Factors associated with time between using a drug and injection initiation among people who inject drugs in Kermanshah, Iran.

Science.gov (United States)

Noroozi, Mehdi; Farhadi, Mohammad Hassan; Armoon, Bahram; Farhoudian, Ali; Shushtari, Zahra Jorjoran; Sharhani, Asaad; Karimi, Salah Eddin; Sayadnasiri, Mohammad; Rezaei, Omid; Ghiasvand, Hesam

2018-05-17

Background The transition from non-injection to injection drug use dramatically increases the risk of transmitting HIV and other blood borne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). The aim of this study was to explore factors associated with the transition from first illicit drug use to first injection among drug users. Methods Using snowball sampling and convenience sampling through needle and syringe programmes (NSPs), we recruited 500 people who inject drugs (PWID) in Kermanshah, between September and December 2014. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our main outcome variable was first illicit drug use to first injection (TIJ). TIJ was calculated by subtracting age at first drug injection from age of first illicit drug use. Results Overall, the average age at first drug use and injection were 21.4 [standard deviation (SD 5.6)] and 22.8 (SD 8.9), respectively. The average duration of injection was 6.0 (SD 4.6) years. Overall, the mean of TIJ for participants was 1.4 (IQR = 2, 4) years. Age of first injecting drug use negatively correlated with TIJ (R2 = 0.219, p = 0.001). Education level and socioeconomic status (SES), and negatively correlated with TIJ. Conclusion Some demographic factors and drug use characteristics including educational level, SES, knowledge of HIV status, age of initiating drug use, being a poly drug user and using methamphetamine were predictors of the time to transition.

Hospitals as a 'risk environment': an ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs.

Science.gov (United States)

McNeil, Ryan; Small, Will; Wood, Evan; Kerr, Thomas

2014-03-01

People who inject drugs (PWID) experience high levels of HIV/AIDS and hepatitis C (HCV) infection that, together with injection-related complications such as non-fatal overdose and injection-related infections, lead to frequent hospitalizations. However, injection drug-using populations are among those most likely to be discharged from hospital against medical advice, which significantly increases their likelihood of hospital readmission, longer overall hospital stays, and death. In spite of this, little research has been undertaken examining how social-structural forces operating within hospital settings shape the experiences of PWID in receiving care in hospitals and contribute to discharges against medical advice. This ethno-epidemiological study was undertaken in Vancouver, Canada to explore how the social-structural dynamics within hospitals function to produce discharges against medical advice among PWID. In-depth interviews were conducted with thirty PWID recruited from among participants in ongoing observational cohort studies of people who inject drugs who reported that they had been discharged from hospital against medical advice within the previous two years. Data were analyzed thematically, and by drawing on the 'risk environment' framework and concepts of social violence. Our findings illustrate how intersecting social and structural factors led to inadequate pain and withdrawal management, which led to continued drug use in hospital settings. In turn, diverse forms of social control operating to regulate and prevent drug use in hospital settings amplified drug-related risks and increased the likelihood of discharge against medical advice. Given the significant morbidity and health care costs associated with discharge against medical advice among drug-using populations, there is an urgent need to reshape the social-structural contexts of hospital care for PWID by shifting emphasis toward evidence-based pain and drug treatment augmented by harm

A dose-dependent relationship between exposure to a street-based drug scene and health-related harms among people who use injection drugs.

Science.gov (United States)

Debeck, Kora; Wood, Evan; Zhang, Ruth; Buxton, Jane; Montaner, Julio; Kerr, Thomas

2011-08-01

While the community impacts of drug-related street disorder have been well described, lesser attention has been given to the potential health and social implications of drug scene exposure on street-involved people who use illicit drugs. Therefore, we sought to assess the impacts of exposure to a street-based drug scene among injection drug users (IDU) in a Canadian setting. Data were derived from a prospective cohort study known as the Vancouver Injection Drug Users Study. Four categories of drug scene exposure were defined based on the numbers of hours spent on the street each day. Three generalized estimating equation (GEE) logistic regression models were constructed to identify factors associated with varying levels of drug scene exposure (2-6, 6-15, over 15 hours) during the period of December 2005 to March 2009. Among our sample of 1,486 IDU, at baseline, a total of 314 (21%) fit the criteria for high drug scene exposure (>15 hours per day). In multivariate GEE analysis, factors significantly and independently associated with high exposure included: unstable housing (adjusted odds ratio [AOR] = 9.50; 95% confidence interval [CI], 6.36-14.20); daily crack use (AOR = 2.70; 95% CI, 2.07-3.52); encounters with police (AOR = 2.11; 95% CI, 1.62-2.75); and being a victim of violence (AOR = 1.49; 95 % CI, 1.14-1.95). Regular employment (AOR = 0.50; 95% CI, 0.38-0.65), and engagement with addiction treatment (AOR = 0.58; 95% CI, 0.45-0.75) were negatively associated with high exposure. Our findings indicate that drug scene exposure is associated with markers of vulnerability and higher intensity addiction. Intensity of drug scene exposure was associated with indicators of vulnerability to harm in a dose-dependent fashion. These findings highlight opportunities for policy interventions to address exposure to street disorder in the areas of employment, housing, and addiction treatment.

Waste management in Greater Vancouver

Energy Technology Data Exchange (ETDEWEB)

Carrusca, K. [Greater Vancouver Regional District, Burnaby, BC (Canada); Richter, R. [Montenay Inc., Vancouver, BC (Canada)]|[Veolia Environmental Services, Vancouver, BC (Canada)

2006-07-01

An outline of the Greater Vancouver Regional District (GVRD) waste-to-energy program was presented. The GVRD has an annual budget for solid waste management of $90 million. Energy recovery revenues from solid waste currently exceed $10 million. Over 1,660,00 tonnes of GVRD waste is recycled, and another 280,000 tonnes is converted from waste to energy. The GVRD waste-to-energy facility combines state-of-the-art combustion and air pollution control, and has processed over 5 million tonnes of municipal solid waste since it opened in 1988. Its central location minimizes haul distance, and it was originally sited to utilize steam through sales to a recycle paper mill. The facility has won several awards, including the Solid Waste Association of North America award for best facility in 1990. The facility focuses on continual improvement, and has installed a carbon injection system; an ammonia injection system; a flyash stabilization system; and heat capacity upgrades in addition to conducting continuous waste composition studies. Continuous air emissions monitoring is also conducted at the plant, which produces a very small percentage of the total air emissions in metropolitan Vancouver. The GVRD is now seeking options for the management of a further 500,000 tonnes per year of solid waste, and has received 23 submissions from a range of waste energy technologies which are now being evaluated. It was concluded that waste-to-energy plants can be located in densely populated metropolitan areas and provide a local disposal solution as well as a source of renewable energy. Other GVRD waste reduction policies were also reviewed. refs., tabs., figs.

Compulsory drug detention and injection drug use cessation and relapse in Bangkok, Thailand.

Science.gov (United States)

Fairbairn, Nadia; Hayashi, Kanna; Ti, Lianping; Kaplan, Karyn; Suwannawong, Paisan; Wood, Evan; Kerr, Thomas

2015-01-01

Strategies to promote the reduction and cessation of injection drug use are central to human immunodeficiency virus prevention and treatment efforts globally. Though drug use cessation is a major focus of drug policy in Thailand, little is known about factors associated with injection cessation and relapse in this setting. A cross-sectional study was conducted between July and October 2011 of a community-recruited sample of people who inject drugs in Bangkok, Thailand. Using multivariate logistic regression, we examined the prevalence and correlates of injection drug use cessation with subsequent relapse. Among 422 participants, 209 (49.5%) reported a period of injection drug use cessation of at least one year. In multivariate analyses, incarceration (adjusted odds ratio [AOR] 13.07), voluntary drug treatment (AOR 2.75), midazolam injection (AOR 2.48) and number of years since first injection (AOR 1.07) were positively associated with injection cessation of duration greater than a year (all P Thailand. © 2014 Australasian Professional Society on Alcohol and other Drugs.

A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada.

Science.gov (United States)

Jozaghi, Ehsan; Reid, Andrew A; Andresen, Martin A; Juneau, Alexandre

2014-08-04

Supervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada's capital city, Ottawa. The current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed. The sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases--when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent. Funded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain.

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

Science.gov (United States)

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

2013-01-01

To identify factors associated with time to initiation of (i) sex work prior to injecting drugs initiation; (ii) injection drug use prior to sex work initiation; and (iii) concurrent sex work and injection drug use (i.e. initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). Parametric survival analysis of baseline data for time to initiation event. Tijuana and Ciudad Juarez situated on the Mexico-US border. A total of 557 FSW-IDUs aged ≥18 years. Interview-administered surveys assessing context of sex work and injection drug use initiation. Nearly half (n = 258) 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. 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. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

Vancouver Island gas supply

International Nuclear Information System (INIS)

Des Brisay, C.

2005-01-01

Terasen Gas is pursuing alternatives for the supply of additional natural gas capacity to Vancouver Island. Its subsidiary, Terasen Gas (Vancouver Island) Inc. (TGVI), is responding to the need for delivery of increased gas supply and, is supporting plans for new gas-fired power generation on Vancouver Island. TGVI's proposal for new natural gas capacity involves a combination of compression and pipeline loops as well as the addition of a storage facility for liquefied natural gas (LNG) at Mt. Hayes to help manage price volatility. This presentation outlined the objectives and components of the resource planning process, including demand forecast scenarios and the preferred infrastructure options. tabs., figs

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

Science.gov (United States)

Rafful, Claudia; Wagner, Karla D; Werb, Dan; González-Zúñiga, Patricia E; Verdugo, Silvia; Rangel, Gudelia; Strathdee, Steffanie A

2015-11-01

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. 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. 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]. 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. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Sex work involvement among women with long-term opioid injection drug dependence who enter opioid agonist treatment.

Science.gov (United States)

Marchand, Kirsten; Oviedo-Joekes, Eugenia; Guh, Daphne; Marsh, David C; Brissette, Suzanne; Schechter, Martin T

2012-01-25

Substitution with opioid-agonists (e.g., methadone) has shown to be an effective treatment for chronic long-term opioid dependency. Survival sex work, very common among injection drug users, has been associated with poor Opioid Agonist Treatment (OAT) engagement, retention and response. Therefore, this study was undertaken to determine factors associated with engaging in sex work among long-term opioid dependent women receiving OAT. Data from a randomized controlled trial, the North American Opiate Medication Initiative (NAOMI), conducted in Vancouver and Montreal (Canada) between 2005-2008, was analyzed. The NAOMI study compared the effectiveness of oral methadone to injectable diacetylmorphine or injectable hydromorphone, the last two on a double blind basis, over 12 months. A research team, independent of the clinic services, obtained outcome evaluations at baseline and follow-up (3, 6, 9, 12, 18 and 24 months). A total 53.6% of women reported engaging in sex work in at least one of the research visits. At treatment initiation, women who were younger and had fewer years of education were more likely to be engaged in sex work. The multivariate logistic generalized estimating equation regression analysis determined that psychological symptoms, and high illicit heroin and cocaine use correlated with women's involvement in sex work during the study period. After entering OAT, women using injection drugs and engaging in sex work represent a particularly vulnerable group showing poorer psychological health and a higher use of heroin and cocaine compared to women not engaging in sex work. These factors must be taken into consideration in the planning and provision of OAT in order to improve treatment outcomes. NCT00175357.

Sex work involvement among women with long-term opioid injection drug dependence who enter opioid agonist treatment

Directory of Open Access Journals (Sweden)

Marchand Kirsten

2012-01-01

Full Text Available Abstract Background Substitution with opioid-agonists (e.g., methadone has shown to be an effective treatment for chronic long-term opioid dependency. Survival sex work, very common among injection drug users, has been associated with poor Opioid Agonist Treatment (OAT engagement, retention and response. Therefore, this study was undertaken to determine factors associated with engaging in sex work among long-term opioid dependent women receiving OAT. Methods Data from a randomized controlled trial, the North American Opiate Medication Initiative (NAOMI, conducted in Vancouver and Montreal (Canada between 2005-2008, was analyzed. The NAOMI study compared the effectiveness of oral methadone to injectable diacetylmorphine or injectable hydromorphone, the last two on a double blind basis, over 12 months. A research team, independent of the clinic services, obtained outcome evaluations at baseline and follow-up (3, 6, 9, 12, 18 and 24 months. Results A total 53.6% of women reported engaging in sex work in at least one of the research visits. At treatment initiation, women who were younger and had fewer years of education were more likely to be engaged in sex work. The multivariate logistic generalized estimating equation regression analysis determined that psychological symptoms, and high illicit heroin and cocaine use correlated with women's involvement in sex work during the study period. Conclusions After entering OAT, women using injection drugs and engaging in sex work represent a particularly vulnerable group showing poorer psychological health and a higher use of heroin and cocaine compared to women not engaging in sex work. These factors must be taken into consideration in the planning and provision of OAT in order to improve treatment outcomes. Trial Registration NCT00175357.

Predictors of injection drug use cessation and relapse in a prospective cohort of young injection drug users in San Francisco, CA (UFO Study).

Science.gov (United States)

Evans, Jennifer L; Hahn, Judith A; Lum, Paula J; Stein, Ellen S; Page, Kimberly

2009-05-01

Studies of injection drug use cessation have largely sampled adults in drug treatment settings. Little is known about injection cessation and relapse among young injection drug users (IDU) in the community. A total of 365 HCV-negative IDU under age 30 years were recruited by street outreach and interviewed quarterly for a prospective cohort between January 2000 and February 2008. Participants were followed for a total of 638 person-years and 1996 visits. We used survival analysis techniques to identify correlates of injection cessation (> or =3 months) and relapse to injection. 67% of subjects were male, median age was 22 years (interquartile range (IQR) 20-26) and median years injecting was 3.6 (IQR 1.3-6.5). 28.8% ceased injecting during the follow-up period. Among those that ceased injecting, nearly one-half resumed drug injection on subsequent visits, one-quarter maintained injecting cessation, and one-quarter were lost to follow-up. Participating in a drug treatment program in the last 3 months and injecting less than 30 times per month were associated with injection cessation. Injecting heroin or heroin mixed with other drugs, injecting the residue from previously used drug preparation equipment, drinking alcohol, and using benzodiazepines were negatively associated with cessation. Younger age was associated with relapse to injection. These results suggest that factors associated with stopping injecting involve multiple areas of intervention, including access to drug treatment and behavioral approaches to reduce injection and sustain cessation. The higher incidence of relapse in the younger subjects in this cohort underscores the need for earlier detection and treatment programs targeted to adolescents and transition-age youth.

[Rational motivation of drug injection and prostitution].

Science.gov (United States)

Beauchamp, Sylvie

2003-01-01

Homeless drug users and prostitutes constitute a population at risk for contracting and propagating AIDS. This study aims at understanding the paradox related to drug injection and prostitution among 21 homeless from Montreal. These behaviors are studied following the picoeconomic paradox of an apprehended desire. The results show that these homeless see drug injection as a self-reward motivated by imaginary emotional object, in spite of the known and dreaded consequences. Prostitution is described as a self-investment accessory to drug injection. This study concludes with reflections on AIDS prevention programs in relation with the needs of the homeless.

Negotiating place and gendered violence in Canada's largest open drug scene.

Science.gov (United States)

McNeil, Ryan; Shannon, Kate; Shaver, Laura; Kerr, Thomas; Small, Will

2014-05-01

Vancouver's Downtown Eastside is home to Canada's largest street-based drug scene and only supervised injection facility (Insite). High levels of violence among men and women have been documented in this neighbourhood. This study was undertaken to explore the role of violence in shaping the socio-spatial relations of women and 'marginal men' (i.e., those occupying subordinate positions within the drug scene) in the Downtown Eastside, including access to Insite. Semi-structured qualitative interviews were conducted with 23 people who inject drugs (PWID) recruited through the Vancouver Area Network of Drug Users, a local drug user organization. Interviews included a mapping exercise. Interview transcripts and maps were analyzed thematically, with an emphasis on how gendered violence shaped participants' spatial practices. Hegemonic forms of masculinity operating within the Downtown Eastside framed the everyday violence experienced by women and marginal men. This violence shaped the spatial practices of women and marginal men, in that they avoided drug scene milieus where they had experienced violence or that they perceived to be dangerous. Some men linked their spatial restrictions to the perceived 'dope quality' of neighbourhood drug dealers to maintain claims to dominant masculinities while enacting spatial strategies to promote safety. Environmental supports provided by health and social care agencies were critical in enabling women and marginal men to negotiate place and survival within the context of drug scene violence. Access to Insite did not motivate participants to enter into "dangerous" drug scene milieus but they did venture into these areas if necessary to obtain drugs or generate income. Gendered violence is critical in restricting the geographies of men and marginal men within the street-based drug scene. There is a need to scale up existing environmental interventions, including supervised injection services, to minimize violence and potential drug

Increasing availability of illicit and prescription opioids among people who inject drugs in a Canadian setting, 2010-2014.

Science.gov (United States)

Ho, Joel; DeBeck, Kora; Milloy, M-J; Dong, Huiru; Wood, Evan; Kerr, Thomas; Hayashi, Kanna

2018-01-01

Nonmedical use of prescription opioid and illicit opioid has been increasing at an alarming rate in North America over the past decade. We sought to examine the temporal trends and correlates of the availability of illicit and prescription opioids among people who inject drugs (PWID) in Vancouver, Canada. Data were derived from three prospective cohort studies of PWID in Vancouver between 2010 and 2014. In semiannual interviews, participants reported the availability of five sets of illicit and prescription opioids: (1) heroin; (2) Percocet (oxycodone/acetaminophen), Vicodin (hydrocodone/acetaminophen), or Demerol (meperidine); (3) Dilaudid (hydromorphone); (4) Morphine; (5) oxycontin/OxyNEO (controlled-release oxycodone). We defined perceived availability as immediate (e.g., available within 10 minutes) versus no availability/available after 10 minutes. The trend and correlation of immediate availability were identified by multivariable generalized estimating equations logistic regression. Among 1584 participants, of which 564 (35.6%) were female, the immediate availability of all illicit and prescribed opioids (except for oxycontin/OxyNEO) increased over time, independent of potential confounders. The Adjusted Odds Ratios of immediate availability associated with every calendar year increase were between 1.09 (95% confidence interval 1.05-1.12) (morphine and Dilaudid) and 1.13 (95% confidence interval 1.09-1.17) (Percocet/Vicodin/Demerol) (all p-values illicit and prescription opioid use among PWID that could potentially increase the risk of overdose.

Factors Associated with the Transition from Drug Abuse to Initiation of Injection Drug Use

Directory of Open Access Journals (Sweden)

Mosayeb Yarmohamadi Vasel

2015-06-01

Full Text Available Objectives: Drug injection carries with it many risks and therefore it is important to understand the initiating factors of injection and its origins. Thus,  the purpose of this study was to identify factors associated with the initiation of injection drug use among substance abusers. Methods:  Study method was a cross-sectional study. The research statistics universe constitutes all people suffering from a substance dependence disorder with a pattern of injection use in Tehran and Hamedan. This study was conducted among 216 individuals with substance dependence disorders who were selected from harm reduction centers in Tehran and Hamedan. The sampling selection method was simply random. The instruments used for data collection included: demographic information, patterns of drug use and initiation of injection scales.  Results: In this study, the average age of initiation to injections was 22.5 years. Factors associated with initiation of drug injection included: acquired more pleasure, easier use, faster effect of injection, ineffective previous use method, curiosity, peer pressure, lack of availability of the drug, poverty, and low quality drugs. Discussion: Results of this study indicate that initiation factors to drug injection are multifaceted (Psychological, Social, Economic and Environmental, therefore, injection interventionists should consider all these factors for prevention, treatment and harm reduction.

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

Science.gov (United States)

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.

Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis.

Science.gov (United States)

Ahmed, Tanvir; Long, Thanh Nguyen; Huong, Phan Thi; Stewart, Donald Edwin

2015-01-29

Hai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices. Fifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants' understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used. Qualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend's home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management

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

Science.gov (United States)

2012-11-28

... poisoning and unapproved injectable drug products containing sodium thiosulfate labeled for the treatment of... for the treatment of cyanide poisoning are new drugs that require approved new drug applications (NDAs... Injection and Sodium Thiosulfate Injection drug product, labeled for treatment of acute cyanide poisoning...

Incarceration and injection drug use in Baltimore, Maryland.

Science.gov (United States)

Genberg, Becky L; Astemborski, Jacquie; Vlahov, David; Kirk, Gregory D; Mehta, Shruti H

2015-07-01

There is limited longitudinal research examining incarceration and subsequent changes in drug use among people who inject drugs (PWID) in the United States. The objective of the current study was to characterize the frequency of incarceration and estimate the association between incarceration and subsequent injection drug use among current and former PWIDs in one US city. ALIVE (AIDS Linked to the Intravenous Experience) is a prospective cohort study of current and former PWIDs, with semi-annual follow-up occurring since 1988. Baltimore, Maryland, USA. A total of 3245 participants with 48 738 study visits were included. Participants enrolled from 1988 to 2012 with a median of 13 follow-up visits per participant (Interquartile range = 7-25). Incarcerations were defined as any self-reported jail or prison stays in the previous 6 months that were ≥7 days or longer. The primary outcome was defined as any self-reported injection drug use in the previous 6 months. At baseline, 29% were female, 90% African American and 33% HIV-positive. Fifty-seven per cent of participants experienced at least one incarceration episode. After adjusting for confounders, there was a positive association between incarceration and subsequent injection drug use [adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.37-1.59]; however, stratified analysis showed that the effect was restricted to those who were not injecting at the time of incarceration (AOR = 2.11, 95% CI = 1.88-2.37). In the United States, incarceration of people who had previously stopped injecting drugs appears to be associated with an increased risk of subsequent injecting. © 2015 Society for the Study of Addiction.

Childhood Sexual Abuse and Age at Initiation of Injection Drug Use

Science.gov (United States)

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

Injecting drug use: Gendered risk.

Science.gov (United States)

Zahnow, Renee; Winstock, Adam R; Maier, Larissa J; Levy, Jay; Ferris, Jason

2018-06-01

Research demonstrates gender related differences in drug-use practices and risk behaviours. Females' structural vulnerability stemming from traditional gender roles and gender-power relations may enhance their propensity to experience injecting related risk. In this paper we explore gender differences in injection practices at the initiation event, during the first year of injecting and in the most recent 12-month period, to inform more effective harm reduction strategies. Data used in this study were drawn from the Global Drug Survey 2015. The study employs chi-square and logistic regression to assess gender differences in injection behaviours in a sample of current injectors residing in six global regions: North-West Europe; Southern Eastern Europe; North America. South America and Oceania. Females were more likely than males to report being injected by an intimate partner at initiation (OR = 4.4, 95%CI: 2.2-8.8), during the first year of injecting (OR = 4.8, 95% CI: 2.4-9.3) and in the most recent 12-month period (OR = 2.5, 95%CI: 1.0-6.2). Females reported greater difficulties accessing sterile equipment (X 2 (2,N = 453) = 8.2, p = 0.02) and were more likely to share injecting equipment than males (X 2 (1,N = 463) = 3.9, p = 0.05). Our findings highlight females' continued dependence on their intimate partner to administer the injection into the first year of their injecting career. Females remained more likely than males to rely on intimate partners for injection during the most recent 12-month period. Females report greater difficulties in sourcing sterile equipment and are more likely to share injecting equipment. We suggest that these findings reflect the broader social structure in which females are disempowered through traditional gender roles and the lack of gender appropriate harm reduction services. Copyright © 2018 Elsevier B.V. All rights reserved.

Admissions of injection drug users to drug abuse treatment following HIV counseling and testing.

Science.gov (United States)

McCusker, J; Willis, G; McDonald, M; Lewis, B F; Sereti, S M; Feldman, Z T

1994-01-01

The outcomes of counseling and testing programs related to human immunodeficiency virus (HIV) infection and risk of infection among injection drug users (IDUs) are not well known or understood. A counseling and testing outcome of potential public health importance is attaining admission to drug abuse treatment by those IDUs who are either infected or who are at high risk of becoming infected. The authors investigated factors related to admission to drug abuse treatment among 519 IDUs who received HIV counseling and testing from September 1987 through December 1990 at a men's prison and at community-based testing sites in Worcester, MA. By June 1991, 123 of the 519 IDUs (24 percent) had been admitted to treatment. Variables associated with their admission included a long history of drug injection, frequent recent drug injection, cleaning injection equipment using bleach, prior drug treatment, and a positive HIV test result. Logistic regression analyses, controlling for effects of recruitment site, year, sex, and area of residence, generally confirmed the associations. IDUs in the study population who were HIV-infected sought treatment or were admitted to treatment more frequently than those who were not infected. The results indicate that access to drug abuse treatment should be facilitated for high-risk IDUs and for those who have begun to inject drugs recently.

“SALOME gave my dignity back”: The role of randomized heroin trials in transforming lives in the Downtown Eastside of Vancouver, Canada

Directory of Open Access Journals (Sweden)

Ehsan Jozaghi

2014-03-01

Full Text Available Although numerous studies on heroin-assisted treatment (HAT have been published in leading international journals, little attention has been given to HAT's clients, their stories, and what constitutes the most influential factor in the treatment process. The present study investigates the role of HAT in transforming the lives of injection drug users (IDUs in Vancouver, Canada. This study is qualitative focusing on 16 in-depth interviews with patients from the randomized trials of HAT. Interviews were transcribed verbatim and analyzed thematically using NVivo 10 software. The findings revealed a positive change in many respects: the randomized trials reduce criminal activity, sex work, and illicit drug use. In addition, the trials improved the health and social functioning of its clients, with some participants acquiring work or volunteer positions. Many of the participants have been able to reconnect with their family members, which was not possible before the program. Furthermore, the relationship between the staff and patients at the project appears to have transformed the behavior of participants. Attending HAT in Vancouver has been particularly effective in creating a unique microenvironment where IDUs who have attended HAT have been able to form a collective identity advocating for their rights. The result of this research points to the need for continuation of the project beyond the current study, leading toward a permanent program.

Socio-economic considerations of cleaning Greater Vancouver's air

International Nuclear Information System (INIS)

2005-08-01

Socio-economic considerations of better air quality on the Greater Vancouver population and economy were discussed. The purpose of the study was to provide socio-economic information to staff and stakeholders of the Greater Vancouver Regional District (GVRD) who are participating in an Air Quality Management Plan (AQMP) development process and the Sustainable Region Initiative (SRI) process. The study incorporated the following methodologies: identification and review of Canadian, American, and European quantitative socio-economic, cost-benefit, cost effectiveness, competitiveness and health analyses of changes in air quality and measures to improve air quality; interviews with industry representatives in Greater Vancouver on competitiveness impacts of air quality changes and ways to improve air quality; and a qualitative analysis and discussion of secondary quantitative information that identifies and evaluates socio-economic impacts arising from changes in Greater Vancouver air quality. The study concluded that for the Greater Vancouver area, the qualitative analysis of an improvement in Greater Vancouver air quality shows positive socio-economic outcomes, as high positive economic efficiency impacts are expected along with good social quality of life impacts. 149 refs., 30 tabs., 6 appendices

Socializing in an open drug scene: the relationship between access to private space and drug-related street disorder.

Science.gov (United States)

Debeck, Kora; Wood, Evan; Qi, Jiezhi; Fu, Eric; McArthur, Doug; Montaner, Julio; Kerr, Thomas

2012-01-01

Limited attention has been given to the potential role that the structure of housing available to people who are entrenched in street-based drug scenes may play in influencing the amount of time injection drug users (IDU) spend on public streets. We sought to examine the relationship between time spent socializing in Vancouver's drug scene and access to private space. Using multivariate logistic regression we evaluated factors associated with socializing (three+ hours each day) in Vancouver's open drug scene among a prospective cohort of IDU. We also assessed attitudes towards relocating socializing activities if greater access to private indoor space was provided. Among our sample of 1114 IDU, 43% fit our criteria for socializing in the open drug scene. In multivariate analysis, having limited access to private space was independently associated with socializing (adjusted odds ratio: 1.80, 95% confidence interval: 1.28-2.55). In further analysis, 65% of 'socializers' reported positive attitudes towards relocating socializing if they had greater access to private space. These findings suggest that providing IDU with greater access to private indoor space may reduce one component of drug-related street disorder. Low-threshold supportive housing based on the 'housing first' model that include safeguards to manage behaviors associated with illicit drug use appear to offer important opportunities to create the types of private spaces that could support a reduction in street disorder. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

[Evaluation of administration errors of injectable drugs in neonatology].

Science.gov (United States)

Cherif, A; Sayadi, M; Ben Hmida, H; Ben Ameur, K; Mestiri, K

2015-11-01

Use of injectable drugs in newborns represents more than 90% of prescriptions and requires special precautions in order to ensure more safety and efficiency. The aim of this study is to gather errors relating to the administration of injectable drugs and to suggest corrective actions. This descriptive and transversal study has evaluated 300 injectable drug administrations in a neonatology unit. Two hundred and sixty-one administrations have contained an error. Data are collected by direct observations of administrative act. Errors observed are: an inappropriate mixture (2.6% of cases); an incorrect delivery rate (33.7% of cases); incorrect dilutions (26.7% of cases); error in calculation of the dose to be injected (16.7% of cases); error while sampling small volumes (6.3% of cases); error or omission of administration schedule (1% of cases). These data have enabled us to evaluate administration of injectable drugs in neonatology. Different types of errors observed could be a source of therapeutic inefficiency, extended lengths of stay or iatrogenic drug. Following these observations, corrective actions have been undertaken by pharmacists and consist of: organizing training sessions for nursing; developing an explanatory guide for dilution and administration of injectable medicines, which was made available to the clinical service. Collaborative strategies doctor-nurse-pharmacist can help to reduce errors in the medication process especially during his administration. It permits improvement of injectable drugs use, offering more security and better efficiency and contribute to guarantee ideal therapy for patients. Copyright © 2015. Published by Elsevier Masson SAS.

Vancouver Cyclotron Conference

International Nuclear Information System (INIS)

Clark, David J.

1993-01-01

Although no longer on the high energy frontier, the cyclotron field is still a major scientific growth area. Its progress is highlighted at the international conference on cyclotron design, development and utilization held at intervals of about three years, under the auspices of the International Union of Pure and Applied Physics (IUPAP). Vancouver, surrounded by mountains, water and some cyclotrons, provided a pleasant setting for the 13th Conference, held last summer. With over 200 cyclotrons in operation around the world, the attendance, 241 delegates and 26 industrial exhibitors, was a near record, reflecting the flourishing state of the field. The early sessions covered the initial operation of new or upgraded cyclotron facilities. Major facilities completed since the previous Conference in Berlin in May 1989 included the 400 MeV ring cyclotron at Osaka, the U400M cyclotron at Dubna which will be coupled to the U400 to give 20 MeV nucléon uranium beams, the 130 MeV cyclotron at Jyvaskyla (in Finland, the furthest north!), the 110 MeV JAERI machine in Japan, and the 65 MeV proton therapy cyclotron in Nice. Among the facility upgrades were the KFA cyclotron at Julich which will inject the 2.5 GeV storage ring COSY, and the addition of an FM mode to the K=200 CW mode at Uppsala to give protons up to 180 MeV. The impressive current of 1.5 mA at 72 MeV obtained from the PSI Injector II will soon be injected into the 590 MeV ring

Risk factors associated with injection initiation among drug users in Northern Thailand

Directory of Open Access Journals (Sweden)

Suriyanon Vinai

2006-03-01

Full Text Available Abstract Background Circumstances surrounding injection initiation have not been well addressed in many developing country contexts. This study aimed to identify demographic factors, sexual behaviors and drug use characteristics related to injection initiation among drug users in northern Thailand. Methods A cross-sectional survey was conducted among 2,231 drug users admitted to the Northern Drug Treatment Center in Mae Rim, Chiang Mai, Thailand, between February 1, 1999 and December 31, 2000. A multiple logistic regression was employed to identify the independent effects from potential risk factors of transition into injection. Results After controlling for other covariates, being 20 years of age or older, single, ever receiving education, urban residence, and having a history of smoking or incarceration were significantly associated with higher likelihood of injection initiation. Multiple sex partners and an experience of sex abuse were associated with an increased risk of injection initiation. Comparing to those whose first drug was opium, individuals using heroin as their initiation drug had greater risk of injection initiation; conversely, those taking amphetamine as their first drug had less risk of injection initiation. Age of drug initiation was negatively associated with the risk of injection initiation: the older the age of drug initiation, the less the risk of injection initiation. Conclusion Injection initiation was related to several demographic factors, sexual behaviors and drug use characteristics. Understanding these factors will benefit the design of approaches to successfully prevent or delay transition into injection.

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

Science.gov (United States)

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

Injection Drug Use Trajectories Among Migrant Populations: A Narrative Review.

