. Physical, sexual and emotional violence, as well as the pragmatics of income generation, including drug and resource sharing in the moral economy of street addicts, oblige most young homeless women to enter into relationships with older men. These relationships are usually abusive and economically parasitical to the women. Sexual objectification and a patriarchal romantic discourse of love and moral worth leads to the misrecognition of gender power inequities by both the men and women who are embroiled in them, as well as by many of the public services and research projects designed to help or control substance abusers. Despite deep epistemological, theoretical and logistical gulfs between quantitative and qualitative methods, applied public health research and the interventions they inform can benefit from the insights provided by a theoretical and cross-methodological focus on how social power contexts shape the spread of infectious disease and promote disproportional levels of social suffering in vulnerable populations. PMID:16685288

  9. Injecting drug use: A vector for the introduction of new hepatitis C virus genotypes

    PubMed Central

    Ruta, Simona; Cernescu, Costin

    2015-01-01

    Hepatitis C virus (HCV) genotypes’ monitoring allows real-time insight into the dynamic changes that occur in the global epidemiological picture of HCV infection. Intravenous drug use is currently the primary driver for HCV transmission in developed and developing countries. The distribution of HCV genotypes/subtypes differs significantly between people who inject drugs (PWID) and the general population. HCV genotypes that previously exhibited a limited geographical distribution (3a, 4) are becoming more prevalent in this high-risk group. Immigration from HCV-endemic countries and the evolving networks of HCV transmission in PWID influence HCV genotypes distribution in Europe. Social vulnerabilities (e.g., unemployment, homelessness, and limited access to social and healthcare insurances systems) are important triggers for illicit drug use, which increases the associated risks of HCV infection and the frequent emergence of less prevalent genotypes. Genotype/subtype determination bears important clinical consequences in the progression of liver disease, susceptibility to antiviral therapies and the emergence of resistance-associated variants. An estimated half of the chronically HCV-infected PWID are unaware of their infection, and only one in ten of those diagnosed enter treatment. Nevertheless, PWID exhibit high response rates to new antiviral regimens, and the level of HCV reinfection is unexpectedly low. The focus of the healthcare system must be on the early detection and treatment of infection, to avoid late presentations that are associated with high levels of viremia and liver fibrosis, which may diminish the therapeutic success rate. PMID:26478672

  10. Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs

    PubMed Central

    Buckingham, Elizabeth; Schrage, Ezra; Cournos, Francine

    2013-01-01

    People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services. PMID:23401785

  11. Developing Effective Health Interventions for Women Who Inject Drugs: Key Areas and Recommendations for Program Development and Policy

    PubMed Central

    Pinkham, Sophie; Stoicescu, Claudia; Myers, Bronwyn

    2012-01-01

    Women who inject drugs face multiple gender-specific health risks and barriers to healthcare access. These gendered factors may contribute to elevated rates of HIV for this population. Though few countries systematically collect gender-disaggregated data related to injecting drug use, evidence indicates that there are large populations of women who inject drugs and who are in need of improved health services, including HIV prevention. Research on the effectiveness of interventions specifically tailored for women who inject drugs, along with the experience of programs working with this subpopulation, suggests that HIV risk practices need to be addressed within the larger context of women's lives. Multifaceted interventions that address relationship dynamics, housing, employment, and the needs of children may have more success in reducing risky practices than interventions that focus exclusively on injecting practices and condom use. Improved sexual and reproductive healthcare for women who use drugs is an area in need of development and should be better integrated into basic harm reduction programs. PMID:23198158

  12. Injection drug use and HIV/AIDS in China: Review of current situation, prevention and policy implications

    PubMed Central

    Qian, Han-Zhu; Schumacher, Joseph E; Chen, Huey T; Ruan, Yu-Hua

    2006-01-01

    Illicit drug abuse and HIV/AIDS have increased rapidly in the past 10 to 20 years in China. This paper reviews drug abuse in China, the HIV/AIDS epidemic and its association with injection drug use (IDU), and Chinese policies on illicit drug abuse and prevention of HIV/AIDS based on published literature and unpublished official data. As a major drug trans-shipment country with source drugs from the "Golden Triangle" and "Gold Crescent" areas in Asia, China has also become an increasingly important drug consuming market. About half of China's 1.14 million documented drug users inject, and many share needles. IDU has contributed to 42% of cumulatively reported HIV/AIDS cases thus far. Drug trafficking is illegal in China and can lead to the death penalty. The public security departments adopt "zero tolerance" approach to drug use, which conflict with harm reduction policies of the public health departments. Past experience in China suggests that cracking down on drug smuggling and prohibiting drug use alone can not prevent or solve all illicit drug related problems in the era of globalization. In recent years, the central government has outlined a series of pragmatic policies to encourage harm reduction programs; meanwhile, some local governments have not fully mobilized to deal with drug abuse and HIV/AIDS problems seriously. Strengthening government leadership at both central and local levels; scaling up methadone substitution and needle exchange programs; making HIV voluntary counseling and testing available and affordable to both urban and rural drug users; and increasing utilization of outreach and nongovernmental organizations are offered as additional strategies to help cope with China's HIV and drug abuse problem. PMID:16451717

  13. Street Policing, Injecting Drug Use and Harm Reduction in a Russian City: A Qualitative Study of Police Perspectives

    PubMed Central

    Platt, Lucy; Sarang, Anya; Vlasov, Alexander; Mikhailova, Larissa; Monaghan, Geoff

    2006-01-01

    We undertook a qualitative exploration of police perspectives on injecting drug use and needle and syringe access among injecting drug users (IDUs) in a Russian city which has witnessed explosive spread of HIV associated with drug injecting. Twenty-seven in-depth qualitative interviews were conducted in May 2002 with police officers of varying rank who reported having regular contact with IDUs. All interviews were tape-recorded, transcribed, translated and coded thematically. Accounts upheld an approach to policing which emphasised high street-based visibility and close surveillance of IDUs. IDUs were depicted as ‘potential criminals’ warranting a ‘pre-emptive’ approach to the prevention of drug-related crime. Street policing was described as a means of maintaining close surveillance leading to the official registration of persons suspected or proven to be users of illicit drugs. Such registration enabled further ongoing surveillance, including through stop and search procedures. While aware of drug users' reluctance to carry injecting equipment linked to their fears of detention or arrest, accounts suggested that the confiscation of previously used injecting equipment can constitute evidence in relation to drugs possession charges and that discovery of clean injecting equipment may be sufficient to raise suspicion and/or further investigation, including through stop and search or questioning. Our findings suggest an uneasy relationship between street policing and needle and syringe access, whereby policing strategies can undermine an HIV prevention ethos promoting needle and syringe accessibility among IDUs. We conclude that facilitating partnerships between policing agencies and HIV prevention initiatives are a critical feature of creating environments conducive for risk reduction. PMID:16855880

  14. Street policing, injecting drug use and harm reduction in a Russian city: a qualitative study of police perspectives.

    PubMed

    Rhodes, Tim; Platt, Lucy; Sarang, Anya; Vlasov, Alexander; Mikhailova, Larissa; Monaghan, Geoff

    2006-09-01

    We undertook a qualitative exploration of police perspectives on injecting drug use and needle and syringe access among injecting drug users (IDUs) in a Russian city which has witnessed explosive spread of HIV associated with drug injecting. Twenty-seven in-depth qualitative interviews were conducted in May 2002 with police officers of varying rank who reported having regular contact with IDUs. All interviews were tape-recorded, transcribed, translated and coded thematically. Accounts upheld an approach to policing which emphasised high street-based visibility and close surveillance of IDUs. IDUs were depicted as 'potential criminals' warranting a 'pre-emptive' approach to the prevention of drug-related crime. Street policing was described as a means of maintaining close surveillance leading to the official registration of persons suspected or proven to be users of illicit drugs. Such registration enabled further ongoing surveillance, including through stop and search procedures. While aware of drug users' reluctance to carry injecting equipment linked to their fears of detention or arrest, accounts suggested that the confiscation of previously used injecting equipment can constitute evidence in relation to drugs possession charges and that discovery of clean injecting equipment may be sufficient to raise suspicion and/or further investigation, including through stop and search or questioning. Our findings suggest an uneasy relationship between street policing and needle and syringe access, whereby policing strategies can undermine an HIV prevention ethos promoting needle and syringe accessibility among IDUs. We conclude that facilitating partnerships between policing agencies and HIV prevention initiatives are a critical feature of creating environments conducive for risk reduction. PMID:16855880

  15. 40 CFR 60.2115 - What if I do not use a wet scrubber, fabric filter, activated carbon injection, selective...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., fabric filter, activated carbon injection, selective noncatalytic reduction, an electrostatic... filter, activated carbon injection, selective noncatalytic reduction, an electrostatic precipitator, or a... than a wet scrubber, activated carbon injection, selective noncatalytic reduction, fabric filter,...

  16. Behavioral risk reduction in a declining HIV epidemic: injection drug users in New York City, 1990-1997.

    PubMed Central

    Des Jarlais, C; Perlis, T; Friedman, S R; Chapman, T; Kwok, J; Rockwell, R; Paone, D; Milliken, J; Monterroso, E

    2000-01-01

    OBJECTIVES: This study assessed trends in HIV risk behaviors among injection drug users in New York City from 1990 to 1997. METHODS: Injection drug users were recruited continuously from a large drug detoxification treatment program (N = 2588) and a research storefront located in a high-drug-use area (N = 2701). Informed consent was obtained, and a trained interviewer administered a structured interview covering sociodemographics, drug use history, HIV risk behavior, and participation in syringe exchange. RESULTS: Trends were assessed for 5 risk behaviors in the 6-month period before the interview. The 3 injection risk behaviors declined significantly over time at each site (all P < .01). When data were pooled across sites, all 5 risk behaviors declined significantly over time (all P < .01). Participation in syringe exchange programs and in HIV counseling and testing increased greatly from 1990 to 1997. CONCLUSIONS: The continuing risk reduction among injection drug users indicates a "declining phase" in the large HIV epidemic in New York City. HIV prevention programs appear to be making an important contribution to the declining phase. PMID:10897190

  17. Condom use with primary partners among injecting drug users in Bangkok, Thailand and New York City, United States.

    PubMed

    Vanichseni, S; Des Jarlais, D C; Choopanya, K; Friedmann, P; Wenston, J; Sonchai, W; Sotheran, J L; Raktham, S; Carballo, M; Friedman, S R

    1993-06-01

    Trained interviewers spoke to 957 drug users attending a detoxification program, methadone maintenance program, or a research storefront in New York City in 1990-91 and to 601 drug users attending 17 drug use treatment clinics in Bangkok, Thailand, in the autumn of 1989 as part of a study to identify factors linked to the probability or failure of condom use with primary sexual partners among IV drug users. The participants also received HIV counseling and testing. IV drug users in New York City were more likely to be older (36.2 years vs. 30.1 years; p .001), female (25% vs. 5%; p .001), more ethnically diverse (p .001), and inject cocaine more often (33 injections/month vs. 0.5 injections/month) than those in Bangkok. 44% of drug users in New York City and 33% of those in Bangkok engaged in some unprotected penetrative intercourse with a primary heterosexual partner in the previous 6 months. Of drug users having penetrative sexual intercourse with a primary partner in the previous 6 months, 20% in New York City and 12% in Bangkok always used condoms (p .02). The strongest predictors of condom use among IV drug users from both countries were a previous positive HIV test and talking about AIDS with sexual partners (p = .001 for US; p = .0008 for Bangkok and p = .004 for US; p = .0596 for Bangkok, respectively). These findings indicated that unsafe sexual behavior with primary sexual partners among drug users is still a major source of HIV transmission in these 2 cities. Nevertheless, knowledge of HIV positive status and partner communication concerning AIDS are predictors of condom use shared by both groups. Thus, HIV/AIDS prevention programs should provide confidential HIV testing and counseling for drug users and should encourage frank discussions of AIDS between drug users and primary sexual partners. Peer support for risk reduction among drug users has the potential to facilitate such discussions. PMID:8363764

  18. An exploratory analysis of communication sources: targeting high risk behavior among injection drug users.

    PubMed

    Bodkin, C D; La Salvia, T A

    1996-01-01

    Currently, most AIDS education and prevention programs attempt to change the high risk behavior of injection drug users (IDU's) (e.g., sharing needles and engaging in unsafe sex) through the implementation of two distinct strategies. First, empirical-rational strategies suggest that people maximize their rational self-interest. Second, normative re-education strategies suggest that people change their individual behavior when they believe that there has been change in the sociocultural norms, values, and habits around them. Both of these strategies make assumptions about how communication changes IDU's beliefs and behavior. An empirical-rational strategy emphasizes non-personal mass communications (e.g., television, radio, newspaper); while normative re-education strategies make use of personal communications (e.g. friends, family, educational outreach workers, and group discussion). The purpose of this paper is to compare these strategies by examining the impact of AIDS communication sources on the beliefs and behaviors of IDU's. PMID:10172894

  19. Knowledge, attitudes and beliefs of European injecting drug users concerning preventive measures for HIV.

    PubMed

    Richardson, S C; Papaevangelou, G; Ancelle-Park, R

    1994-04-01

    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. PMID:7813690

  20. The lived experience of grieving for persons living with HIV who have used injection drugs.

    PubMed

    Cody, W K

    2000-01-01

    Parse's research method was used to investigate the lived experience of grieving for 10 persons self-identified as HIV-positive injection drug users. These individuals compose an understudied and poorly understood population, and their grief experiences have rarely been documented. The losses grieved by persons living with HIV infection include the loss of life, friends, family members, employment, energy, and sex. The lived experience of grieving was found to be "overwhelming anguish that shapes hopes and intentions as a wretched aloneness is punctuated with cherished uplifting engagements, while gratitude inspires courage in the midst of ambiguity." This new conceptualization of the grieving process is discussed in light of Parse's human becoming theory of nursing. PMID:10826306

  1. Topological and Historical Considerations for Infectious Disease Transmission among Injecting Drug Users in Bushwick, Brooklyn (USA).

    PubMed

    Dombrowski, Kirk; Curtis, Richard; Friedman, Samuel; Khan, Bilal

    2013-03-01

    Recent interest by physicists in social networks and disease transmission factors has prompted debate over the topology of degree distributions in sexual networks. Social network researchers have been critical of "scale-free" Barabasi-Albert approaches, and largely rejected the preferential attachment, "rich-get-richer" assumptions that underlie that model. Instead, research on sexual networks has pointed to the importance of homophily and local sexual norms in dictating degree distributions, and thus disease transmission thresholds. Injecting Drug User (IDU) network topologies may differ from the emerging models of sexual networks, however. Degree distribution analysis of a Brooklyn, NY, IDU network indicates a different topology than the spanning tree configurations discussed for sexual networks, instead featuring comparatively short cycles and high concurrency. Our findings suggest that IDU networks do in some ways conform to a "scale-free" topology, and thus may represent "reservoirs" of potential infection despite seemingly low transmission thresholds. PMID:24672745

  2. Safe sex? Misconceptions, gender differences and barriers among injection drug users: a focus group approach.

    PubMed

    Weiss, S H; Weston, C B; Quirinale, J

    1993-01-01

    Heterosexual transmission is one factor involved in the spread of the human immunodeficiency virus (HIV) within the injection drug use (IDU) population and between IDU and non-IDU individuals. Insufficient information is currently available to reduce this heterosexual transmission. As a basis for designing a questionnaire aimed at the IDU population, we conducted 5 focus groups to collect information on knowledge of and attitudes toward safe sex as held by male and female IDUs in methadone treatment. We identified misconceptions related to HIV infection, condoms, and sexual behavior. We also found gender-based differences in knowledge and learning style. Also, while individuals felt a responsibility to prevent HIV transmission, they lacked sufficient control to do so. The wide range of responses on questions concerning sexually transmitted diseases (STDs), condoms, reproductive decisions, and methods of promoting safe sex provides a basis for developing a questionnaire designed to identify and target specific subgroups for educational intervention. PMID:8297708

  3. Correlations between compulsory drug abstinence treatments and HIV risk behaviors among injection drug users in a border city of South China.

    PubMed

    Chen, Huey T; Tuner, Nannette; Chen, Charlene J; Lin, Hui-yi; Liang, Shaoling; Wang, Siven

    2013-08-01

    Compulsory drug abstinence treatments (CAT) provided by the public security system have been one of the predominant methods of addressing drug abuse and HIV risks in China. This study assessed the association between CAT and HIV risk behaviors by surveying a community sample of 613 injection drug users (IDUs) at a city located in South China. The data indicated that the great majority of the participants (89.6%) had received the institutionalized treatments an average of 4.5 times. The study found that the number of compulsory drug abstinence treatments increased IDUs' HIV/AIDS knowledge. However, other HIV-related outcomes were not encouraging. The study found that the number of compulsory drug abstinence treatments was not related to an increase in condom use. Furthermore, the frequency of compulsory drug abstinence treatments was not related to needle/syringe sharing, but was positively associated with cooker/cotton/rinse water sharing and drug solution sharing. The number of compulsory drug abstinence treatments was positively associated with HIV status. In general, this study found little support that CAT has accomplished its goal in reducing HIV risks among injection drug users in the sample. Policy implications for reforming CAT are suggested. PMID:23837811

  4. State laws, syringe exchange, and HIV among persons who inject drugs in the United States: History and effectiveness.

    PubMed

    Bramson, Heidi; Des Jarlais, Don C; Arasteh, Kamyar; Nugent, Ann; Guardino, Vivian; Feelemyer, Jonathan; Hodel, Derek

    2015-05-01

    In 1981, when acquired immune deficiency syndrome (AIDS) was first observed among persons who inject drugs, almost all US states had laws criminalizing the possession and distribution of needles and syringes for injecting illicit drugs. We reviewed changes to these laws to permit 'syringe exchanges' and the provision of public funding for such programs. Most of the changes in law occurred during the 1990s, 5-10 years later than in many other countries. Public funding of syringe exchanges is associated with lower rates of human immunodeficiency virus (HIV) infection, greater numbers of syringes distributed (a possible causal mechanism), and greater numbers of health and social services provided. Experience in the United states may prove useful in other countries: state, provincial, and local governments may need to move ahead of central governments in addressing HIV infection among persons who inject drugs. PMID:25590514

  5. A longitudinal study of hepatitis C virus testing and infection status notification on behaviour change in people who inject drugs

    PubMed Central

    Spelman, T; Morris, MD; Zang, G; Rice, T; Page, K; Maher, L; Lloyd, A; Grebely, J; Dore, GJ; Kim, AY; Shoukry, NH; Hellard, M; Bruneau, J

    2015-01-01

    Background Hepatitis C virus (HCV) testing and counseling have the potential for impacting individual behaviour and transmission dynamics at the population level. Evidence of the impact of HCV-positive status notification on injection risk reduction is limited. The objective of our study was to (1) assess drug and alcohol use and injection risk behaviors following notification; (2) to compare behaviour change in people who inject drugs (PWID) who received a positive test result and those who remained negative; and (3) to assess the effect of age on risk behavior. Methods Data from the InC3 Study were analyzed. Participants initially HCV seronegative were followed prospectively with periodic HCV blood testing and post-test disclosure and interview-administered questionnaires assessing drug use and injection behaviours. Multivariable generalized estimating equations were used to assess behavioral changes over time. Results Notification of a HCV positive test was independently associated with a small increase in alcohol use relative to notification of a negative test. No significant differences in post-notification injection drug use, receptive sharing of ancillary injecting equipment and syringe borrowing post-notification were observed between diagnosis groups. Younger PWID receiving a positive HCV test notification demonstrated a significant increase in subsequent alcohol use compared with younger HCV negative. Conclusion PWID receiving a HCV positive notification increased frequency of alcohol use post-notification, whilst no reduction in injection drug use behaviors was observed between notification groups. These findings underscore the need to develop novel communication strategies during post-test notification to improve their impact on subsequent alcohol use and risk behaviors. PMID:25814695

  6. Trends in HIV and hepatitis C virus infections among injecting drug users in Europe, 2005 to 2010.

    PubMed

    Wiessing, L; Likatavicius, G; Hedrich, D; Guarita, B; van de Laar, M J; Vicente, J

    2011-01-01

    Data on newly diagnosed HIV infections and HIV prevalence in 2005 to 2010 suggest falling infection rates in injecting drug users (IDUs) in the European Union (EU). However, recent increases in HIV and hepatitis C virus (HCV) infection rates in IDUs suggest increasing injecting risks in some countries. The coverage of effective prevention measures has increased, but is still low in several countries. Overall the data suggest a continued risk of new outbreaks of HIV infection among IDUs. PMID:22172300

  7. High-Risk Behaviors after Release from Incarceration among People Who Inject Drugs in St. Petersburg, Russia

    PubMed Central

    Cepeda, Javier A.; Niccolai, Linda M.; Lyubimova, Alexandra; Kershaw, Trace; Levina, Olga; Heimer, Robert

    2014-01-01

    Background Injection drug use, infectious disease, and incarceration are inextricably linked in Russia. We aimed to identify factors associated with time to relapse (first opioid injection after release from prison) and using a non-sterile, previously used syringe at relapse in a sample of people who inject drugs in St. Petersburg. Methods We collected data on time from release to relapse among individuals with a history of incarceration, a subsample of a larger study among people who inject drugs. Proportional hazards and logistic regression were used to identify factors associated with time to relapse and injection with a non-sterile previously used syringe at relapse, respectively. Results The median time to relapse after release was 30 days. Factors that were independently associated with relapsing sooner were being a native of St. Petersburg compared to not being native (AHR: 1.64; 95% CI 1.15 – 2.33), unemployed at relapse compared to employed (AHR: 4.49; 95% CI 2.96 – 6.82) and receiving a previous diagnosis of HBV and HCV compared to no previous diagnosis (AHR: 1.49; 95% CI 1.03 – 2.14). Unemployment at relapse was also significant in modeling injection with a non-sterile, previously used syringe at relapse compared to those who were employed (AOR: 6.80; 95% CI 1.96 – 23.59). Conclusions Unemployment was an important correlate for both resuming opioid injection after release and using a non-sterile previously used syringe at relapse. Linkage to medical, harm reduction, and employment services should be developed for incarcerated Russian people who inject drugs prior to release. PMID:25496706

  8. [Human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) testing among injecting drug users].