Science.gov (United States)

Melo, Jason S; Mittal, Maria Luisa; Horyniak, Danielle; Strathdee, Steffanie A; Werb, Dan

2018-01-24

Dual epidemics of injection drug use and blood-borne disease, characterized as "syndemics," are present in a range of settings. Behaviors that drive such syndemics are particularly prevalent among mobile drug-using populations, for whom cross-border migration may pose additional risks. This narrative review aims to characterize the risk factors for injection drug use initiation associated with migration, employing a risk environment framework and focusing on the San Diego-Tijuana border region as the most dynamic example of these phenomena. Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use, as well as the transmission of hepatitis and HIV, and to delineate how these might be addressed through public health intervention. Population mixing between migrants and receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation. These risk environments have been characterized as a result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants. Policies that exacerbate risk environments for migrants may inadvertently contribute to the expansion of epidemics of injection-driven blood-borne disease. Successful interventions that address emerging syndemics in border regions may therefore need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.

INJECTING EQUPMENT SHARING AND PERCEPTION OF HIV AND HEPATITIS RISK AMONG INJECTING DRUG USERS IN BUDAPEST

Science.gov (United States)

Gyarmathy, V. Anna; Neaigus, Alan; Ujhelyi, Eszter

2008-01-01

In Central European states, rates of HIV among IDUs have been low although HCV infection is widespread. The goal of our study was to assess HIV infection, risk perceptions and injecting equipment sharing among injection drug users in Budapest, Hungary. Altogether 150 IDUs were interviewed (121 structured between 1999-2000 and 29 ethnographic between 2003-2004). The majority of them injected heroin (52% and 79%) and many injected amphetamines (51% and 35%). One person tested positive for HIV. Two thirds (68% of 121) shared injecting equipment (syringes, cookers and filters). Some participants said they shared syringes because they were not carrying them for fear of police harassment, and that they reused filters as a backup drug supply. In multivariate analysis, sharing of injecting equipment was associated with higher perceived susceptibility to HIV/AIDS, lower self-efficacy for sterile equipment use, higher motivation to comply with peer pressure to use dirty injecting equipment, and with having a criminal record. The high levels of injecting risk behaviors found in this study are a cause for serious concern. HIV prevention interventions need to address not only sharing syringes but also sharing and reusing other injecting equipment and drug filters. PMID:17129858

Resilient children of injection drug users.

Science.gov (United States)

Pilowsky, Daniel J; Zybert, Patricia A; Vlahov, David

2004-11-01

To examine associations between resilience in children of injection drug users and children's coping strategies, parenting stress, and children's social support. Injection drug-using parents (n=91) and their children aged 6 to 11 (n=117) were recruited in Baltimore (1997-1999). Resilience was defined as scoring in the lowest quartile of the Child Behavior Checklist total psychopathology score. Coping strategies used by resilient and nonresilient children, the extent and types of social support that they received, and the level of parenting stress reported by their parents were compared and contrasted. Rates of depressive, anxiety, and disruptive behavior disorders were 15.4%, 22.2%, and 21.4%, respectively, for the entire sample. Compared with the nonresilient, resilient children were less likely to use two avoidance coping strategies (internalizing [p=.002] and externalizing [p=.017]). The level of actual support received by resilient and nonresilient children did not differ significantly (p=.202). Perceived support was greater among resilient children (as reported by their parents; p parents reported lower parenting stress (p=.042). A significant proportion of children of injection drug users are in need of clinical care. Interventions to help children of substance-abusing parents modify their coping style merit exploration.

Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran

Directory of Open Access Journals (Sweden)

Shakeshaft Anthony

2006-01-01

Full Text Available Abstract Aim This study aimed to examine drug use, drug treatment history and risk behaviour among a sample of Iranian drug users seeking treatment through a general practice clinic in Iran. Methods Review of medical records and an intake questionnaire at a large general practice in Marvdasht, Iran, with a special interest in drug dependence treatment. Records from a random sample of injecting drug users (IDU, non-injecting drug users (DU and non-drug using patients were examined. Results 292 records were reviewed (34% IDU, 31% DU and 35% non-drug users. Eighty-three percent were males; all females were non-drug users. The mean age of the sample was 30 years. Of the IDU sample, 67% reported sharing a needle or syringe, 19% of these had done so in prison. Of those who had ever used drugs, being 'tired' of drug use was the most common reason for seeking help (34%. Mean age of first drug use was 20 years. The first drugs most commonly used were opium (72%, heroin (13% and hashish/ other cannabinoids (13%. Three quarters reported having previously attempted to cease their drug use. IDU were more likely than DU to report having ever been imprisoned (41% vs 7% and 41% to have used drugs in prison. Conclusion This study has shown that there is a need for general practice clinics in Iran to treat drug users including those who inject and that a substantial proportion of those who inject have shared needles and syringes, placing them at risk of BBVI such as HIV and hepatitis C. The expansion of services for drug users in Iran such as needle and syringe programs and pharmacotherapies are likely to be effective in reducing the harms associated with opium use and heroin injection.

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

Science.gov (United States)

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.

Telling our stories: heroin-assisted treatment and SNAP activism in the Downtown Eastside of Vancouver.

Science.gov (United States)

Boyd, Susan; Murray, Dave; MacPherson, Donald

2017-05-18

This article highlights the experiences of a peer-run group, SALOME/NAOMI Association of Patients (SNAP), that meets weekly in the Downtown Eastside of Vancouver, British Columbia, Canada. SNAP is a unique independent peer- run drug user group that formed in 2011 following Canada's first heroin-assisted treatment trial (HAT), North America Opiate Medication Initiative (NAOMI). SNAP's members are now made up of former research participants who participated in two heroin-assisted trials in Vancouver. This article highlights SNAP members' experiences as research subjects in Canada's second clinical trial conducted in Vancouver, Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), that began recruitment of research participants in 2011. This paper draws on one brainstorming session, three focus groups, and field notes, with the SALOME/NAOMI Association of Patients (SNAP) in late 2013 about their experiences as research subjects in Canada's second clinical trial, SALOME in the DTES of Vancouver, and fieldwork from a 6-year period (March 2011 to February 2017) with SNAP members. SNAP's research draws on research principles developed by drug user groups and critical methodological frameworks on community-based research for social justice. The results illuminate how participating in the SALOME clinical trial impacted the lives of SNAP members. In addition, the findings reveal how SNAP member's advocacy for HAT impacts the group in positive ways. Seven major themes emerged from the analysis of the brainstorming and focus groups: life prior to SALOME, the clinic setting and routine, stability, 6-month transition, support, exiting the trial and ethics, and collective action, including their participation in a constitutional challenge in the Supreme Court of BC to continue receiving HAT once the SALOME trial ended. HAT benefits SNAP members. They argue that permanent HAT programs should be established in Canada because they are an effective harm reduction

Improving measurement of injection drug risk behavior using item response theory.

Science.gov (United States)

Janulis, Patrick

2014-03-01

Recent research highlights the multiple steps to preparing and injecting drugs and the resultant viral threats faced by drug users. This research suggests that more sensitive measurement of injection drug HIV risk behavior is required. In addition, growing evidence suggests there are gender differences in injection risk behavior. However, the potential for differential item functioning between genders has not been explored. To explore item response theory as an improved measurement modeling technique that provides empirically justified scaling of injection risk behavior and to examine for potential gender-based differential item functioning. Data is used from three studies in the National Institute on Drug Abuse's Criminal Justice Drug Abuse Treatment Studies. A two-parameter item response theory model was used to scale injection risk behavior and logistic regression was used to examine for differential item functioning. Item fit statistics suggest that item response theory can be used to scale injection risk behavior and these models can provide more sensitive estimates of risk behavior. Additionally, gender-based differential item functioning is present in the current data. Improved measurement of injection risk behavior using item response theory should be encouraged as these models provide increased congruence between construct measurement and the complexity of injection-related HIV risk. Suggestions are made to further improve injection risk behavior measurement. Furthermore, results suggest direct comparisons of composite scores between males and females may be misleading and future work should account for differential item functioning before comparing levels of injection risk behavior.

Injecting risk behavior among traveling young injection drug users: travel partner and city characteristics.

Science.gov (United States)

Montgomery, Martha E; Fatch, Robin S; Evans, Jennifer L; Yu, Michelle; Davidson, Peter J; Page, Kimberly; Hahn, Judith A

2013-06-01

Young injection drug users (IDUs), a highly mobile population, engage in high levels of injecting risk behavior, yet little is understood about how such risk behavior may vary by the characteristics of the cities to which they travel, including the existence of a syringe exchange program (SEP), as well as travel partner characteristics. In 2004-2005, we conducted a 6-month prospective study to investigate the risk behavior of 89 young IDUs as they traveled, with detailed information gathered about 350 city visits. In multivariable analyses, travel to larger urban cities with a population of 500,000-1,000,000 was significantly associated with injecting drugs (adjusted odds ratio (AOR) = 3.71; 95 % confidence interval (CI), 1.56-8.82), ancillary equipment sharing (AES; AOR = 7.05; 95 % CI, 2.25-22.06) and receptive needle sharing (RNS; AOR = 5.73; 95 % CI, 1.11-27.95), as compared with visits to smaller cities with populations below 50,000. Region of the country, and the existence of a SEP within the city visited, were not independently associated with injecting drugs, AES, or RNS during city visits. Traveling with more than one injecting partner was associated with injecting drugs during city visits (AOR = 2.77; 95 % CI, 1.46-5.27), when compared with traveling alone. Additionally, both non-daily and daily/almost daily alcohol use during city visits were associated with AES (AOR = 3.37; 95 % CI, 1.42-7.68; AOR = 3.03; 95 % CI, 1.32-6.97, respectively) as compared with no alcohol consumption. Traveling young IDUs are more likely to inject when traveling with other IDUs and to engage in higher risk injection behavior when they are in large cities. Risk behavior occurring in city visits, including equipment sharing and alcohol consumption, suggests further need for focused interventions to reduce risk for viral infection among this population.

Prostitution in Vancouver: violence and the colonization of First Nations women.

Science.gov (United States)

Farley, Melissa; Lynne, Jacqueline; Cotton, Ann J

2005-06-01

We interviewed 100 women prostituting in Vancouver, Canada. We found an extremely high prevalence of lifetime violence and post-traumatic stress disorder (PTSD). Fifty-two percent of our interviewees were women from Canada's First Nations, a significant overrepresentation in prostitution compared with their representation in Vancouver generally (1.7-7%). Eighty-two percent reported a history of childhood sexual abuse, by an average of four perpetrators. Seventy-two percent reported childhood physical abuse, 90% had been physically assaulted in prostitution, 78% had been raped in prostitution. Seventy-two percent met DSM-IV criteria for PTSD. Ninety-five percent said that they wanted to leave prostitution. Eighty-six percent reported current or past homelessness with housing as one of their most urgent needs. Eighty-two percent expressed a need for treatment for drug or alcohol addictions. Findings are discussed in terms of the legacy of colonialism, the intrinsically traumatizing nature of prostitution and prostitution's violations of basic human rights.

HIV and injecting drug use in Indonesia: epidemiology and national response.

Science.gov (United States)

Afriandi, Irvan; Aditama, Tjandra Yoga; Mustikawati, Dyah; Oktavia, Martiani; Alisjahbana, Bachti; Riono, Pandu

2009-07-01

Indonesia is facing one of the most rapidly growing HIV-epidemics in Asia. Risk behaviour associated with injecting drug use, such as sharing contaminated needles, is the main risk factor for HIV infection. Among the general population the prevalence of HIV-infection is still low (0.2%), but up to 50% or more of the estimated 145.000 - 170.000 injecting drug users are already HIV-positive. Overrepresentation of injecting drug users and continued risk behavior inside Indonesian prisons contribute to spread of HIV. Through sexual contacts, HIV is transmitted from current or previous injecting drug users to their non-injecting sexual partners; 10-20% of this group may already be infected. The national response targeted to limit spread of HIV through injecting drug use has included needle and syringe program (NSP), methadone maintenance treatment (MMT), voluntary counseling and testing (VCT), and outreach program as priority programs. However coverage and utilization of the harm reduction services is still limited, but effective integration with HIV testing and treatment is expanding. By 2008, there were 110 service points for NSP and 24 operational MMT clinics. Nevertheless, utilization of these services has been less satisfactory and their effectiveness has been questioned. Besides effective prevention, HIV- testing and earlier treatment of HIV-seropositve individuals, including those with a history of injecting drug use, will help control the growing HIV-epidemic in Indonesia.

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

Science.gov (United States)

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.

"The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil.

Science.gov (United States)

Oliveira, Maria de Lourdes Aguiar; Hacker, Mariana A; Oliveira, Sabrina Alberti Nóbrega de; Telles, Paulo Roberto; O, Kycia Maria Rodrigues do; Yoshida, Clara Fumiko Tachibana; Bastos, Francisco I

2006-04-01

The context of first drug injection and its association with ongoing injecting practices and HCV (hepatitis C virus) infection were investigated. Injection drug users (IDUs) (N = 606) were recruited in "drug scenes" (public places, bars) in Rio de Janeiro, Brazil, interviewed, and tested for HCV. Sharing of needles/syringes was more prevalent at the first injection (51.3%) than at the baseline interview (36.8%). Those who shared syringes/needles at first injection were more likely to be currently engaged in direct/indirect sharing practices. Among young injectors (drug injection were identified as independent predictors of HCV infection. To effectively curb HCV transmission among IDUs and minimize harms associated with risk behaviors, preventive strategies should target individuals initiating drug injection beginning with their very first injection and discourage the transition from non-injecting use to the self-injection of illicit drugs.

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

Directory of Open Access Journals (Sweden)

Keijzer Lenneke

2011-08-01

Full Text Available Abstract 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.

The association between neighborhood socioeconomic disadvantage and high-risk injection behavior among people who inject drugs.

Science.gov (United States)

DeCuir, Jennifer; Lovasi, Gina S; El-Sayed, Abdulrahman; Lewis, Crystal Fuller

2018-02-01

Although much research has been conducted on the determinants of HIV risk behavior among people who inject drugs (PWID), the influence of the neighborhood context on high-risk injection behavior remains understudied. To address this gap in the literature, we measured associations between neighborhood socioeconomic disadvantage and high-risk injection behavior, and determined whether these associations were modified by drug-related police activity and syringe exchange program (SEP) accessibility. Our sample was comprised of 484 pharmacy-recruited PWID in New York City. Measures of neighborhood socioeconomic disadvantage were created using data from the 2006-2010 American Community Survey. Associations with high-risk injection behavior were estimated using multivariable Poisson regression. Effect modification by drug-related police activity and SEP accessibility was assessed by entering cross-product terms into adjusted models of high-risk injection behavior. Neighborhood socioeconomic disadvantage was associated with decreased receptive syringe sharing and unsterile syringe use. In neighborhoods with high drug-related police activity, associations between neighborhood disadvantage and unsterile syringe use were attenuated to the null. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased acquisition of syringes from an unsafe source. PWID in disadvantaged neighborhoods reported safer injection behaviors than their counterparts in neighborhoods that were relatively better off. The contrasting patterns of effect modification by SEP accessibility and drug-related police activity support the use of harm reduction approaches over law enforcement-based strategies for the control of blood borne virus transmission among PWID in disadvantaged urban areas. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Science.gov (United States)

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.

Vulnerability to drug-related infections and co-infections among injecting drug users in Budapest, Hungary

Science.gov (United States)

Neaigus, Alan; Ujhelyi, Eszter

2009-01-01

Background: Drug-related infectious diseases are among the major health consequences of drug use, and any existing drug-related infection may predispose injecting drug users (IDUs) to other infections. Methods: We assessed among IDUs in Budapest, Hungary the prevalence of and vulnerability to selected drug-related infections and co-infections. The sample consisted of 186 participants recruited between October 2005 and December 2006. Results: We found 0% HIV, 37% HCV, 24% HAV, and 14% past HBV infection. Infections with Herpes 1 or 2, tuberculosis, Chlamydia, syphilis, and gonorrhoea were 79%, 12%, 7%, 4%, and 0%, respectively. Co-infection with HAV/HCV was 12%, HBV/HCV 9%, HAV/HBV 7%, and HAV/HBV/HCV 4%. Those over age 30, the ethnic Roma, and the homeless were more likely to have any hepatitis and a higher number of drug-related infections. Amphetamine injectors were more likely to have a higher number of drug-related infections and those who travelled within Hungary were more likely to have any STI. However, those who worked at least part time and those who were in treatment were less likely to have drug-related infections. Conclusions: These results highlight the need of interventions in Hungary to reach and focus on marginalized (Roma or homeless) IDUs and address not only injecting and sex risk, but also hygienic living and injecting conditions. Furthermore, structural interventions to increase social integration (working or being in treatment) may improve welfare and decrease drug use and infection risk tied to drug use/injection among disadvantaged, marginalized, mostly minority populations. PMID:19224936

Insite or Outside the Law: Examining the Place of Safe Injection Sites within the Canadian Legal System

Directory of Open Access Journals (Sweden)

Aidan Macdonald

2011-01-01

Full Text Available In response to the mounting number of HIV/AIDS and overdose deaths directly attributable to intravenous drug use during the 1980 and 1990’s, governments across the world began considering alternatives to traditional prohibitionist drug policies. These alternatives, generally described as harm reduction strategies involving needle exchange programs and safe injection sites, rapidly gained acceptance across Europe. By contrast, they encountered significant opposition in North America. This thesis summarily traces the history of Canadian drug law, describing the development and impact of the harm reduction movement in Canada and the establishment of the first and only safe injection site (SIS in North America (Insite. Employing a repressive formalist analysis of the application of federal drug laws, I then examine the role of the current Conservative government in contesting harm reduction strategies and refusing full legalization of Insite. I illustrate that through the strategic manipulation and discriminatory enforcement of drug laws and political gamesmanship relating to the criteria grounding Insite’s exemption from current drug laws, the government has failed to fulfill a set of fundamental social values with respect to Insite’s users and members of the downtown eastside of Vancouver. Interviews with injection drug users, workers at Insite and residents of the local community provide empirical support for the beneficial effects of safe injection sites, and expose the politics of the struggle for Insite’s continued existence. I also show how the Conservative anti-drug ideologues have led a resistance against classifying drug addiction as a health-related rather than criminal problem, despite significant scientific evidence to the contrary, and how this resistance has resulted in the further marginalization of injection drug users.

Associations between injection risk and community disadvantage among suburban injection drug users in southwestern Connecticut, USA.

Science.gov (United States)

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

2014-03-01

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.

"The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil

Directory of Open Access Journals (Sweden)

Maria de Lourdes Aguiar Oliveira

Full Text Available The context of first drug injection and its association with ongoing injecting practices and HCV (hepatitis C virus infection were investigated. Injection drug users (IDUs (N = 606 were recruited in "drug scenes" (public places, bars in Rio de Janeiro, Brazil, interviewed, and tested for HCV. Sharing of needles/syringes was more prevalent at the first injection (51.3% than at the baseline interview (36.8%. Those who shared syringes/needles at first injection were more likely to be currently engaged in direct/indirect sharing practices. Among young injectors (< 30 years, those reporting sharing of needles/ syringes at the first injection were about four times more likely to have been infected by HCV. Hepatitis C virus prevalence among active IDUs (n = 272 was 11%. Prison history and longer duration of drug injection were identified as independent predictors of HCV infection. To effectively curb HCV transmission among IDUs and minimize harms associated with risk behaviors, preventive strategies should target individuals initiating drug injection beginning with their very first injection and discourage the transition from non-injecting use to the self-injection of illicit drugs.

Effectiveness of HIV prevention social marketing with injecting drug users.

Science.gov (United States)

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.

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

Directory of Open Access Journals (Sweden)

Green Traci

2006-03-01

Full Text Available Abstract 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

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

Science.gov (United States)

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.

The importance of social networks in their association to drug equipment sharing among injection drug users: a review.

Science.gov (United States)

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

2007-11-01

To examine the scientific evidence regarding the association between characteristics of social networks of injection drug users (IDUs) and the sharing of drug injection equipment. A search was performed on MEDLINE, EMBASE, BIOSIS, Current Contents, PsycINFO databases and other sources to identify published studies on social networks of IDUs. Papers were selected based on their examination of social network factors in relation to the sharing of syringes and drug preparation equipment (e.g. containers, filters, water). Additional relevant papers were found from the reference list of identified articles. Network correlates of drug equipment sharing are multi-factorial and include structural factors (network size, density, position, turnover), compositional factors (network member characteristics, role and quality of relationships with members) and behavioural factors (injecting norms, patterns of drug use, severity of drug addiction). Factors appear to be related differentially to equipment sharing. Social network characteristics are associated with drug injection risk behaviours and should be considered alongside personal risk behaviours in prevention programmes. Recommendations for future research into the social networks of IDUs are proposed.

[Injecting drug abuse: survival after intensive care admission and forensic toxicology reports at death].

Science.gov (United States)

Sigvaldason, Kristinn; Ingvarsson, Thoroddur; Thordardottir, Svava; Kristinsson, Jakob; Karason, Sigurbergur

2014-10-01

Injecting drug abuse is a worldwide problem with serious consequences for the individual and for society. The purpose of this study was to gather information on the most serious complications of injecting drug use from two perspectives, intensive care admissions and forensic toxicology reports. Firstly, intensive care admissions related to injecting drug abuse during a five year period were reviewed for demographics, complications and 5 year survival. Secondly, information from forensic toxicology reports regarding deaths amongst known injecting drug abusers were gathered for the same period. A total of 57 patients with a history of active injecting drug use were admitted to intensive care or approximately 1% of admissions, most often for overdose (52%) or life threatening infections (39%). Median age was 26, males were 66%. The most common substances used were prescription drugs. Hospital mortality was 16% and five year survival 65%. Average time from hospital discharge to death was 916±858 days. During the study period 38 deaths of individuals with a history of injecting drugs were identified by forensic toxicology reports or 4.1/10(5) population/year (age 15-59). Cause of death was most often overdose (53%), usually from prescription opiates but multiple drug use was common. The life expectancy of injecting drug abusers after intensive care admission is substantially decreased, with 35% death rate within five years. A widespread use of prescription drugs is of concern. Injecting drug abuse seems to be a similar health problem in magnitude in Iceland as in other Scandinavian countries.

Association between prescription drug misuse and injection among runaway and homeless youth.

Science.gov (United States)

Al-Tayyib, Alia A; Rice, Eric; Rhoades, Harmony; Riggs, Paula

2014-01-01

The nonmedical use of prescription drugs is the fastest growing drug problem in the United States, disproportionately impacting youth. Furthermore, the population prevalence of injection drug use among youth is also on the rise. This short communication examines the association between current prescription drug misuse (PDM) and injection among runaway and homeless youth. Homeless youth were surveyed between October 2011 and February 2012 at two drop-in service agencies in Los Angeles, CA. Prevalence ratios (PR) and 95% confidence intervals (CI) for the association between current PDM and injection behavior were estimated. The outcome of interest was use of a needle to inject any illegal drug into the body during the past 30 days. Of 380 homeless youth (median age, 21; IQR, 17-25; 72% male), 84 (22%) reported current PDM and 48 (13%) reported currently injecting. PDM during the past 30 days was associated with a 7.7 (95% CI: 4.4, 13.5) fold increase in the risk of injecting during that same time. Among those reporting current PDM with concurrent heroin, cocaine, and methamphetamine use, the PR with injection was 15.1 (95% CI: 8.5, 26.8). Runaway and homeless youth are at increased risk for a myriad of negative outcomes. Our preliminary findings are among the first to show the strong association between current PDM and injection in this population. Our findings provide the basis for additional research to delineate specific patterns of PDM and factors that enable or inhibit transition to injection among homeless and runaway youth. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Incidence and predictors of mental health disorder diagnoses among people who inject drugs in a Canadian setting.

Science.gov (United States)

Reddon, Hudson; Pettes, Tyler; Wood, Evan; Nosova, Ekaterina; Milloy, Michael-John; Kerr, Thomas; Hayashi, Kanna

2018-04-01

Limited attention has been given to the predictors of mental health diagnoses among people who inject drugs (PWID) in community settings. Therefore, we sought to longitudinally examine the prevalence, incidence and predictors of mental disorder diagnosis among a community-recruited cohort of PWID. Data were derived from two prospective cohort studies of PWID (VIDUS and ACCESS) in Vancouver, Canada between December 2005 and May 2015. We used multivariable extended Cox regression to identify factors independently associated with self-reported mental disorder diagnosis during follow-up among those without a history of such diagnoses at baseline. Among the 923 participants who did not report a mental disorder at baseline, 206 (22.3%) reported a first diagnosis of a mental disorder during follow-up for an incidence density of 4.29 [95% confidence interval (CI) 3.72-4.91] per 100 person-years. In the multivariable analysis, female sex [adjusted hazards ratio (AHR) = 1.74, 95% CI 1.29-2.33], experiencing non-fatal overdose (AHR = 2.33, 95% CI 1.38-3.94), accessing any drug or alcohol treatment (AHR = 1.68, 95% CI 1.24-2.27), accessing any community health or social services (AHR = 1.53, 95% CI 1.02-2.28) and experiencing violence (AHR = 1.60, 95% CI 1.12-2.29) were independently associated with a mental disorder diagnosis at follow-up. We observed a high prevalence and incidence of mental disorders among our community-recruited sample of PWID. The validity and implication of these diagnoses for key substance use and public health outcomes are an urgent priority. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Botulism in injecting drug users, Dublin, Ireland, November-December 2008.

LENUS (Irish Health Repository)

Ward, M

2009-01-08

In November and December 2008, six cases of suspect wound botulism were reported in heroin injecting drug users, all residents in Dublin, Ireland. Patients were aged between 23-42 years of age; four cases were male; one patient died shortly after admission. The patients presented to four different hospitals across the city. Botulism in injecting drug users in Ireland was last reported in 2002.

Syringe vending machines for injection drug users: an experiment in Marseille, France.

Science.gov (United States)

Obadia, Y; Feroni, I; Perrin, V; Vlahov, D; Moatti, J P

1999-01-01

OBJECTIVES: This study evaluated the usefulness of vending machines in providing injection drug users with access to sterile syringes in Marseille, France. METHODS: Self-administered questionnaires were offered to 485 injection drug users obtaining syringes from 32 pharmacies, 4 needle exchange programs, and 3 vending machines. RESULTS: Of the 343 respondents (response rate = 70.7%), 21.3% used the vending machines as their primary source of syringes. Primary users of vending machines were more likely than primary users of other sources to be younger than 30 years, to report no history of drug maintenance treatment, and to report no sharing of needles or injection paraphernalia. CONCLUSIONS: Vending machines may be an appropriate strategy for providing access to syringes for younger injection drug users, who have typically avoided needle exchange programs and pharmacies. PMID:10589315

Structural Barriers to Antiretroviral Therapy Among Sex Workers Living with HIV: Findings of a Longitudinal Study in Vancouver, Canada.

Science.gov (United States)

Goldenberg, Shira M; Montaner, Julio; Duff, Putu; Nguyen, Paul; Dobrer, Sabina; Guillemi, Silvia; Shannon, Kate

2016-05-01

In light of limited data on structural determinants of access and retention in antiretroviral therapy (ART) among sex workers, we examined structural correlates of ART use among sex workers living with HIV over time. Longitudinal data were drawn from a cohort of 646 female sex workers in Vancouver, Canada (2010-2012) and linked pharmacy records on ART dispensation. We used logistic regression with generalized estimating equations (GEE) to examine correlates of gaps in ART use (i.e., treatment interruptions or delayed ART initiation), among HIV seropositive participants (n = 74). Over a 2.5-year period, 37.8 % of participants experienced gaps in ART use (i.e., no ART dispensed in a 6-month period). In a multivariable GEE model, younger age, migration/mobility, incarceration, and non-injection drug use independently correlated with gaps in ART use. In spite of successes scaling-up ART in British Columbia, younger, mobile, or incarcerated sex workers face persistent gaps in access and retention irrespective of drug use. Community-based, tailored interventions to scale-up entry and retention in ART for sex workers should be further explored in this setting.

Predictors of injecting cessation among a cohort of people who inject drugs in Tijuana, Mexico.

Science.gov (United States)

Horyniak, Danielle; Strathdee, Steffanie A; West, Brooke S; Meacham, Meredith; Rangel, Gudelia; Gaines, Tommi L

2018-04-01

Little is known about the cessation of injecting drug use (IDU) among people who inject drugs (PWID) in low and middle-income settings, where access to effective interventions for reducing drug use (e.g., opioid substitution treatment; OST), may be limited. We measured the incidence and identified predictors of IDU cessation among a cohort of PWID in Tijuana, Mexico. Data were drawn from 621 participants in Proyecto El Cuete IV, a prospective cohort of PWID recruited in 2011 and interviewed biannually to 2016. A multivariable Extended Cox model was constructed to identify socio-demographic, drug use, risk environment and health-related predictors of IDU cessation (no IDU for ≥six months). 141 participants (23%) reported at least one IDU cessation event during follow-up. The crude IDU cessation rate was 7.3 per 100 person-years (95% Confidence Interval [CI]: 6.2-8.7). IDU cessation was negatively associated with injecting at least daily on average and heroin/methamphetamine co-injection in the past six months, and positively associated with testing HIV positive at baseline, being on methadone maintenance therapy in the past six months, and recent arrest. Concern for personal safety was also independently associated with IDU cessation. The rate of IDU cessation among PWID in Tijuana was low. These findings underscore the importance of expansion of services including OST to help reduce drug use and facilitate IDU cessation for those who wish to do so. In this setting, interventions addressing individual-level economic barriers as well as broader social and structural barriers to harm reduction services are integral. Copyright © 2018 Elsevier B.V. All rights reserved.

Development of a brief substance use sensation seeking scale: validation and prediction of injection-related behaviors.

Science.gov (United States)

Werb, Dan; Richardson, Chris; Buxton, Jane; Shoveller, Jeannie; Wood, Evan; Kerr, Thomas

2015-02-01

Sensation seeking, a personality trait, has been shown to predict engagement in high-risk behaviors. However, little is known regarding the impact of sensation seeking on substance use among street youth. We therefore sought to modify a sensation seeking scale (SSS) for use among this population. Street youth from the Vancouver-based At-Risk Youth Study (n = 226) completed the modified SSS. Exploratory and confirmatory factor analysis (EFA/CFA) were undertaken to establish the scale's dimensionality and internal validity. The association between SSS score and injection-related behaviors was tested using generalized estimating equation analysis. EFA results indicated scale unidimensionality. The comparative fit index (CFI) suggested acceptable fit (CFI = 0.914). In multivariate analysis, sensation seeking was independently associated with injection drug use, crystal methamphetamine use, polysubstance use, and binge drug use (all p < 0.05). Our findings provide preliminary support for the use of the modified SSS among street youth.

Microwave coagulation therapy and drug injection to treat splenic injury.

Science.gov (United States)

Zhang, Guoming; Sun, Yuanyuan; Yu, Jie; Dong, Lei; Mu, Nannan; Liu, Xiaohong; Liu, Lanfen; Zhang, Yan; Wang, Xiaofei; Liang, Ping

2014-01-01

The present study compares the efficacy of 915- and 2450-MHz contrast-enhanced ultrasound (CEUS)-guided percutaneous microwave coagulation with that of CEUS-guided thrombin injection for the treatment of trauma-induced spleen hemorrhage. In a canine splenic artery hemorrhage model with two levels of arterial diameter (A, microwaves and drug injection. Therapy efficacy was measured by comparing bleeding rate, hemostatic time, bleeding index, bleeding volume, and pathology. The most efficient technique was CEUS-guided 915-MHz percutaneous microwave coagulation therapy in terms of action time and total blood loss. The success rate of the 915-MHz microwave group was higher than that of the 2450-MHz microwave and the drug injection groups (except A level, P microwave group than those in the 2450-MHz microwave and drug injection groups (P microwave group, but pathologic changes of light injury could be seen in the other groups. The present study provides evidence that microwave coagulation therapy is more efficient than thrombin injection for the treatment of splenic hemorrhage. Furthermore, treatment with 915-MHz microwaves stops bleeding more rapidly and generates a wider cauterization zone than does treatment with 2450-MHz microwaves. Copyright © 2014 Elsevier Inc. All rights reserved.

Commentary: the value of PrEP for people who inject drugs.