    PubMed

    Gyarmathy, V Anna; Rácz, József

    2011-01-23

    In Hungary, there is a need for widely accessible HIV and HCV testing and counseling for injecting drug users. Theoretically, free and confidential rapid HIV and HCV testing would be the most suitable for this purpose. Low threshold agencies, such as needle and syringe programs, would provide ideal premises for such a testing system, Here, participants would be able to undergo regular testing every six months. Making rapid testing widely available raises the following three main issues: 1. validity of the testing results (or: the verification of positive rapid test results), 2. circumstances of taking blood (or: legislation regarding drawing blood), and 3. cost effectiveness (or: how important is it to prevent an HIV epidemic). The authors propose the establishment of a system that offers screening using rapid tests and which would be an expansion of a currently existing system of HIV and HCV testing based on finger prick blood. The current system would thus serve as a means to verify the results of the rapid tests. At the same time, there is a need to obtain permission from a public health body to enable in needle and syringe programs the provision of rapid testing and testing of blood using finger pricks. In many countries, test results are given to injecting drug users not by doctors but by trained social workers - such a system could also be established in Hungary. If preventing an HIV epidemic in Hungary is a priority, then wide access to rapid HIV testing is justified. Widely accessible free and confidential rapid HIV and HCV testing and counseling - combined with screening and verification using finger prick blood - may function not only as a testing and counseling service but also as a good quality public health monitoring system. Such a system, however, requires regular financial support from the government. PMID:21224188

  9. Housing instability among people who inject drugs: results from the Australian needle and syringe program survey.

    PubMed

    Topp, Libby; Iversen, Jenny; Baldry, Eileen; Maher, Lisa

    2013-08-01

    High rates of substance dependence are consistently documented among homeless people, and are associated with a broad range of negative outcomes among this population. Investigations of homelessness among drug users are less readily available. This study examined the prevalence and correlates of housing instability among clients of needle syringe programs (NSPs) via the Australian NSP Survey, annual cross-sectional seroprevalence studies among NSP attendees. Following self-completion of a brief, anonymous survey and provision of a capillary blood sample by 2,396 NSP clients, multivariate logistic regressions identified the variables independently associated with housing instability. Nineteen percent of ANSPS participants reported current unstable housing, with primary ('sleeping rough'; 5 %), secondary (staying with friends/relatives or in specialist homelessness services; 8 %), and tertiary (residential arrangements involving neither secure lease nor private facilities; 6 %) homelessness all evident. Extensive histories of housing instability were apparent among the sample: 66 % reported at least one period of sleeping rough, while 77 % had shifted between friends/relatives (73 %) and/or resided in crisis accommodation (52 %). Participants with a history of homelessness had cycled in and out of homelessness over an average of 10 years; and one third reported first being homeless before age 15. Compared to their stably housed counterparts, unstably housed participants were younger, more likely to be male, of Indigenous Australian descent, and to report previous incarceration; they also reported higher rates of key risk behaviors including public injecting and receptive sharing of injecting equipment. The high prevalence of both historical and current housing instability among this group, particularly when considered in the light of other research documenting the many adverse outcomes associated with this particular form of disadvantage, highlights the need

  10. Canada's highest court unchains injection drug users; implications for harm reduction as standard of healthcare.

    PubMed

    Small, Dan

    2012-01-01

    North America's only supervised injection facility, Insite, opened its doors in September of 2003 with a federal exemption as a three-year scientific study. The results of the study, evaluated by an independent research team, showed it to be successful in engaging the target group in healthcare, preventing overdose death and HIV infections while increasing uptake and retention in detox and treatment. The research, published in peer-reviewed medical and scientific journals, also showed that the program did not increase public disorder, crime or drug use. Despite the substantial evidence showing the effectiveness of the program, the future of Insite came under threat with the election of a conservative federal government in 2006. As a result, the PHS Community Services Society (PHS), the non-profit organization that operates Insite, launched a legal case to protect the program. On 30 September 2011, Supreme Court of Canada ruled in favour of Insite and underscored the rights of people with addictions to the security of their person under section 7 of the Charter of Rights and Freedoms (Charter of Rights). The decision clears the ground for other jurisdictions in Canada, and perhaps North America, to implement supervised injection and harm reduction where it is epidemiologically indicated. The legal case validates the personhood of people with addictions while metaphorically unchaining them from the criminal justice system. PMID:22817679

  11. 30 Years on Selected Issues in the Prevention of HIV among Persons Who Inject Drugs

    PubMed Central

    Des Jarlais, D. C.; Pinkerton, S.; Hagan, H.; Guardino, V.; Feelemyer, J.; Cooper, H.; Hatzatkis, A.; Uuskula, A.

    2013-01-01

    After 30 years of extensive research on human immunodeficiency virus (HIV) among persons who inject drugs (PWID), we now have a good understanding of the critical issues involved. Following the discovery of HIV in 1981, epidemics among PWID were noted in many countries, and consensus recommendations for interventions for reducing injection related HIV transmission have been developed. While high-income countries have continued to develop and implement new Harm Reduction programs, most low-/middle-income countries have implemented Harm Reduction at very low levels. Modeling of combined prevention programming including needle exchange (NSP) and antiretroviral therapy (ARV) suggests that NSP be given the highest priority. Future HIV prevention programming should continue to provide Harm Reduction programs for PWID coupled with interventions aimed at reducing sexual transmission. As HIV continues to spread in low- and middle-income countries, it is important to achieve and maintain high coverage of Harm Reduction programs in these locations. As PWID almost always experience multiple health problems, it will be important to address these multiple problems within a comprehensive approach grounded in a human rights perspective. PMID:23840957

  12. Investigation of Plasma Treatment on Micro-Injection Moulded Microneedle for Drug Delivery.

    PubMed

    Nair, Karthik; Whiteside, Benjamin; Grant, Colin; Patel, Rajnikant; Tuinea-Bobe, Cristina; Norris, Keith; Paradkar, Anant

    2015-01-01

    Plasma technology has been widely used to increase the surface energy of the polymer surfaces for many industrial applications; in particular to increase in wettability. The present work was carried out to investigate how surface modification using plasma treatment modifies the surface energy of micro-injection moulded microneedles and its influence on drug delivery. Microneedles of polyether ether ketone and polycarbonate and have been manufactured using micro-injection moulding and samples from each production batch have been subsequently subjected to a range of plasma treatment. These samples were coated with bovine serum albumin to study the protein adsorption on these treated polymer surfaces. Sample surfaces structures, before and after treatment, were studied using atomic force microscope and surface energies have been obtained using contact angle measurement and calculated using the Owens-Wendt theory. Adsorption performance of bovine serum albumin and release kinetics for each sample set was assessed using a Franz diffusion cell. Results indicate that plasma treatment significantly increases the surface energy and roughness of the microneedles resulting in better adsorption and release of BSA. PMID:26529005

  13. Investigation of Plasma Treatment on Micro-Injection Moulded Microneedle for Drug Delivery

    PubMed Central

    Nair, Karthik; Whiteside, Benjamin; Grant, Colin; Patel, Rajnikant; Tuinea-Bobe, Cristina; Norris, Keith; Paradkar, Anant

    2015-01-01

    Plasma technology has been widely used to increase the surface energy of the polymer surfaces for many industrial applications; in particular to increase in wettability. The present work was carried out to investigate how surface modification using plasma treatment modifies the surface energy of micro-injection moulded microneedles and its influence on drug delivery. Microneedles of polyether ether ketone and polycarbonate and have been manufactured using micro-injection moulding and samples from each production batch have been subsequently subjected to a range of plasma treatment. These samples were coated with bovine serum albumin to study the protein adsorption on these treated polymer surfaces. Sample surfaces structures, before and after treatment, were studied using atomic force microscope and surface energies have been obtained using contact angle measurement and calculated using the Owens-Wendt theory. Adsorption performance of bovine serum albumin and release kinetics for each sample set was assessed using a Franz diffusion cell. Results indicate that plasma treatment significantly increases the surface energy and roughness of the microneedles resulting in better adsorption and release of BSA. PMID:26529005

  14. Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers.

    PubMed Central

    Chung, S. S.; Lau, J. Y.; Sung, J. J.; Chan, A. C.; Lai, C. W.; Ng, E. K.; Chan, F. K.; Yung, M. Y.; Li, A. K.

    1997-01-01

    OBJECTIVE: To compare endoscopic adrenaline injection alone and adrenaline injection plus heat probe for the treatment of actively bleeding peptic ulcers. DESIGN: Randomised prospective study of patients admitted with actively bleeding peptic ulcers. SETTING: One university hospital. SUBJECTS: 276 patients with actively bleeding ulcers detected by endoscopy within 24 hours of admission: 136 patients were randomised to endoscopic adrenaline injection alone and 140 to adrenaline injection plus heat probe treatment. MAIN OUTCOME MEASURES: Initial endoscopic haemostasis; clinical rebleeding; requirement for operation; requirement for blood transfusion; hospital stay, ulcer healing at four weeks; and mortality in hospital. RESULTS: Initial haemostasis was achieved in 131/134 patients (98%) who received adrenaline injection alone and 135/136 patients (99%) who received additional heat probe treatment (P = 0.33). Outcome as measured by clinical rebleeding (12 v 5), requirement for emergency operation (14 v 8), blood transfusion (2 v 3 units), hospital stay (4 v 4 days), ulcer healing at four weeks (79.1% v 74%), and in hospital mortality (7 v 8) were not significantly different in the two groups. In the subgroup of patients with spurting haemorrhage 8/27 (29.6%; 14.5% to 50.3%) patients from the adrenaline injection alone group and 2/31 (6.5%; 1.1% to 22.9%) patients from the dual treatment group required operative intervention. The relative risk of this was lower in the dual treatment group (0.17; 0.03 to 0.87). Hospital stay was significantly shorter in the dual treatment group than the adrenaline injection alone group (4 v 6 days, P = 0.01). CONCLUSION: The addition of heat probe treatment after endoscopic adrenaline injection confers an advantage in ulcers with spurting haemorrhage. PMID:9158465

  15. Differential effects of migration and deportation on HIV infection among male and female injection drug users in Tijuana, Mexico.

    PubMed

    Strathdee, Steffanie A; Lozada, Remedios; Ojeda, Victoria D; Pollini, Robin A; Brouwer, Kimberly C; Vera, Alicia; Cornelius, Wayne; Nguyen, Lucie; Magis-Rodriguez, Carlos; Patterson, Thomas L

    2008-01-01

    HIV prevalence is rising, especially among high risk females in Tijuana, Baja California, a Mexico-US border city situated on major migration and drug trafficking routes. We compared factors associated with HIV infection among male and female injection drug users (IDUs) in Tijuana in an effort to inform HIV prevention and treatment programs. IDUs aged > or = 18 years were recruited using respondent-driven sampling and underwent testing for HIV, syphilis and structured interviews. Logistic regression identified correlates of HIV infection, stratified by gender. Among 1056 IDUs, most were Mexican-born but 67% were born outside Tijuana. Reasons for moving to Tijuana included deportation from the US (56% for males, 29% for females), and looking for work/better life (34% for females, 15% for males). HIV prevalence was higher in females versus males (10.2% vs. 3.5%, p = 0.001). Among females (N = 158), factors independently associated with higher HIV prevalence included younger age, lifetime syphilis infection and living in Tijuana for longer durations. Among males (N = 898), factors independently associated with higher HIV prevalence were syphilis titers consistent with active infection, being arrested for having 'track-marks', having larger numbers of recent injection partners and living in Tijuana for shorter durations. An interaction between gender and number of years lived in Tijuana regressed on HIV infection was significant (p = 0.03). Upon further analysis, deportation from the U.S. explained the association between shorter duration lived in Tijuana and HIV infection among males; odds of HIV infection were four-fold higher among male injectors deported from the US, compared to other males, adjusting for all other significant correlates (p = 0.002). Geographic mobility has a profound influence on Tijuana's evolving HIV epidemic, and its impact is significantly modified by gender. Future studies are needed to elucidate the context of mobility and HIV acquisition in

  16. Role of community pharmacies in prevention of AIDS among injecting drug misusers: findings of a survey in England and Wales.

    PubMed Central

    Glanz, A.; Byrne, C.; Jackson, P.

    1989-01-01

    OBJECTIVE--To determine the current and potential roles of community pharmacists in the prevention of AIDS among misusers of injected drugs. DESIGN--Cross sectional postal survey of a one in four random sample of registered pharmacies in England and Wales. SETTING--Project conducted in the addiction research unit of the Institute of Psychiatry, London. SUBJECTS--2469 Community pharmacies in the 15 regional health authorities in England and Wales. MAIN OUTCOME MEASURES--Willingness of pharmacists to sell injecting equipment to known or suspected misusers of drugs; pharmacists' attitudes to syringe exchange schemes, keeping a "sharps" box for use by misusers of drugs, and offering face to face advice and leaflets; and opinions of community pharmacists on their role in AIDS prevention and drug misuse. RESULTS--1946 Questionnaires were returned, representing a response rate of 79%. This fell short of the target of one in four pharmacies in each family practitioner committee area in England and Wales, and total numbers of respondents were therefore weighted in inverse proportion to the response rate in each area. The findings disclosed a substantial demand for injecting equipment by drug misusers. After weighting of numbers of respondents an estimated 676 of 2434 pharmacies were currently selling injecting equipment and 65 of 2415 (3%) were participating in local syringe exchange schemes; only 94 of 2410 pharmacies (4%) had a sharps box for used equipment. There was a high degree of concern among pharmacists about particular consequences of drug misusers visiting their premises, along with a widespread acceptance that the community pharmacist had an important part to play. CONCLUSIONS--Promoting the participation of community pharmacists in the prevention of AIDS among misusers of injected drugs is a viable policy, but several problems would need to be overcome before it was implemented. PMID:2511969

  17. Evaluating outcome-correlated recruitment and geographic recruitment bias in a respondent-driven sample of people who inject drugs in Tijuana, Mexico

    PubMed Central

    Rudolph, Abby E.; Gaines, Tommi L.; Lozada, Remedios; Vera, Alicia; Brouwer, Kimberly C.

    2015-01-01

    Respondent-driven sampling’s (RDS) widespread use and reliance on untested assumptions suggests a need for new exploratory/diagnostic tests. We assessed geographic recruitment bias and outcome-correlated recruitment among 1048 RDS-recruited people who inject drugs (Tijuana, Mexico). Surveys gathered demographics, drug/sex behaviors, activity locations, and recruiter-recruit pairs. Simulations assessed geographic and network clustering of active syphilis (RPR titers≥1:8). Gender-specific predicted probabilities were estimated using logistic regression with GEE and robust standard errors. Active syphilis prevalence was 7% (crude: men=5.7% and women=16.6%; RDS-adjusted: men=6.7% and women=7.6%). Syphilis clustered in the Zona Norte, a neighborhood known for drug and sex markets. Network simulations revealed geographic recruitment bias and non-random recruitment by syphilis status. Gender-specific prevalence estimates accounting for clustering were highest among those living/working/injecting/buying drugs in the Zona Norte and directly/indirectly connected to syphilis cases (men:15.9%, women:25.6%) and lowest among those with neither exposure (men:3.0%, women:6.1%). Future RDS analyses should assess/account for network and spatial dependencies. PMID:24969586

  18. Facilitating outpatient treatment entry following detoxification for injection drug use: a multisite test of three interventions.

    PubMed

    Campbell, Barbara K; Fuller, Bret E; Lee, Eun Sul; Tillotson, Carrie; Woelfel, Tiffany; Jenkins, Lindsay; Robinson, James; Booth, Robert E; McCarty, Dennis

    2009-06-01

    A multisite, randomized trial within the National Drug Abuse Treatment Clinical Trials Network (CTN) was conducted to test 3 interventions to enhance treatment initiation following detoxification: (a) a single session, therapeutic alliance intervention (TA) added to usual treatment; (b) a 2-session, counseling and education, HIV/HCV risk reduction intervention (C&E), added to usual treatment; and (c) treatment as usual (TAU) only. Injection drug users (n=632) enrolled in residential detoxification at 8 community treatment programs were randomized to 1 of the 3 study conditions. TA participants reported entering outpatient treatment sooner and in greater numbers than TAU participants. Reported treatment entry for C&E fell between TA and TAU with no significant differences between C&E and the other conditions. There were no differences among the interventions in retention, as measured by weeks of outpatient treatment for all participants who reported treatment entry. Alliance building interventions appear to be effective in facilitating transfer from detoxification to outpatient treatment, but additional treatment engagement interventions may be necessary to improve retention. PMID:19586142

  19. Prevention, treatment and care of hepatitis C virus infection among people who inject drugs.

    PubMed

    Bruggmann, Philip; Grebely, Jason

    2015-02-01

    People who inject drugs (PWID) represent the core of the hepatitis C virus (HCV) epidemic in many countries. HCV transmission continues among PWID, despite evidence demonstrating that high coverage of combined harm reduction strategies, such as needle syringe programs (NSP) and opioid substitution treatment (OST), can be effective in reducing the risk of HCV transmission. Among infected individuals, HCV-related morbidity and mortality continues to grow and is accompanied by major public health, social and economic burdens. Despite the high prevalence of HCV infection, the proportion of PWID who have been tested, assessed and treated for HCV infection remains unacceptably low, related to systems-, provider- and patient-related barriers to care. This is despite compelling data demonstrating that with the appropriate programs, HCV treatment is safe and successful among PWID. The approaching era of interferon-free directly acting antiviral therapy has the potential to provide one of the great advances in clinical medicine. Simple, tolerable and highly effective therapy will likely address many of these barriers, thereby enhancing the numbers of PWID cured of HCV infection. However, the high cost of new HCV therapies will be a barrier to implementation in many settings. This paper highlights that restrictive national drug policy and law enforcement are key drivers of the HCV epidemic among PWID. This paper also calls for enhanced HCV treatment settings built on a foundation of both prevention (e.g. NSP and OST) and improved access to health care for PWID. PMID:25245939

  20. Taking Care of Themselves: How Long-Term Injection Drug Users Remain HIV and Hepatitis C Free

    PubMed Central

    Meylakhs, Peter; Friedman, Samuel R.; Mateu-Gelabert, Pedro; Sandoval, Milagros; Meylakhs, Nastia

    2014-01-01

    Though prevalence of HIV and especially Hepatitis C is high among injection drug users (IDUs) in New York, about a third of those who have injected for 8 – 15 years have avoided infection by either virus despite their long-term drug use. Based on life history interviews with 35 long-term IDUs in New York, this paper seeks to show how successful integration and performance of various drug using and non-drug using roles may have contributed to some of these IDUs’ staying uninfected with either virus. We argue that analysis of non-risk related aspects of the lives of the risk-takers (IDUs) is very important in understanding their risk-taking behavior and its outcomes (infection statuses). Drawing on work-related, social, and institutional resources, our double-negative informants underwent both periods of stability and turmoil without getting infected. PMID:25688570

  1. ASYMMETRY OF HELICITY INJECTION FLUX IN EMERGING ACTIVE REGIONS

    SciTech Connect

    Tian Lirong; Alexander, David

    2009-04-20

    Observational and modeling results indicate that typically the leading magnetic field of bipolar active regions (ARs) is often spatially more compact, while more dispersed and fragmented in following polarity. In this paper, we address the origin of this morphological asymmetry, which is not well understood. Although it may be assumed that, in an emerging {omega}-shaped flux tube, those portions of the flux tube in which the magnetic field has a higher twist may maintain its coherence more readily, this has not been tested observationally. To assess this possibility, it is important to characterize the nature of the fragmentation and asymmetry in solar ARs and this provides the motivation for this paper. We separately calculate the distribution of the helicity flux injected in the leading and following polarities of 15 emerging bipolar ARs, using the Michelson Doppler Image 96 minute line-of-sight magnetograms and a local correlation tracking technique. We find from this statistical study that the leading (compact) polarity injects several times more helicity flux than the following (fragmented) one (typically 3-10 times). This result suggests that the leading polarity of the {omega}-shaped flux tube possesses a much larger amount of twist than the following field prior to emergence. We argue that the helicity asymmetry between the leading and following magnetic field for the ARs studied here results in the observed magnetic field asymmetry of the two polarities due to an imbalance in the magnetic tension of the emerging flux tube. We suggest that the observed imbalance in the helicity distribution results from a difference in the speed of emergence between the leading and following legs of an inclined {omega}-shaped flux tube. In addition, there is also the effect of magnetic flux imbalance between the two polarities with the fragmented following polarity displaying spatial fluctuation in both the magnitude and sign of helicity measured.