Science.gov (United States)

Coleman, Rosalind L; McLean, Susie

2016-01-01

The offer of pre-exposure prophylaxis (PrEP) is recommended as an additional option for HIV prevention for people at substantial risk of HIV infection as part of combination HIV prevention approaches. Implementing this depends on integrating PrEP in public health programmes that address risky practices with evidence-based interventions, and that operate in an enabling legal and policy environment for the delivery of health services to those at higher risk of HIV infection. What does this recommendation mean in terms of the diverse range of HIV prevention needs of key populations, some of whom are so discriminated against that they exist essentially outside formal systems such as national public health services, and for whom a substantial risk of HIV is part of a larger adverse and hostile situation? We discuss this question with reference to people who inject drugs, informed by concerns and comments that emerged from a series of consultations. HIV prevention is part of a spectrum of injecting drug users' priorities, and their access and uptake of HIV prevention services is contingent on their wider "risk environment." The need to address structural barriers to services and human rights violations, and to improve access to comprehensive harm reduction programmes are of prime importance and would have higher value than a mono-focus on HIV prevention. Where existing harm reduction activities are inadequate, fragile or dependent on external donors, shifts in funding priorities, including, for example, towards PrEP, could threaten investment in the broader programmes. For these reasons, it cannot be assumed that PrEP promotion will always be supported by people who inject drugs.The sexual partners of people who inject drugs, non-opioid users who also inject and for whom there is no established substitution treatment, as well as drug users who are unable to negotiate safe sex may value PrEP. As for all key populations, the involvement of people who inject drugs in

The Edinburgh Addiction Cohort: recruitment and follow-up of a primary care based sample of injection drug users and non drug-injecting controls

Directory of Open Access Journals (Sweden)

Kimber Jo

2010-02-01

Full Text Available Abstract Background Injection drug use is an important public health problem. Epidemiological understanding of this problem is incomplete as longitudinal studies in the general population are difficult to undertake. In particular little is known about early life risk factors for later drug injection or about the life course of injection once established including the influence of medical and social interventions. Methods Individuals thought to be drug injectors were identified through a single primary medical care facility in Edinburgh between 1980 and 2006 and flagged with the General Registry Office. From October 2005 - October 2007, these cases were traced and invited to undergo interview assessment covering early life experience, substance use, health and social histories. Age and sex matched controls for confirmed cases (alive and dead were later recruited through the same health facility. Controls for living cases completed the same structured interview schedule. Data were also collected on cases and controls through linkage to routine primary care records, death registrations, hospital contact statistics and police and prison records. All interviews were conducted with the knowledge and permission of the current GP. Results The initial cohort size was 814. At start of follow up 227 had died. Of the remaining 587: 20 had no contact details and 5 had embarked from the UK; 40 declined participation; 38 did not respond to invitations; 14 were excluded by their GP on health or social grounds and 22 had their contact details withheld by administrative authorities. 448 were interviewed of whom 16 denied injection and were excluded. Of 191 dead cases with medical records 4 were excluded as their records contained no evidence of injection. 5 interviewed cases died before follow up was concluded though these individuals were counted as "live" cases. 1 control per case (dead and alive was recruited. Linkage to Scottish Morbidity Records data

Nicolau Syndrome after Intramuscular Injection of Non-Steroidal Anti-Inflammatory Drugs (NSAID

Directory of Open Access Journals (Sweden)

Mehmet Dadaci

2015-01-01

Full Text Available 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.

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

Directory of Open Access Journals (Sweden)

Shaboltas Alla V

2009-07-01

Full Text Available Abstract 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.

Drug use and AIDS: estimating injection prevalence in a rural state.

Science.gov (United States)

Leukefeld, Carl G; Logan, T K; Farabee, David; Clayton, Richard

2002-01-01

This paper presents approaches used in one rural U.S. state to describe the level of injecting drug use and to estimate the number of injectors not receiving drug-user treatment. The focus is on two broad areas of estimation that were used to present the prevalence of injecting drug use in Kentucky. The first estimation approach uses available data from secondary data sources. The second approach involves three small community studies.

The Potential for Wind Energy Meeting Electricity Needs on Vancouver Island

OpenAIRE

Ryan Prescott; G. Cornelis van Kooten; Hui Zhu

2006-01-01

In this paper, an in-depth analysis of power supply and demand on Vancouver Island is used to provide information about the optimal allocation of power across ‘generating’ sources and to investigate the economics of wind generation and penetrability into the Island grid. The methodology developed can be extended to a region much larger than Vancouver Island. Results from the model indicate that Vancouver Island could experience blackouts in the near future unless greater name-plate capacity i...

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

Science.gov (United States)

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.

Mental health and family relations among people who inject drugs and their family members in Vietnam.

Science.gov (United States)

Li, Li; Tuan, Nguyen Anh; Liang, Li-Jung; Lin, Chunqing; Farmer, Shu C; Flore, Martin

2013-11-01

This article explores the association of people who inject drugs and their family members in terms of mental health and family relations. The objective was to understand the family context and its impact on people who inject drugs in a family-oriented culture in Vietnam. Cross-sectional assessment data were gathered from 83 people who inject drugs and 83 of their family members recruited from four communes in Phú Thọ province, Vietnam. Depressive symptoms and family relations were measured for both people who inject drugs and family members. Internalized shame and drug-using behavior were reported by people who inject drugs, and caregiver burden was reported by family members. We found that higher level of drug using behavior of people who inject drugs was significantly associated with higher depressive symptoms and lower family relations reported by themselves as well as their family members. Family relations reported by people who inject drugs and their family members were positively correlated. The findings highlight the need for interventions that address psychological distress and the related challenges faced by family members of people who inject drugs. The article has policy implication which concludes with an argument for developing strategies that enhance the role of families in supporting behavioral change among people who inject drugs. Copyright © 2013 Elsevier B.V. All rights reserved.

Still "at risk": An examination of how street-involved young people understand, experience, and engage with "harm reduction" in Vancouver's inner city.

Science.gov (United States)

Bozinoff, Nikki; Small, Will; Long, Cathy; DeBeck, Kora; Fast, Danya

2017-07-01

Vancouver is an international leader in implementing interventions to reduce harms related to drug use. However, street-involved young people who use drugs continue to be vulnerable to overdose death, hepatitis C (HCV) infection, and high rates of syringe sharing. To better understand this in the context of the intensive public health response, we examined how young people, who are involved in the 'street drug scene', understood, experienced and engaged with harm reduction. Twelve semi-structured interviews were conducted in 2013 with 13 young people (ages 17-28) recruited from the At-Risk Youth Study, a prospective cohort of street-involved and drug-using young people. These interviews were embedded within a larger, eight-year program of ethnographic research and explored participants' understandings of harm reduction, their use of specific services, and their ideas about improving their day-to-day lives. Interviews were transcribed verbatim and a thematic analysis was performed. Young peoples' ideas about harm reduction were diverse and expansive. They articulated the limitations of existing programs, indicating that while they are positioned to reduce the risk of HIV and HCV transmission, they offer little meaningful support to improve young peoples' broader life chances. Young people described strategies to mitigate risk and harm in their own lives, including transitioning to drugs deemed less harmful and attempting to gain access to drug treatment. Finally, young people indicated that spatial considerations (e.g., distance from Vancouver's Downtown Eastside) strongly determined access to services. In Vancouver, a large, well established harm reduction infrastructure seeks to reduce HIV and HCV transmission among street-involved young people. However, young peoples' multiple understandings, experiences and engagements with harm reduction in this setting illustrate the limitations of the existing infrastructure in improving their broader life chances. Copyright

Greater Vancouver's water supply receives ozone treatment

Energy Technology Data Exchange (ETDEWEB)

Crosby, J.; Singh, I.; Reil, D. D.; Neden, G.

2000-10-01

To improve the overall quality of the treated water delivered to the member municipalities of the Greater Vancouver Water District (GVWD), the GVWD implemented a phased drinking water quality improvement program. The phased treatment program is directed at attaining effective disinfection while minimizing the formation of chlorinated disinfection by-products. Accordingly, the current primary disinfection method of chlorination was reevaluated and an ozone primary disinfection without filtration was authorized. Ozonization provides increased protection against Giardia and Cryptosporidium and a decrease in the formation potential for disinfection by-products (DPBs). This paper describes the design for the ozonation facility at Coquitlam, construction of which began in 1998 and completed during the summer of 2000. The facility houses the liquid oxygen supply, ozone generation, cooling water, ozone injection, primary off-gas ozone destruct system, and provides a home for various office, electrical maintenance and diesel generating functions. The second site at Capilano is expected to start construction in the fall of 2000 and be completed late in 2002. Wit its kilometre long stainless steel ozone contactor and sidestream injector tower, the Coquitlam Ozonation Facility is the first ozone pressure injection system of its kind in North America. 1 tab., 2 figs.

Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who inject drugs.

Science.gov (United States)

Smirnov, Andrew; Kemp, Robert; Ward, James; Henderson, Suzanna; Williams, Sidney; Dev, Abhilash; Najman, Jake M

2016-09-01

Despite over-representation of Indigenous Australians in sentinel studies of injecting drug use, little is known about relevant patterns of drug use and dependence. This study compares drug dependence and possible contributing factors in Indigenous and non-Indigenous Australians who inject drugs. Respondent-driven sampling was used in major cities and 'peer recruitment' in regional towns of Queensland to obtain a community sample of Indigenous (n = 282) and non-Indigenous (n = 267) injectors. Data are cross sectional. Multinomial models were developed for each group to examine types of dependence on injected drugs (no dependence, methamphetamine-dependent only, opioid-dependent only, dependent on methamphetamine and opioids). Around one-fifth of Indigenous and non-Indigenous injectors were dependent on both methamphetamine and opioids in the previous 12 months. Psychological distress was associated with dual dependence on these drugs for Indigenous [adjusted relative risk (ARR) 4.86, 95% confidence interval (CI) 2.08-11.34] and non-Indigenous (ARR 4.14, 95% CI 1.59-10.78) participants. Unemployment (ARR 8.98, 95% CI 2.25-35.82) and repeated (> once) incarceration as an adult (ARR 3.78, 95% CI 1.43-9.97) were associated with dual dependence for Indigenous participants only. Indigenous participants had high rates of alcohol dependence, except for those dependent on opioids only. The drug dependence patterns of Indigenous and non-Indigenous people who inject drugs were similar, including the proportions dependent on both methamphetamine and opioids. However, for Indigenous injectors, there was a stronger association between drug dependence and contextual factors such as unemployment and incarceration. Expansion of treatment options and community-level programs may be required. [Smirnov A, Kemp R, Ward J, Henderson S, Williams S, Dev A, Najman J M. Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who

The intravenous injection of illicit drugs and needle sharing: an historical perspective.

Science.gov (United States)

Zule, W A; Vogtsberger, K N; Desmond, D P

1997-01-01

This study reviewed the literature on the history of needle sharing and intravenous drug abuse. Reports suggest that needle sharing was practiced by drug abusers as early as 1902 in China and 1914 in the United States. Intravenous drug abuse was first mentioned in the literature in 1925. However other references suggest that some opioid users were injecting intravenously prior to 1920. Outbreaks of malaria in Egypt, the United States, and China between 1929 and 1937 were attributed to needle sharing and intravenous injection of opioids. These reports suggest that both needle sharing and intravenous drug use were common by 1937. Factors such as medical use of intravenous injections, enactment and zealous enforcement of antinarcotic laws, and interactions among drug users in institutional settings such as regional hospitals and prisons may have contributed to the spread of both needle sharing and the intravenous technique among drug abusers.

76 FR 3488 - Implantation or Injectable Dosage Form New Animal Drugs; Oxytetracycline and Flunixin

Science.gov (United States)

2011-01-20

.... FDA-2010-N-0002] Implantation or Injectable Dosage Form New Animal Drugs; Oxytetracycline and Flunixin... combination drug injectable solution containing oxytetracycline and flunixin meglumine in cattle. [[Page 3489... veterinary prescription use of HEXASOL (oxytetracycline and flunixin meglumine) Injection for the treatment...

Immunological Risk of Injectable Drug Delivery Systems

NARCIS (Netherlands)

Jiskoot, W.; van Schie, R.M.F.; Carstens, M.G.; Schellekens, H.

2009-01-01

Injectable drug delivery systems (DDS) such as particulate carriers and water-soluble polymers are being used and developed for a wide variety of therapeutic applications. However, a number of immunological risks with serious clinical implications are associated with administration of DDS. These

Drug use and risk behaviours among injecting drug users: a comparison between sex workers and non-sex workers in Sydney, Australia

Directory of Open Access Journals (Sweden)

Breen Courtney

2005-06-01

Full Text Available Abstract Background This paper examines the differences in demographics, drug use patterns and self reported risk behaviours between regular injecting drug users (IDU who report engaging in sex work for money or drugs and regular injecting drug users who do not. Methods Cross sectional data collected from regular IDU interviewed as part of the New South Wales (NSW Illicit Drug Reporting System (IDRS in 2003 were analysed. Results IDU who reported engaging in sex work were more likely to be female, and identify as being of Aboriginal and/or Torres Strait Islander descent. They initiated injecting drug use at a significantly younger age and were more likely to report injection related problems than IDU who had not engaged in sex work. There were no differences in the drug classes used, but findings suggested that the sex workers tended to be more frequent users of crystalline methamphetamine (ice and benzodiazepines. Conclusion The similarities between these groups were more striking than the differences. Further research, examining a larger sample is needed to clarify whether injecting drug users who are sex workers have heavier use patterns.

Suboptimal Addiction Interventions for Patients Hospitalized with Injection Drug Use-Associated Infective Endocarditis.

Science.gov (United States)

Rosenthal, Elana S; Karchmer, Adolf W; Theisen-Toupal, Jesse; Castillo, Roger Araujo; Rowley, Chris F

2016-05-01

Infective endocarditis is a serious infection, often resulting from injection drug use. Inpatient treatment regularly focuses on management of infection without attention to the underlying addiction. We aimed to determine the addiction interventions done in patients hospitalized with injection drug use-associated infective endocarditis. This is a retrospective review of patients hospitalized with injection drug use-associated infective endocarditis from January, 2004 through August, 2014 at a large academic tertiary care center in Boston, Massachusetts. For the initial and subsequent admissions, data were collected regarding addiction interventions, including consultation by social work, addiction clinical nurse and psychiatry, documentation of addiction in the discharge summary plan, plan for medication-assisted treatment and naloxone provision. There were 102 patients admitted with injection drug use-associated infective endocarditis, 50 patients (49.0%) were readmitted and 28 (27.5%) patients had ongoing injection drug use at readmission. At initial admission, 86.4% of patients had social work consultation, 23.7% had addiction consultation, and 24.0% had psychiatry consultation. Addiction was mentioned in 55.9% of discharge summary plans, 7.8% of patients had a plan for medication-assisted treatment, and naloxone was never prescribed. Of 102 patients, 26 (25.5%) are deceased. The median age at death was 40.9 years (interquartile range 28.7-48.7). We found that patients hospitalized with injection drug use-associated infective endocarditis had high rates of readmission, recurrent infective endocarditis and death. Despite this, addiction interventions were suboptimal. Improved addiction interventions are imperative in the treatment of injection drug use-associated infective endocarditis. Copyright © 2016 Elsevier Inc. All rights reserved.

Intravitreal, Subretinal, and Suprachoroidal Injections: Evolution of Microneedles for Drug Delivery.

Science.gov (United States)

Hartman, Rachel R; Kompella, Uday B

Even though the very thought of an injection into the eye may be frightening, an estimated 6 million intravitreal (IVT) injections were made in the USA during 2016. With the introduction of new therapeutic agents, this number is expected to increase. In addition, drug products that are injectable in ocular compartments other than the vitreous humor are expected to enter the back of the eye market in the not so distant future. Besides the IVT route, some of the most actively investigated routes of invasive administration to the eye include periocular, subretinal, and suprachoroidal (SC) routes. While clinical efficacy is the driving force behind new injectable drug product development for the eye, safety is also being improved with time. In the case of IVT injections, the procedural guidelines have evolved over the years to improve patient comfort and reduce injection-related injury and infection. Similar advances are anticipated for other routes of administration of injectable products to the eye. In addition to procedural improvements, the design of needles, particularly those with smaller diameters, length, and controlled bevel angles are expected to improve overall safety and acceptance of injected ophthalmic drug products. A key development in this area is the introduction of microneedles of a length less than a millimeter that can target the SC space. In the future, needles with smaller diameters and lengths, potentially approaching nanodimensions, are expected to revolutionize ophthalmic disease management.

A randomized intervention trial to reduce the lending of used injection equipment among injection drug users infected with hepatitis C.

Science.gov (United States)

Latka, Mary H; Hagan, Holly; Kapadia, Farzana; Golub, Elizabeth T; Bonner, Sebastian; Campbell, Jennifer V; Coady, Micaela H; Garfein, Richard S; Pu, Minya; Thomas, Dave L; Thiel, Thelma K; Strathdee, Steffanie A

2008-05-01

We evaluated the efficacy of a peer-mentoring behavioral intervention designed to reduce risky distributive injection practices (e.g., syringe lending, unsafe drug preparation) among injection drug users with hepatitis C virus (HCV) infection. A randomized trial with a time-equivalent attention-control group was conducted among 418 HCV-positive injection drug users aged 18 to 35 years in 3 US cities. Participants reported their injection-related behaviors at baseline and at 3- and 6-month follow-ups. Compared with the control group, intervention-group participants were less likely to report distributive risk behaviors at 3 months (odds ratio [OR]=0.46; 95% confidence interval [CI]=0.27, 0.79) and 6 months (OR=0.51; 95% CI=0.31, 0.83), a 26% relative risk reduction, but were no more likely to cite their HCV-positive status as a reason for refraining from syringe lending. Effects were strongest among intervention-group participants who had known their HCV-positive status for at least 6 months. Peer mentoring and self-efficacy were significantly increased among intervention-group participants, and intervention effects were mediated through improved self-efficacy. This behavioral intervention reduced unsafe injection practices that may propagate HCV among injection drug users.

Continued high prevalence of HIV, HBV and HCV among injecting and noninjecting drug users in Italy

Directory of Open Access Journals (Sweden)

Laura Camoni

2010-03-01

Full Text Available We estimated the prevalence of HIV, HBV and HCV infections among injecting and non-injecting drug users treated within public drug-treatment centres in Italy to determine the correlates of infection. In the sample of 1330 drug users, the prevalence of HIV was 14.4% among drug injectors and 1.6% among non-injectors; the prevalence of HBV was 70.4% among injecting drug users and 22.8% among non-injectors and of HCV was 83.2% among injecting drug users and 22.0% among non-injectors. Old age, unemployment, and intravenous drug use were significantly correlated with each of the infections, as well as a longer history of injecting drug use. The results indicate that these infections continue to circulate among drug users, highlighting the need for monitoring of this group in Italy.

Vancouver Accelerator Conference

Energy Technology Data Exchange (ETDEWEB)

Anon.

1985-06-15

Anyone who contends that particle physics is conducted in an ivory tower, not contributing to other fields of science or to humanity at large, should have attended the 1985 Particle Accelerator Conference in Vancouver. Over a thousand participants contributed 781 papers and only a fraction were actually related to accelerators for high energy physics. The majority of present developments are in the service of other fields of science, for alternative power sources, for medicine, for industrial applications, etc.

Vancouver Accelerator Conference

International Nuclear Information System (INIS)

Anon.

1985-01-01

Anyone who contends that particle physics is conducted in an ivory tower, not contributing to other fields of science or to humanity at large, should have attended the 1985 Particle Accelerator Conference in Vancouver. Over a thousand participants contributed 781 papers and only a fraction were actually related to accelerators for high energy physics. The majority of present developments are in the service of other fields of science, for alternative power sources, for medicine, for industrial applications, etc

Willingness to use drug checking within future supervised injection services among people who inject drugs in a mid-sized Canadian city.

Science.gov (United States)

Kennedy, Mary Clare; Scheim, Ayden; Rachlis, Beth; Mitra, Sanjana; Bardwell, Geoff; Rourke, Sean; Kerr, Thomas

2018-04-01

Esclating epidemics of fatal overdose are affecting communities across Canada. In many instances, the unanticipated presence of powerful opioids, such as fentanyl, in street drugs is a contributing factor. Drug checking offered within supervised injection services (SIS) is being considered as a potential measure for reducing overdose and related harms. We therefore sought to characterize the willingness of people who inject drugs (PWID) to use drug checking within SIS. Data were derived from a cross-sectional survey examining the feasibility of SIS in London, Canada, a mid-sized city. Multivariable logistic regression was used to examine factors associated with willingness to frequently (always or usually) use drug checking at SIS. Between March and April 2016, 180 PWID were included in the present study, including 68 (38%) women. In total, 78 (43%) reported that they would frequently check their drugs at SIS if this service were available. In multivariable analyses, female gender (Adjusted Odds Ratio [AOR] = 2.31; 95% confidence interval [CI]: (1.20-4.46), homelessness (AOR = 2.36; 95% CI: 1.14-4.86), and drug dealing (AOR = 2.16; 95% CI: 1.07-4.33) were positively associated with willingness to frequently check drugs at SIS. These findings highlight the potential of drug checking as a complement to other services offered within SIS, particularly given that subpopulations of PWID at heightened risk of overdose were more likely to report willingness to frequently use this service. However, further research is needed to determine the possible health impacts of offering drug checking at SIS. Copyright © 2018 Elsevier B.V. All rights reserved.

Injectable, in situ forming poly(propylene fumarate)-based ocular drug delivery systems.

Science.gov (United States)

Ueda, H; Hacker, M C; Haesslein, A; Jo, S; Ammon, D M; Borazjani, R N; Kunzler, J F; Salamone, J C; Mikos, A G

2007-12-01

This study sought to develop an injectable formulation for long-term ocular delivery of fluocinolone acetonide (FA) by dissolving the anti-inflammatory drug and the biodegradable polymer poly(propylene fumarate) (PPF) in the biocompatible, water-miscible, organic solvent N-methyl-2-pyrrolidone (NMP). Upon injection of the solution into an aqueous environment, a FA-loaded PPF matrix is precipitated in situ through the diffusion/extraction of NMP into surrounding aqueous fluids. Fabrication of the matrices and in vitro release studies were performed in phosphate buffered saline at 37 degrees C. Drug loadings up to 5% were achieved. High performance liquid chromatography was employed to determine the released amount of FA. The effects of drug loading, PPF content of the injectable formulation, and additional photo-crosslinking of the matrix surface were investigated. Overall, FA release was sustained in vitro over up to 400 days. After an initial burst release of 22 to 68% of initial FA loading, controlled drug release driven by diffusion and bulk erosion was observed. Drug release rates in a therapeutic range were demonstrated. Release kinetics were found to be dependent on drug loading, formulation PPF content, and extent of surface crosslinking. The results suggest that injectable, in situ formed PPF matrices are promising candidates for the formulation of long-term, controlled delivery devices for intraocular drug delivery. Copyright 2007 Wiley Periodicals, Inc.

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

Science.gov (United States)

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 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.

Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia.

Science.gov (United States)

Wickersham, Jeffrey A; Loeliger, Kelsey B; Marcus, Ruthanne; Pillai, Veena; Kamarulzaman, Adeeba; Altice, Frederick L

2016-01-01

While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.

Clinical effectiveness of multiple-drug injection treatment in unruptured ectopic pregnancies: a retrospective study.

Science.gov (United States)

Dai, Quan; Wang, Lu-Lu; Shao, Xiao-Hui; Wang, Si-Ming; Dong, Xiao-Qiu

2012-10-01

To study the effect of local interventional treatment of unruptured ectopic pregnancies with multiple-drug injection guided by color Doppler sonography. In this retrospective analysis, 49 patients with an unruptured ectopic pregnancy were treated with two different local injection methods administered under sonographic guidance. The patients were divided into single-drug (n = 23) and multiple-drug (n = 26) injection groups, and they received a locally administered injection of methotrexate alone or a combination including methotrexate, hemocoagulase, antibiotics, and anti-inflammatory drugs, respectively. Overall, local injection treatment was successful in 44 patients. The 5 patients with failed treatment underwent laparotomy about 1 week after single-drug injection. Serum β-human chorionic gonadotropin (β-hCG ) levels, ectopic pregnancy mass sizes, blood flow at various points after treatment, the incidence of pelvic bleeding, and the time for serum β-hCG levels to return to normal and the mass to resolve were analyzed in the remaining 44 patients. Single-drug treatment was successful in 18 patients; 10 of 23 had low to moderate pelvic bleeding after treatment, and 5 were referred for surgery. All 26 patients were successfully treated by multiple-drug injection. Only 2 patients had a small amount of pelvic bleeding. Differences between groups were statistically significant (P injection under color Doppler guidance is a new, safe, and effective method for treating unruptured ectopic pregnancies. It accelerates the serum β-hCG decline and facilitates mass resolution. This regimen is associated with a very low rate of pelvic bleeding, improves the success rate of conservative treatment, and, therefore, has value as an important clinical application.

International migration from non-endemic settings as a protective factor for HIV/STI risk among female sex workers in Vancouver, Canada.

Science.gov (United States)

Goldenberg, Shira M; Liu, Vivian; Nguyen, Paul; Chettiar, Jill; Shannon, Kate

2015-02-01

Given heterogeneous evidence regarding the impacts of migration on HIV/sexually transmitted infections (STIs) among female sex workers (FSWs), we explored factors associated with international migration among FSWs in Vancouver, Canada. We draw on baseline questionnaire and HIV/STI testing data from a community-based cohort, AESHA, from 2010-2012. Logistic regression identified correlates of international migration. Of 650 FSWs, 163 (25.1%) were international migrants, who primarily worked in formal indoor establishments. HIV/STI prevalence was lower among migrants than Canadian-born women (5.5 vs. 25.9%). In multivariate analysis, international migration was positively associated with completing high school, supporting dependents, and paying a third party, and negatively associated with HIV, injecting drugs and inconsistent condom use with clients. Although migrants experience lower workplace harms and HIV risk than Canadian-born women, they face concerning levels of violence, police harassment, and HIV/STIs. Research exploring structural and socio-cultural factors shaping risk mitigation and migrants' access to support remains needed.

Using standardized methods for research on HIV and injecting drug use in developing/transitional countries: case study from the WHO Drug Injection Study Phase II

Directory of Open Access Journals (Sweden)

Stimson Gerry V

2006-03-01

Full Text Available Abstract Background Successful cross-national research requires methods that are both standardized across sites and adaptable to local conditions. We report on the development and implementation of the methodology underlying the survey component of the WHO Drug Injection Study Phase II – a multi-site study of risk behavior and HIV seroprevalence among Injecting Drug Users (IDUs. Methods Standardized operational guidelines were developed by the Survey Coordinating Center in collaboration with the WHO Project Officer and participating site Investigators. Throughout the duration of the study, survey implementation at the local level was monitored by the Coordinating Center. Surveys were conducted in 12 different cities. Prior rapid assessment conducted in 10 cities provided insight into local context and guided survey implementation. Where possible, subjects were recruited both from drug abuse treatment centers and via street outreach. While emphasis was on IDUs, non-injectors were also recruited in cities with substantial non-injecting use of injectable drugs. A structured interview and HIV counseling/testing were administered. Results Over 5,000 subjects were recruited. Subjects were recruited from both drug treatment and street outreach in 10 cities. Non-injectors were recruited in nine cities. Prior rapid assessment identified suitable recruitment areas, reduced drug users' distrust of survey staff, and revealed site-specific risk behaviors. Centralized survey coordination facilitated local questionnaire modification within a core structure, standardized data collection protocols, uniform database structure, and cross-site analyses. Major site-specific problems included: questionnaire translation difficulties; locating affordable HIV-testing facilities; recruitment from drug treatment due to limited/selective treatment infrastructure; access to specific sub-groups of drug users in the community, particularly females or higher income groups

Risky Behaviors of Injecting Drug Users (IDUs Referred to Addiction Rehabilitation Centers in Khuzestan Province in 2014

Directory of Open Access Journals (Sweden)

Farkhondeh Jamshidi

2017-07-01

Full Text Available Aim: In the last decade, the prevalence of injecting drugs has been increasing rapidly. Injecting drug use puts one at the risk of risky behaviors that affect the health of individual and society. The present study aims at evaluating and comparing risky behaviors of injecting and non-injecting drug users. Methods: In this cross-sectional descriptive study, 4400 addicts referred to public, private and drop-in-centers (DICs in 2014 were enrolled. The addicts were divided into injecting and non-injecting drug users. A researcher-made questionnaire was used to collect demographic data and the pattern of drug use and risky behavior. Data were analyzed by SPSSV21, chi-square test and ANOVA. A significance level of less than 0.05 was considered. Results: Among the addicts, 4% were injecting drug users (IDUs and 96% non-injecting drug addicts (non-IDUs. The age of the first injection was 24.68 ± 6.45 years old. The age of onset of drug use in IDUs was significantly lower than in non-IDUs (P<0.001. Risky behaviors including the use of shared needles, risky sexual relations, a history of sexually transmitted infections and a history of imprisonment and suicide were significantly higher in IDUs. Addiction relapse and slip during treatment were higher in IDUs (P<0.001. Conclusion: Injecting drug addiction significantly increases the risk of relapse and risky behaviors. Priority should be given to risky behavior prevention programs.

The Role of Internalized Stigma in the Disclosure of Injecting Drug Use Among People Who Inject Drugs and Self-Report as HIV-Positive in Kohtla-Järve, Estonia.

Science.gov (United States)

Johannson, Annika; Vorobjov, Sigrid; Heimer, Robert; Dovidio, John F; Uusküla, Anneli

2017-04-01

Disclosure of injecting drug use and its associations with stigma have received very little research attention. This cross-sectional study examined the role of internalized HIV and drug stigma (i.e., self-stigmatization) in the disclosure of injecting drug use among people who inject drugs (PWID) self-reporting as HIV-positive (n = 312) in Kohtla-Järve, Estonia. The internalization of both stigmas was relatively high. On average, PWID disclosed to three disclosure targets out of seven. Disclosure was highest to close friends and health care workers and lowest to employers and casual sex partners. Internalized drug stigma was negatively associated with disclosure to other family members (AOR = 0.48; 95% CI 0.30-0.77) and health care workers (AOR = 0.46; 95% CI 0.25-0.87). Internalized HIV stigma was positively associated with disclosure to health care workers (AOR = 2.26; 95% CI 1.27-4.00). No interaction effect of internalized stigmas on disclosures emerged. We concluded that effects of internalized stigmas on disclosures are few and not uniform.

Venous access and care: harnessing pragmatics in harm reduction for people who inject drugs.

Science.gov (United States)

Harris, Magdalena; Rhodes, Tim

2012-06-01

To explore the facilitators of long-term hepatitis C avoidance among people who inject drugs. We employed a qualitative life history design. Recruitment took place through low-threshold drug services and drug user networks in South East and North London. Participants were interviewed at the recruitment services or in their homes. The sample comprised 35 people who inject drugs, 20 of whom were hepatitis C antibody-negative. Participants' average injecting trajectory was 19 years (6-33), with 66% primarily injecting heroin, and 34% a crack and heroin mix. Nine (26%) of the sample were female and the average age was 39 years (23-53). Two interviews were conducted with each participant, with the second interview incorporating reference to a computer-constructed life history time-line. Interview accounts were audiorecorded, transcribed verbatim and analysed thematically. Hepatitis C risk awareness was recent and deprioritized by the majority of participants. The facilitation of venous access and care was an initial and enduring rationale for safe injecting practices. Difficult venous access resulted in increased contamination of injecting environments and transitions to femoral injecting. Participants expressed an unmet desire for non-judgemental venous access information and advice. Harm reduction interventions which attend to the immediate priorities of people who inject drugs, such as venous access and care, have the potential to re-engage individuals who are jaded or confused by hepatitis C prevention messages. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Female spouses of injection drug users in Pakistan: a bridge population of the HIV epidemic?

Science.gov (United States)

Ahmad, S; Mehmood, J; Awan, A B; Zafar, S T; Khoshnood, K; Khan, A A

2011-04-01

An estimated 21% of injection drug users (IDUs) in Pakistan are HIV-positive and data suggest that the spouses of IDUs may be a critical component of the HIV transmission chain. This study interviewed 101 spouses of male IDUs about their sexual practices and drug use. We found that 43% had been sexually active with their partners in the past month but only 4% reported selling sex. Almost a quarter (23%) used drugs and 19% injected drugs, usually a combination of diazepam and pheniramine. Although sex work was infrequent among spouses of IDUs, their risk of contracting HIV and transmitting it to others was high because they received injection drugs, sometimes along with their IDU husbands, from the same health centres that provided therapeutic injections to the rest of the community. IDU spouses may thus serve as a bridge group via therapeutic injections, rather than via sex work.

Injection Drug Use Quality of Life scale (IDUQOL: A validation study

Directory of Open Access Journals (Sweden)

Palepu Anita

2005-07-01

Full Text Available Abstract Background Existing measures of injection drug users' quality of life have focused primarily on health and health-related factors. Clearly, however, quality of life among injection drug users is impacted by a range of unique cultural, socioeconomic, medical, and geographic factors that must also be considered in any measure. The Injection Drug User Quality of Life (IDUQOL scale was designed to capture the unique and individual circumstances that determine quality of life among injection drug users. The overall purpose of the present study was to examine the validity of inferences made from the IDUQOL by examining the (a dimensionality, (b reliability of scores, (c criterion-related validity evidence, and (d both convergent and discriminant validity evidence. Methods An exploratory factor analysis using principal axis factoring in SPSS 12.0 was conducted to determine whether the use of a total score on the IDUQOL was advisable. Reliability of scores from the IDUQOL was obtained using internal consistency and one-week test-retest reliability estimates. Criterion-related validity evidence was gathered using variables such as stability of housing, sex trade involvement, high-risk injection behaviours, involvement in treatment programs, emergency treatment or overdose over the previous six months, hospitalization and emergency treatment over the subsequent six month period post data collection. Convergent and discriminant validity evidence was gathered using measures of life satisfaction, self-esteem, and social desirability. Results The sample consisted of 241 injection drug users ranging in age from 19 to 61 years. Factor analysis supports the use of a total score. Both internal consistency (alpha = .88 and one-week test-retest reliability (r = .78 for IDUQOL total scores were good. Criterion-related, convergent, and discriminant validity evidence supports the interpretation of IDUQOL total scores as measuring a construct consistent with

'Trafficking' or 'personal use': do people who regularly inject drugs understand Australian drug trafficking laws?