  2. Within-Prison Drug Injection among HIV-Infected Ukrainian Prisoners: Prevalence and Correlates of an Extremely High-Risk Behaviour

    PubMed Central

    Izenberg, Jacob; Bachireddy, Chethan; Wickersham, Jeffrey A.; Soule, Michael; Kiriazova, Tetiana; Dvoriak, Sergii; Altice, Frederick L.

    2014-01-01

    Background In Ukraine, HIV-infection, injection drug use, and incarceration are syndemic; however, few services are available to incarcerated people who inject drugs (PWIDs). While data are limited internationally, within-prison drug injection (WP-DI) appears widespread and may pose significant challenges in countries like Ukraine, where PWIDs contribute heavily to HIV incidence. To date, WP-DI has not been specifically examined among HIV-infected prisoners, the only persons that can transmit HIV. Methods A convenience sample of 97 HIV-infected adults recently released from prison within 1–12 months was recruited in two major Ukrainian cities. Post-release surveys inquired about WP-DI and injection equipment sharing, as well as current and prior drug use and injection, mental health, and access to within-prison treatment for HIV and other comorbidities. Logistic regression identified independent correlates of WP-DI. Results Complete data for WP-DI were available for 95 (97.9%) respondents. Overall, 54 (56.8%) reported WP-DI, among whom 40 (74.1%) shared injecting equipment with a mean of 4.4 (range 0–30) other injectors per needle/syringe. Independent correlates of WP-DI were recruitment in Kyiv (AOR 7.46, p=0.003), male gender (AOR 22.07, p=0.006), and active pre-incarceration opioid use (AOR 8.66, p=0.005). Conclusions Among these recently released HIV-infected prisoners, WP-DI and injection equipment sharing were frequent and involved many injecting partners per needle/syringe. The overwhelming majority of respondents reporting WP-DI used opioids both before and after incarceration, suggesting that implementation of evidence-based harm reduction practices, such as opioid substitution therapy and/or needle/syringe exchange programs within prison, is crucial to addressing continuing HIV transmission among PWIDs within prison settings. The positive correlation between Kyiv site and WP-DI suggests that additional structural interventions may be useful. PMID

  3. Evaluation of an injectable thermosensitive hydrogel as drug delivery implant for ocular glaucoma surgery.

    PubMed

    Xi, Lei; Wang, Tao; Zhao, Feng; Zheng, Qiongjuan; Li, Xiaoning; Luo, Jing; Liu, Ji; Quan, Daping; Ge, Jian

    2014-01-01

    In this study, a biodegradable thermo-sensitive hydrogel from poly(trimethylene carbonate)15-F127-poly(trimethylene carbonate)15 (PTMC15-F127-PTMC15) was designed and evaluated as an injectable implant during ocular glaucoma filtration surgery in vivo and in vitro. Mitomycin C (MMC) was loaded into this hydrogel for controlled released to prolong the efficacy and to reduce the long-term toxicity. The properties of the hydrogel were confirmed using 1H NMR and gel permeation chromatography (GPC). Compared to the Pluronic F127 hydrogel, the PTMC15-F127-PTMC15 hydrogel showed a good solution-gel transition temperature at 37°C, a lower work concentration of 5% w/v and a longer mass loss time of more than 2 weeks. The in vitro study showed that the drug could be released from PTMC15-F127-PTMC15 (5% w/v) hydrogel for up to 16 days with only 57% of drug released in the first day. Moreover, the cell toxicity, which was tested via LDH and ANNEXIN V/PI, decreased within 72 h in human tenon's fibroblast cells (HTFs). The in vivo behavior in a rabbit glaucoma filtration surgery model indicated that this hydrogel loaded with 0.1 mg/ml MMC led to a better functional bleb with a prolonged mean bleb survival time (25.5±2.9 days). The scar tissue formation, new collagen deposition and myofibroblast generation appeared to be reduced upon histological and immunohistochemistry examinations, with no obvious side effects and inflammatory reactions. The in vitro and in vivo results demonstrated that this novel hydrogel is a safe and effective drug delivery candidate in ocular glaucoma surgery. PMID:24950176

  4. Evaluation of an Injectable Thermosensitive Hydrogel As Drug Delivery Implant for Ocular Glaucoma Surgery

    PubMed Central

    Zhao, Feng; Zheng, Qiongjuan; Li, Xiaoning; Luo, Jing; Liu, Ji; Quan, Daping; Ge, Jian

    2014-01-01

    In this study, a biodegradable thermo-sensitive hydrogel from poly(trimethylene carbonate)15-F127-poly(trimethylene carbonate)15 (PTMC15-F127-PTMC15) was designed and evaluated as an injectable implant during ocular glaucoma filtration surgery in vivo and in vitro. Mitomycin C (MMC) was loaded into this hydrogel for controlled released to prolong the efficacy and to reduce the long-term toxicity. The properties of the hydrogel were confirmed using 1H NMR and gel permeation chromatography (GPC). Compared to the Pluronic F127 hydrogel, the PTMC15-F127-PTMC15 hydrogel showed a good solution-gel transition temperature at 37°C, a lower work concentration of 5% w/v and a longer mass loss time of more than 2 weeks. The in vitro study showed that the drug could be released from PTMC15-F127-PTMC15 (5% w/v) hydrogel for up to 16 days with only 57% of drug released in the first day. Moreover, the cell toxicity, which was tested via LDH and ANNEXIN V/PI, decreased within 72 h in human tenon's fibroblast cells (HTFs). The in vivo behavior in a rabbit glaucoma filtration surgery model indicated that this hydrogel loaded with 0.1 mg/ml MMC led to a better functional bleb with a prolonged mean bleb survival time (25.5±2.9 days). The scar tissue formation, new collagen deposition and myofibroblast generation appeared to be reduced upon histological and immunohistochemistry examinations, with no obvious side effects and inflammatory reactions. The in vitro and in vivo results demonstrated that this novel hydrogel is a safe and effective drug delivery candidate in ocular glaucoma surgery. PMID:24950176

  5. Impairment of learning and memory in shuttle box-trained rats neonatally injected with 6-hydroxydopamine. Effects of nootropic drugs.

    PubMed

    Stancheva, S; Papazova, M; Alova, L; Lazarova-Bakarova, M

    1993-01-01

    The effect of neonatal 6-hydroxydopamine (6-OHDA) treatment on learning and retention and on the level of biogenic monoamines in some brain structures as well as the influence of the nootropic drugs--piracetam, aniracetam, meclofenoxate and fipexide on the 6-OHDA-induced effect was studied. Two- way active avoidance (shuttle box) was used. The levels of noradrenaline (NA), dopamine (DA) and serotonin (5-HT) in the frontal cortex, striatum, hypothalamus, hippocampus and pons were measured. In mature rats, injected with 6-OHDA (100 mg/kg s.c.) in the first 3 postnatal days learning and retention were impaired and the NA level in the frontal cortex and hippocampus was decreased. Piracetam (600 mg/kg), aniracetam (50 mg/kg), meclofenoxate (100 mg/kg) and fipexide (10 mg/kg) administered orally 5 days before and 5 days during training, abolished the amnestic effect of 6-OHDA and restored to control values the NA level in the frontal cortex and hippocampus. This finding suggests the important role of the noradrenergic neurotransmitter system in the 6-OHDA-induced amnesia, as well as in the favorable effect of the nootropic drugs tested on 6-OHDA-impaired memory processes. PMID:8203277

  6. Nitroheterocyclic drugs with broad spectrum activity.

    PubMed

    Raether, W; Hänel, H

    2003-06-01

    The group of biologically active nitroheterocyclic compounds includes various 5- and 2-nitroimidazoles and 5-nitrofurans, which can be used as therapeutic agents against a variety of protozoan and bacterial (anaerobic) infections of humans and animals. The current status in the the treatment of giardiasis, trichomoniasis, balantidiasis, histomoniasis, and amebiasis (including infections due to opportunistic amebas) is presented. The most relevant drugs (benznidazole, furazolidone, metronidazole, misonidazole, nifurtimox, nimorazole, nitazoxanide, ornidazole, secnidazole, and tinidazole) are characterized with regard to their chemical, chemotherapeutic, toxicological, pharmacokinetic, and pharmacological properties, including the mechanism of action and resistance in certain parasitic protozoa. PMID:12811546

  7. Active waste-injection systems in Florida, 1976

    USGS Publications Warehouse

    Vecchioli, John; McKenzie, D.J.; Pascale, C.A.; Wilson, W.E.

    1979-01-01

    As of the end of 1976, seven systems were injecting liquid wastes into Florida 's subsurface environment at a combined average rate of 15 million gallons per day. This report presents for each of these systems information on the kind and amount of waste injected and type of pretreatment, construction characteristics of the injection and monitor wells, type of test and monitoring data available, and brief discussion of any operational problems experienced. (Kosco-USGS)

  8. Similar time restriction for intracytoplasmic sperm injection and round spermatid injection into activated oocytes for efficient offspring production.

    PubMed

    Kishigami, Satoshi; Wakayama, Sayaka; Nguyen, Van Thuan; Wakayama, Teruhiko

    2004-06-01

    The injection of male haploid germ cells, such as spermatozoa and round spermatids, into preactivated mouse oocytes can result in the development of viable embryos and offspring. However, it is not clear how the timing of intracytoplasmic sperm injection (ICSI) and round spermatid injection (ROSI) affects the production of offspring. We carried out ICSI and ROSI every 20 min for up to 4 h after the activation of mouse oocytes by Sr(2+) and compared the late-stage development of ICSI- and ROSI- treated oocytes, including the formation of pronuclei, blastocyst formation, and offspring production. The rate of pronucleus formation (RPF) after carrying out ICSI started to decrease from >95% at 100 min following oocyte activation and declined to <20% by 180 min. In comparison, RPF by ROSI decreased gradually from >70% between 0 and 4 h after activation. The RPFs were closely correlated with blastocyst formation. Offspring production for both ICSI and ROSI decreased significantly when injections were conducted after 100 min, a time at which activated oocytes were in the early G1 stage of the cell cycle. These results suggest that spermatozoa and round spermatids have different potentials for inducing the formation of a male pronucleus in activated oocytes, but ICSI and ROSI are both subject to the same time constraint for the efficient production of offspring, which is determined by the cell cycle of the activated oocyte. PMID:14985245

  9. Spatial Accessibility of Drug Treatment Facilities and the Effects on Locus of Control, Drug Abuse, and Service Use among Heroin-Injecting Mexican American Men

    PubMed Central

    Kao, Dennis; Torres, Luis R.; Guerrero, Erick G.; Mauldin, Rebecca; Bordnick, Patrick S.

    2014-01-01

    Background This study explores the spatial accessibility of outpatient drug treatment facilities and the potential relationship with drug abuse-related outcomes among Mexican American heroin users. Methods Secondary data on 219 current and former heroin-injecting Mexican American men aged 45 and older were drawn from a research study in Houston, Texas. We used geographic information systems (GIS) to derive two spatial accessibility measures: distance from one’s place of residence to the closest drug treatment facility (in minutes); and the number of facilities within a 10-minute driving distance from one’s place of residence. Exploratory logistic regression analyses examined the association between the spatial accessibility of drug treatment facilities and several drug abuse-related outcomes: internal locus of control (LOC); perceived chances and worries of injecting in the next six months; treatment utilization; and location of last heroin purchase. Results Participants with greater spatial access to treatment programs were more likely to report a higher chance of injecting in the near future. However, while current heroin users were more worried about injecting in the next six months, greater spatial access to treatment programs seemed to have a buffering effect. Finally, those who lived closer to a treatment programs were more likely to have last purchased heroin inside the neighborhood versus outside the neighborhood. Spatial accessibility was not associated with internal LOC or treatment utilization. Conclusion The findings showed that the presence of outpatient treatment facilities—particularly services in Spanish—may influence perceived risk of future heroin use and purchasing behaviors among Mexican American men. Implications for future spatially-informed drug abuse research and the planning of culturally and linguistically responsive drug treatment programs are discussed. PMID:24440123

  10. An injectable, dual pH and oxidation-responsive supramolecular hydrogel for controlled dual drug delivery.

    PubMed

    Cheng, Xinfeng; Jin, Yong; Sun, Tongbing; Qi, Rui; Li, Hanping; Fan, Wuhou

    2016-05-01

    A novel pH and oxidation dual-responsive and injectable supramolecular hydrogel was developed, which was formed from multi-block copolymer poly(ether urethane) (PEU) and α-cyclodextrin (α-CD) inclusion complexes (ICs). The PEU copolymer was synthesized through a simple one-pot condensation polymerization of poly(ethylene glycol), di(1-hydroxyethylene) diselenide, dimethylolpropionic acid and 3-isocyanatomethyl-3,5,5-trimethylcyclohexyl isocyanate. In aqueous solution, the amphiphilic PEU copolymers could self-assemble into nanoparticles with dual pH and oxidation sensitivities, which can efficiently load and controllably release a hydrophobic drug indomethacin (IND). Then a dual-drug loaded supramolecular hydrogel was obtained by addition of α-CD and hydrophilic model drug (rhodamine B, RB) into the resulting IND-loaded PEU nanoparticle solution. The rheology studies showed that the supramolecular hydrogels with good injectability underwent a pH-induced reversible sol-gel transition and an oxidation-triggered degradation behavior. The in vitro drug release results demonstrated that the hydrogels showed dual drug release behavior and the release rates could be significantly accelerated by addition of an oxidizing agent (H2O2) or increasing the environmental pH. Therefore, this injectable and dual stimuli-responsive supramolecular hydrogel based codelivery systems could potentially be a promising candidate for controlled drug delivery systems. PMID:26851440

  11. Modeling injection molding of net-shape active ceramic components.

    SciTech Connect

    Baer, Tomas; Cote, Raymond O.; Grillet, Anne Mary; Yang, Pin; Hopkins, Matthew Morgan; Noble, David R.; Notz, Patrick K.; Rao, Rekha Ranjana; Halbleib, Laura L.; Castaneda, Jaime N.; Burns, George Robert; Mondy, Lisa Ann; Brooks, Carlton, F.

    2006-11-01

    To reduce costs and hazardous wastes associated with the production of lead-based active ceramic components, an injection molding process is being investigated to replace the current machining process. Here, lead zirconate titanate (PZT) ceramic particles are suspended in a thermoplastic resin and are injected into a mold and allowed to cool. The part is then bisque fired and sintered to complete the densification process. To help design this new process we use a finite element model to describe the injection molding of the ceramic paste. Flow solutions are obtained using a coupled, finite-element based, Newton-Raphson numerical method based on the GOMA/ARIA suite of Sandia flow solvers. The evolution of the free surface is solved with an advanced level set algorithm. This approach incorporates novel methods for representing surface tension and wetting forces that affect the evolution of the free surface. Thermal, rheological, and wetting properties of the PZT paste are measured for use as input to the model. The viscosity of the PZT is highly dependent both on temperature and shear rate. One challenge in modeling the injection process is coming up with appropriate constitutive equations that capture relevant phenomenology without being too computationally complex. For this reason we model the material as a Carreau fluid and a WLF temperature dependence. Two-dimensional (2D) modeling is performed to explore the effects of the shear in isothermal conditions. Results indicate that very low viscosity regions exist near walls and that these results look similar in terms of meniscus shape and fill times to a simple Newtonian constitutive equation at the shear-thinned viscosity for the paste. These results allow us to pick a representative viscosity to use in fully three-dimensional (3D) simulation, which because of numerical complexities are restricted to using a Newtonian constitutive equation. Further 2D modeling at nonisothermal conditions shows that the choice of

  12. Drug Treatment as HIV Prevention Among Women and Girls Who Inject Drugs From a Global Perspective: Progress, Gaps, and Future Directions.

    PubMed

    Springer, Sandra A; Larney, Sarah; Alam-Mehrjerdi, Zahra; Altice, Frederick L; Metzger, David; Shoptaw, Steven

    2015-06-01

    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. PMID:25978482

  13. Drug Treatment as HIV Prevention Among Women and Girls Who Inject Drugs From a Global Perspective: Progress, Gaps, and Future Directions

    PubMed Central

    Springer, Sandra A.; Larney, Sarah; Alam-mehrjerdi, Zahra; Altice, Frederick L.; Metzger, David; Shoptaw, Steven

    2015-01-01

    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. PMID:25978482

  14. Community Impact of Pharmacy-Randomized Intervention to Improve Access to Syringes and Services for Injection Drug Users

    ERIC Educational Resources Information Center

    Crawford, Natalie D.; Amesty, Silvia; Rivera, Alexis V.; Harripersaud, Katherine; Turner, Alezandria; Fuller, Crystal M.

    2014-01-01

    Objectives: In an effort to reduce HIV transmission among injection drug users (IDUs), New York State deregulated pharmacy syringe sales in 2001 through the Expanded Syringe Access Program by removing the requirement of a prescription. With evidence suggesting pharmacists' ability to expand their public health role, a structural,…

  15. Weighing the Consequences: Self-Disclosure of HIV-Positive Status among African American Injection Drug Users

    ERIC Educational Resources Information Center

    Valle, Maribel; Levy, Judith

    2009-01-01

    Theorists posit that personal decisions to disclose being HIV positive are made based on the perceived consequences of that disclosure. This study examines the perceived costs and benefits of self-disclosure among African American injection drug users (IDUs). A total of 80 African American IDUs were interviewed in-depth subsequent to testing HIV…

  16. INJECTING DRUG USERS’ EXPERIENCES OF POLICING PRACTICES IN TWO MEXICAN-U.S. BORDER CITIES: PUBLIC HEALTH PERSPECTIVES

    PubMed Central

    Miller, Cari L.; Firestone, Michelle; Ramos, Rebeca; Burris, Scott; Ramos, Maria Elena; Case, Patricia; Brouwer, Kimberly C.; Fraga, Miguel Angel; Strathdee, Steffanie A.

    2008-01-01

    Background Previous research has identified the impact of law enforcement practices on the behaviors and health of injection drug users (IDUs). We undertook a qualitative study of IDUs’ experiences of policing practices in two Mexican cities on the U.S. border. Methods In 2004, two teams of Mexican interviewers conducted in-depth interviews with IDUs residing in Tijuana and Ciudad Juarez (Cd. Juarez), Mexico who had injected drugs at least once in the prior month. Topics included types of drug used, injection settings, access to sterile needles and experiences with police. Field notes and transcribed interviews were analyzed to identify emergent themes. Results Among the 43 participants, most reported that it is common for IDUs to be arrested and detained for 36 hours for carrying sterile or used syringes. Most reported that they or someone they knew had been beaten by police. Interviews suggested 5 key themes relating to police influence on the risk environment: 1) impact of policing practices on accessibility of sterile syringes, 2) influence of police on choice of places to inject drugs (e.g., shooting galleries), 3) police violence, 4) police corruption, and 5) perceived changes in policing practices. Conclusion Findings suggest that some behavior of police officers in Tijuana and Cd. Juarez is inconsistent with legal norms and may be negatively influencing the risk of acquiring blood-borne infections among IDUs. Implementing a comprehensive and successful HIV prevention program among IDUs requires interventions to influence the knowledge, attitudes and practices of law enforcement officers. PMID:17997089

  17. A Randomized Trial of Long-Term Reinforcement of Cocaine Abstinence in Methadone-Maintained Patients Who Inject Drugs

    ERIC Educational Resources Information Center

    Silverman, Kenneth; Robles, Elias; Mudric, Timothy; Bigelow, George E.; Stitzer, Maxine L.

    2004-01-01

    This study determined whether long-term abstinence reinforcement could maintain cocaine abstinence throughout a yearlong period. Patients who injected drugs and used cocaine during methadone treatment (n = 78) were randomly assigned to 1 of 2 abstinence-reinforcement groups or to a usual care control group. Participants in the 2…

  18. Active stabilization of a diode laser injection lock.

    PubMed

    Saxberg, Brendan; Plotkin-Swing, Benjamin; Gupta, Subhadeep

    2016-06-01

    We report on a device to electronically stabilize the optical injection lock of a semiconductor diode laser. Our technique uses as discriminator the peak height of the laser's transmission signal on a scanning Fabry-Perot cavity and feeds back to the diode current, thereby maintaining maximum optical power in the injected mode. A two-component feedback algorithm provides constant optimization of the injection lock, keeping it robust to slow thermal drifts and allowing fast recovery from sudden failures such as temporary occlusion of the injection beam. We demonstrate the successful performance of our stabilization method in a diode laser setup at 399 nm used for laser cooling of Yb atoms. The device eases the requirements on passive stabilization and can benefit any diode laser injection lock application, particularly those where several such locks are employed. PMID:27370428

  19. Active stabilization of a diode laser injection lock

    NASA Astrophysics Data System (ADS)

    Saxberg, Brendan; Plotkin-Swing, Benjamin; Gupta, Subhadeep

    2016-06-01

    We report on a device to electronically stabilize the optical injection lock of a semiconductor diode laser. Our technique uses as discriminator the peak height of the laser's transmission signal on a scanning Fabry-Perot cavity and feeds back to the diode current, thereby maintaining maximum optical power in the injected mode. A two-component feedback algorithm provides constant optimization of the injection lock, keeping it robust to slow thermal drifts and allowing fast recovery from sudden failures such as temporary occlusion of the injection beam. We demonstrate the successful performance of our stabilization method in a diode laser setup at 399 nm used for laser cooling of Yb atoms. The device eases the requirements on passive stabilization and can benefit any diode laser injection lock application, particularly those where several such locks are employed.