Science.gov (United States)

Hughes, Caitlin E; Ritter, Alison; Cowdery, Nicholas; Sindicich, Natasha

2014-11-01

Legal thresholds for drug trafficking, over which possession of an illicit drug is deemed 'trafficking' as opposed to 'personal use', are employed in all Australian states and territories excepting Queensland. In this paper, we explore the extent to which people who regularly inject drugs understand such laws. Participants from the seven affected states/territories in the 2012 Illicit Drug Reporting System (n = 823) were asked about their legal knowledge of trafficking thresholds: whether, if arrested, quantity possessed would affect legal action taken; and the quantities of heroin, methamphetamine, cocaine and cannabis that would constitute an offence of supply. Data were compared against the actual laws to identify the accuracy of knowledge by drug type and state, and sociodemographics, use and purchasing patterns related to knowledge. Most Illicit Drug Reporting System participants (77%) correctly said that quantity possessed would affect charge received. However, only 55.8% nominated any specific quantity that would constitute an offence of supply, and of those 22.6% nominated a wrong quantity, namely a quantity that was larger than the actual quantity for supply (this varied by state and drug). People who regularly inject drugs have significant gaps in knowledge about Australian legal thresholds for drug trafficking, particularly regarding the actual threshold quantities. This suggests that there may be a need to improve education for this population. Necessity for accurate knowledge would also be lessened by better design of Australian drug trafficking laws. © 2014 Australasian Professional Society on Alcohol and other Drugs.

Mental Health and Family Relations: Correlated Reports from People Who Inject Drugs and their Family Members in Vietnam

Science.gov (United States)

Li, Li; Tuan, Nguyen Anh; Liang, Li-Jung; Lin, Chunqing; Farmer, Shu C.; Flore, Martin

2013-01-01

Background This article explores the association of people who inject drugs and their family members in terms of mental health and family relations. The objective was to understand the family context and its impact on people who inject drugs in a family-oriented culture in Vietnam. Methods Cross-sectional assessment data were gathered from 83 people who inject drugs and 83 of their family members recruited from four communes in Phú Thọ province, Vietnam. Depressive symptoms and family relations were measured for both people who inject drugs and family members. Internalized shame and drug-using behavior were reported by people who inject drugs, and caregiver burden was reported by family members. Results We found that higher level of drug using behavior of people who inject drugs was significantly associated with higher depressive symptoms and lower family relations reported by themselves as well as their family members. Family relations reported by people who inject drugs and their family members were positively correlated. Conclusion The findings highlight the need for interventions that address psychological distress and the related challenges faced by family members of people who inject drugs. The article has policy implication which concludes with an argument for developing strategies that enhance the role of families in supporting behavioral change of people who inject drugs. PMID:23910167

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

Science.gov (United States)

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

Profile of male Brazilian injecting drug users who have sex with men

Directory of Open Access Journals (Sweden)

Ferreira Aline Dayrell

2006-01-01

Full Text Available This study aims to characterize the profile of male injecting drug users who have sex with other men (MSM IDUs recruited through a cross-sectional multi-city survey (AjUDE-Brasil II Project in six Brazilian cities, in 2000-2001. MSM IDUs were compared to other male IDUs using bivariate and multivariate procedures (logistic regression and answer tree analysis with the CHAID algorithm. Among the 709 male IDUs, 187 (26.4% reported ever having had sex with other men, while only 37 reported sex with other men in the previous six months. MSM IDUs were more likely to be unemployed (OR = 2.3, to have injected tranquilizers (OR = 3.6, and to be HIV-seropositive (OR = 2.1, compared to other male IDUs. Male same-sex relations in this subgroup appear to be associated with strategies to finance drug consuming habits, including sex for drugs with occasional female partners or obtaining injection paraphernalia from occasional sex partners. Further studies should focus on this especially vulnerable subgroup of IDUs, due to the bidirectional and complex interrelationships between their drug injecting habits and sexual risk behaviors.

Ocular manifestations of injection drug use.

Science.gov (United States)

Kim, Rubin W; Juzych, Mark S; Eliott, Dean

2002-09-01

Injection drug use can result in a variety of severe ocular conditions. Hematogenous dissemination of various fungi and bacteria may produce endophthalmitis with resultant severe visual loss. Retinal arterial occlusive disease may result from talc and other particulate emboli. Most commonly, life-threatening systemic diseases such as endocarditis and HIV infection secondarily affect the eye. Because many of these conditions may result in blindness if untreated, accurate diagnosis and prompt initiation of therapy are essential.

76 FR 22610 - Implantation or Injectable Dosage Form New Animal Drugs; Enrofloxacin

Science.gov (United States)

2011-04-22

.... FDA-2011-N-0003] Implantation or Injectable Dosage Form New Animal Drugs; Enrofloxacin AGENCY: Food... the indications for use of enrofloxacin solution in cattle, as a single injection, for the treatment... supplement to NADA 141-068 for BAYTRIL 100 (enrofloxacin), an injectable solution. The supplemental NADA...

An analysis of respondent-driven sampling with injecting drug users in a high HIV prevalent state of India.

Science.gov (United States)

Phukan, Sanjib Kumar; Medhi, Gajendra Kumar; Mahanta, Jagadish; Adhikary, Rajatashuvra; Thongamba, Gay; Paranjape, Ramesh S; Akoijam, Brogen S

2017-07-03

Personal networks are significant social spaces to spread of HIV or other blood-borne infections among hard-to-reach population, viz., injecting drug users, female sex workers, etc. Sharing of infected needles or syringes among drug users is one of the major routes of HIV transmission in Manipur, a high HIV prevalence state in India. This study was carried out to describe the network characteristics and recruitment patterns of injecting drug users and to assess the association of personal network with injecting risky behaviors in Manipur. A total of 821 injecting drug users were recruited into the study using respondent-driven sampling (RDS) from Bishnupur and Churachandpur districts of Manipur; data on demographic characteristics, HIV risk behaviors, and network size were collected from them. Transition probability matrices and homophily indices were used to describe the network characteristics, and recruitment patterns of injecting drug users. Univariate and multivariate binary logistic regression models were performed to analyze the association between the personal networks and sharing of needles or syringes. The average network size was similar in both the districts. Recruitment analysis indicates injecting drug users were mostly engaged in mixed age group setting for injecting practice. Ever married and new injectors showed lack of in-group ties. Younger injecting drug users had mainly recruited older injecting drug users from their personal network. In logistic regression analysis, higher personal network was found to be significantly associated with increased likelihood of injecting risky behaviors. Because of mixed personal network of new injectors and higher network density associated with HIV exposure, older injecting drug users may act as a link for HIV transmission or other blood-borne infections to new injectors and also to their sexual partners. The information from this study may be useful to understanding the network pattern of injecting drug users

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

NARCIS (Netherlands)

Havinga, Petra; van der Velden, Claudia; de Gee, Anouk; van der Poel, Agnes; Yin, Huifang

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

High risk behavior for HIV transmission among former injecting drug users:a survey from Indonesia

Directory of Open Access Journals (Sweden)

Iskandar Shelly

2010-08-01

Full Text Available Abstract Background Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs in Indonesia, which has a rapidly growing HIV-epidemic largely driven by injecting drug use. Methods Current and former IDUs were recruited by respondent driven sampling in an urban setting in Java, and interviewed regarding drug use and HIV risk behavior using the European Addiction Severity Index and the Blood Borne Virus Transmission Questionnaire. Drug use and HIV transmission risk behavior were compared between current IDUs and former IDUs, using the Mann-Whitney and Pearson Chi-square test. Results Ninety-two out of 210 participants (44% were self reported former IDUs. Risk behavior related to sex, tattooing or piercing was common among current as well as former IDUs, 13% of former IDUs were still exposed to contaminated injecting equipment. HIV-infection was high among former (66% and current (60% IDUs. Conclusion Former IDUs may contribute significantly to the HIV-epidemic in Indonesia, and HIV-prevention should therefore also target this group, addressing sexual and other risk behavior.

"It Goes on Everywhere": Injection Drug Use in Canadian Federal Prisons.

Science.gov (United States)

van der Meulen, Emily

2017-06-07

International and Canadian research on in-prison injection drug use has documented the frequency of its occurrence as well as some of the resulting consequences such as increased prevalence of HIV and hepatitis C virus. Access to prison-based harm reduction programing is thus important. The aim of this study was to learn from former prisoner experiences and insights on in-prison injection drug use in order to advance and improve access to harm reduction options, in particular prison-based needle and syringe programs (PNSPs). The qualitative and community-based study was conducted in 2014/2015 and included former prisoners from Ontario, Canada (N = 30) who had recent experience of incarceration in a federal prison and knowledge of injection drug use. Data analysis followed the deductive approach, drawing on the expertise of the academic and community-based research team members. Interview and focus group participants disclosed that drugs are readily available in Canadian federal prisons and that equipment used to inject is accessed in a variety of ways, sometimes gained through illicit means and sometimes made by prisoners themselves. Equipment sharing is a frequent occurrence, and disposal of such supplies is rare. Conclusions/Importance: While not yet available in Canada, PNSPs have led to positive outcomes in international contexts, including reductions in needle sharing and transmission of HIV and hepatitis C. Support for PNSPs among numerous Canadian organizations and associations, along with a recent change in government, could suggest a renewed opportunity for PNSP implementation.

Gender differences in HIV and hepatitis C related vulnerabilities among aboriginal young people who use street drugs in two Canadian cities.

Science.gov (United States)

Mehrabadi, Azar; Paterson, Katharina; Pearce, Margo; Patel, Sheetal; Craib, Kevin J P; Moniruzzaman, Akm; Schechter, Martin T; Spittal, Patricia M

2008-01-01

Vulnerability to HIV and Hepatitis C virus (HCV) infection for indigenous populations worldwide must be contextualized in experiences of current and past trauma. Aboriginal women entrenched in poverty face further gender-specific harms which place them at increased risk for HIV infection. This study was cross-sectional and based on a community-based sample of Aboriginal young people (Metis, Aboriginal, First Nations, Inuit, and non-status Indians) between the ages of 14 and 30 years who used injection or non-injection non-cannabis illegal drugs (street drugs) in the previous month. Between October 2003 and July 2005, 543 participants living in either Vancouver or Prince George, Canada, were recruited by word of mouth, posters, and street outreach. Young people in the study completed a questionnaire administered by Aboriginal interviewers. Female participants (n = 262) were compared to male participants (n = 281) with respect to sociodemographics, trauma, sexual risk variables, and drug use patterns. Trained nurses drew blood samples for HIV and HCV antibodies and provided pre- and post-test counseling. Proportions positive for HIV and HCV were significantly higher among young women. HIV was 13.1% [9.5, 17.7] in women compared to 4.3% [2.5, 7.4] in men, and HCV was 43.6% [37.6, 49.8] in women as compared to 25.4% [20.5, 30.9] in men. When the analysis was restricted to young people who reported injection drug use, the proportions positive for HIV and HCV remained significantly higher among young women. Experiences of forced sex were reported by 70% of young women compared to 29% of young men, p < 0.001, while the median age of first forced sex was 6-years-old for both men and women. The results of the final model indicated that HIV had been associated with residing in Vancouver, having injected for longer, and sexual abuse, but not being female. However, this gendered analysis demonstrated that a greater proportion of young women were experiencing sexual abuse, and

Pubs in Public Life: A Place for Liquor Spaces in the City of Vancouver

OpenAIRE

Forbes, Heather

2010-01-01

Vancouver liquor licensing bylaws has been described by members of the media, industry, government and general public as overly restrictive, especially in the areas of hours ofservice, geographical distribution and the cultural diversity ofpublic liquor spaces. According to the City of Vancouver, the objective of city stewardship is to provide for the social, economic and physical well-being of citizens. A consultation of both academic research and the Vancouver community suggests that public...

Prevalence and Correlates of Heroin–Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico

Science.gov (United States)

Meacham, Meredith C.; Strathdee, Steffanie A.; Rangel, Gudelia; Armenta, Richard F.; Gaines, Tommi L.; Garfein, Richard S.

2016-01-01

Objective: Although persons who inject drugs (PWID) in the western United States–Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant–stimulant combination (also known as “goofball” and “Mexican speedball”). Method: Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin–methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin–methamphetamine co-injection. Results: The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana. Conclusions: These findings indicate that heroin–methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin–methamphetamine co-injection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants. PMID:27588536

Experiences with urine drug testing by police among people who inject drugs in Bangkok, Thailand.

Science.gov (United States)

Hayashi, Kanna; Ti, Lianping; Buxton, Jane A; Kaplan, Karyn; Suwannawong, Paisan; Wood, Evan; Kerr, Thomas

2014-03-01

Thailand has relied on drug law enforcement in an effort to curb illicit drug use. While anecdotal reports suggest that Thai police frequently use urine toxicology to identify drug users, little is known about the prevalence or impacts of this practice among people who inject drugs (IDU). Therefore, we sought to examine experiences with urine drug testing by police among IDU in Bangkok. Data were derived from a community-recruited sample of IDU in Bangkok participating in the Mitsampan Community Research Project between July and October 2011. We assessed the prevalence and correlates of being subjected to urine toxicology testing by police using multivariate Poisson regression. In total, 438 IDU participated in this study, with 293 (66.9%) participants reporting having been tested for illicit drugs by police. In multivariate analyses, reports of drug testing by police were independently and positively associated with younger age (adjusted prevalence ratio [APR]: 1.28), a history of methamphetamine injection (APR: 1.22), a history of incarceration (APR: 1.21), having been in compulsory drug detention (APR: 1.43), avoiding healthcare (APR: 1.15), and HIV seropositivity (APR: 1.19), and negatively associated with access to voluntary drug treatment (APR: 0.82) (all p<0.05). A high proportion of IDU in Bangkok were subjected to drug testing by police. Young people and methamphetamine injectors were more likely to have been tested. The findings indicate that drug testing by police is associated with the compulsory drug detention system and may be interfering with IDU's access to healthcare and voluntary drug treatment. These findings raise concern about the widespread practice of drug testing by police and its associated impacts. Copyright © 2013 Elsevier B.V. All rights reserved.

Cross-border migration and initiation of others into drug injecting in Tijuana, Mexico.

Science.gov (United States)

Rafful, Claudia; Melo, Jason; Medina-Mora, María Elena; Rangel, Gudelia; Sun, Xiaoying; Jain, Sonia; Werb, Dan

2018-04-01

Efforts to prevent injection drug use (IDU) are increasingly focusing on the role that people who inject drugs (PWID) play in facilitating the entry of others into this behaviour. This is particularly relevant in settings experiencing high levels of IDU, such as Mexico's northern border region, where cross-border migration, particularly through forced deportation, has been found to increase a range of health and social harms related to injecting. PWID enrolled in a prospective cohort study in Tijuana, Mexico, since 2011 were interviewed semi-annually, which solicited responses on their experiences initiating others into injecting. Univariate and multivariable logistic regression analyses were conducted at the Preventing Injection by Modifying Existing Responses (PRIMER) baseline, with the dependent variable defined as reporting ever initiating others into injection. The primary independent variable was lifetime deportation from the USA to Mexico. Among 532 participants, 14% (n = 76) reported initiating others into injecting, the majority of participants reporting initiating acquaintances (74%, n = 56). In multivariable analyses, initiating others into injecting was independently associated with reporting living in the USA for 1-5 years [adjusted odds ratio (AOR) = 2.42; 95% confidence interval (CI) 1.22-4.79, P = 0.01], and methamphetamine and heroin injection combined (AOR = 3.67; 95% CI 1.11-12.17, P = 0.03). Deportation was not independently associated with initiating others into injecting. The impact of migration needs to be considered within binational programming seeking to prevent the expansion of epidemics of injecting and HIV transmission among mobile populations residing in the Mexico-USA border region. © 2017 Australasian Professional Society on Alcohol and other Drugs.

The context of illicit drug overdose deaths in British Columbia, 2006

Directory of Open Access Journals (Sweden)

Waheed Bilal

2009-05-01

Full Text Available Abstract Background Illicit drug overdose deaths (IDD relate to individual drug dose and context of use, including use with other drugs and alcohol. IDD peaked in British Columbia (BC in 1998 with 417 deaths, and continues to be a public health problem. The objective of this study was to examine IDD in 2006 in BC by place of residence, injury and death, decedents' age and sex and substances identified. Methods IDD data was obtained through the BC Coroners Office and entered into SPSS (version 14. Fisher's exact and Pearson's χ2 were used for categorical data; Mann-Whitney U-test for continuous variables. Rates were calculated using 2006 population estimates. Results We identified 223 IDD in BC; 54 (24% occurred in Vancouver. Vancouver decedents (compared to those occurring outside Vancouver were older (mean age 43.9 vs. 39.2 years; p Cocaine was identified in 80.3%, opiates 59.6%, methadone 13.9%, methamphetamine/amphetamine 6.3%, and alcohol in 22.9% of deaths. Poly-substance use was common, 2 substances were identified in 43.8% and 3 or more in 34.5% of deaths. Opiates were more frequently identified in Vancouver compared to outside Vancouver (74.1% vs. 55.0% p = 0.015. Conclusion Collaboration with the Coroner's office allowed us to analyze IDD in detail including place of death; cocaine, opiates and poly-substance use were commonly identified. Poly-substance use should be explored further to inform public health interventions.

Complex and Conflicting Social Norms: Implications for Implementation of Future HIV Pre-Exposure Prophylaxis (PrEP Interventions in Vancouver, Canada.

Directory of Open Access Journals (Sweden)

Rod Knight

Full Text Available HIV Pre-Exposure Prophylaxis (PrEP has been found to be efficacious in preventing HIV acquisition among seronegative individuals in a variety of risk groups, including men who have sex with men and people who inject drugs. To date, however, it remains unclear how socio-cultural norms (e.g., attitudes towards HIV; social understandings regarding HIV risk practices may influence the scalability of future PrEP interventions. The objective of this study is to assess how socio-cultural norms may influence the implementation and scalability of future HIV PrEP interventions in Vancouver, Canada.We conducted 50 interviews with young men (ages 18-24 with a variety of HIV risk behavioural profiles (e.g., young men who inject drugs; MSM. Interviews focused on participants' experiences and perceptions with various HIV interventions and policies, including PrEP.While awareness of PrEP was generally low, perceptions about the potential personal and public health gains associated with PrEP were interconnected with expressions of complex and sometimes conflicting social norms. Some accounts characterized PrEP as a convenient form of reliable protection against HIV, likening it to the female birth control pill. Other accounts cast PrEP as a means to facilitate 'socially unacceptable' behaviour (e.g., promiscuity. Stigmatizing rhetoric was used to position PrEP as a tool that could promote some groups' proclivities to take 'risks'.Stigma regarding 'risky' behaviour and PrEP should not be underestimated as a serious implementation challenge. Pre-implementation strategies that concomitantly aim to improve knowledge about PrEP, while addressing associated social prejudices, may be key to effective implementation and scale-up.

Prevalence and Correlates of Heroin-Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico.

Science.gov (United States)

Meacham, Meredith C; Strathdee, Steffanie A; Rangel, Gudelia; Armenta, Richard F; Gaines, Tommi L; Garfein, Richard S

2016-09-01

Although persons who inject drugs (PWID) in the western United States-Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant-stimulant combination (also known as "goofball" and "Mexican speedball"). Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin-methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin-meth-amphetamine co-injection. The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana. These findings indicate that heroin-methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin-methamphetamine coinjection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants.

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

Science.gov (United States)

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

Outlier populations: individual and social network correlates of solvent-using injection drug users.

Directory of Open Access Journals (Sweden)

Souradet Y Shaw

Full Text Available We previously identified a high prevalence of Hepatitis C (HCV amongst solvent-using injection drug users (S-IDU relative to other injection drug users within the same locality. Here we incorporated social network variables to better characterize some of the behavioural characteristics that may be putting this specific subgroup of IDU at elevated disease risk.A cross-sectional survey of at-risk populations was carried out in Winnipeg, Canada in 2009. Individuals reporting any history of injection drug and/or solvent use were included in the study. Associations between subgroup membership, infection with HCV and HIV and individual and social network variables were examined.In relation to other IDU, S-IDU were more likely to be infected with HCV, to report ever having shared a syringe, and to associate with other IDU. They were further differentiated in terms of their self-reported sexual orientation, ethnicity and in the injection drugs typically used.Solvent use stands as a proxy measure of numerous other characteristics that put this group of IDU at higher risk of infection. Provision of adequate services to ostracized subpopulations may result in wider population-level benefits.

Plasma HIV-1 RNA viral load rebound among people who inject drugs receiving antiretroviral therapy (ART) in a Canadian setting: an ethno-epidemiological study.

Science.gov (United States)

Small, Will; Milloy, M J; McNeil, Ryan; Maher, Lisa; Kerr, Thomas

2016-01-01

People who inject drugs (PWID) living with HIV often experience sub-optimal antiretroviral therapy (ART) treatment outcomes, including HIV plasma viral load (PVL) rebound. While previous studies have identified risk factors for PVL rebound among PWID, no study has examined the perspectives of PWID who have experienced PVL rebound episodes. We conducted an ethno-epidemiological study to investigate the circumstances surrounding the emergence of rebound episodes among PWID in Vancouver, BC, Canada. Comprehensive clinical records linked to a community-based prospective observational cohort of HIV-positive drug users were used to identify PWID who had recently experienced viral rebound. In-depth qualitative interviews with 16 male and 11 female participants explored participant perspectives regarding the emergence of viral rebound. A timeline depicting each participant's HIV viral load and adherence to ART was used to elicit discussion of circumstances surrounding viral rebound. Viral rebound episodes were shaped by interplay between various individual, social, and environmental factors that disrupted routines facilitating adherence. Structural-environmental influences resulting in non-adherence included housing transitions, changes in drug use patterns and intense drug scene involvement, and inadequate care for co-morbid health conditions. Social-environmental influences on ART adherence included poor interactions between care providers and patients producing non-adherence, and understandings of HIV treatment that fostered intentional treatment discontinuation. This study describes key pathways which led to rebound episodes among PWID receiving ART and illustrates how environmental forces may increase vulnerability for non-adherence leading to treatment failure. Our findings have potential to help inform interventions and supports that address social-structural forces that foster non-adherence among PWID.

Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US.

Science.gov (United States)

Des Jarlais, D C; Cooper, H L F; Arasteh, K; Feelemyer, J; McKnight, C; Ross, Z

2018-01-01

We identified potential geographic "hotspots" for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an "end of the epidemic" stage, while HCV is in a continuing, high prevalence (> 50%) stage. We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011-2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential "hotspots" for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk-passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk-injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.

Deportation experiences of women who inject drugs in Tijuana, Mexico.

Science.gov (United States)

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

2012-04-01

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.

High risk behavior for HIV transmission among former injecting drug users: a survey from Indonesia.

NARCIS (Netherlands)

Iskandar, S.; Basar, D.; Hidayat, T.; Siregar, I.M.; Pinxten, W.J.L.; Crevel, R. van; Ven, A.J.A.M. van der; Jong, C.A.J. de

2010-01-01

BACKGROUND: Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce

High risk behavior for HIV transmission among former injecting drug users: a survey from Indonesia

NARCIS (Netherlands)

Iskandar, S.; Basar, D.; Hidayat, T.; Siregar, I.M.P.; Pinxten, W.J.L.; Crevel, R. van; Ven, A.J.A.M. van der; Jong, C.A.J. de

2010-01-01

Background: Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce

Spread of Rare Fungus from Vancouver Island

Centers for Disease Control (CDC) Podcasts

Cryptococcus gattii, a rare fungus normally found in the tropics, has infected people and animals on Vancouver Island, Canada. Dr. David Warnock, Director, Division of Foodborne, Bacterial, and Mycotic Diseases, CDC, discusses public health concerns about further spread of this organism

Traveling to Canada for the Vancouver 2010 Winter Olympic and Paralympic Games.

Science.gov (United States)

Heggie, Travis W

2009-07-01

The 21st Winter Olympic Games will be held in Vancouver, British Columbia, Canada from February 12 to 28, 2010. Following the Winter Olympic Games, the Winter Paralympic Games will be held from March 12 to 21, 2010. There will be 86 winter sporting events hosted in Vancouver with 5500 athletes staying in two Olympic Villages. Another 2800 members of the media, 25,000 volunteers, and 1 million spectators are expected in attendance. This paper reviews health and safety issues for all travelers to Canada for the 2010 Vancouver Winter Olympic Games with a specific focus on pre-travel planning, road and transportation safety in British Columbia, natural and environmental hazards, Olympic medical facilities, safety and security, and infectious disease.

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

Science.gov (United States)

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. Copyright © 2013 Elsevier B.V. All rights reserved.

"Who has ever loved a drug addict? It's a lie. They think a 'teja' is as bad person": multiple stigmas faced by women who inject drugs in coastal Kenya.

Science.gov (United States)

Mburu, Gitau; Ayon, Sylvia; Tsai, Alexander C; Ndimbii, James; Wang, Bangyuan; Strathdee, Steffanie; Seeley, Janet

2018-05-25

A tenth of all people who inject drugs in Kenya are women, yet their social contexts and experiences remain poorly understood. This paper reports how multiple forms of stigma are experienced by women who inject drugs in coastal Kenya and the impact that they have on their ability to access essential health services. In 2015, in-depth interviews and focus group discussions were held with 45 women who inject drugs in two coastal towns. These data were supplemented with in-depth interviews with five individual stakeholders involved in service provision to this population. Data were analyzed thematically using NVivo. Women who inject drugs experience multiple stigmas, often simultaneously. These included the external stigma and self-stigma of injection drug use, external gender-related stigma of being a female injecting drug user, and the external stigma of being HIV positive (i.e., among those living with HIV). Stigma led to rejection, social exclusion, low self-esteem, and delay or denial of services at health facilities. HIV and harm reduction programs should incorporate interventions that address different forms of stigma among women who inject drugs in coastal Kenya. Addressing stigma will require a combination of individual, social, and structural interventions, such as collective empowerment of injecting drug users, training of healthcare providers on issues and needs of women who inject drugs, peer accompaniment to health facilities, addressing wider social determinants of stigma and discrimination, and expansion of harm reduction interventions to change perceptions of communities towards women who inject drugs.

Network constrained wind integration on Vancouver Island

NARCIS (Netherlands)

Maddaloni, J.D.; Rowe, A.M.; Kooten, van G.C.

2008-01-01

The aim of this study is to determine the costs and carbon emissions associated with operating a hydro-dominated electricity generation system (Vancouver Island, Canada) with varying degrees of wind penetration. The focus is to match the wind resource, system demand and abilities of extant

Frequent food insecurity among injection drug users: correlates and concerns

Directory of Open Access Journals (Sweden)

Strike Carol

2012-12-01

Full Text Available Abstract Background Food insecurity and nutrition are two topics that are under-researched among injection drug users (IDUs. Our study examined the extent and correlates of food insecurity among a sample of IDUs and explored whether there is an association between food insecurity and injection-related HIV risk. Methods A cross-sectional survey was conducted using interviewer-administered questionnaires. Data were collected at a needle exchange program in London, Ontario, Canada between September 2006 and January 2007. Participants included 144 English-speaking IDUs who had injected drugs in the past 30 days. Participants were asked about their socio-demographic characteristics, HIV risk behaviours, food insecurity, and health/social service use. Results In the past 6 months, 54.5% of participants reported that on a daily/weekly basis they did not have enough to eat because of a lack of money, while 22.1% reported this type of food insecurity on a monthly basis. Moreover, 60.4% and 24.3% reported that they did not eat the quality or quantity of food they wanted on a daily/weekly or a monthly basis, respectively. Participants reported re-using someone else’s injection equipment: 21% re-used a needle, 19% re-used water, and 37.3% re-used a cooker. The odds of sharing injection equipment were increased for food insecure individuals. Conclusions Findings show that IDUs have frequent and variable experiences of food insecurity and these experiences are strongly correlated with sharing of injection-related equipment. Such behaviours may increase the likelihood of HIV and HCV transmission in this population. Addressing food-related needs among IDUs is urgently needed.

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

Directory of Open Access Journals (Sweden)

Sheikh Mohammed Shariful Islam

2015-01-01

Full Text Available 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.

Estimating the number of HIV-infected injection drug users in Bangkok: a capture--recapture method.

Science.gov (United States)

Mastro, T D; Kitayaporn, D; Weniger, B G; Vanichseni, S; Laosunthorn, V; Uneklabh, T; Uneklabh, C; Choopanya, K; Limpakarnjanarat, K

1994-07-01

The purpose of the study was to estimate the number of injection drug users infected with the human immunodeficiency virus (HIV) in Bangkok to allow planning for health services for this population. A two-sample capture-recapture method was used. The first capture listed all persons on methadone treatment for opiate addiction from April 17 through May 17, 1991, at 18 facilities in Bangkok. The second capture involved urine testing of persons held at 72 Bangkok police stations from June 3 through September 30, 1991. Persons whose urine tests were positive for opiate metabolites or methadone were included on the second list. The first capture comprised 4064 persons and the recapture 1540 persons. There were 171 persons included on both lists, yielding an estimate of 36,600 opiate users in Bangkok. Existing data indicate that 89% of opiate users in Bangkok inject drugs and that about one third are infected with HIV, yielding an estimate of approximately 12,000 HIV-infected injection drug users in Bangkok in 1991. During the 1990s the number of cases of acquired immunodeficiency syndrome (AIDS) and other HIV-related diseases, including tuberculosis, in the population of HIV-infected injection drug users in Bangkok will increase dramatically, placing new demands on existing health care facilities. The capture-recapture method may be useful in estimating difficult-to-count populations, including injection drug users.

[Injecting drug users and antiretroviral therapy: perceptions of pharmacy teams].

Science.gov (United States)

Yokaichiya, Chizuru Minami; Figueiredo, Wagner dos Santos; Schraiber, Lilia Blima

2007-12-01

To understand the perceptions of pharmacy teams about their role in the healthcare assistance challenges and adherence to antiretroviral therapy by injecting drug users living with HIV/AIDS. Qualitative study through focus groups and thematic discourse analysis of pharmacists, technicians and assistants with more than six months of experience with medication supply, in 15 assisting units for STD/AIDS in the city of São Paulo, in 2002. Three groups were formed, totaling 29 participants, originating from 12 out of the 15 existing services, and including 12 university level professionals and 17 high-school level professionals. The groups concluded that the pharmacy has an important role in the antiretroviral drug supply, which is reflected in the treatment adherence, because trust-based relationships can be built up through their procedures. In spite of this, they pointed out that such building-up does not take place through excessively bureaucratic activities. This has negative repercussions for all patients, especially for injecting drug users, considered "difficult people". Such concept sums up their behavior: they are supposed to be confused and incapable to adhere to treatment, and have limited understanding. Staff members, however, affirm they treat these patients equally. They do not realize that, by this acting, the specific needs of injecting drug users may become invisible in the service. There is also the possibility that stigmatizing stereotypes may be created, resulting in yet another barrier to the work on adherence. Although the pharmacy is recommended as a potentially favorable place to listen to and form bonds with users, the results show objective and subjective obstacles to render it suitable for the work on adherence.

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

Directory of Open Access Journals (Sweden)

Boyd James J

2012-02-01

Full Text Available Abstract 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.

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

Science.gov (United States)

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

2004-12-07

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.

Microwave freeze-thaw technique of injectable drugs. A review from 1980 to 2014.

Science.gov (United States)

Hecq, J-D; Godet, M; Jamart, J; Galanti, L

2015-11-01

Microwave freeze-thaw treatment (MFTT) of injectable drugs can support the development of centralized intravenous admixtures services (CIVAS). The aim of the review is to collect information and results about this method. A systematic review of the scientific literature about injectable drug stability studies was performed. The data are presented in a table and describe name of the drug, producer, final concentration, temperature and time of freezing storage, type of microwave oven, thawing power, method of dosage and results after treatment or final long-term storage at 5±3 °C. From 1980 to 2014, 59 drugs were studied by MFTT and the results were presented in 49 publications. Forty papers were presented by 8 teams (2 to 18 by team). The temperatures of freezing storage vary from -70 °C to -10 °C, the time storage from 4 hours to 12 months, the thaw from low to full power. Dosages are mainly made by high performance liquid chromatography. Most of the 59 drugs are stable during and after treatment. Only 3 teams have tested the long-term stability after MFTT, the first for ganciclovir after 7 days, the second for ceftizoxime after 30 days and the third for 19 drugs after 11 to 70 days. This review can help CIVAS to take in charge the productions of ready-to-use injectable drugs. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

The association between psychosocial and structural-level stressors and HIV injection drug risk behavior among Malaysian fishermen: A cross-sectional study.

Science.gov (United States)

Michalopoulos, Lynn Murphy; Jiwatram-Negrón, Tina; Choo, Martin K K; Kamarulzaman, Adeeba; El-Bassel, Nabila

2016-06-02

Malaysian fishermen have been identified as a key-affected HIV population with HIV rates 10 times higher than national rates. A number of studies have identified that psychosocial and structural-level stressors increase HIV injection drug risk behaviors. The purpose of this paper is to examine psychosocial and structural-level stressors of injection drug use and HIV injection drug risk behaviors among Malaysian fishermen. The study employs a cross-sectional design using respondent driven sampling methods. The sample includes 406 fishermen from Pahang state, Malaysia. Using multivariate logistic regressions, we examined the relationship between individual (depression), social (adverse interactions with the police), and structural (poverty-related) stressors and injection drug use and risky injection drug use (e.g.., receptive and non-receptive needle sharing, frontloading and back-loading, or sharing drugs from a common container). Participants below the poverty line had significantly lower odds of injection drug use (OR 0.52, 95 % CI: 0.27-0.99, p = 0.047) and risky injection drug use behavior (OR 0.48, 95 % CI: 0.25-0.93, p = 0.030). In addition, participants with an arrest history had higher odds of injection use (OR 19.58, 95 % CI: 9.81-39.10, p HIV injection drug risk behaviors.

Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China.

Science.gov (United States)

Wu, Zunyou; Luo, Wei; Sullivan, Sheena G; Rou, Keming; Lin, Peng; Liu, Wei; Ming, Zhongqiang

2007-12-01

To evaluate the effectiveness of a needle social marketing strategy to reduce needle sharing and hepatitis C Virus (HCV)/HIV transmission among injecting drug users (IDU) in China. Two-armed, prospective, community-randomized prevention trial. Four counties/townships in Guangxi and Guangdong provinces; one randomized to intervention the other to control in each province. Injecting drug users: 823 (443 intervention, 382 control) at baseline and 852 (415 intervention, 407 control) at the second cross-sectional survey 12 months later. A needle social marketing programme, including promotion of safe injection norms and increased access to clean needles over a 12 month period. Cross sectional surveys at baseline and follow-up compared changes in drug using behaviours and HIV and HCV rates in the intervention and control communities. Needle sharing behaviours were similar in the two groups at baseline (68.4 vs. 67.8%), and dropped significantly to 35.3% in the intervention community and remained relatively stable in the control community (62.3%; P marketing can reduce risky injecting behaviour and HIV/HCV transmission among injecting drug users in China and should be expanded.

Seroprevalence of HTLV1,2 Virus Among Injection Drug Addicts in Isfahan, 2007-2008

Directory of Open Access Journals (Sweden)

Sh Farzaneh

2009-10-01

Full Text Available Introduction: Human T-cell lymphotropic virus (HTLV, is a member of the retroviridae family. Infection with this virus leads to adult T-cell leukemia (ATL and tropical spastic paraparesis (TSP. HTLV is endemic in Japan, parts of central Africa, Caribbean basin and Iran (Mashhad. Transmission routes of HTLV are believed to be from mother to child, especially during breastfeeding, sexual contact, and through blood transfusion or needle sharing. Considering the risk of HTLV infection among injection drug addicts, the authors evaluated the seroprevalence of HTLV1,2 infection among injection drug addicts in Isfahan Methods: This cross sectional study included a total of 150 injection drug users who were recruited at the drug abuse treatment clinic and the infectious diseases department of Alzahra university Hospital. Participants were interviewed using a structured questionnaire. Epidemiologic data were recorded and their blood samples were tested for HBs Ag and antibodies against HTLV1,2, human immunodeficiency virus (HIV and hepatitis C (HCV by Elisa method . Results were analyzed by SPSS software version 13. Results: Seroprevalence of HTLV1,2, HBV(HBs Ag, HCV and HIV was 2.7%, 1.3% 23.3% and 2.7%, respectively. Some of the subjects were co infected with two viruses. One patient was infected with both HCV Ab and HBs Ag , while another was positive for HIV Ab plus HBs Ag . Three were co infected with HCV and HIV. Among those with HTLV1,2, only one was HCV Ab positive. Only in one person with HTLV1,2 Ab had a positive history of blood transfusion. Conclusion: This study shows that this virus is present in injection drug users community of Isfahan and can be a potential source for transmission. But proposal of screening of HTLV1,2 among injection drug users in Isfahan requires further investigations.

A Reliable Method for the Evaluation of the Anaphylactoid Reaction Caused by Injectable Drugs

Directory of Open Access Journals (Sweden)

Fang Wang

2016-10-01

Full Text Available Adverse reactions of injectable drugs usually occur at first administration and are closely associated with the dosage and speed of injection. This phenomenon is correlated with the anaphylactoid reaction. However, up to now, study methods based on antigen detection have still not gained wide acceptance and single physiological indicators cannot be utilized to differentiate anaphylactoid reactions from allergic reactions and inflammatory reactions. In this study, a reliable method for the evaluation of anaphylactoid reactions caused by injectable drugs was established by using multiple physiological indicators. We used compound 48/80, ovalbumin and endotoxin as the sensitization agents to induce anaphylactoid, allergic and inflammatory reactions. Different experimental animals (guinea pig and nude rat and different modes of administration (intramuscular, intravenous and intraperitoneal injection and different times (15 min, 30 min and 60 min were evaluated to optimize the study protocol. The results showed that the optimal way to achieve sensitization involved treating guinea pigs with the different agents by intravenous injection for 30 min. Further, seven related humoral factors including 5-HT, SC5b-9, Bb, C4d, IL-6, C3a and histamine were detected by HPLC analysis and ELISA assay to determine their expression level. The results showed that five of them, including 5-HT, SC5b-9, Bb, C4d and IL-6, displayed significant differences between anaphylactoid, allergic and inflammatory reactions, which indicated that their combination could be used to distinguish these three reactions. Then different injectable drugs were used to verify this method and the results showed that the chosen indicators exhibited good correlation with the anaphylactoid reaction which indicated that the established method was both practical and reliable. Our research provides a feasible method for the diagnosis of the serious adverse reactions caused by injectable drugs which

The association between psychosocial and structural-level stressors and HIV injection drug risk behavior among Malaysian fishermen: A cross-sectional study

Directory of Open Access Journals (Sweden)

Lynn Murphy Michalopoulos

2016-06-01

Full Text Available Abstract Background Malaysian fishermen have been identified as a key-affected HIV population with HIV rates 10 times higher than national rates. A number of studies have identified that psychosocial and structural-level stressors increase HIV injection drug risk behaviors. The purpose of this paper is to examine psychosocial and structural-level stressors of injection drug use and HIV injection drug risk behaviors among Malaysian fishermen. Methods The study employs a cross-sectional design using respondent driven sampling methods. The sample includes 406 fishermen from Pahang state, Malaysia. Using multivariate logistic regressions, we examined the relationship between individual (depression, social (adverse interactions with the police, and structural (poverty-related stressors and injection drug use and risky injection drug use (e.g.., receptive and non-receptive needle sharing, frontloading and back-loading, or sharing drugs from a common container. Results Participants below the poverty line had significantly lower odds of injection drug use (OR 0.52, 95 % CI: 0.27-0.99, p = 0.047 and risky injection drug use behavior (OR 0.48, 95 % CI: 0.25-0.93, p = 0.030. In addition, participants with an arrest history had higher odds of injection use (OR 19.58, 95 % CI: 9.81-39.10, p < 0.001 and risky injection drug use (OR 16.25, 95 % CI: 4.73-55.85, p < 0.001. Participants with depression had significantly higher odds of engaging in risky injection drug use behavior (OR 3.26, 95 % 1.39-7.67, p = 0.007. Focusing on participants with a history of injection drug use, we found that participants with depression were significantly more likely to engage in risky drug use compared to participants below the depression cutoff (OR 3.45, 95 % CI: 1.23-9.66, p < 0.02. Conclusions Findings underscore the need to address psychosocial and structural-level stressors among Malaysian fishermen to reduce HIV injection drug risk behaviors.

Women who inject drugs in the republic of georgia: in their own words.

Science.gov (United States)

Kirtadze, Irma; Otiashvili, David; O'Grady, Kevin; Zule, William; Krupitsky, Evgeny; Wechsberg, Wendee; Jones, Hendrée

2015-01-01

This study describes the initiation and maintenance of illicit drug use, risky behaviors, and the substance use treatment experiences of women in Georgia. Qualitative interviews with 55 drug-using women (mean age 36 years; SD = 9.52), were conducted during April-September 2011. Participants presented diverse histories of drug use initiation and substance use, risky behaviors, and drug treatment participation. All participants reported concurrent use of different substances, including home-produced injection preparations. Women described their experiences of both the positive and negative effects (physical and psychological) that they attributed to their use of drugs. Findings enrich our understanding of the environment in which substance use is initiated and maintained in a female population in Georgia, and illustrate the importance of culture and the role of social factors in the development of injection drug use. Results can provide direction for tailoring the development of interventions for substance use disorders, public policy discussions regarding the treatment of women who use drugs, and future research on substance use among women in Georgia and other post-Soviet nations.

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis.

Science.gov (United States)

Guise, Andy; Horyniak, Danielle; Melo, Jason; McNeil, Ryan; Werb, Dan

2017-12-01

Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We reviewed and synthesized existing qualitative scientific literature systematically to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. We searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS and SSCI) systematically, along with a manual search, including key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes throughout studies. From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher-order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity and coping with pain and trauma. Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual

Echocardiographic Findings Suggestive of Infective Endocarditis in Asymptomatic Danish Injection Drug Users Attending Urban Injection Facilities

DEFF Research Database (Denmark)

Axelsson, Anna; Søholm, Helle; Dalsgaard, Morten

2014-01-01

Injection drug users (IDUs) account for a considerable number of the hospitalizations for infective endocarditis (IE), but the prevalence of diagnosed and unrecognized IE in IDUs is unknown. The aim of the present study was to assess the prevalence of valvular abnormalities suggestive of IE in IDUs...

The context of HIV risk behaviours among HIV-positive injection drug users in Viet Nam: Moving toward effective harm reduction

Directory of Open Access Journals (Sweden)

Thanh Duong

2009-04-01

Full Text Available Abstract Background Injection drug users represent the largest proportion of all HIV reported cases in Viet Nam. This study aimed to explore the perceptions of risk and risk behaviours among HIV-positive injection drug users, and their experiences related to safe injection and safe sex practices. Methods This study used multiple qualitative methods in data collection including in-depth interviews, focus group discussions and participant observation with HIV-positive injection drug users. Results The informants described a change in the sharing practices among injection drug users towards more precautions and what was considered 'low risk sharing', like sharing among seroconcordant partners and borrowing rather than lending. However risky practices like re-use of injection equipment and 'syringe pulling' i.e. the use of left-over drugs in particular, were frequently described and observed. Needle and syringe distribution programmes were in place but carrying needles and syringes and particularly drugs could result in being arrested and fined. Fear of rejection and of loss of intimacy made disclosure difficult and was perceived as a major obstacle for condom use among recently diagnosed HIV infected individuals. Conclusion HIV-positive injection drug users continue to practice HIV risk behaviours. The anti-drug law and the police crack-down policy appeared as critical factors hampering ongoing prevention efforts with needle and syringe distribution programmes in Viet Nam. Drastic policy measures are needed to reduce the very high HIV prevalence among injection drug users.

Deportation and mental health among migrants who inject drugs along the US-Mexico border

Science.gov (United States)

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

2016-01-01

Objective This study describes the prevalence and factors of depressive symptoms among a sample of persons who inject drugs (PWID) with a history of deportation from the US in Tijuana, Mexico. In 2014, 132 deported PWID completed a structured questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Short Depression Scale (CESD-10) screening instrument. Eligible participants were ≥18 years old, injected drugs in the past month, spoke English or Spanish, and resided in Tijuana. Multivariate analyses identified factors associated with depressive symptoms. Among deported PWID, 45% reported current symptoms of depression. Deported PWID who were initially detained in the US for a crime-related reason before being deported (Adjusted Odds Ratio (AOR): 5.27; 95% CI: 1.79–15.52) and who perceived needing help with their drug use (AOR: 2.15; 95% 1.01–4.61) had higher odds of reporting depressive symptoms. Our findings highlight the need for effective strategies targeting deported migrants who inject drugs to treat mental health and drug abuse in Tijuana. Investing in the mental health of deported PWID may also be a viable HIV prevention strategy. PMID:27132880

Incident syphilis infection among people who inject drugs in Tijuana, Mexico.

Science.gov (United States)

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. © The Author(s) 2015.

Does size really matter? A sensitivity analysis of number of seeds in a respondent-driven sampling study of gay, bisexual and other men who have sex with men in Vancouver, Canada.

Science.gov (United States)

Lachowsky, Nathan John; Sorge, Justin Tyler; Raymond, Henry Fisher; Cui, Zishan; Sereda, Paul; Rich, Ashleigh; Roth, Eric A; Hogg, Robert S; Moore, David M

2016-11-16

Respondent-driven sampling (RDS) is an increasingly used peer chain-recruitment method to sample "hard-to-reach" populations for whom there are no reliable sampling frames. Implementation success of RDS varies; one potential negative factor being the number of seeds used. We conducted a sensitivity analysis on estimates produced using data from an RDS study of gay, bisexual and other men who have sex with men (GBMSM) aged ≥16 years living in Vancouver, Canada. Participants completed a questionnaire on demographics, sexual behavior and substance use. For analysis, we used increasing seed exclusion criteria, starting with all participants and subsequently removing unproductive seeds, chains of ≤1 recruitment waves, and chains of ≤2 recruitment waves. We calculated estimates for three different outcomes (HIV serostatus, condomless anal intercourse with HIV discordant/unknown status partner, and injecting drugs) using three different RDS weighting procedures: RDS-I, RDS-II, and RDS-SS. We also assessed seed dependence with bottleneck analyses and convergence plots. Statistical differences between RDS estimators were assessed through simulation analysis. Overall, 719 participants were recruited, which included 119 seeds and a maximum of 16 recruitment waves (mean chain length = 1.7). The sample of >0 recruitment waves removed unproductive seeds (n = 50/119, 42.0%), resulting in 69 chains (mean length = 3.0). The sample of >1 recruitment waves removed 125 seeds or recruits (17.4% of overall sample), resulting in 37 chains (mean length = 4.8). The final sample of >2 recruitment waves removed a further 182 seeds or recruits (25.3% of overall sample), resulting in 25 chains (mean length = 6.1). Convergence plots and bottleneck analyses of condomless anal intercourse with HIV discordant/unknown status partner and injecting drugs outcomes were satisfactory. For these two outcomes, regardless of seed exclusion criteria used, the crude proportions

NEGOTIATING PLACE AND GENDERED VIOLENCE IN CANADA’S LARGEST OPEN DRUG SCENE

Science.gov (United States)

McNeil, Ryan; Shannon, Kate; Shaver, Laura; Kerr, Thomas; Small, Will

2014-01-01

Background Vancouver’s Downtown Eastside is home to Canada’s largest street-based drug scene and only supervised injection facility (Insite). High levels of violence among men and women have been documented in this neighbourhood. This study was undertaken to explore the role of violence in shaping the socio-spatial relations of women and ‘marginal men’ (i.e., those occupying subordinate positions within the drug scene) in the Downtown Eastside, including access to Insite. Methods Semi-structured qualitative interviews were conducted with 23 people who inject drugs (PWID) recruited through the Vancouver Area Network of Drug Users, a local drug user organization. Interviews included a mapping exercise. Interview transcripts and maps were analyzed thematically, with an emphasis on how gendered violence shaped participants’ spatial practices. Results Hegemonic forms of masculinity operating within the Downtown Eastside framed the everyday violence experienced by women and marginal men. This violence shaped the spatial practices of women and marginal men, in that they avoided drug scene milieus where they had experienced violence or that they perceived to be dangerous. Some men linked their spatial restrictions to the perceived 'dope quality' of neighbourhood drug dealers to maintain claims to dominant masculinities while enacting spatial strategies to promote safety. Environmental supports provided by health and social care agencies were critical in enabling women and marginal men to negotiate place and survival within the context of drug scene violence. Access to Insite did not motivate participants to enter into “dangerous” drug scene milieus but they did venture into these areas if necessary to obtain drugs or generate income. Conclusion Gendered violence is critical in restricting the geographies of men and marginal men within the street-based drug scene. There is a need to scale up existing environmental interventions, including supervised injection

Is Climate influencing Cryptococcus gattii on Vancouver Island?

Centers for Disease Control (CDC) Podcasts

2016-03-24

Dr. Christopher Uejio, Department of Geography and Program in Public Health, Florida State University, discusses Cryptococcus gattii on Vancouver Island.  Created: 3/24/2016 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 3/24/2016.

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

Science.gov (United States)

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. Copyright © 2013 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Injectable nanocomposite cryogels for versatile protein drug delivery.

Science.gov (United States)

Koshy, Sandeep T; Zhang, David K Y; Grolman, Joshua M; Stafford, Alexander G; Mooney, David J

2018-01-01

Sustained, localized protein delivery can enhance the safety and activity of protein drugs in diverse disease settings. While hydrogel systems are widely studied as vehicles for protein delivery, they often suffer from rapid release of encapsulated cargo, leading to a narrow duration of therapy, and protein cargo can be denatured by incompatibility with the hydrogel crosslinking chemistry. In this work, we describe injectable nanocomposite hydrogels that are capable of sustained, bioactive, release of a variety of encapsulated proteins. Injectable and porous cryogels were formed by bio-orthogonal crosslinking of alginate using tetrazine-norbornene coupling. To provide sustained release from these hydrogels, protein cargo was pre-adsorbed to charged Laponite nanoparticles that were incorporated within the walls of the cryogels. The presence of Laponite particles substantially hindered the release of a number of proteins that otherwise showed burst release from these hydrogels. By modifying the Laponite content within the hydrogels, the kinetics of protein release could be precisely tuned. This versatile strategy to control protein release simplifies the design of hydrogel drug delivery systems. Here we present an injectable nanocomposite hydrogel for simple and versatile controlled release of therapeutic proteins. Protein release from hydrogels often requires first entrapping the protein in particles and embedding these particles within the hydrogel to allow controlled protein release. This pre-encapsulation process can be cumbersome, can damage the protein's activity, and must be optimized for each protein of interest. The strategy presented in this work simply premixes the protein with charged nanoparticles that bind strongly with the protein. These protein-laden particles are then placed within a hydrogel and slowly release the protein into the surrounding environment. Using this method, tunable release from an injectable hydrogel can be achieved for a variety of

Command and Control Analysis of the South West Provincial Regional Emergency Operations Centre during Vancouver 2010

Science.gov (United States)

2011-06-01

Venue Site WACC - Whistler Area Command Centre OTHER GPPAG - Government Partners Public Affairs Group 18 ANNEX B. Interview questions...Vancouver Vancouver Richmond WACC Decision Authority Link Information Sharing Link DOC’s 2010 Provincial Games Secretariat GPPAG CCG

Insite: Canada's landmark safe injecting program at risk

Directory of Open Access Journals (Sweden)

Drucker Ernest

2006-08-01

Full Text Available Abstract InSite is North Americas first supervised injection site and a landmark public heath initiative operating in Vancouver since 2003. The program is a vital component of that cities internationally recognized harm reduction approach to its serious problems with drugs, crime, homelessness and AIDS. InSite currently operates under a waiver of Federal rules that allow it to provide services as a research project. An extensive evaluation has produced very positive results for thousands of users. Normally such strong evidence documenting the successes of such a program, and the medical and public health significance of these positive outcomes, would be the basis for celebration and moves to expand the model and provide similar services elsewhere in Canada. Instead, there is a distinct possibility that InSite will be closed by the newly elected Canadian Prime Minister Paul Harper – a conservative who has traveled to the US to visit George WQ Bush and come back antagonistic to harm reduction in all its forms. Because InSites federal waiver is expiring and up for renewal in September, the fear is that Mr. Harpers will not renew the approval and that the program will be forced to close down. The risks associated with the potential closure of InSite need to be fully understood. This editorial lays out these public health risks and the associated economic impact if InSite were to be closed. In addition to preventable deaths and disease, InSites closure will cost Vancouver and British Columbia between $3.8 and $ 8.8 million in preventable health care expenses over the next two years.

Increasing availability of illicit drugs among people who inject drugs in Bangkok, Thailand.

Science.gov (United States)

Hayashi, Kanna; Nosyk, Bohdan; Ti, Lianping; Suwannawong, Paisan; Kaplan, Karyn; Wood, Evan; Kerr, Thomas

2013-09-01

In recent years, the Thai government has strengthened drug law enforcement as a strategy to address a continuing epidemic of illicit drug use. We sought to assess temporal trends in street-level availability of illicit drugs among injection drug users (IDUs) in Bangkok, Thailand. Using univariate statistics and multivariate logistic regression, we assessed changes in the availability of five substances (heroin, methamphetamine, crystal methamphetamine, midazolam, and illicit methadone) between 2009 and 2011 and examined social, structural and individual factors influencing availability among community-recruited samples of IDUs in Bangkok. Availability was measured in three levels: immediate (available in ≤10 min); moderate (available in 10-90 min); and delayed (available in >90 min; our reference category). The analyses included 718 IDUs, including 165 (23.0%) women. Controlling for changes in participant characteristics between assessments, and in a period of constant nominal illicit drug prices, moderate availability of all substances increased significantly between 2009 and 2011, with adjusted odds ratios ranging between 2.36 (illicit methadone) and 4.61 (crystal methamphetamine) (all pdrug suppression efforts, the availability of illicit drugs among IDUs in Bangkok increased significantly between 2009 and 2011. The findings raise concern about the overreliance on drug law enforcement-based approaches and point to the need for greater investment in evidence-based drug policies. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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

LENUS (Irish Health Repository)

Giese, Coralie

2015-10-08

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.

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

Science.gov (United States)

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.

Spread of Rare Fungus from Vancouver Island

Centers for Disease Control (CDC) Podcasts

2006-12-20

Cryptococcus gattii, a rare fungus normally found in the tropics, has infected people and animals on Vancouver Island, Canada. Dr. David Warnock, Director, Division of Foodborne, Bacterial, and Mycotic Diseases, CDC, discusses public health concerns about further spread of this organism.  Created: 12/20/2006 by Emerging Infectious Diseases.   Date Released: 12/29/2006.

Short-term cessation of sex work and injection drug use: evidence from a recurrent event survival analysis.

Science.gov (United States)

Gaines, Tommi L; Urada, Lianne A; Martinez, Gustavo; Goldenberg, Shira M; Rangel, Gudelia; Reed, Elizabeth; Patterson, Thomas L; Strathdee, Steffanie A

2015-06-01

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. 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. 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. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

Incarceration experiences among a community-recruited sample of injection drug users in Bangkok, Thailand

Directory of Open Access Journals (Sweden)

Lai Calvin

2009-12-01

Full Text Available Abstract Background Since 2003 Thailand has waged an aggressive "war on drugs" campaign focused on arresting and incarcerating suspected drug users and dealers. However, little is known about incarceration experiences among IDU in the wake of the recent war on drugs. Therefore, we sought to examine incarceration experiences among IDU in Bangkok, Thailand. Methods We examined the prevalence of incarceration among community-recruited IDU participating in the Mitsampan Community Research Project. Multivariate logistic regression was used to identify factors associated with a self-reported history of incarceration. We also examined the prevalence of injection drug use and syringe sharing within prisons. Results 252 IDU were recruited in August 2008; 66 (26.2% were female and the median age was 36.5 years. In total, 197 (78.2% participants reported a history of incarceration. In multivariate analyses, reporting a history of incarceration was associated with a history of compulsory drug treatment (adjusted odds ratio [AOR] = 4.93; 95% confidence interval [CI]: 1.95 - 12.48, non-fatal overdose (AOR = 3.69; 95%CI: 1.45 - 9.39, syringe sharing (AOR = 2.20; 95%CI: 1.12 - 4.32, and female gender (AOR = 0.41; 95%CI: 0.20 - 0.82. Among those who reported a history of incarceration, 59 (29.9% reported injection drug use in prison, and 48 (81.4% of these individuals reported sharing syringes in prison. Incarceration was not associated with the number of injections performed in the previous week (p = 0.202. Conclusion Over three-quarters of the IDU participating in this study reported a history of incarceration, and 30% of these individuals reported injection drug use within prison. Further, an alarmingly high level of syringe sharing within prison was reported, and incarceration was not associated with reductions in drug use. These findings provide further evidence of the need for community diversion strategies, as well as harm reduction programs, in Thai

Hard to Stomach: Food Insecurity and Inequitable Access to Nutritious Food in Vancouver

OpenAIRE

Moe, Jennifer Lauren

2014-01-01

Food insecurity is a problem in Vancouver, BC. Through analysis of the systemic causes and negative correlates of food insecurity, this study examines effective ways to mitigate food insecurity in Vancouver by enabling consistent access to sufficient, nutritious food. Assessments of the economics of food insecurity and multi-level governmental positions on the issue provide a theoretical and practical basis for the research. A literature review and four in-depth stakeholder interviews identif...

Update on the Vancouver Fuel Cell Vehicle Program

International Nuclear Information System (INIS)

Rothwell, B.

2004-01-01

'Full text:' The Vancouver Fuel Cell Vehicle Program (VFCVP) is a $5.8 million initiative designed to test four Ford Focus Fuel Cell Vehicles for three years in the Lower Mainland of British Columbia. The project is the first of its kind in Canada and is led by Fuel Cells Canada (FCC), the Ford Motor Company (Ford), and the Governments of Canada and British Columbia. This presentation will provide program details and an update on activities leading up to currently planned delivery to Vancouver in November 2004. The VFCVP will test the performance, durability and reliability of the Ford fuel cell vehicle cars in real-world conditions and will examine fuelling issues and solutions, the reduction of greenhouse gas emissions and public acceptance of hydrogen fuel cell vehicles. The program will generate data to help evolve the technology and develop international codes and standards E cents Epnd the implementation and adoption of fuel cell technology. (author)

Pregnancy and Sexual Health among Homeless Young Injection Drug Users

Science.gov (United States)

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…

Sexual and injection-related risks in Puerto Rican-born injection drug users living in New York City: A mixed-methods analysis

Directory of Open Access Journals (Sweden)

Gelpí-Acosta Camila

2011-10-01

Full Text Available Abstract Background These data were collected as part of the National HIV Behavioral Surveillance (NHBS study. NHBS is a cross-sectional study to investigate HIV behavioral risks among core risk groups in 21 U.S. cities with the highest HIV/AIDS prevalence. This analysis examines data from the NHBS data collection cycle with IDU conducted in New York City in 2009. We explored how the recency of migration from Puerto Rico (PR to New York City (NYC impacts both syringe sharing and unprotected sex among injection drug users (IDU currently living in NYC. Methods We used a mixed-methods approach to examine differences in risk between US-born IDU, PR IDU who migrated to NYC more than three years ago (non-recent migrants, and PR IDU who migrated in the last three years (recent migrants. Respondent-driven sampling (RDS was used to recruit the sample (n = 514. In addition, qualitative individual and group interviews with recent PR migrants (n = 12 and community experts (n = 2 allowed for an in-depth exploration of the IDU migration process and the material and cultural factors behind continued risk behaviors in NYC. Results In multiple logistic regression controlling for confounding factors, recent migrants were significantly more likely to report unprotected sexual intercourse with casual or exchange partners (adjusted odds ratio [AOR]: 2.81; 95% confidence intervals [CI]: 1.37-5.76 and receptive syringe sharing (AOR = 2.44; 95% CI: 1.20-4.97 in the past year, compared to US-born IDU. HIV and HCV seroprevalence were highest among non-recent migrants. Qualitative results showed that risky injection practices are partly based on cultural norms acquired while injecting drugs in Puerto Rico. These same results also illustrate how homelessness influences risky sexual practices. Conclusions Poor material conditions (especially homelessness may be key in triggering risky sexual practices. Cultural norms (ingrained while using drugs in PR around injection drug

Drawing attention to a neglected injecting-related harm: a systematic review of AA amyloidosis among people who inject drugs.

Science.gov (United States)

Harris, Magdalena; Brathwaite, Rachel; Scott, Jenny; Gilchrist, Gail; Ciccarone, Dan; Hope, Vivian; McGowan, Catherine R

2018-04-26

Chronic skin and soft tissue infections (SSTI) among people who inject drugs (PWID) can lead to AA amyloidosis: a serious, yet neglected, multi-organ disease. We aim to synthesize findings on the epidemiology, risk factors, clinical outcomes, screening recommendations and challenges to treatment for AA amyloidosis among PWID. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the following bibliographic databases in July 2017: CINAHL Plus, Embase, Global Health, MEDLINE, PsycEXTRA, PsycINFO and SCOPUS. Studies were included if they investigated AA amyloidosis in PWID. Studies were not restricted to location, study type, year or language of publication. Study heterogeneity precluded meta-analysis; we present a narrative review of the literature. Thirty-seven papers from eight countries met inclusion criteria. A total of 781 PWID are reported on, of whom 177 had AA amyloidosis. Where disease causality is established, it is attributed to chronic inflammation caused by injecting-related SSTIs. Most (88.7%) PWID with AA amyloidosis had SSTIs. The proportion of PWID with AA amyloidosis at post-mortem ranged from 1.6% (Germany) to 22.5% (Serbia). Biopsy studies reported from 5.26% (Portugal) to 50% (Germany) of AA amyloidosis in PWID with suspected or known kidney disease. Following diagnosis, the typical trajectory for PWID with AA amyloidosis was rapid deterioration of renal function requiring haemodialysis. Treatment difficulties, end-stage renal failure and premature death from sepsis were observed. Good outcomes, including reversibility of AA amyloidosis, are attributed to rapid treatment of the underlining inflammation and injecting cessation. Notably, given the population in question, no studies were published in addiction or harm reduction journals; most (92%) appeared in specialist nephrology and medical journals. There is strong evidence of an association between skin

Controlled-release, pegylation, liposomal formulations: new mechanisms in the delivery of injectable drugs.

Science.gov (United States)

Reddy, K R

2000-01-01

To review recent developments in novel injectable drug delivery mechanisms and outline the advantages and disadvantages of each. A MEDLINE (1995-January 2000) search using the terms polyethylene glycol, liposomes, polymers, polylactic acid, and controlled release was conducted. Additional references were identified by scanning bibliographies. All articles were considered for inclusion. Abstracts were included only if they were judged to add critical information not otherwise available in the medical literature. A number of systems that alter the delivery of injectable drugs have been developed in attempts to improve pharmacodynamic and pharmacokinetic properties of therapeutic agents. New drug delivery systems can be produced either through a change in formulation (e.g., continuous-release products, liposomes) or an addition to the drug molecule (e.g., pegylation). Potential advantages of new delivery mechanisms include an increased or prolonged duration of pharmacologic activity, a decrease in adverse effects, and increased patient compliance and quality of life. Injectable continuous-release systems deliver drugs in a controlled, predetermined fashion and are particularly appropriate when it is important to avoid large fluctuations in plasma drug concentrations. Encapsulating a drug within a liposome can produce a prolonged half-life and a shift of distribution toward tissues with increased capillary permeability (e.g., tumors, infected tissue). Pegylation provides a method for modification of therapeutic proteins to minimize many of the limitations (e.g., poor stability, short half-life, immunogenicity) associated with these agents. Pegylation of therapeutic proteins is an established process with new applications. However, not all pegylated proteins are alike, and each requires optimization on a protein-by-protein basis to derive maximum clinical benefit. The language required to describe each pegylated therapeutic protein must be more precise to accurately

Identification and management of physical health problems among an injecting drug using population

OpenAIRE

Patton, Robert

2013-01-01

Injecting drug use is highly prevalent in London and is associated with specific physical health problems. These problems are related to the toxicity of the substances, their mode of consumption and as a consequence of the drug taking lifestyle. Hepatitis B and C viral infections are common among drug users due to sharing of both needles and other drug taking paraphernalia. Hepatitis B infection can be prevented by immunisation. Hepatitis C infection can interact with alcohol consumption to a...

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

Science.gov (United States)

Pinedo, Miguel; Burgos, Jose Luis; Zuniga, Maria Luisa; Perez, Ramona; Macera, Caroline A; Ojeda, Victoria D

2015-09-01

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. 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). 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. 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.