  20. Satellite needle distribution among injection drug users: policy and practice in two canadian cities.

    PubMed

    Tyndall, Mark W; Bruneau, Julie; Brogly, Susan; Spittal, Patricia; O'Shaughnessy, Michael V; Schechter, Martin T

    2002-09-01

    Access to clean needles and syringes through needle exchange programs (NEPs) has reduced both high-risk behaviors and the transmission of blood-borne infections among injection drug users (IDUs). However, policies regarding "needle-for-needle" exchange versus unrestricted needle distribution remain controversial. The objective of this study was to compare sources of needles, trends in needle distribution, and the practice of satellite needle distribution (SND) among IDUs in Vancouver and Montreal. SND was defined as receiving a new syringe from another individual through trading, purchasing, borrowing, or being given the syringe outright, or supplying a syringe to another individual through trading, selling, lending, or giving a syringe outright. This was practiced by 46% of IDUs in Vancouver and 50% of IDUs in Montreal. SND was associated with borrowing used injection equipment (adjusted OR [AOR], 2.62; 95% CI: 1.85-3.71), conducting bulk needle exchanges (AOR, 1.85; 95% CI: 1.34-2.54), being married or in a common-law relationship (AOR, 1.85; 95% CI: 1.34-2.54), and regular visits to the NEP (> weekly) (AOR, 1.54; 95% CI: 1.17-2.13). In Vancouver, SND was also associated with borrowing used needles (AOR, 2.07; 95% CI: 1.22-3.52). In these two cities, despite different distribution policies, almost half of the participants reported SND, and this was associated with high risk sharing. The practice of SND appears to be an important mechanism for needle acquisition, especially for those at highest risk for HIV and hepatitis C transmission. PMID:12352156

  1. A bio-ballistic micro-jet for drug injection into animal skin using a Nd:YAG laser

    NASA Astrophysics Data System (ADS)

    Yoh, J. J.; Jang, H.; Park, M.; Han, T.; Hah, J.

    2016-01-01

    Imaging of the abdominal skin of a guinea pig after injecting a fluorescent probe and biotin via the laser-induced ballistic technique revealed the epidermal and dermal layers which were stained well below 60 \\upmu m underneath the outer layer of the skin. An extensive network of cells was evident in the deeper layer of the stained dermis as the distributed fluorescein isothiocyanate dose was administered by repeated injection using a laser-based micro-jet. We performed optically controlled release of the drug by breaching the guinea pig's skin tissue targeting the region 10-400 \\upmu m beneath the outermost layer. Tissue damage was minimized by reducing the injection volume to approximately 100 nl per pulse. This was done using a micro-jet diameter equal to half of that of a conventional 200 \\upmu m syringe needle. Thus, the optimally controlled delivery of liquid drugs using an irradiated laser pulse was shown to be possible.

  2. Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries

    PubMed Central

    2013-01-01

    Background About a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries. Methods A data collection form was designed to cover questions on rates of IDU, prevalence and incidence of HIV and information on HIV treatment and harm reduction services available to people who inject drugs (PWID). National and regional data on HIV infection, IDU in the form of reports and journal articles were sought from key informants in conjunction with a systematic search of the literature. Results Completed data collection forms were received for 11 countries. Additional country-specific information was sourced via the literature search. The overall proportion of HIV positive PWID in the selected countries ranged from 3% in Kazakhstan to 58% in Vietnam. While IDU is relatively rare in sub-Saharan Africa, it is the main driver of HIV in Mauritius and Kenya, with roughly 47% and 36% of PWID respectively being HIV positive. All countries had antiretroviral treatment (ART) available to PWID, but data on service coverage were mainly missing. By the end of 2010, uptake of needle and syringe programmes (NSP) in Bangladesh, India and Slovakia reached the internationally recommended target of 200 syringes per person, while uptake in Kazakhstan, Vietnam and Tajikistan reached between 100-200 syringes per person. The proportion of PWID receiving opioid substitution therapy (OST) ranged from 0.1% in Kazakhstan to 32.8% in Mauritius, with coverage of less than 3% for most countries. Conclusions In order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to

  3. Multiscale Modeling of Drug-induced Effects of ReDuNing Injection on Human Disease: From Drug Molecules to Clinical Symptoms of Disease

    NASA Astrophysics Data System (ADS)

    Luo, Fang; Gu, Jiangyong; Zhang, Xinzhuang; Chen, Lirong; Cao, Liang; Li, Na; Wang, Zhenzhong; Xiao, Wei; Xu, Xiaojie

    2015-05-01

    ReDuNing injection (RDN) is a patented traditional Chinese medicine, and the components of it were proven to have antiviral and important anti-inflammatory activities. Several reports showed that RDN had potential effects in the treatment of influenza and pneumonia. Though there were several experimental reports about RDN, the experimental results were not enough and complete due to that it was difficult to predict and verify the effect of RDN for a large number of human diseases. Here we employed multiscale model by integrating molecular docking, network pharmacology and the clinical symptoms information of diseases and explored the interaction mechanism of RDN on human diseases. Meanwhile, we analyzed the relation among the drug molecules, target proteins, biological pathways, human diseases and the clinical symptoms about it. Then we predicted potential active ingredients of RDN, the potential target proteins, the key pathways and related diseases. These attempts may offer several new insights to understand the pharmacological properties of RDN and provide benefit for its new clinical applications and research.

  4. Prevalence and Correlates of the Use of Prefilled Syringes Among Persons Who Inject Drugs in San Diego, CA.

    PubMed

    Armenta, Richard F; Roth, Alexis M; Wagner, Karla D; Strathdee, Steffanie A; Brodine, Stephanie K; Cuevas-Mota, Jazmine; Munoz, Fatima A; Garfein, Richard S

    2015-12-01

    Persons who inject drugs (PWID) are at increased risk for blood-borne virus (BBV) infections and overdose resulting from high-risk injecting practices. Studies of prefilled syringe use ([PFSU] using a syringe that already contained drug solution when it was obtained by the user), an injection practice previously described in Eastern Europe, suggest that it increases susceptibility to BBV. However, little is known about this practice in the USA. Data were obtained from an ongoing cohort study of PWID to determine the prevalence and assess correlates of PFSU in San Diego, CA. Baseline interviews assessed socio-demographics and drug use behaviors. Logistic regression was used to identify factors independently associated with ever using a prefilled syringe (yes/no). Participants (n = 574) were predominately males (73.9%) and white (50.9%) with a mean age of 43.4 years (range 18-80); 33.3% reported ever using prefilled syringes, although only 4.9% reported use in the past 6 months. In multivariable analyses, PFSU was independently associated with ever having a rushed injection due to police presence [adjusted odds ratio (AOR) = 2.51, 95% CI 1.66, 3.79], ever being in prison (AOR = 1.80, 95% CI 1.23, 2.63), injecting most often in public versus private places in the past 6 months (AOR = 1.66, 95% CI 1.11, 2.48), and injecting drugs in Mexico (AOR = 1.70, 95% CI 1.16, 2.49). Results indicate that a history of PFSU is common and associated with environmental factors that may also increase risk for adverse health outcomes. Studies are needed to better understand PFSU in order to develop interventions to prevent adverse outcomes associated with their use. PMID:26382653

  5. 'Workers', 'clients' and the struggle over needs: understanding encounters between service providers and injecting drug users in an Australian city.

    PubMed

    Moore, David

    2009-03-01

    A feature of contemporary Western, neo-liberal democracies is the frequent interaction between representatives of health and social services and the members of stigmatised and 'unruly' populations, such as injecting drug users. Previous research on drugs has tended to ignore the power relations and cultural dynamics at work in these encounters, and the ways in which they are framed by the wider neo-liberal context. Drawing on an ethnography of street-based heroin use in Melbourne, Australia's second largest city, I show how the discourses of both service providers and injecting drug users draw on wider neo-liberal values of independence, autonomy, rationality and responsibility. Service providers negotiate a framework of needs interpretation that creates and reproduces professional identities, and maintains boundaries between 'workers' and 'clients'. It also includes tensions around the definition of injecting drug users as 'chaotic' (i.e., failed neo-liberal) subjects, and slippage between service philosophies that emphasise a social model of health and forms of service delivery that emphasise the production of responsibilised subjects. For their part, street-based injectors construct an alternative framework of needs interpretation that emphasises their self-reliance, autonomy and independence, attributes and capacities largely denied them in service-provider discourse. In encounters with service providers, street-based injectors respond in various ways that include elements of resistance, strategic accommodation and the incorporation of therapeutic discourse. I conclude by considering the implications of my analysis for the future development of drug policy and practice. PMID:19167141

  6. Cognitive Behavioral Theories Used to Explain Injection Risk Behavior Among Injection Drug Users: A Review and Suggestions for the Integration of Cognitive and Environmental Models

    PubMed Central

    Wagner, Karla D.; Unger, Jennifer B.; Bluthenthal, Ricky N.; Andreeva, Valentina A.; Pentz, Mary Ann

    2011-01-01

    Injection drug users (IDUs) are at risk for HIV and viral hepatitis, and risky injection behavior persists despite decades of intervention. Cognitive behavioral theories (CBT) are commonly used to help understand risky injection behavior. We review findings from CBT-based studies of injection risk behavior among IDUs. An extensive literature search was conducted in Spring 2007. In total 33 studies were reviewed—26 epidemiological and 7 intervention studies. Findings suggest that some theoretical constructs have received fairly consistent support (e.g., self-efficacy, social norms), while others have yielded inconsistent or null results (e.g., perceived susceptibility, knowledge, behavioral intentions, perceived barriers, perceived benefits, response efficacy, perceived severity). We offer some possible explanations for these inconsistent findings, including differences in theoretical constructs and measures across studies and a need to examine the environmental structures that influence risky behaviors. Greater integration of CBT with a risk environment perspective may yield more conclusive findings and more effective interventions in the future. PMID:20705809

  7. A perfect storm: crack cocaine, HSV-2, and HIV among non-injecting drug users in New York City.

    PubMed

    Des Jarlais, Don C; McKnight, Courtney; Arasteh, Kamyar; Feelemyer, Jonathan; Perlman, David C; Hagan, Holly; Dauria, Emily F; Cooper, Hannah L F

    2014-06-01

    Prevalence of human immunodeficiency virus (HIV) infection has reached 16% among non-injecting drug users (NIDU) in New York City, an unusually high prevalence for a predominantly heterosexual population that does not inject drugs. Using a long-term study (1983-2011, >7,000 subjects) among persons entering the Beth Israel drug-treatment programs in New York City, we identified factors that contributed to this high prevalence: a preexisting HIV epidemic among injectors, a crack cocaine epidemic, mixing between injectors and crack users, policy responses not centered on public health, and herpes-simplex virus 2 facilitating HIV transmission. Implications for avoiding high prevalence among NIDU in other areas are discussed. PMID:24502371

  8. Low Non-structured Antiretroviral Therapy Interruptions in HIV-Infected Persons Who Inject Drugs Receiving Multidisciplinary Comprehensive HIV Care at an Outpatient Drug Abuse Treatment Center.