A pH-Sensitive Injectable Nanoparticle Composite Hydrogel for Anticancer Drug Delivery

Directory of Open Access Journals (Sweden)

Yuanfeng Ye

2016-01-01

Full Text Available According to previous reports, low pH-triggered nanoparticles were considered to be excellent carriers for anticancer drug delivery, for the reason that they could trigger encapsulated drug release at mild acid environment of tumor. Herein, an acid-sensitive β-cyclodextrin derivative, namely, acetalated-β-cyclodextrin (Ac-β-CD, was synthesized by acetonation and fabricated to nanoparticles through single oil-in-water (o/w emulsion technique. At the same time, camptothecin (CPT, a hydrophobic anticancer drug, was encapsulated into Ac-β-CD nanoparticles in the process of nanoparticle fabrication. Formed nanoparticles exhibited nearly spherical structure with diameter of 209±40 nm. The drug release behavior of nanoparticles displayed pH dependent changes due to hydrolysis of Ac-β-CD. In order to overcome the disadvantages of nanoparticle and broaden its application, injectable hydrogels with Ac-β-CD nanoparticles were designed and prepared by simple mixture of nanoparticles solution and graphene oxide (GO solution in this work. The injectable property was confirmed by short gelation time and good mobility of two precursors. Hydrogels were characterized by dynamic mechanical test and SEM, which also reflected some structural features. Moreover, all hydrogels underwent a reversible sol-gel transition in alkaline environment. Finally, the results of in vitro drug release profile indicated that hydrogel could control drug release or bind drug inside depending on the pH value of released medium.

The dynamics of injection drug users' personal networks and HIV risk behaviors.

Science.gov (United States)

Costenbader, Elizabeth C; Astone, Nan M; Latkin, Carl A

2006-07-01

While studies of the social networks of injection drug users (IDUs) have provided insight into how the structures of interpersonal relationships among IDUs affect HIV risk behaviors, the majority of these studies have been cross-sectional. The present study examined the dynamics of IDUs' social networks and HIV risk behaviors over time. Using data from a longitudinal HIV-intervention study conducted in Baltimore, MD, this study assessed changes in the composition of the personal networks of 409 IDUs. We used a multi-nomial logistic regression analysis to assess the association between changes in network composition and simultaneous changes in levels of injection HIV risk behaviors. Using the regression parameters generated by the multi-nomial model, we estimated the predicted probability of being in each of four HIV risk behavior change groups. Compared to the base case, individuals who reported an entirely new set of drug-using network contacts at follow-up were more than three times as likely to be in the increasing risk group. In contrast, reporting all new non-drug-using contacts at follow-up increased the likelihood of being in the stable low-risk group by almost 50% and decreased the probability of being in the consistently high-risk group by more than 70%. The findings from this study show that, over and above IDUs' baseline characteristics, changes in their personal networks are associated with changes in individuals' risky injection behaviors. They also suggest that interventions aimed at reducing HIV risk among IDUs might benefit from increasing IDUs' social contacts with individuals who are not drug users.

Vitamin A levels and human immunodeficiency virus load in injection drug users.

Science.gov (United States)

Semba, R D; Farzadegan, H; Vlahov, D

1997-01-01

Although low plasma vitamin A levels are associated with increased mortality and higher vertical transmission during human immunodeficiency virus (HIV) infection, it is unknown whether plasma low vitamin A levels are a marker for circulating HIV load. We conducted a cross-sectional study within a prospective cohort study of injection drug users in order to evaluate the relationship between plasma vitamin A levels and HIV viral load. Plasma vitamin A level was measured by high-performance liquid chromatography. Infectious viral load was measured by quantitative microculture of serial fivefold dilutions of 10(6) peripheral blood mononuclear cells. A total of 284 HIV-infected adults (79 women, 205 men) were studied. Plasma vitamin A levels consistent with deficiency were found in 28.9% of adults. A total of 38.0% of women and 25.3% of men had vitamin A deficiency (P < 0.04). The median infectious viral load for the entire study population was 8 infectious units per million cells. No significant relationship between plasma vitamin A levels and infectious viral load was observed in these injection drug users. This study suggests that there is no correlation between HIV viral load and plasma vitamin A levels in injection drug users, and these variables may represent independent risk factors during HIV infection. HIV-infected adult women appear to be at higher risk of developing vitamin A deficiency. PMID:9008289

Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs

Science.gov (United States)

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

Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs

Directory of Open Access Journals (Sweden)

Elizabeth Buckingham

2013-01-01

Full Text Available 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.

Coffee shops and clinics: the give and take of doing HIV/AIDS research with injecting drug users.

Science.gov (United States)

Marsh, A; Loxley, W

1992-06-01

We discuss recruiting and interviewing injecting drug users and using research as health promotion in the context of collecting information related to human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) from a convenience sample of 200 injecting drug users, half in treatment and half not, in 1989 and 1990 in Perth, Western Australia. A variety of recruiting methods were used including advertising, referral by agency staff, 'snowballing' and approaches to personal contacts and others known to inject by the interviewer. Snowballing and personal contacts were the most successful means of recruiting those not in treatment, while advertising was comparatively unsuccessful with this group because of the importance of establishing the credibility of the study and the interviewer among injecting drug users before they will volunteer to be involved. The promotion of behavioural risk reduction among respondents during the interview is detailed. We argue that the traditionally rigid separation between research and intervention is inappropriate in the HIV/AIDS context. When lives are potentially at stake, any contact with injecting drug users, especially those not in treatment (where may receive HIV/AIDS education), must be used as an HIV/AIDS prevention opportunity, and the interview is an ideal opportunity. The employment of research as community intervention is also discussed.

Patterns of drug treatment entry by Latino male injection drug users from different national/geographical backgrounds.

Science.gov (United States)

Reynoso-Vallejo, Humberto; Chassler, Deborah; Witas, Julie; Lundgren, Lena M

2008-02-01

This study examined patterns of treatment entry by Puerto Rican, Central American, Dominican, and other Latino male injection drug users (IDUs) in the state of Massachusetts over the time period 1996-2002. Specifically, it explored whether these populations had different patterns relative to three paths: entry into detoxification only, entry into residential treatment, or entry into methadone maintenance. Using a state-level MIS dataset on all substance abuse treatment entries to all licensed treatment programs, bi-variate and logistic regression methods were employed to examine patterns of drug treatment utilization among Latino men residing in Massachusetts. Three logistic regression models, which controlled for age, education, homelessness, employment, history of mental health treatment, health insurance, criminal justice involvement, having injected drugs in the past month, and number of treatment entries, indicated that Puerto Rican men were significantly less likely to only use detoxification services and residential treatment services, and significantly more likely to enter methadone maintenance compared to Latino men from Central American, Dominican, or other Latino backgrounds. For example, Central American men were 2.4 times more likely to enter only detoxification programs and 54% less likely to enter methadone maintenance programs than Puerto Rican male IDUs. For program planning, include the need to (a) develop varied drug treatment services to meet the needs of non-homogenous Latino groups within the population, (b) tailor outreach efforts to effectively reach all Latino groups, and (c) increase awareness among practitioners of differential patterns of treatment utilization.

Will "Combined Prevention" Eliminate Racial/Ethnic Disparities in HIV Infection among Persons Who Inject Drugs in New York City?

Directory of Open Access Journals (Sweden)

Don Des Jarlais

Full Text Available 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.

Acquired A amyloidosis from injection drug use presenting with atraumatic splenic rupture in a hospitalized patient: a case report

Directory of Open Access Journals (Sweden)

Hanks Douglas K

2011-01-01

Full Text Available Abstract Introduction Little is known about splenic rupture in patients who develop systemic acquired A amyloidosis. This is the first report of a case of atraumatic splenic rupture in a patient with acquired A amyloidosis from chronic injection drug use. Case presentation A 58-year-old Caucasian man with a long history of injection drug use, hospitalized for infective endocarditis, experienced atraumatic splenic rupture and underwent splenectomy. Histopathological and microbiological analyses of the splenic tissue were consistent with systemic acquired A amyloidosis, most likely from injection drug use, that led to splenic rupture without any recognized trauma or evidence of bacterial embolization to the spleen. Conclusion In patients with chronic inflammatory conditions, including the use of injection drugs, who experience acute onset of left upper quadrant pain, the diagnosis of atraumatic splenic rupture must be considered.

Peptide Drug Release Behavior from Biodegradable Temperature-Responsive Injectable Hydrogels Exhibiting Irreversible Gelation

Directory of Open Access Journals (Sweden)

Kazuyuki Takata

2017-10-01

Full Text Available We investigated the release behavior of glucagon-like peptide-1 (GLP-1 from a biodegradable injectable polymer (IP hydrogel. This hydrogel shows temperature-responsive irreversible gelation due to the covalent bond formation through a thiol-ene reaction. In vitro sustained release of GLP-1 from an irreversible IP formulation (F(P1/D+PA40 was observed compared with a reversible (physical gelation IP formulation (F(P1. Moreover, pharmaceutically active levels of GLP-1 were maintained in blood after subcutaneous injection of the irreversible IP formulation into rats. This system should be useful for the minimally invasive sustained drug release of peptide drugs and other water-soluble bioactive reagents.

Examining the Spatial Distribution of Law Enforcement Encounters among People Who Inject Drugs after Implementation of Mexico’s Drug Policy Reform

OpenAIRE

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

2014-01-01

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) ...

Gallium-67 detection of intramammary injection sites secondary to intravenous drug abuse

International Nuclear Information System (INIS)

Swayne, L.C.

1989-01-01

A case of gallium localization within the breast occurred secondary to intravenous drug abuse. In the appropriate clinical setting, prior self-administered injections should be considered as a cause of Ga-67 accumulation at unusual sites

Willingness to pay for methadone maintenance treatment in Vietnamese epicentres of injection-drug-driven HIV infection.

Science.gov (United States)

Tran, Bach Xuan

2013-07-01

Willingness to pay for methadone maintenance treatment (MMT) in three Vietnamese epicentres of injection-drug-driven human immunodeficiency virus (HIV) infection was assessed. A convenience sample of 1016 patients receiving HIV treatment in seven clinics was enrolled during 2012. Contingent valuation was used to assess willingness to pay. Interviewers reviewed adverse consequences of injection drug use and the benefits of MMT. Interviewers then described the government's plan to scale up MMT and the financial barriers to scale-up. Willingness to pay was assessed using double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay. A total of 548 non-drug-users and 468 injection drug users were enrolled; 988 were willing to pay for MMT. Monthly mean willingness to pay among non-drug-users, 347 drug users not receiving MMT and 121 drug users receiving MMT was 10.7 United States dollars [US$] (35.7% of treatment costs), US$ 21.1 (70.3%) and US$ 26.2 (87.3%), respectively (mean: US$ 15.9; 95% confidence interval, CI: 13.6-18.1). Fifty per cent of drug users were willing to pay 50% of MMT costs. Residence in households with low monthly per capita income and poor health status predicted willingness to pay less among drug users; educational level, employment status, health status and current antiretroviral therapy receipt predicted willingness to pay less among non-drug-users. Willingness to pay for MMT was very high, supporting implementation of a co-payment programme.

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

Science.gov (United States)

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%). Copyright © 2011 Elsevier Ltd. All rights reserved.

Mobility of Scottish injecting drug users and risk of HIV infection.

Science.gov (United States)

Goldberg, D J; Frischer, M; Taylor, A; Green, S T; McKeganey, N; Bloor, M; Reid, D; Cossar, J

1994-08-01

Nine hundred and nineteen injecting drug users (IDUs) were interviewed in Glasgow, Scotland during 1990 and 1991, as part of a wider study of HIV risk behaviour, about their injecting and sexual behaviour outside the city in the previous two years. Forty-five percent of respondents injected outside Glasgow, 6% shared needles and syringes (n/s) and 20% had sexual intercourse. Much activity occurred outside Scotland but mainly within the UK, particularly London. Predictors of n/s sharing outside Glasgow during the previous two years included current injecting with and passing on of used n/s and sexual intercourse with casual partners. Predictors of sexual behaviour outside Glasgow included passing on used n/s, having sexual intercourse with casual partners and, for females, engaging in prostitution. Glasgow IDUs are a highly mobile group and although HIV prevalence remains low within this population, considerable potential for importation/exportation of HIV and other bloodborne and sexually transmitted infections exists. Further work is required to establish why IDUs travel to, and engage in high-risk activities in locations outside their home environment, and detailed data about activities such as frequency of condom usage and n/s cleaning practices need to obtained. While there is a widespread network of services for IDUs in the UK, information provided usually relates to local services and may not fully address the needs of this mobile population. Therefore, we recommend that IDUs be provided with details of facilities such as n/s exchange schemes and drug-treatment establishments in centres to where they most commonly travel.

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

Science.gov (United States)

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. Copyright © 2016 Elsevier B.V. All rights reserved.

High dead-space syringe use among people who inject drugs in Tijuana, Mexico.

Science.gov (United States)

Rafful, Claudia; Zule, William; González-Zúñiga, Patricia E; Werb, Dan; Medina-Mora, María Elena; Magis-Rodriguez, Carlos; Strathdee, Steffanie A

2015-05-01

High dead-space syringes (HDSS) are believed to confer an elevated risk of acquiring HIV and other blood-borne infections. 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. Beginning in 2011, IDU who reported being 18 years or older and 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. 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). 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.

Sex work, injection drug use, and abscesses: Associations in women, but not men.

Science.gov (United States)

Wurcel, Alysse G; Burke, Deirdre; Skeer, Margie; Landy, David; Heimer, Robert; Wong, John B; Chui, Kenneth K H; Stopka, Thomas J

2018-04-01

Abscesses commonly occur among people who inject drugs (PWID). However, whether the risks are comparable between males and females, and the impact of sex work on abscess risk is unclear. The goal of this study was to examine the contemporary associations of gender and sex work with the risk of abscesses in PWID. Combining data from two cross-sectional studies conducted in the Greater Boston Area with people at risk for HIV and hepatitis C virus (HCV), we used the following inclusion criteria: age 18-45 years and report of illicit or non-prescription drug injection within the 30 days prior to the survey. Information on demographics, injection-mediated risks, and sexual behaviors was collected using Audio Computer-Assisted Self-Interview Software. Multivariable logistic regressions were used to model associations. The study sample included 298 people including 30% were female. Females were more likely than men to report sex work (28% vs. 16%, p = .012) and abscess during their lifetime (55% vs. 37% p = .004). Among the females, engaging in sex work increased by >5-fold the odds of reporting abscesses [Adjusted odds ratio 5.42; 95% CI: 1.27, 23.10]. There was no association between sex work and abscesses among men. We found a female-specific association between sex work, injection drug use, and abscesses among PWID. Although the cross-sectional designs precluded causal inferences, longitudinal studies could enhance understanding of gender-associated risks for abscesses and inform the development of harm reduction interventions. Published by Elsevier B.V.

A Cross-Sectional Analysis of Acute Hepatitis B Virus Reported to the Vancouver Coastal Health Authority from 2000 to 2003

Directory of Open Access Journals (Sweden)

Yvette Leung

2006-01-01

Full Text Available BACKGROUND: Acute hepatitis B virus (HBV transmission remains a significant public health problem despite effective vaccination and prophylaxis strategies. Vancouver, British Columbia, has a large ethnic community from endemic areas, which may further impact on the epidemiology of acute HBV. A cross-sectional study of factors associated with acute HBV cases reported to the Vancouver Coastal Health Authority (Vancouver, British Columbia from 2000 to 2003 is reported.

Prevalence and correlates of recent injecting drug use among gay and bisexual men in Australia: Results from the FLUX study.

Science.gov (United States)

Bui, H; Zablotska-Manos, I; Hammoud, M; Jin, F; Lea, T; Bourne, A; Iversen, J; Bath, N; Grierson, J; Degenhardt, L; Prestage, G; Maher, L

2018-05-01

While illicit drug use is prevalent among gay and bisexual men (GBM) in Australia, little is known about the factors associated with injecting drug use among GBM. The Following Lives Undergoing Change (FLUX) study is a national, online prospective observational cohort investigating drug use among Australian GBM. Eligible participants were men living in Australia who were aged 16.5 years or older, identified as gay or bisexual or had sex with at least one man in the last year. We examined baseline data for associations between socio-demographic and behavioural characteristics and recent (last six months) injecting using log-binomial regression. Of 1995 eligible respondents, 206 (10.3%) reported ever injecting drugs and 93 (4.7%) had injected recently, most commonly crystal (91.4%) and speed (9.7%). Among recent injectors, only 16 (17.2%) reported injecting at least weekly; eight (8.6%) reported recent receptive syringe sharing. Self-reported HIV and HCV prevalence was higher among recent injectors than among other participants (HIV: 46.2% vs 5.0%, p drug classes (adjusted prevalence ratio (APR) = 1.31, 95% Confidence Interval (95%CI) 1.21-1.41), longer time since initiating party drug use (APR = 1.02, 95%CI 1.01-1.04), greater numbers of sex partners (2-10 sex partners: APR = 3.44, 95%CI 1.45-8.20; >10 sex partners: APR = 3.21, 95%CI 1.30-7.92), group sex (APR = 1.42, 95%CI 1.05-1.91) and condomless anal intercourse with casual partners (APR = 1.81, 95%CI 1.34-2.43) in the last six months. Observed associations between injecting and sexual risk reflect a strong relationship between these practices among GBM. The intersectionality between injecting drug use and sex partying indicates a need to integrate harm reduction interventions for GBM who inject drugs into sexual health services and targeted sexual health interventions into Needle and Syringe Programs. Copyright © 2018 Elsevier B.V. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Rich Josiah D

2003-11-01

Full Text Available Abstract 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.

Rhodotorula Endogenous Endophthalmitis: A Novel Harbinger of the Injection Drug Epidemic in the United States

Directory of Open Access Journals (Sweden)

Preston M. Luong

2017-01-01

Full Text Available Endogenous endophthalmitis is a rare but feared infectious ocular complication of injection drug use (IDU. The recent opioid epidemic in the United States threatens to increase the incidence of this disease. We report the first case of endogenous endophthalmitis in the United States caused by the emerging fungal pathogen Rhodotorula in an injection drug user which led to no light perception vision (NLP. Worldwide experience with Rhodotorula endogenous endophthalmitis is limited, but existing cases suggest infection by this particular fungal genus has a grim prognosis.

75 FR 20268 - Implantation or Injectable Dosage Form New Animal Drugs; Change of Sponsor; Propofol

Science.gov (United States)

2010-04-19

... 21 CFR Part 522 Animal drugs. Therefore, under the Federal Food, Drug, and Cosmetic Act and under... use in dogs and cats--(1) Amount. The drug is administered by intravenous injection as follows: (i) Dogs. For induction of general anesthesia without the use of preanesthetics the dosage is 5.5 to 7.0 mg...

Estimating incidence of problem drug use using the Horwitz-Thompson estimator - A new approach applied to people who inject drugs in Oslo 1985-2008.

Science.gov (United States)

Amundsen, Ellen J; Bretteville-Jensen, Anne L; Kraus, Ludwig

2016-01-01

The trend in the number of new problem drug users per year (incidence) is the most important measure for studying the diffusion of problem drug use. Due to sparse data sources and complicated statistical models, estimation of incidence of problem drug use is challenging. The aim of this study is to widen the palette of available methods and data types for estimating incidence of problem drug use over time, and for identifying the trends. This study presents a new method of incidence estimation, applied to people who inject drugs (PWID) in Oslo. The method took into account the transition between different phases of drug use progression - active use, temporary cessation, and permanent cessation. The Horwitz-Thompson estimator was applied. Data included 16 cross-sectional samples of problem drug users who reported their onset of injecting drug use. We explored variation in results for selected probable scenarios of parameter variation for disease progression, as well as the stability of the results based on fewer years of cross-sectional samples. The method yielded incidence estimates of problem drug use, over time. When applied to people in Oslo who inject drugs, we found a significant reduction of incidence of 63% from 1985 to 2008. This downward trend was also present when the estimates were based on fewer surveys (five) and in the results of sensitivity analysis for likely scenarios of disease progression. This new method, which incorporates temporarily inactive problem drug users, may become a useful tool for estimating the incidence of problem drug use over time. The method may be less data intensive than other methods based on first entry to treatment and may be generalized to other groups of substance users. Further studies on drug use progression would improve the validity of the results. Copyright © 2015 Elsevier B.V. All rights reserved.

Violence, trauma and living with HIV: Longitudinal predictors of initiating crystal methamphetamine injection among sex workers.

Science.gov (United States)

Argento, Elena; Strathdee, Steffanie A; Goldenberg, Shira; Braschel, Melissa; Montaner, Julio; Shannon, Kate

2017-06-01

Despite rapid increases in crystal methamphetamine (CM) use worldwide and established gendered patterns of use, empirical research on CM injection initiation among sex workers is limited. Given the wide range of harms associated with CM, alongside stimulant effects including sexual dis-inhibition and prolonged awake-ness, this study aimed to longitudinally investigate socio-structural predictors of initiating CM injection among sex workers in Vancouver, Canada. Data (2010-2014) were drawn from a community-based cohort of women sex workers: AESHA (An Evaluation of Sex Workers Health Access). Participants completed bi-annual interviewer-administered questionnaires and HIV/STI testing. Kaplan Meier methods and Cox proportional hazards regression were used to model predictors of CM injection initiation among CM injection-naïve participants. Of 455 participants eligible at baseline, 14.3% (n=65) injected CM for the first time over follow-up, with an incidence density of 6.79 per 100 person-years (95% Confidence Interval [CI] 5.30-8.69). In multivariable analysis, injection heroin use (Adjusted Hazard Ratio [AHR] 6.11; 95%CI 3.24-11.52), having an intimate partner who injects drugs (AHR 2.93; 95%CI 1.57-5.46), workplace violence (AHR 2.85; 95%CI 1.74-4.67), HIV seropositivity (AHR 2.69; 95%CI 1.45-5.00), and childhood abuse (AHR 1.86; 95%CI 0.99-3.49) were independently associated with initiating CM injection. Findings underscore the gendered and social risk environment of CM injection initiation among sex workers. The strong influences of historical/workplace violence, coupled with heroin injection (known to be self-medicating for post-traumatic stress) as a primary risk pathway, emphasize the urgency of increasing access to integrated, trauma-informed addiction treatment and HIV care for marginalized women. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Science.gov (United States)

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

2012-01-01

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. 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. 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). 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. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Roman Yorick

2012-01-01

Full Text Available 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.

The association between psychosocial and structural-level stressors and HIV injection drug risk behavior among Malaysian fishermen: A cross-sectional study

OpenAIRE

Michalopoulos, Lynn Murphy; Jiwatram-Negr?n, Tina; Choo, Martin K. K.; Kamarulzaman, Adeeba; El-Bassel, Nabila

2016-01-01

Background Malaysian fishermen have been identified as a key-affected HIV population with HIV rates 10 times higher than national rates. A number of studies have identified that psychosocial and structural-level stressors increase HIV injection drug risk behaviors. The purpose of this paper is to examine psychosocial and structural-level stressors of injection drug use and HIV injection drug risk behaviors among Malaysian fishermen. Methods The study employs a cross-sectional design using res...

Risk factors for hepatitis C seropositivity among young people who inject drugs in New York City: Implications for prevention.

Directory of Open Access Journals (Sweden)

Benjamin Eckhardt

Full Text Available Hepatitis C virus (HCV infection remains a significant problem in the United States, with people who inject drugs (PWID disproportionately afflicted. Over the last decade rates of heroin use have more than doubled, with young persons (18-25 years demonstrating the largest increase.We conducted a cross-sectional study in New York City from 2005 to 2012 among young people who injected illicit drugs, and were age 18 to 35 or had injected drugs for ≤5 years, to examine potentially modifiable factors associated with HCV among young adults who began injecting during the era of syringe services.Among 714 participants, the median age was 24 years; the median duration of drug injection was 5 years; 31% were women; 75% identified as white; 69% reported being homeless; and 48% [95% CI 44-52] had HCV antibodies. Factors associated with HCV included older age (adjusted odds ratio [AOR], 1.99 [1.52-2.63]; p<0.001, longer duration of injection drug use (AOR, 1.68 [1.39-2.02]; p<0.001,more frequent injection (AOR, 1.26 [1.09-1.45]; p = 0.001, using a used syringe with more individuals (AOR, 1.26 [1.10-1.46]; p = 0.001, less confidence in remaining uninfected (AOR, 1.32 [1.07-1.63]; p<0.001, injecting primarily in public or outdoors spaces (AOR, 1.90 [1.33-2.72]; p<0.001, and arrest for carrying syringes (AOR, 3.17 [1.95-5.17]; p<0.001.Despite the availability of harm reduction services, the seroprevalence of HCV in young PWID in New York City remained high and constant during 2005-2012. Age and several injection behaviors conferred independent risk. Individuals were somewhat aware of their own risk. Public and outdoor injection and arrest for possession of a syringe are risk factors for HCV that can be modified through structural interventions.

Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study

DEFF Research Database (Denmark)

Larsen, Mette V; Omland, Lars H; Gerstoft, Jan

2010-01-01

To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era.......To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era....

Forest insect and disease conditions, Vancouver forest region, 1986. Annual publication

Energy Technology Data Exchange (ETDEWEB)

Humphreys, N; Ferris, R L

1987-01-01

This report outlines the status of forest pest conditions in the Vancouver Forest Region, and forecasts population trends of some potentially damaging pests. Pests are listed by host in order of importance.

Drug-related stigma and access to care among people who inject drugs in Vietnam.

Science.gov (United States)

Lan, Chiao-Wen; Lin, Chunqing; Thanh, Duong Cong; Li, Li

2018-03-01

There are considerable challenges faced by people with a history of injecting drug use (PWID) in Vietnam, including drug-related stigma and lack of access to healthcare. Seeking and utilising healthcare, as well as harm reduction programs for PWID, are often hampered by drug-related stigma. This study aimed to examine the impacts of drug-related stigma on access to care and utilisation of harm reduction programs among PWID in Vietnam. A cross-sectional study was conducted in two provinces in Vietnam, Phú Thọ and Vinh Phúc. The study participants completed the survey by using Audio Computer-Assisted Self-Interview between late 2014 and early 2015. Linear multiple regression models and logistic regression models were used to assess the relationship among drug-related stigma, access to care and utilisation of harm reduction programs, including methadone maintenance treatment (MMT) and needle exchange programs (NEP). A total of 900 PWID participated in this study. Drug-related stigma was significantly associated with lower level of access to care, but not with utilisation of MMT or NEP. Older age was positively associated with higher levels of access to care. Levels of education were positively correlated with access to care, as well as utilisation of MMT and NEP. This study underscores the need for future interventions to reduce drug-related stigma in society and in health-care settings to improve PWID's utilisation of care services. Special attention should be paid to younger PWID and those with lower levels of education. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Self-reported injection practices among people who use drugs in French prisons: Public health implications (ANRS-Coquelicot survey 2011-2013).

Science.gov (United States)

Michel, Laurent; Trouiller, Philippe; Chollet, Aude; Molinier, Marie; Duchesne, Lucie; Jauffret-Roustide, Marie

2018-04-01

The aims of this study were to describe the prevalences of injection practices and needle/syringe sharing in people who use drugs in French prisons, and to investigate associated factors. Using the ANRS-Coquelicot survey (2011-2013), a random sample of 1718 people who used drugs in free society was included. Information regarding a history of incarceration, drug-injection practices inside prison and needle/syringe sharing was collected during interviews. In our sample, 65.5% reported a history of injection and 57.4% had been incarcerated at least once. Among those who reported both of these conditions, 14% reported injection practices inside prison, 40.5% of whom had shared needles/syringes. In the multivariable model, the following variables were associated with injection practices inside prison: being a Russian-speaking detainee, having spent more time in prison, and having started to inject before 1996 and especially before 1987. Being Russian speaking was also associated with needle/syringe sharing in prison. The prevalences of injection practices and needle/syringe sharing in prisons are alarmingly high. Effective interventions to prevent the transmission of infectious diseases among people who use drugs in the prison setting are essential. The implementation of international recommendations on the principle of equivalence between prisons and the community is still very limited in most countries, and should be complemented with tailored interventions for the most vulnerable prison populations, especially Russian-speaking detainees. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Injecting drug use in prison: prevalence and implications for needle exchange policy.

Science.gov (United States)

Wright, Nat M J; Tompkins, Charlotte N E; Farragher, Tracey M

2015-01-01

The purpose of this paper is to explore prison drug injecting prevalence, identify any changes in injecting prevalence and practice during imprisonment and explore views on prison needle exchange. An empirical prospective cohort survey conducted between 2006 and 2008. The study involved a random sample of 267 remand and sentenced prisoners from a large male category B prison in England where no prison needle exchange operates. Questionnaires were administered with prisoners on reception and, where possible, at one, three and six months during their sentence. In total, 64 per cent were injecting until admission into prison. The majority intended to stop injecting in prison (93 per cent), almost a quarter due to the lack of needle exchange (23 per cent). Yet when hypothetically asked if they would continue injecting in prison if needle exchange was freely available, a third of participants (33 per cent) believed that they would. Injecting cessation happened on prison entry and appeared to be maintained during the sentence. Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of needle exchange programmes (NEPs) not being provided in the UK prison setting. Practical implications - Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of NEPs not being provided in the UK prison setting. This survey is the first to question specifically regarding the timing of injecting cessation amongst male prisoners and explore alongside intention to inject should needle exchange facilities be provided in prison.

Gender differences in clinical manifestations before AIDS diagnosis among injecting drug users

NARCIS (Netherlands)

Spijkerman, I. J.; Langendam, M. W.; van Ameijden, E. J.; Coutinho, R. A.; van den Hoek, A.

1998-01-01

We compared incidence rates of self-reported HIV-related symptoms and illnesses, verified clinical manifestations and findings on physical examination between female and male injecting drug users (IDU) stratified by HIV serostatus in the Amsterdam cohort study on the natural history of HIV

A Cost Analysis of Hospitalizations for Infections Related to Injection Drug Use at a County Safety-Net Hospital in Miami, Florida

OpenAIRE

Tookes, Hansel; Diaz, Chanelle; Li, Hua; Khalid, Rafi; Doblecki-Lewis, Susanne

2015-01-01

Background Infections related to injection drug use are common. Harm reduction strategies such as syringe exchange programs and skin care clinics aim to prevent these infections in injection drug users (IDUs). Syringe exchange programs are currently prohibited by law in Florida. The goal of this study was to estimate the mortality and cost of injection drug use-related bacterial infections over a 12-month period to the county safety-net hospital in Miami, Florida. Additionally, the prevalence...

Impact of a longitudinal community HIV intervention targeting injecting drug users' stage of change for condom and bleach use.

Science.gov (United States)

Jamner, M S; Wolitski, R J; Corby, N H

1997-01-01

To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation. Repeated cross-sectional sampling with matched intervention and comparison communities. Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution. 3081 injecting drug users who were sexually active and/or shared injection equipment. Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms. Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners. Toward the end of the study, 77% of injection drug users in the intervention area reported being exposed to the intervention. In the intervention area, rates of condom carrying increased from 10 to 27% (p project exposure had higher stage-of-change scores for using condoms with a main partner (p Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.

A Cost Analysis of Hospitalizations for Infections Related to Injection Drug Use at a County Safety-Net Hospital in Miami, Florida.

Directory of Open Access Journals (Sweden)

Hansel Tookes

Full Text Available Infections related to injection drug use are common. Harm reduction strategies such as syringe exchange programs and skin care clinics aim to prevent these infections in injection drug users (IDUs. Syringe exchange programs are currently prohibited by law in Florida. The goal of this study was to estimate the mortality and cost of injection drug use-related bacterial infections over a 12-month period to the county safety-net hospital in Miami, Florida. Additionally, the prevalence of HIV and hepatitis C virus among this cohort of hospitalized IDUs was estimated.IDUs discharged from Jackson Memorial Hospital were identified using the International Classification of Diseases, Ninth Revision, codes for illicit drug abuse and endocarditis, bacteremia or sepsis, osteomyelitis and skin and soft tissue infections (SSTIs. 349 IDUs were identified for chart abstraction and 92% were either uninsured or had publicly funded insurance. SSTIs, the most common infection, were reported in 64% of IDUs. HIV seroprevalence was 17%. Seventeen patients (4.9% died during their hospitalization. The total cost for treatment for injection drug use-related infections to Jackson Memorial Hospital over the 12-month period was $11.4 million.Injection drug use-related bacterial infections represent a significant morbidity for IDUs in Miami-Dade County and a substantial financial cost to the county hospital. Strategies aimed at reducing risk of infections associated with injection drug use could decrease morbidity and the cost associated with these common, yet preventable infections.

Motives for and against injecting drug use among young adults in Amsterdam: qualitative findings and considerations for disease prevention

NARCIS (Netherlands)

Witteveen, Ewald; van Ameijden, Erik J. C.; Schippers, Gerard M.

2006-01-01

To elucidate injection initiation and risky injection practices among young drug users (YDUs) in Amsterdam, this study identifies self-reported motives for injecting and not injecting to inform interventions to be targeted at issues personally relevant for this population. A qualitative study was

Pathways linking drug use and labour market trajectories: the role of catastrophic events.

Science.gov (United States)

Richardson, Lindsey; Small, Will; Kerr, Thomas

2016-01-01

People affected by substance use disorders often experience sub-optimal employment outcomes. The role of drug use in processes that produce and entrench labour market precarity among people who inject drugs (PWID) have not, however, been fully described. We recruited 22 PWID from ongoing prospective cohort studies in Vancouver, Canada, with whom we conducted semi-structured retrospective interviews and then employed a thematic analysis that drew on concepts from life course theory to explore the mechanisms and pathways linking drug use and labour market trajectories. The participants' narratives identified processes corresponding to causation, whereby suboptimal employment outcomes led to harmful drug use; direct selection, where impairment, health complications or drug-seeking activities selected individuals out of employment; and indirect selection, where external factors, such as catastrophic events, marked the initiation or intensification of substance use concurrent with sudden changes in capacities for employment. Catastrophic events linking negative transitions in both drug use and labour market trajectories were of primary importance, demarcating critical initiation and transitional events in individual risk trajectories. These results challenge conventional assumptions about the primacy of drug use in determining employment outcomes among PWID and suggest the importance of multidimensional support to mitigate the initiation, accumulation and entrenchment of labour market and drug-related disadvantage. © 2015 Foundation for the Sociology of Health & Illness.

Tuberculosis report among injection drug users and their partners in Kazakhstan.

Science.gov (United States)

Hermosilla, S; El-Bassel, N; Aifah, A; Terlikbayeva, A; Zhumadilov, Z; Berikkhanova, K; Darisheva, M; Gilbert, L; Schluger, N; Galea, S

2015-05-01

Tuberculosis (TB) is a major threat to global public health. Kazakhstan has the second highest percentage of multidrug-resistant tuberculosis (MDR-TB) cases among incident tuberculosis cases in the world (WHO 2013). A high burden of MDR-TB suggests TB prevention, control, and treatment programs are failing. This study provides an epidemiologic profile of TB among injection drug users (IDUs), a high-risk and chronically underserved population, in Kazakhstan. Cross-sectional study. The authors studied the characteristics and risk environment of IDUs with self-reported previous active TB and their primary sexual partners in Almaty, Kazakhstan. 728 individuals (364 couples) participated in a couple-based study in 2009. 16.75% of participants reported at least one positive TB test (x-ray) in their lifetime. In a multivariable logistic regression adjusting for couple-based sampling, persons with positive TB test were significantly more likely to be older (odds ratio (OR) 7.26, 95% confidence interval (CI): 1.73, 30.43), male (OR 5.53, 95% CI: 2.74, 11.16), have a shorter duration of injection drug use (OR 0.17, 95% CI: 0.04, 0.65), have received high social support from their significant other (OR 2.13, 95% CI: 1.03, 4.40) and more likely (non-significantly) to have been incarcerated (OR 7.03, 95% CI: 0.64, 77.30). Older men with a history of incarceration and recent injection drug use were more likely to have positive TB test in Kazakhstan. Social network support, while potentially positive for many aspects of population health, may increase risk of TB among IDUs in this context. Public health policies that target high-risk populations and their at-risk networks may be necessary to stem the rise of MDR-TB in Central Asia. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

HIV prevalence and sexual risk behaviour among non-injection drug users in Tijuana, Mexico.

Science.gov (United States)

Deiss, Robert G; Lozada, Remedios M; Burgos, Jose Luis; Strathdee, Steffanie A; Gallardo, Manuel; Cuevas, Jazmine; Garfein, Richard S

2012-01-01

Prior studies estimate HIV prevalence of 4% among injection drug users (IDUs), compared with 0.8% in the general population of Tijuana, Mexico. However, data on HIV prevalence and correlates among non-injecting drug users (NIDUs) are sparse. Individuals were recruited through street outreach for HIV testing and behavioural risk assessment interviews to estimate HIV prevalence and identify associated sexual risk behaviours among NIDUs in Tijuana. Descriptive statistics were used to characterise 'low-risk' NIDUs (drug users who were not commercial sex workers or men who have sex with men). Results showed that HIV prevalence was 3.7% among low-risk NIDUs. During the prior six months, 52% of NIDUs reported having >1 casual partner; 35% reported always using condoms with a casual partner; and 13% and 15%, respectively, reported giving or receiving something in exchange for sex. Women were significantly more likely than men to have unprotected sex with an IDU (pTijuana. Broad interventions including HIV testing, condom promotion and sexual risk reduction should be offered to all drug users in Tijuana.

Gender differences among regular injecting drug users in Sydney, Australia, 1996-2003.

Science.gov (United States)

Breen, Courtney; Roxburgh, Amanda; Degenhardt, Louisa

2005-07-01

Previous research has found that female injecting drug users (IDU) are younger and more likely to be involved in risky behaviours such as needle sharing and sex work than male IDU. Aboriginal female drug users, in particular, are over-represented in IDU and prison populations. These factors place female IDU at increased risk of health problems and complicate issues such as homelessness, unemployment and poverty. Although a substantial body of research exists, little trend analysis has been done in Australia and much of the previous literature has focused on treatment populations. Cross-sectional data from 1996 to 2003 from regular IDU in Sydney interviewed as part of Australia's drug monitoring system, the Illicit Drug Reporting System (IDRS) were examined for trends over time. The demographic characteristics, drug use patterns and self-reported risk behaviours of the most recent sample (2003) were analysed for gender differences. Female IDU were younger in all sample years. Female IDU were more likely to identify as Aboriginal or Torres Strait Islander (ATSI) and engage in sex work. There has been a steady increase in these proportions over time. Female IDU were less likely to have a prison history, although there has been an increase among both male and female IDU over time. There were no gender differences in drug use patterns or frequency of drug use. Larger proportions of females report lending needles. Reports of lending and borrowing needles have decreased over time among both male and female IDU. Female IDU may place themselves at greater risk than male IDU by being more likely to share injecting equipment and engage in sex work. Treatment and other measures to reduce harm may need to be targeted specifically at women and, in particular, indigenous women.

Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia

Science.gov (United States)

Burke, Sara E.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Heimer, Robert

2016-01-01

Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services. PMID:26050155

Drug injection into fat tissue with a laser based microjet injector

Science.gov (United States)

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.

Treatment readiness, attitudes toward, and experiences with methadone and buprenorphine maintenance therapy among people who inject drugs in Malaysia.

Science.gov (United States)

Vijay, Aishwarya; Bazazi, Alexander R; Yee, Ilias; Kamarulzaman, Adeeba; Altice, Frederick L

2015-07-01

Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experiences with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (polder age (ppeople who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Attracting new advertisers and retaining old ones: carving a niche in Vancouver's city magazine market

OpenAIRE

McCready, Kathryn Elizabeth

2009-01-01

This report examines city magazine advertising in Vancouver. It explores the types of advertisers that use this medium, their marketing needs, the range of media in Vancouver that attempt to satisfy these needs, and how these local businesses plan and execute their media campaigns. It uses a case study of a city magazine, VLM to explore and analyse the advertising sales process. It provides an overview of the changes in editorial, circulation and advertising strategy that VLM introduced in 20...

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

Directory of Open Access Journals (Sweden)

M Kamal Pasa

Full Text Available 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.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.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.Interventions must take social context into account when scaling up programmes in diverse settings. The social organization of PWID include values that foster needle

Ethical issues in HIV prevention research with people who inject drugs.

Science.gov (United States)

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

2014-04-01

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 of acquiring HIV so as to minimize harm to participants in research. 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. The ethical issues encountered during the life cycle of the trial were cataloged 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. 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. Furthermore, 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. The issues described in this article are necessarily limited to how they manifested themselves within the context of a

The social determinants of emergency department and hospital use by injection drug users in Canada.

Science.gov (United States)

Palepu, A; Strathdee, S A; Hogg, R S; Anis, A H; Rae, S; Cornelisse, P G; Patrick, D M; O'Shaughnessy, M V; Schechter, M T

1999-12-01

The aim of this study was to describe the relationship between sociodemographic characteristics and human immunodeficiency (HIV) status of a cohort of injection drug users (IDUs) on their self-reported health service utilization. Interviewer-administered questionnaire. IDUs who had injected illicit drugs within the previous month were recruited through street outreach. They underwent serology for HIV-1 and questionnaires on demographics, drug using behaviors, housing status, and health service utilization (hospitalization overnight and emergency department visits) in the previous 6 months. Logistic regression analysis was used to identify independent associations with the use of health services. Of 1,103 cohort participants, 65% were male, 63% were white, and 23% were HIV positive. Cocaine was the most frequently injected drug used. Almost half (47%) had used health services in the previous 6 months. The following variables were associated independently with health service utilization (adjusted odds ratio; 95% confidence interval): unstable housing, defined as living primarily in a hotel, boarding room, or transition house or on the street in the past 6 months (1.44; 1.11-1.86); female gender (1.45; 1.11-1.89); HIV-positive status (1.43; 1.06-1.92); injection of cocaine (1.50; 1.12-2.02); and primary care I physician visit in past 6 months (1.91; 1.39-2.64). IDUs with unstable housing were more likely to report emergency department and hospital use, which may be a reflection of their disorganized lifestyle or poorer health status. Further studies are required to assess the effect on the health status and health care use of IDUs of interventions that increase the availability of safe, affordable housing.

75 FR 59610 - Implantation and Injectable Dosage Form New Animal Drugs; Firocoxib

Science.gov (United States)

2010-09-28

...) filed by Merial Ltd. The NADA provides for the veterinary prescription use of firocoxib injectable... Veterinary Medicine (HFV-110), Food and Drug Administration, 7500 Standish Pl., Rockville, MD 20855, 240-276...., Bldg. 500, Duluth, GA 30096-4640 filed NADA 141-313 that provides for veterinary prescription use of...

The Cedar Project: high incidence of HCV infections in a longitudinal study of young Aboriginal people who use drugs in two Canadian cities

Directory of Open Access Journals (Sweden)

Spittal Patricia M

2012-08-01

Full Text Available Abstract Background Factors associated with HCV incidence among young Aboriginal people in Canada are still not well understood. We sought to estimate time to HCV infection and the relative hazard of risk factors associated HCV infection among young Aboriginal people who use injection drugs in two Canadian cities. Methods The Cedar Project is a prospective cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants’ venous blood samples were drawn and tested for HCV antibodies. Analysis was restricted to participants who use used injection drugs at enrolment or any of follow up visit. Cox proportional hazards regression was used to identify independent predictors of time to HCV seroconversion. Results In total, 45 out of 148 participants seroconverted over the study period. Incidence of HCV infection was 26.3 per 100 person-years (95% Confidence Interval [CI]: 16.3, 46.1 among participants who reported using injection drugs for two years or less, 14.4 per 100 person-years (95% CI: 7.7, 28.9 among participants who had been using injection drugs for between two and five years, and 5.1 per 100 person-years (95% CI: 2.6,10.9 among participants who had been using injection drugs for over five years. Independent associations with HCV seroconversion were involvement in sex work in the last six months (Adjusted Hazard Ratio (AHR: 1.59; 95% CI: 1.05, 2.42 compared to no involvement, having been using injection drugs for less than two years (AHR: 4.14; 95% CI: 1.91, 8.94 and for between two and five years (AHR: 2.12; 95%CI: 0.94, 4.77 compared to over five years, daily cocaine injection in the last six months (AHR: 2.47; 95% CI: 1.51, 4.05 compared to less than daily, and sharing intravenous needles in the last six months (AHR: 2.56; 95% CI: 1.47, 4.49 compared to not sharing. Conclusions This study contributes to the limited body of research addressing HCV infection among

The therapeutic workplace to promote treatment engagement and drug abstinence in out-of-treatment injection drug users: a randomized controlled trial.

Science.gov (United States)

Holtyn, August F; Koffarnus, Mikhail N; DeFulio, Anthony; Sigurdsson, Sigurdur O; Strain, Eric C; Schwartz, Robert P; Leoutsakos, Jeannie-Marie S; Silverman, Kenneth

2014-11-01

Determine if employment-based reinforcement can increase methadone treatment engagement and drug abstinence in out-of-treatment injection drug users. This study was conducted from 2008 to 2012 in a therapeutic workplace in Baltimore, MD. After a 4-week induction, participants (N=98) could work and earn pay for 26 weeks and were randomly assigned to Work Reinforcement, Methadone & Work Reinforcement, and Abstinence, Methadone & Work Reinforcement conditions. Work Reinforcement participants had to work to earn pay. Methadone & Work Reinforcement and Abstinence, Methadone, & Work Reinforcement participants had to enroll in methadone treatment to work and maximize pay. Abstinence, Methadone, & Work Reinforcement participants had to provide opiate- and cocaine-negative urine samples to maximize pay. Most participants (92%) enrolled in methadone treatment during induction. Drug abstinence increased as a graded function of the addition of the methadone and abstinence contingencies. Abstinence, Methadone & Work Reinforcement participants provided significantly more urine samples negative for opiates (75% versus 54%) and cocaine (57% versus 32%) than Work Reinforcement participants. Methadone & Work Reinforcement participants provided significantly more cocaine-negative samples than Work Reinforcement participants (55% versus 32%). The therapeutic workplace can promote drug abstinence in out-of-treatment injection drug users. Clinical trial registration number: NCT01416584. Copyright © 2014 Elsevier Inc. All rights reserved.

Contests over social memory in waterfront Vancouver: Historical editing & obfuscation through public art

Directory of Open Access Journals (Sweden)

Gordon Brent Ingram

2000-02-01

Full Text Available Every public art site has a relationship to the history of surrounding areas whether in obscuring social memory or in highlighting certain relationships and events over others. Over the last decade, much of central Vancouver's waterfront, particularly around False Creek (a marine inlet, has been redeveloped with international capital - much of which has been linked to Hong Kong. Several large redevelopment areas have involved close cooperation in urban design processes between `the city' and `the developer'. In these megaprojects, public art has emerged as a more substantial and stable urban amenity while becoming less overtly ideological and associated with democratic public space. In this part of North America, such relatively public art projects have become almost iconographic for economic and social changes associated with globalization. Contentious historical information has tended to be censored - particularly around a range of non-European communities and events over the last century involving social conflict. In the same period, outdoor art has been increasingly used as a part of strategies to reclaim public space and attempts to democratize it. These two kinds and functions of public art have tended to be used for divergent experiences of the relationships of history to the present, of public space and the existence of and responses to social conflict, and of `sense of place'. Six public art sites, with four built, along the north shore of False Creek, in central Vancouver, are analyzed in terms of their cultural, urban and spatial politics and, in particular, in terms of contemporary tensions around the extent of aboriginal presence before and after the arrival of Europeans, the multiracial and multicultural origins and character of the city, contamination with toxic chemicals, violence against women, and the AIDS pandemic. A method for better analyzing the cultural politics of public art sites (and the design processes that were

Getting the message straight: effects of a brief hepatitis prevention intervention among injection drug users.

Science.gov (United States)

Grau, Lauretta E; Green, Traci C; Singer, Merrill; Bluthenthal, Ricky N; Marshall, Patricia A; Heimer, Robert

2009-12-15

To redress gaps in injection drug users' (IDUs) knowledge about hepatitis risk and prevention, we developed a brief intervention to be delivered to IDUs at syringe exchange programs (SEPs) in three US cities. Following a month-long campaign in which intervention packets containing novel injection hygiene supplies and written materials were distributed to every client at each visit, intervention effectiveness was evaluated by comparing exposed and unexposed participants' self-reported injection practices. Over one-quarter of the exposed group began using the novel hygiene supplies which included an absorbent pad ("Safety Square") to stanch blood flow post-injection. Compared to those unexposed to the intervention, a smaller but still substantial number of exposed participants continued to inappropriately use alcohol pads post-injection despite exposure to written messages to the contrary (22.8% vs. 30.0%). It should also be noted that for those exposed to the intervention, 8% may have misused Safety Squares as part of pre-injection preparation of their injection site; attention should be paid to providing explicit and accurate instruction on the use of any health promotion materials being distributed. While this study indicates that passive introduction of risk reduction materials in injection drug users through syringe exchange programs can be an economical and relatively simple method of changing behaviors, discussions with SEP clients regarding explicit instructions about injection hygiene and appropriate use of novel risk reduction materials is also needed in order to optimize the potential for adoption of health promotion behaviors. The study results suggest that SEP staff should provide their clients with brief, frequent verbal reminders about the appropriate use when distributing risk reduction materials. Issues related to format and language of written materials are discussed.

Treatment of emulsified oily wastewater by commercial scale electrocoagulation at Vancouver shipyards

Energy Technology Data Exchange (ETDEWEB)

Stephenson, R.J.; Tennant, B.D. [McKay Creek Technologies Ltd., North Vancouver, BC (Canada); Hartle, D.R. [Vancouver Shipping Co. Ltd., BC (Canada); Stuckert, B. [Quantum Environmental Group, Richmond, BC (Canada)

2002-06-01

Some of the emulsified oily wastewater generated by the Washington Marine Group fleet and the Vancouver shipyards are from sources such as bilge water, tank wash water from gas freeing operations, ballast water, and wastewater from pressure washing equipment. The Washington Marine Group is the largest shipbuilding, ship maintenance and repair, and marine transportation company in Canada, a group to which McKay Creek Technologies belongs. A investigation was performed in an attempt to find commercially viable means of treating this wastewater. McKay Creek Technologies developed its own cleaning process. Electrocoagulation is a process based on the use of an electrical current in an electrochemical cell to coagulate contaminants in wastewater. With three years of experience gained by treating the wastewater of the Washington Marine Group operations at Vancouver shipyards using this technology, McKay Creek Technologies has found ways to treat emulsified oily wastewater simply and effectively. It has been determined that electrocoagulation is an effective treatment method for emulsified oils, poly-nuclear aromatic hydrocarbons (PAHs), poorly settling solids, poorly soluble organics, contaminants which add turbidity to water, and negatively charged metal species like arsenic, molybdenum, and phosphate. A brief history of electrocoagulation was provided, and the authors explained the process and how it was applied to the situation at Vancouver shipyards. 2 refs., 5 tabs., 1 fig.

Network constrained wind integration on Vancouver Island

International Nuclear Information System (INIS)

Maddaloni, Jesse D.; Rowe, Andrew M.; Kooten, G. Cornelis van

2008-01-01

The aim of this study is to determine the costs and carbon emissions associated with operating a hydro-dominated electricity generation system (Vancouver Island, Canada) with varying degrees of wind penetration. The focus is to match the wind resource, system demand and abilities of extant generating facilities on a temporal basis, resulting in an operating schedule that minimizes system cost over a given period. This is performed by taking the perspective of a social planner who desires to find the lowest-cost mix of new and existing generation facilities. Unlike other studies, this analysis considers variable efficiency for thermal and hydro-generators, resulting in a fuel cost that varies with respect to generator part load. Since this study and others have shown that wind power may induce a large variance on existing dispatchable generators, forcing more frequent operation at reduced part load, inclusion of increased fuel cost at part load is important when investigating wind integration as it can significantly reduce the economic benefits of utilizing low-cost wind. Results indicate that the introduction of wind power may reduce system operating costs, but this depends heavily on whether the capital cost of the wind farm is considered. For the Vancouver Island mix with its large hydro-component, operating cost was reduced by a maximum of 15% at a wind penetration of 50%, with a negligible reduction in operating cost when the wind farm capital cost was included

Water and nutrient budgets for Vancouver Lake, Vancouver, Washington, October 2010-October 2012

Science.gov (United States)

Sheibley, Rich W.; Foreman, James R.; Marshall, Cameron A.; Welch, Wendy B.

2014-01-01

Vancouver Lake, a large shallow lake in Clark County, near Vancouver, Washington, has been undergoing water-quality problems for decades. Recently, the biggest concern for the lake are the almost annual harmful cyanobacteria blooms that cause the lake to close for recreation for several weeks each summer. Despite decades of interest in improving the water quality of the lake, fundamental information on the timing and amount of water and nutrients entering and exiting the lake is lacking. In 2010, the U.S. Geological Survey conducted a 2-year field study to quantify water flows and nutrient loads in order to develop water and nutrient budgets for the lake. This report presents monthly and annual water and nutrient budgets from October 2010–October 2012 to identify major sources and sinks of nutrients. Lake River, a tidally influenced tributary to the lake, flows into and out of the lake almost daily and composed the greatest proportion of both the water and nutrient budgets for the lake, often at orders of magnitude greater than any other source. From the water budget, we identified precipitation, evaporation and groundwater inflow as minor components of the lake hydrologic cycle, each contributing 1 percent or less to the total water budget. Nutrient budgets were compiled monthly and annually for total nitrogen, total phosphorus, and orthophosphate; and, nitrogen loads were generally an order of magnitude greater than phosphorus loads across all sources. For total nitrogen, flow from Lake River at Felida, Washington, made up 88 percent of all inputs into the lake. For total phosphorus and orthophosphate, Lake River at Felida flowing into the lake was 91 and 76 percent of total inputs, respectively. Nutrient loads from precipitation and groundwater inflow were 1 percent or less of the total budgets. Nutrient inputs from Burnt Bridge Creek and Flushing Channel composed 12 percent of the total nitrogen budget, 8 percent of the total phosphorus budget, and 21 percent

Proportion of long-term injection drug users as an indicator to characterize the state and prognosis of HIV-epidemic within a certain territory

Directory of Open Access Journals (Sweden)

Andreeva, Tatiana

2012-07-01

Full Text Available BACKGROUND: Epidemics of drug use and thus the spread of HIV have different duration in different regions, and, therefore, the prognosis of these epidemics may differ. We aimed to assess indicators measuring the peculiarities of injection drug use epidemics by region, informative for prevention activities among vulnerable to HIV groups. METHODS: Data from cross-sectional survey of 4026 injection drug users (IDUs conducted in 2007 in Ukraine were analyzed. The outcome measure was a binary variable depicting whether a respondent injects drugs for 20 years and over. Binary Logistic Regression in SPSS software was used to test associations with socio-demographic characteristics. RESULTS: More respondents from Odessa, Mykolayiv, Dnipropetrovsk, Cherkassy, Poltava, and Crimea regions inject over 20 years. Older respondents were more likely to belong to the group of long-term users. Men were more likely to inject over 20 years than women. Those respondents who were married, but did not live with their spouse or other sexual partner were more likely to inject longer than 20 years compared to those single or in a stable marriage. Those respondents who use opiates or combine them with stimulants were more likely to inject over 20 years and those who use only stimulants were more likely to inject less than 20 years. CONCLUSION: Injection drug use in Ukraine started earlier among men, on certain territories and was associated with opiate use. Percentage of IDUs who inject for more than 20 years was found to be a good indicator to distinguish territories with long-lasting epidemics.

High HCV seroprevalence and HIV drug use risk behaviors among injection drug users in Pakistan

Directory of Open Access Journals (Sweden)

Zafar Tariq

2006-08-01

Full Text Available Abstract Introduction HIV and HCV risk behaviors among injection drug users (IDUs in two urban areas in Pakistan were identified. Methods From May to June 2003, 351 IDUs recruited in harm-reduction drop-in centers operated by a national non-governmental organization in Lahore (Punjab province and Quetta (Balochistan province completed an interviewer-administered survey and were tested for HIV and HCV. Multivariable logistic regression identified correlates of seropositivity, stratifying by site. All study participants provided written, informed consent. Results All but two were male; median age was 35 and Discussion Despite no HIV cases, overall HCV prevalence was very high, signaling the potential for a future HIV epidemic among IDUs across Pakistan. Programs to increase needle exchange, drug treatment and HIV and HCV awareness should be implemented immediately.

Community reentry challenges after release from prison among people who inject drugs in St. Petersburg, Russia.

Science.gov (United States)

Cepeda, Javier A; Vetrova, Marina V; Lyubimova, Alexandra I; Levina, Olga S; Heimer, Robert; Niccolai, Linda M

2015-01-01

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. 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). 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. 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. 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.

Making a difference? Applying Vitellone's Social Science of the Syringe to performance and image enhancing drug injecting.

Science.gov (United States)

Hart, Aaron

2018-04-18

Vitellone's Social Science of the Syringe investigates epistemologies of injecting drug use. She argues for a methodology that can be simultaneously sensitive to biopolitical power regimes; the trajectories of social stratification; and the resistance, creativity and dignity of human agency. She proposes a methodological focus on the syringe-in-use as an active participant in these dynamics. Harm reduction policy and service provision frameworks have paid little attention to the phenomena of performance and image enhancing drug (PIEDs) injection. One way of assessing the merit of Vitellone's proposal is to use it to investigate these phenomena. I argue that Vitellone's method can be used to articulate a range of significant differences between people who inject PIEDs and other people who inject drugs, and that these differences can inform harm reduction initiatives. When compared to the heroin syringe, the PIED syringe participates in different socio-economic and material contexts, gendered identities, and biopolitical governance regimes. These differences materialise in different rates of syringe sharing and blood-borne virus transmission; and different experiences of needle exchange services. I offer a thought experiment demonstrating how a different syringe might alter the structural dynamics, biopolitical governance, and the agentic choices of people who inject PIEDs. Judging by the productive effects of diffracting Vitellone's analysis through an empirical concern with PIED injecting, I concur with Vitellone's proposition that 'something objective may be gained from an empirical investigation of the syringe-in-use' (p. 33). Copyright © 2018 Elsevier B.V. All rights reserved.

Infection disclosure in the injecting dyads of Hungarian and Lithuanian injecting drug users who self-reported being infected with hepatitis C virus or human immunodeficiency virus.

Science.gov (United States)

Gyarmathy, V Anna; Neaigus, Alan; Li, Nan; Ujhelyi, Eszter; Caplinskiene, Irma; Caplinskas, Saulius; Latkin, Carl A

2011-01-01

The aim of this study was to assess the prevalence and correlates of disclosure to network members of being hepatitis C virus (HCV)- or human immunodeficiency virus (HIV)-infected among injecting dyads of infected injection drug users (IDUs) in Budapest, Hungary and Vilnius, Lithuania,. Multivariate generalized estimating equations (GEE) were used to assess associations. Very strong infection disclosure norms exist in Hungary, and HCV disclosure was associated with using drugs and having sex within the dyad. Non-ethnic Russian IDUs in Lithuania were more likely to disclose HCV infection to non-Roma, emotionally close and HCV-infected network members, and to those with whom they shared cookers, filters, drug solutions or rinse water or got used syringes from, and if they had fewer non-IDU or IDU network members. Ethnic Russian Lithuanian IDUs were more likely to disclose HCV if they had higher disclosure attitude and knowledge scores, 'trusted' network members, and had lower non-injecting network density and higher injecting network density. HIV-infected Lithuanian IDUs were more likely to disclose to 'trusted' network members. Disclosure norms matched disclosure behaviour in Hungary, while disclosure in Lithuania to 'trusted' network members suggests possible stigmatization. Ongoing free and confidential HCV/HIV testing services for IDUs are needed to emphasize and strengthen disclosure norms, and to decrease stigma.

Suicidal ideation and HIV risk behaviors among a cohort of injecting drug users in New Delhi, India

Directory of Open Access Journals (Sweden)

Sarin Enisha

2013-01-01

Full Text Available Abstract Background Data on mental health among injecting drug users in South Asia is scarce yet poor mental health among users has significant implications for the success of HIV prevention and treatment programmes. A cohort of 449 injecting drug users in Delhi was examined on the following issues (1 examine trends in suicidal ideation, suicide plan and suicidal attempts over a 12-month period, (2 examine association between injecting practices (receive and give used syringes and suicidal ideation over a 12 month study period. Methods An observational study was conducted providing phased interventions with follow up interviews every 3 months to 449 injecting drug users (IDUs, from August 2004 to November 2005. The study was conducted in Yamuna Bazaar, a known hub of drug peddling in Delhi. Interventions included nutrition, basic medical services, needle exchange, health education, HIV voluntary counseling and testing, STI diagnosis and treatment, oral buprenorphine substitution, and detoxification, each introduced sequentially. Results Suicidal ideation and suicide attempts, did not significantly change over 12 months of observation, while suicide plans actually increased over the time period. Keeping other factors constant, IDUs with suicidal ideation reported more giving and receiving of used syringes in the recent past. Conclusions: Mental health services are warranted within harm reduction programmes. Special attention must be paid to suicidal IDUs given their higher risk behaviours for acquiring HIV and other blood borne infections. IDU intervention programmes should assess and address suicide risk through brief screening and enhanced counseling.

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

Science.gov (United States)

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). 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.

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

Directory of Open Access Journals (Sweden)

Anne Guichard

2015-01-01

Full Text Available 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.

Drug use and sexual behavior: the multiple HIV vulnerabilities of men and women who inject drugs in Kumasi, Ghana.

Science.gov (United States)

Messersmith, Lisa J; Adjei, Rose; Beard, Jennifer; Agyarko-Poku, Thomas; Wondergem, Peter; Falconer, Ariel; Sabin, Lora; Adu-Sarkodie, Yaw

2015-03-01

Recent evidence suggests that injecting drug use presents a new challenge to HIV prevention in West Africa. Very little is known about the HIV vulnerability of people who inject drugs (PWID) in Ghana, and no HIV prevention efforts are currently targeting PWID. Purposive sampling was used to recruit 30 (20 men and 10 women) PWID to participate in in-depth interviews in Kumasi, Ghana. Transcripts were coded and analyzed by theme. Half the men and more than half the women in this study reported sharing needles/syringes (N/S); most shared a common mixing container; and all said they shared N/S with intimate partners. Some PWID who said that they do not share N/S with other PWID, also said they routinely use N/S that they find on the ground at injecting sites or in the hospital dumpster. Nearly, all the women (9/10) and more than half the men (12/20) were currently sexually active; most had more than 1 partner in the last 6 months, but very few reported condom use. Three women said they exchanged sex for money and 3 men reported buying sex in the last year. Several PWID had no knowledge of HIV transmission through injecting. PWID in Kumasi are highly vulnerable to HIV because of N/S sharing and reuse, lack of condom use, low knowledge of HIV transmission, and lack of services. Program and policy recommendations include N/S and condom distribution, peer education, opioid substitution therapy, and training of health providers, police, and pharmacy staff.

Association of opioid agonist therapy with lower incidence of hepatitis C virus infection in young adult injection drug users.

Science.gov (United States)

Tsui, Judith I; Evans, Jennifer L; Lum, Paula J; Hahn, Judith A; Page, Kimberly

2014-12-01

Injection drug use is the primary mode of transmission for hepatitis C virus (HCV) infection. Prior studies suggest opioid agonist therapy may reduce the incidence of HCV infection among injection drug users; however, little is known about the effects of this therapy in younger users. To evaluate whether opioid agonist therapy was associated with a lower incidence of HCV infection in a cohort of young adult injection drug users. Observational cohort study conducted from January 3, 2000, through August 21, 2013, with quarterly interviews and blood sampling. We recruited young adult (younger than 30 years) injection drug users who were negative for anti-HCV antibody and/or HCV RNA. Substance use treatment within the past 3 months, including non-opioid agonist forms of treatment, opioid agonist (methadone hydrochloride or buprenorphine hydrochloride) detoxification or maintenance therapy, or no treatment. Incident HCV infection documented with a new positive result for HCV RNA and/or HCV antibodies. Cumulative incidence rates (95% CI) of HCV infection were calculated assuming a Poisson distribution. Cox proportional hazards regression models were fit adjusting for age, sex, race, years of injection drug use, homelessness, and incarceration. Baseline characteristics of the sample (n = 552) included median age of 23 (interquartile range, 20-26) years; 31.9% female; 73.1% white; 39.7% who did not graduate from high school; and 69.2% who were homeless. During the observation period of 680 person-years, 171 incident cases of HCV infection occurred (incidence rate, 25.1 [95% CI, 21.6-29.2] per 100 person-years). The rate ratio was significantly lower for participants who reported recent maintenance opioid agonist therapy (0.31 [95% CI, 0.14-0.65]; P = .001) but not for those who reported recent non-opioid agonist forms of treatment (0.63 [95% CI, 0.37-1.08]; P = .09) or opioid agonist detoxification (1.45 [95% CI, 0.80-2.69]; P = .23). After adjustment for

Overdose experiences among injection drug users in Bangkok, Thailand

Directory of Open Access Journals (Sweden)

Wood Evan

2010-05-01

Full Text Available Abstract 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.

Research on the comparison of the demethylvancomycin's diffusion-deposition characteristics in the ocular solid tissues of sustained subtenon drug delivery with subconjunctival injection.