    PubMed

    Vallecillo, Gabriel; Mojal, Sergio; Roquer, Albert; Samos, Pilar; Luque, Sonia; Martinez, Diana; Martires, Paula Karen; Torrens, Marta

    2016-05-01

    Continuous HIV treatment is necessary to ensure successful combined antiretroviral therapy (cART). The aim of this study was to evaluate the incidence of patient-initiated non-structured treatment interruptions in HIV-infected persons who inject drugs and who received a multidisciplinary comprehensive program, including medical HIV care, drug-dependence treatment and psychosocial support, at a drug outpatient addiction center. Non-structured treatment interruptions were defined as ≥30 consecutive days off cART without medical indication. During a median follow-up of 53.8 months, 37/132 (28 %) patients experienced the first non-structured treatment interruptions. The cumulative probability of cART interruption at 5 years was 31.2 % (95 % CI 22.4-40.0). Current drug use injection ≥1/day (HR 14.77; 95 % CI 5.90-36.96) and cART naive patients (HR 0.35, 95 % CI 0.14-0.93) were predictive factors for non-structured treatment interruptions. HIV care provided at a drug addiction center is a useful strategy to sustain continuous cART, however, drug abstinence is essential for the long-term maintenance of cART. PMID:26427376

  9. Social Disorganization, Drug Market Activity, and Neighborhood Violent Crime.

    PubMed

    Martínez, Ramiro; Rosenfeld, Richard; Mares, Dennis

    2008-01-01

    Although illicit drug activity occurs within local communities, past quantitative research on drug markets and violent crime in the United States has been conducted mainly at the city level. The authors use neighborhood-level data from the city of Miami to test hypotheses regarding the effect of drug activity and traditional indicators of social disorganization on rates of aggravated assault and robbery. The results show that drug activity has robust effects on violent crime that are independent of other disorganization indicators. The authors also find that drug activity is concentrated in neighborhoods with low rates of immigration, less linguistic isolation and ethnic heterogeneity, and where nondrug accidental deaths are prevalent. The authors find no independent effect of neighborhood racial composition on drug activity or violent crime. The results suggest that future neighborhood-level research on social disorganization and violent crime should devote explicit attention to the disorganizing and violence-producing effects of illicit drug activity. PMID:19655037

  10. Social Disorganization, Drug Market Activity, and Neighborhood Violent Crime

    PubMed Central

    Martínez, Ramiro; Rosenfeld, Richard; Mares, Dennis

    2009-01-01

    Although illicit drug activity occurs within local communities, past quantitative research on drug markets and violent crime in the United States has been conducted mainly at the city level. The authors use neighborhood-level data from the city of Miami to test hypotheses regarding the effect of drug activity and traditional indicators of social disorganization on rates of aggravated assault and robbery. The results show that drug activity has robust effects on violent crime that are independent of other disorganization indicators. The authors also find that drug activity is concentrated in neighborhoods with low rates of immigration, less linguistic isolation and ethnic heterogeneity, and where nondrug accidental deaths are prevalent. The authors find no independent effect of neighborhood racial composition on drug activity or violent crime. The results suggest that future neighborhood-level research on social disorganization and violent crime should devote explicit attention to the disorganizing and violence-producing effects of illicit drug activity. PMID:19655037

  11. Spatial Analysis of HIV Positive Injection Drug Users in San Francisco, 1987 to 2005

    PubMed Central

    Martinez, Alexis N.; Mobley, Lee R.; Lorvick, Jennifer; Novak, Scott P.; Lopez, Andrea M.; Kral, Alex H.

    2014-01-01

    Spatial analyses of HIV/AIDS related outcomes are growing in popularity as a tool to understand geographic changes in the epidemic and inform the effectiveness of community-based prevention and treatment programs. The Urban Health Study was a serial, cross-sectional epidemiological study of injection drug users (IDUs) in San Francisco between 1987 and 2005 (N = 29,914). HIV testing was conducted for every participant. Participant residence was geocoded to the level of the United States Census tract for every observation in dataset. Local indicator of spatial autocorrelation (LISA) tests were used to identify univariate and bivariate Census tract clusters of HIV positive IDUs in two time periods. We further compared three tract level characteristics (% poverty, % African Americans, and % unemployment) across areas of clustered and non-clustered tracts. We identified significant spatial clustering of high numbers of HIV positive IDUs in the early period (1987–1995) and late period (1996–2005). We found significant bivariate clusters of Census tracts where HIV positive IDUs and tract level poverty were above average compared to the surrounding areas. Our data suggest that poverty, rather than race, was an important neighborhood characteristic associated with the spatial distribution of HIV in SF and its spatial diffusion over time. PMID:24722543

  12. Childhood sexual abuse and syringe sharing among people who inject drugs

    PubMed Central

    Lee, William; Ti, Lianping; Marshall, Brandon D.L.; Dong, Huiru; Wood, Evan; Kerr, Thomas

    2014-01-01

    Childhood sexual abuse is associated with adverse health outcomes. However, the impact of sexual abuse on HIV risk behaviors among people who inject drugs (IDU) has not been thoroughly characterized. We therefore sought to identify whether childhood sexual abuse was associated with syringe sharing among a sample of IDU in Vancouver, Canada. We assessed sexual abuse among two cohorts of IDUs via the Childhood Trauma Questionnaire (CTQ). Multivariate logistic regression was used to estimate the relationship between childhood sexual abuse and syringe sharing. In total, 1380 IDU were included in the study, and 426 (30.9%) IDU reported childhood sexual abuse. Syringe sharing (Adjusted Odds Ratio = 1.83, 95% Confidence Interval: 1.28–2.60) remained independently associated with childhood sexual abuse after adjustment for potential confounders. Given that a history of childhood sexual abuse appears to be elevated among IDU who engage in HIV risk behaviors (i.e., syringe sharing), HIV prevention efforts should include efforts to address historical trauma in this population. PMID:25428283

  13. Modeling the HIV/AIDS epidemic among injecting drug users and sex workers in Kunming, China.

    PubMed

    Bacaër, Nicolas; Abdurahman, Xamxinur; Ye, Jianli

    2006-04-01

    This paper presents a mathematical model of the HIV/AIDS epidemic in Kunming, the provincial capital of Yunnan, China. The population is divided into several groups, with individuals possibly changing group. Two transmission routes of HIV are considered: needle sharing between injecting drug users (IDUs) and commercial sex between female sex worker (FSWs) and clients. The model includes male IDUs who are also clients and female IDUs who are also FSWs. Groups are split in two--risky and safe--according to condom use and needle sharing. A system of partial differential equations is derived to describe the spread of the disease. For the simulation, parameters are chosen to fit as much as possible data publicly available for Kunming. Some mathematical properties of the model--in particular the epidemic threshold R0 which determines the goal of public health interventions--are also presented. Though the model couples two transmission routes of HIV, the approximation R0 approximately = max[R0(IDU), R0(sex)], with closed formulas for R0(IDU) and R0(sex), appears to be quite good. The critical levels of condom use and clean needle use necessary to stop both the sexual transmission and the transmission among IDUs can therefore be determined independently. PMID:16794944

  14. HIV among injection drug users and their intimate partners in Almaty, Kazakhstan.

    PubMed

    El-Bassel, Nabila; Gilbert, Louisa; Terlikbayeva, Assel; Wu, Elwin; Beyrer, Chris; Shaw, Stacey; Hunt, Tim; Ma, Xin; Chang, Mingway; Ismayilova, Leyla; Tukeyev, Marat; Zhussupov, Baurzhan; Rozental, Yelena

    2013-09-01

    This paper examines prevalence rates of HIV, HCV, and syphilis among a sample of injecting drug users (IDUs) and their heterosexual intimate partners (N = 728) from Almaty, Kazakhstan. The study uses baseline data from Project Renaissance, a couple-based HIV prevention intervention delivered to a couple where one or both partners are IDUs. HIV prevalence rates among female and male IDUs were 28 %. Among the full sample, 75 % had HCV, and 13 % tested positive for the syphilis antibody test. Only 10 % of the sample ever visited a needle exchange program. One-fourth (25.3 %) had never been tested for HIV. One-quarter of those who tested positive were unaware of their status. Being HIV positive was associated with a history of incarceration, being an IDU, and having access to needle exchange programs. The findings call for increasing efforts to improve access to HIV testing, prevention, treatment, and care for IDUs in Almaty, Kazakhstan. PMID:23612942

  15. Recommendations for the management of hepatitis C virus infection among people who inject drugs.

    PubMed

    Grebely, Jason; Robaeys, Geert; Bruggmann, Philip; Aghemo, Alessio; Backmund, Markus; Bruneau, Julie; Byrne, Jude; Dalgard, Olav; Feld, Jordan J; Hellard, Margaret; Hickman, Matthew; Kautz, Achim; Litwin, Alain; Lloyd, Andrew R; Mauss, Stefan; Prins, Maria; Swan, Tracy; Schaefer, Martin; Taylor, Lynn E; Dore, Gregory J

    2015-10-01

    In high income countries, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). In many low and middle income countries large HCV epidemics have also emerged among PWID populations. The burden of HCV-related liver disease among PWID is increasing, but treatment uptake remains extremely low. There are a number of barriers to care which should be considered and systematically addressed, but should not exclude PWID from HCV treatment. The rapid development of interferon-free direct-acting antiviral (DAA) therapy for HCV infection has brought considerable optimism to the HCV sector, with the realistic hope that therapeutic intervention will soon provide near optimal efficacy with well-tolerated, short duration, all oral regimens. Further, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provide a framework for HCV assessment and care. Further research is needed to evaluate strategies to enhance testing, linkage to care, treatment, adherence, viral cure, and prevent HCV reinfection among PWID, particularly as new interferon-free DAA treatments for HCV infection become available. PMID:26282715

  16. Assessing Syringe Exchange Program Access among Persons Who Inject Drugs (PWID) in the District of Columbia.

    PubMed

    Allen, Sean T; Ruiz, Monica S; Jones, Jeff

    2016-02-01

    Prior research has explored spatial access to syringe exchange programs (SEPs) among persons who inject drugs (PWID), but these studies have been based on limited data from short periods of time. No research has explored changes in spatial access to SEPs among PWID longitudinally. The purpose of this research is to examine spatial access to SEPs among PWID who accessed services at a SEP in Washington, District of Columbia (DC), from 1996 to 2010. Th