Science.gov (United States)

Duan, Yi-Qin; Yang, Ye-Zhen; Huang, Xue-Tao; Lin, Ding

2017-11-01

To compare the demethylvancomycin's diffusion-deposition characteristics in the ocular solid tissues of sustained subtenon drug delivery with subconjunctival injection. Sixty adult white rabbits were randomly assigned to the subtenon drug delivery group and the subconjunctival injection group. The subtenon drug delivery group was continuously infused demethylvancomycin to the subtenon of rabbits. The subconjunctival injection group was injected demethylvancomycin to the subconjunctival of rabbits. Cornea, iris and sclera were collected for high-performance liquid chromatography analyses to determine drug concentrations at one hour, three hours, six hours, 12 h and 24 h of drug administration. WinNonlin 6.3 was used to calculate the parameters of cumulative area under the curve (AUC cum ) of demethylvancomycin. The peak levels of demethylvancomycin concentration of the subtenon drug delivery group and the subconjunctival injection group were 92.406 ± 21.555 and 51.778 ± 14.001 μg/g in cornea, 28.451 ± 10.229 μg/g and 42.271 ± 27.291 μg/g in iris, 153.166 ± 51.738 μg/g and 57.423 ± 18.480 μg/g in sclera. The differences of concentrations between the two groups in cornea and sclera were statistically significant (F = 487.775, p drug delivery group and the subconjunctival injection group was 1808.23 h * μg/g and 273.73 h * μg/g in cornea, 489.12 h * μg/g and 216.16 h * μg/g in iris and 2166.34 h * μg/g and 392.57 h * μg/g in sclera at 24 h of drug administration. The sustained subtenon drug delivery had a better drug permeability and accumulation in the intraocular solid tissue compared to subconjunctival injection, which demonstrated it was probably a promising and effective approach for treating posterior segment diseases and endophthalmitis.

Role of substance use in HIV care cascade outcomes among people who inject drugs in Russia.

Science.gov (United States)

Idrisov, Bulat; Lunze, Karsten; Cheng, Debbie M; Blokhina, Elena; Gnatienko, Natalia; Quinn, Emily; Bridden, Carly; Walley, Alexander Y; Bryant, Kendall J; Lioznov, Dmitry; Krupitsky, Evgeny; Samet, Jeffrey H

2017-12-04

Engaging people who drink alcohol or inject drugs in HIV care can be challenging, particularly in Eastern Europe. Healthcare facilities in Russia are organized by specialty; therefore linking patients from addiction care to HIV hospitals has been difficult. The HIV care cascade outlines stages of HIV care (e.g., linkage to care, prescribed antiretroviral therapy [ART], and achieving HIV viral suppression). We hypothesized that unhealthy alcohol use, injection drug use, and opioid craving are associated with unfavorable HIV care cascade outcomes. We analyzed data from a cohort (n = 249) of HIV-positive Russians who have been in addiction hospital treatment in the past year and had a lifetime history of injection drug use (IDU). We evaluated the association between unhealthy alcohol use (AUDIT score > 7 [both hazardous drinking and dependence]), past-month injection drug use (IDU), and opioid craving (visual analogue scale from 1 to 100) with HIV care cascade outcomes. The primary outcome was linkage to HIV care within 12 months. Other outcomes were prescription of ART (secondary) and achievement of undetectable HIV viral load (HVL < 500 copies/mL) within 12 months (exploratory); the latter was analyzed on a subset in which HVL was measured (n = 48). We assessed outcomes via medical record review (linkage, ART) and serum tests (HVL). To examine the primary outcome, we used multiple logistic regression models controlling for potential confounders. Among 249 study participants, unhealthy alcohol use (n = 148 [59%]) and past-month IDU (n = 130 [52%]) were common. The mean opioid craving score was 49 (SD: 38). We were unable to detect significant associations between the independent variables (i.e., unhealthy alcohol use, IDU and opioid craving) and any HIV care cascade outcomes in unadjusted and adjusted analyses. In this cohort of HIV-positive Russians with a history of IDU, individual substance use factors were not significantly associated with achieving

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

Science.gov (United States)

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.

Verification of an ENSO-Based Long-Range Prediction of Anomalous Weather Conditions During the Vancouver 2010 Olympics and Paralympics

Science.gov (United States)

Mo, Ruping; Joe, Paul I.; Doyle, Chris; Whitfield, Paul H.

2014-01-01

A brief review of the anomalous weather conditions during the Vancouver 2010 Winter Olympic and Paralympic Games and the efforts to predict these anomalies based on some preceding El Niño-Southern Oscillation (ENSO) signals are presented. It is shown that the Olympic Games were held under extraordinarily warm conditions in February 2010, with monthly mean temperature anomalies of +2.2 °C in Vancouver and +2.8 °C in Whistler, ranking respectively as the highest and the second highest in the past 30 years (1981-2010). The warm conditions continued, but became less anomalous, in March 2010 for the Paralympic Games. While the precipitation amounts in the area remained near normal through this winter, the lack of snow due to warm conditions created numerous media headlines and practical problems for the alpine competitions. A statistical model was developed on the premise that February and March temperatures in the Vancouver area could be predicted using an ENSO signal with considerable lead time. This model successfully predicted the warmer-than-normal, lower-snowfall conditions for the Vancouver 2010 Winter Olympics and Paralympics.

Animal experiment and clinical preliminary application of percutaneous 70% ethanol injection therapy in multi-drug resistant pulmonary tuberculosis

International Nuclear Information System (INIS)

Liu Fuquan; Yue Zhendong; Gao Shunyu; Li YanSheng; Wei Guobin; Guo Weiyi; Chen Xijun; Li Baoyu

2004-01-01

Objective: To evaluate the clinical value of percutaneous injection of 70% ethanol in the treatment of multidrug resistant pulmonary tuberculosis. Methods: Percutaneous and transcatheter absolute ethanol, 70% ethanol, and 60% meglucamine diatrizoate(or distilled water) injection into the lung (25 cases) and the bronchi (25 cases) of healthy rabbits were performed, respectively.All specimens were studied with pathology. On the base of animals experiment, thirty-five patients with multi-drug resistant pulmonary tuberculosis were treated with percutaneous 70% ethanol injection. Every patient was treated by the same way for 1-3 times. Results: Pathological findings of the specimens of pulmonary tissue showed nonspecific inflammation, necrosis, and fibrosis. The chief pathological changes with percutaneous or transcatheter 70% ethanol injection were slighter than those with absolute ethanol injection. Pathological findings of the specimens of bronchi showed slight mucosal edema, nonspecific inflammation, and focal cytonecrosis. Recovery of the damaged bronchial mucosa occurred within 14-30 days after the treatment. All patients with multi-drug resistant pulmonary tuberculosis were followed up for 6 to 33 months. The sputum bacterial conversion to negative rate was 100% within 6 months after the treatment. Cavity closing, shrinking, and no changing rate were 47.1% (16/34), 50.0% (17/34), and 2.9% (1/34), respectively. Radiographic improvement rate was 94.3 % (33/35). No severe complications and adverse reactions occurred. Conclusion: Percutaneous 70% ethanol injection is safe, effective, and easy to perform in the treatment of multi-drug resistant pulmonary tuberculosis. (authors)

The intersection between sex and drugs: a cross-sectional study among the spouses of injection drug users in Chennai, India

Directory of Open Access Journals (Sweden)

Anand Santhanam

2011-01-01

Full Text Available Abstract Background It is estimated that there are up to 1.1 million injection drug users (IDUs in India; the majority are likely married. We characterize HIV, hepatitis B (HBV and hepatitis C (HCV prevalence and the risk environment of a sample of spouses of IDUs. Methods A cohort of 1158 IDUs (99% male was recruited in Chennai, India from 2005-06. A convenience sample of 400 spouses of the male IDUs in this cohort was recruited in 2009. A risk assessment questionnaire was administered and a blood sample collected. Logistic regression was used to identify factors associated with prevalent HIV. Results Median age was 31 years; thirteen percent were widowed and 7% were not currently living with their spouse. Only 4 (1% reported ever injecting drugs; Twenty-two percent and 25% reported ever using non-injection drugs and alcohol, respectively. The majority had one lifetime sexual partner and 37 (9% reporting exchanging sex. Only 7% always used condoms with their regular partner. HIV, HBV and HCV prevalence were 2.5%, 3.8% and 0.5%, respectively; among spouses of HIV+ IDUs (n = 78, HIV prevalence was 10.3%. The strongest predictor of HIV was spousal HIV status (OR: 17.9; p Conclusions Our finding of a 10-fold higher HIV prevalence among spouses of IDUs compared with general population women indicates their vulnerability; prevalence is likely to increase given the context of low condom use and frequent sexual violence. Prevention efforts directed at IDUs should also include programs for spouses.

Metro Vancouver air quality management plan : progress report

Energy Technology Data Exchange (ETDEWEB)

NONE

2008-10-15

The Greater Vancouver Regional District (GVRD) developed an air quality management plan (AQMP) in 2005 as a means of addressing air quality issues in the region. The plan required progress reports every 2 years as well as a comprehensive review every 5 years. The AQMP established goals to minimize risk to public health from air pollution, improve visibility, and minimize the region's contributions to global climatic change by reducing emissions; implementing local air quality management programs; and enhancing air quality information and public awareness. The AQMP also included a sustainability framework for GVRD's policies and regulations related to regional growth, service delivery and political leadership. Regional strategies for solid waste and liquid waste management were developed in 2008. The sustainability framework has developed 3 priority goals: (1) to reduce diesel particulates by 75 per cent from Metro Vancouver corporate sources by 2012, (2) to be carbon neutral by 2012 excluding solid waste operations, and (3) to reduce regional GHGs by 15 per cent by 2015, and 33 per cent by 2020. Progress updates on regional planning efforts for the AQMP were presented. The report also outlined trends and performance measures used by the GVRD, and discussed changes in air quality issues and priorities that have occurred since the AQMP was adopted in 2005. 1 tab., 8 figs.

Metro Vancouver air quality management plan : progress report

International Nuclear Information System (INIS)

2008-10-01

The Greater Vancouver Regional District (GVRD) developed an air quality management plan (AQMP) in 2005 as a means of addressing air quality issues in the region. The plan required progress reports every 2 years as well as a comprehensive review every 5 years. The AQMP established goals to minimize risk to public health from air pollution, improve visibility, and minimize the region's contributions to global climatic change by reducing emissions; implementing local air quality management programs; and enhancing air quality information and public awareness. The AQMP also included a sustainability framework for GVRD's policies and regulations related to regional growth, service delivery and political leadership. Regional strategies for solid waste and liquid waste management were developed in 2008. The sustainability framework has developed 3 priority goals: (1) to reduce diesel particulates by 75 per cent from Metro Vancouver corporate sources by 2012, (2) to be carbon neutral by 2012 excluding solid waste operations, and (3) to reduce regional GHGs by 15 per cent by 2015, and 33 per cent by 2020. Progress updates on regional planning efforts for the AQMP were presented. The report also outlined trends and performance measures used by the GVRD, and discussed changes in air quality issues and priorities that have occurred since the AQMP was adopted in 2005. 1 tab., 8 figs

The potential for wind energy meeting electricity needs on Vancouver Island

NARCIS (Netherlands)

Prescott, R.; Kooten, van G.C.; Zhu, H.

2007-01-01

In this paper, an in-depth analysis of power supply and demand on Vancouver Island is used to provide information about the optimal allocation of power across 'generating' sources and to investigate the economics of wind generation and penetrability into the Island grid. The methodology developed

'Women at risk': the health and social vulnerabilities of the regular female partners of men who inject drugs in Delhi, India.

Science.gov (United States)

Sharma, Vartika; Sarna, Avina; Luchters, Stanley; Sebastian, Mary; Degomme, Olivier; Saraswati, Lopamudra Ray; Madan, Ira; Thior, Ibou; Tun, Waimar

2015-01-01

Needle and syringe sharing is common among people who inject drugs and so is unprotected sex, which consequently puts their sex partners at risk of sexually transmitted infections (STIs) including HIV and other blood-borne infections, like hepatitis. We undertook a nested study with the regular female partners of men who inject drugs participating in a longitudinal HIV incidence study in Delhi, India. In-depth interviews were conducted with female partners of 32 men. The interviews aimed to gather focused and contextual knowledge of determinants of safe sex and reproductive health needs of these women. Information obtained through interviews was triangulated and linked to the baseline behavioural data of their partner (index men who injected drugs). The study findings illustrate that women in monogamous relationships have a low perception of STI- and HIV-related risk. Additionally, lack of awareness about hepatitis B and C is a cause of concern. Findings also suggest impact of male drug use on the fertility of the female partner. It is critical to empower regular female partners to build their self-risk assessment skills and self-efficacy to negotiate condom use. Future work must explore the role of drug abuse among men who inject drugs in predicting fertility and reproductive morbidity among their female partners.

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

Science.gov (United States)

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

Prevalence and correlates of hepatitis C virus infection among street-recruited injection drug users in San Juan, Puerto Rico.

Science.gov (United States)

Reyes, Juan C; Colón, Héctor M; Robles, Rafael R; Rios, Eddy; Matos, Tomás D; Negrón, Juan; Marrero, Carmen Amalia; Calderón, José M; Shepard, Elizabeth

2006-11-01

Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.

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

OpenAIRE

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 and use cocaine during methadone treatment. Participants could work 4 hr every weekday in a workplace where they could earn about $10.00 per hour in ...

An integrated approach to care attracts people living with HIV who use illicit drugs in an urban centre with a concentrated HIV epidemic

Directory of Open Access Journals (Sweden)

S. Fernando

2016-11-01

Full Text Available Abstract Background People living with HIV (PLHIV who are also marginalized by social and structural inequities often face barriers to accessing and adhering to HIV treatment and care. The Dr. Peter Centre (DPC is a non-profit integrated care facility with a supervised injection room that serves PLHIV experiencing multiple barriers to social and health services in Vancouver, Canada. This study examines whether the DPC is successful in drawing in PLHIV with complex health issues, including addiction. Methods Using data collected by the Longitudinal Investigations into Supportive and Ancillary health services (LISA study from July 2007 to January 2010, linked with clinical variables available through the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program, we identified DPC and non-DPC clients with a history of injection drug use. Bivariable and multivariable logistic regression analyses compared socio-demographic and clinical characteristics of DPC clients (n = 76 and non-DPC clients (n = 482 with a history of injection drug use. Results Of the 917 LISA participants included within this analysis, 100 (10.9% reported being a DPC client, of which 76 reported a history of injection drug use. Adjusted results found that compared to non-DPC clients with a history of injection drug use, DPC-clients were more likely to be male (AOR: 4.18, 95% CI = 2.09–8.37; use supportive services daily vs. less than daily (AOR: 3.16, 95% CI = 1.79–5.61; to have been diagnosed with a mental health disorder (AOR: 2.11; 95% CI: 1.12–3.99; to have a history of interpersonal violence (AOR: 2.76; 95% CI: 1.23–6.19; and to have ever experienced ART interruption longer than 1 year (AOR: 2.39; 95% CI: 1.38–4.15. Conclusions Our analyses suggest that the DPC operating care model engages PLHIV with complex care needs, highlighting that integrated care facilities are needed to support the multiple intersecting vulnerabilities faced

Policy responses to viral hepatitis B and C among people who inject drugs in Member States of the WHO European region

DEFF Research Database (Denmark)

Spina, Alexander; Eramova, Irina; Lazarus, Jeffrey V

2014-01-01

BACKGROUND: Unsafe injections, through infectious bodily fluids, are a major route of transmission for hepatitis B and C. Viral hepatitis burden among people who inject drugs is particularly high in many Member States of central and Eastern Europe while national capacity and willingness to address......, with less than one-third reportedly conducting regular serosurveys among people who inject drugs. CONCLUSIONS: Findings highlight key gaps requiring attention in order to improve national policies and programmes in the region and ensure an adequate response to injection drug use-associated viral hepatitis...... of a national policy for hepatitis prevention and control; however less than one-third (27%) reported having written national strategies. Under half of the responding Member States reported holding events for World Hepatitis Day 2012. One-fifth reported offering hepatitis B and C testing free of charge...

NEGOTIATING STRUCTURAL VULNERABILITY FOLLOWING REGULATORY CHANGES TO A PROVINCIAL METHADONE PROGRAM IN VANCOUVER, CANADA: A QUALITATIVE STUDY

Science.gov (United States)

McNeil, Ryan; Kerr, Thomas; Anderson, Solanna; Maher, Lisa; Keewatin, Chereece; Milloy, MJ; Wood, Evan; Small, Will

2015-01-01

While regulatory frameworks governing methadone maintenance therapy (MMT) require highly regimented treatment programs that shape treatment outcomes, little research has examined the effects of regulatory changes to these programs on those receiving treatment, and located their experiences within the wider context of socialstructural inequities. In British Columbia (BC), Canada, provincial regulations governing MMT have recently been modified, including: replacing the existing methadone formulation with Methadose® (pre-mixed and 10 times more concentrated); prohibiting pharmacy delivery of methadone; and, prohibiting pharmacies incentives for methadone dispensation. We undertook this study to examine the impacts of these changes on a structurally vulnerable population enrolled in MMT in Vancouver, BC. Qualitative interviews were conducted with 34 people enrolled in MMT and recruited from two ongoing observational prospective cohort studies comprised of drug-using individuals in the six-month period in 2014 following these regulatory changes. Interview transcripts were analyzed thematically, and by drawing on the concept of ‘structural vulnerability’. Findings underscore how these regulatory changes disrupted treatment engagement, producing considerable health and social harms. The introduction of Methadose® precipitated increased withdrawal symptoms. The discontinuation of pharmacy delivery services led to interruptions in MMT and codispensed HIV medications due to constraints stemming from their structural vulnerability (e.g., poverty, homelessness). Meanwhile, the loss of pharmacy incentives limited access to material supports utilized by participants to overcome barriers to MMT, while diminishing their capacity to assert some degree of agency in negotiating dispensation arrangements with pharmacies. Collectively, these changes functioned to compromise MMT engagement and increased structural vulnerability to harm, including re-initiation of injection drug

Perceived Treatment Need and Latent Transitions in Heroin and Methamphetamine Polydrug Use among People who Inject Drugs in Tijuana, Mexico.

Science.gov (United States)

Meacham, Meredith C; Roesch, Scott C; Strathdee, Steffanie A; Gaines, Tommi L

2018-01-01

People who inject drugs (PWID) in Tijuana, Mexico, use heroin and/or methamphetamine. While polydrug use is associated with HIV risk behavior, less is known about the stability of polydrug use patterns over time and how polydrug use is related to perceived treatment need. Within a cohort of PWID in Tijuana (N = 735) we sought to (1) characterize subgroups of polydrug and polyroute use from baseline to six months; (2) determine the probabilities of transitioning between subgroups; and (3) examine whether self-reported need for help for drug use modified these transition probabilities. Latent transition analysis (LTA) identified four latent statuses: heroin-only injection (38% at both baseline and follow-up); co-injection of heroin with methamphetamine (3% baseline, 15% follow-up); injection of heroin and methamphetamine (37% baseline, 32% follow-up); and polydrug and polyroute users who injected heroin and both smoked and injected methamphetamine (22% baseline, 14% follow-up). Heroin-only injectors had the highest probability of remaining in the same latent status at follow-up. The majority reported great or urgent need for treatment (51%) and these PWID had greater odds of transitioning to a higher-risk status at follow-up, emphasizing the need for evidence-based drug treatment options for PWID.

Employment-based abstinence reinforcement promotes opiate and cocaine abstinence in out-of-treatment injection drug users.

Science.gov (United States)

Holtyn, August F; Koffarnus, Mikhail N; DeFulio, Anthony; Sigurdsson, Sigurdur O; Strain, Eric C; Schwartz, Robert P; Silverman, Kenneth

2014-01-01

We examined the use of employment-based abstinence reinforcement in out-of-treatment injection drug users, in this secondary analysis of a previously reported trial. Participants (N = 33) could work in the therapeutic workplace, a model employment-based program for drug addiction, for 30 weeks and could earn approximately $10 per hr. During a 4-week induction, participants only had to work to earn pay. After induction, access to the workplace was contingent on enrollment in methadone treatment. After participants met the methadone contingency for 3 weeks, they had to provide opiate-negative urine samples to maintain maximum pay. After participants met those contingencies for 3 weeks, they had to provide opiate- and cocaine-negative urine samples to maintain maximum pay. The percentage of drug-negative urine samples remained stable until the abstinence reinforcement contingency for each drug was applied. The percentage of opiate- and cocaine-negative urine samples increased abruptly and significantly after the opiate- and cocaine-abstinence contingencies, respectively, were applied. These results demonstrate that the sequential administration of employment-based abstinence reinforcement can increase opiate and cocaine abstinence among out-of-treatment injection drug users. © Society for the Experimental Analysis of Behavior.

The social and environmental context of cross-border drug use in Mexico: findings from a mixed methods study of young injection drug users living in San Diego, CA.

Science.gov (United States)

Wagner, Karla D; Moynihan, Matthew J; Strathdee, Steffanie A; Cuevas-Mota, Jazmine; Clark, Maureen; Zúñiga, María Luisa; Volkmann, Tyson A; Teshale, Eyasu; Garfein, Richard S

2012-01-01

The authors report the results of qualitative (n = 19) and quantitative (n = 545) interviews with young injection drug users (IDUs) in San Diego, California about their experiences using drugs in Tijuana, Mexico, and associated risks for HIV infection. Young IDUs who have ever traveled to Mexico (n = 365) used a variety of injection (54%) and noninjection (30%) drugs there and appear to be heavier users than those who have never traveled to Mexico. Sociocultural themes influencing drug use in Mexico included interactions among the purpose of travel, drug preference, and route of administration; familiarity with the border region; evolving relationships with the United States and Mexican drug markets; and the experience of crossing the U.S.-Mexico border. Interventions for IDUs in border regions need to be sensitive to the ethnicity, familiarity with the border region, and life history of participants, as well as differences in national policies that could influence drug use and risk for HIV on both sides of the border.

Exchange Sex Among Persons Who Inject Drugs in the New York Metropolitan Area: The Importance of Local Context, Gender and Sexual Identity.

Science.gov (United States)

Walters, Suzan M; Rivera, Alexis V; Reilly, Kathleen H; Anderson, Bridget J; Bolden, Barbara; Wogayehu, Afework; Neaigus, Alan; Braunstein, Sarah

2018-02-21

Exchanging sex for money or drugs is known to increase risk for HIV among persons who inject drugs (PWID). To better understand determinants of exchange sex among PWID we examined factors associated with exchange sex in the New York metropolitan area-defined as New York City (NYC), NY; Newark, NJ; and Long Island, NY-using data from the 2012 National HIV Behavioral Surveillance system cycle on injection drug use. Of the 1160 PWID in this analysis, 24% reported exchange sex, with differences in gender and sexual identity by location. In multivariable analysis gay/bisexual men, heterosexual women, and lesbian, gay, or bisexual (LGB) women were more likely to exchange sex compared to heterosexual men. Exchange sex was also associated with race/ethnicity, homelessness, incarceration, location, and non-injection crack and cocaine use. We find that heterosexual women and LGB women who injected drugs residing in Newark were more likely to report exchange sex compared to NYC. This study highlights how local conditions impact exchange sex.

Impact of injecting drug use on response to highly active antiretroviral treatment in HIV-1-infected patients: a nationwide population-based cohort study

DEFF Research Database (Denmark)

Larsen, Mette Vang; Omland, Lars; Gerstoft, Jan

2010-01-01

The objective of this study was to determine the effect of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected patients infected through injecting drug use (injecting drug users, IDUs) compared to patients infected via other routes (non-IDUs). We conducted...... for non-IDUs, and IDUs initiated HAART later than non-IDUs. In conclusion, more than half of the HIV-infected patients in Denmark infected through injecting drug use gained full viral suppression after initiating HAART. Absolute CD4(+) cell count was lower and mortality higher among IDUs than non-IDUs....

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.

Science.gov (United States)

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.

A bio-ballistic micro-jet for drug injection into animal skin using a Nd:YAG laser

Science.gov (United States)

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.

The effects of oil pollution on seabirds off the west coast of Vancouver Island

International Nuclear Information System (INIS)

Burger, A.E.

1992-01-01

Annual oil shipments off the west coast of Vancouver Island include over 300 tankers carrying 26 million m 3 of crude oil, over 400 loads totalling ca 2 million m 3 of refined petroleum products delivered to local ports, and thousands of smaller fuel deliveries. The incidence and estimated risks of oil spills off the coast of Vancouver Island are reviewed. Large spills of over 1,000 bbl are likely to affect the area every 4-5 y, but several hundred minor spills occur annually. Beached bird surveys yielded densities of 0.72 carcasses/km, of which at least 12% were oiled by small, predominantly unreported spills. Under normal conditions, the incidence of oiled birds on beaches is low relative to beach survey results from other parts of the world, but these data underestimate the actual at-sea mortality because of the characteristics of the beaches and the ocean currents off the island. This has been confirmed by experiments using bird-sized drift blocks released off the island and studies of carcass persistence on beaches. The effects of the Nestucca spill, which killed ca 56,000 seabirds off Vancouver Island and northern Washington in winter 1988-89, are reviewed. 57 refs., 6 figs., 7 tabs

Treatment readiness, attitudes toward, and experiences with methadone and buprenorphine maintenance therapy among people who inject drugs in Malaysia

Science.gov (United States)

Vijay, Aishwarya; Bazazi, Alexander R.; Yee, Ilias; Kamarulzaman, Adeeba; Altice, Frederick L.

2016-01-01

Background Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. Methods In 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experience with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Results All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores. Conclusion There are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics

Risk of violence in drug rehabilitation centers: perceptions of people who inject drugs in Tijuana, Mexico.

Science.gov (United States)

Harvey-Vera, Alicia Yolanda; González-Zúñiga, Patricia; Vargas-Ojeda, Adriana Carolina; Medina-Mora, Maria Elena; Magis-Rodríguez, Carlos Leonardo; Wagner, Karla; Strathdee, Steffanie Anne; Werb, Daniel

2016-01-26

In 2009, Mexico reformed its health law to partially decriminalize drug possession considered for personal use and to increase mandatory referrals to certified drug rehabilitation centers in lieu of incarceration. Concurrently, news media reported violent attacks perpetrated by drug cartels against Mexican drug rehabilitation centers and instances of human rights violations by staff against people who inject drugs (PWID) in treatment. In many cases, these violent situations took place at "Peer Support" (Ayuda Mutua) drug rehabilitation centers that house a large number of drug-dependent PWID. In an effort to understand barriers to treatment uptake, we examined prevalence and correlates of perceived risk of violence at drug rehabilitation centers among PWID in Tijuana, Mexico. Secondary analysis of baseline data collected between March 2011 and May 2013 of PWID recruited into a prospective cohort study in Tijuana. Interviewer-administered surveys measured perceived risk of violence at drug rehabilitation centers by asking participants to indicate their level of agreement with the statement "going to rehabilitation puts me at risk of violence". Logistic regression was used to examine factors associated with perceived risk of violence. Of 733 PWID, 34.5 % perceived risk of violence at drug rehabilitation centers. In multivariate analysis, reporting ever having used crystal methamphetamine and cocaine (separately), having a great or urgent need to get help for drug use, and ever receiving professional help for drug/alcohol use were negatively associated with perceived risk of violence at drug rehabilitation centers, while having been told by law enforcement that drug rehabilitation attendance is mandatory was positively associated with perceived risk of violence. All associations were significant at a 0.05 alpha level. The perception of violence at drug rehabilitation centers among PWID does not represent the lived experience of those PWID who attended

Early stages of the HIV epidemic among injecting drug users: Lessons to be learned

Directory of Open Access Journals (Sweden)

Tanvir Ahmed

2014-09-01

Full Text Available Injecting drug use driving the HIV epidemic is currently a major global public health concern. However, the early epidemic among injecting drug users (IDUs, more than three decades ago, was only concentrated in few places. The HIV epidemic among the IDUs in New York, USA; Edinburgh, Scotland, UK; and northern Italy provides examples of where the recorded prevalence exceeded 50% within a very short period of time. This brief review highlights historical perspectives of HIV transmission risk among IDUs during the early stages of the epidemic. Salient features and related experiences during this period might provide valuable insights for current HIV prevention. Our overview of the selected locations reemphasizes the importance of early prevention. The discussion also introduces to new researchers the early situation associated with the HIV epidemic in IDUs and highlights some crucial components need to be included during current HIV prevention activities.

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

Science.gov (United States)

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…

Estimating the size of the HIV epidemic among injecting drug users in Amsterdam

NARCIS (Netherlands)

van Haastrecht, H. J.; Bindels, P. J.; van den Hoek, A. A.; Coutinho, R. A.

1997-01-01

Aim of this study was to assess the cumulative incidence of HIV-infection, AIDS and pre-AIDS death in the population of injecting drug users (IDU) in Amsterdam. By assuming equivalence, between a cohort of IDU and the IDU population, of the ratios of incidences of AIDS and pre-AIDS death to the

Breaking worse: the emergence of krokodil and excessive injuries among people who inject drugs in Eurasia.

Science.gov (United States)

Grund, Jean-Paul C; Latypov, Alisher; Harris, Magdalena

2013-07-01

Krokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated with its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon, krokodil use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively estimated to have injected the drug in 2011. In this paper we review the existing information on the production and use of krokodil, within the context of the region's recent social history. We searched PubMed, Google Advanced Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or media reports, grey literature and video reports. Survey data from HIV prevention and treatment NGOs was consulted, as well as regional experts and NGO representatives. Krokodil production emerged in an atypical homemade drug production and injecting risk environment that predates the fall of communism. Made from codeine, the active ingredient is reportedly desomorphine, but - given the rudimentary 'laboratory' conditions - the solution injected may include various opioid alkaloids as well as high concentrations of processing chemicals, responsible for the localized and systemic injuries reported here. Links between health care and law enforcement, stigma and maltreatment by medical providers are likely to thwart users seeking timely medical help. A comprehensive response to the emergence of krokodil and associated harms should focus both on the substance itself and its rudimentary production methods, as well as on its micro and macro risk environments - that of the on-going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend more on political will than on the practical implementation of interventions. The legal status of opioid substitution treatment in Russia is a point

Social network-related risk factors for bloodborne virus infections among injection drug users receiving syringes through secondary exchange.

Science.gov (United States)

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

2008-01-01

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.

Safe havens and rough waters: networks, place, and the navigation of risk among injection drug-using Malaysian fishermen.

Science.gov (United States)

West, Brooke S; Choo, Martin; El-Bassel, Nabila; Gilbert, Louisa; Wu, Elwin; Kamarulzaman, Adeeba

2014-05-01

HIV prevalence among Malaysian fishermen is ten times that of the general population. Fishing boats are a key place where drug use occurs, but we know little about how these environments shape HIV risk behaviour. Utilizing Rhodes' 'risk environment' framework, we assessed drug use contexts and how characteristics of place associated with fishing and fishermen's social networks served as key axes along which drug use and HIV risk behaviour occurred. Data were collected during 2009-2011 in Kuantan, a fishing port on the eastern coast of Malaysia, and include 28 in-depth interviews and 398 surveys collected using RDS. Logistic regression was used to determine the effect of occupational, network and risk environment characteristics on unsafe injection behaviour and access to clean needles/syringes; qualitative data were coded and analyzed thematically. Drug injecting was common and occurred on boats, often with other crewmembers. Captains and crewmembers were aware of drug use. Unsafe injection practices were significantly associated with having a larger proportion of drug injectors in network (OR=3.510, 95% CI=1.053-11.700) and having a captain provide drugs for work (OR=2.777, 95% CI=1.018-7.576). Size of fishermen network (OR=0.987, 95% CI=0.977-0.996), crewmembers' knowledge of drug use (OR=7.234, 95% CI=1.430-36.604), and having a captain provide drugs for work (OR=0.134, 95% CI=0.025-0.720) predicted access to clean needles/syringes. Qualitative analyses revealed that occupational culture and social relationships on boats drove drug use and HIV risk. While marginalized in broader society, the acceptance of drug use within the fishing community created occupational networks of risk. Fishing boats were spaces of both risk and safety; where drug users participated in the formal economy, but also where HIV risk behaviour occurred. Understanding the interplay between social networks and place is essential for developing HIV prevention and harm reduction policies

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

Science.gov (United States)

Sarang, Anya; Rhodes, Tim; Sheon, Nicolas

2013-10-01

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.

Community health workers: a bridge to healthcare for people who inject drugs.

Science.gov (United States)

Morgan, Kirsty; Lee, Jessica; Sebar, Bernadette

2015-04-01

Although people who inject drugs (PWIDs) have increased healthcare needs, their poor access and utilisation of mainstream primary healthcare services is well documented. To address this situation, community health workers (CHWs) who have personal experience of drug injecting in addition to healthcare training or qualifications are sometimes utilised. However, the role peer workers play as members of clinical primary healthcare teams in Australia and how they manage the healthcare needs of PWID, has been poorly documented. A qualitative ethnomethodological approach was used to study the methods used by CHWs. Data was collected using participant observation of CHWs in a PWID-targeted primary healthcare centre. CHW healthcare consultations with PWID were audio-recorded and transcribed verbatim. Transcripts along with field notes were analysed using membership categorisation and conversation analysis techniques to reveal how CHWs' personal and professional experience shapes their healthcare interactions with PWID clients. CHWs' personal experience of injecting drug use is an asset they utilise along with their knowledge of clinical practice and service systems. It provides them with specialised knowledge and language--resources that they draw upon to build trust with clients and accomplish transparent, non-judgmental interactions that enable PWID clients to be active participants in the management of their healthcare. Existing literature often discusses these principles at a theoretical level. This study demonstrates how CHWs achieve them at a micro-level through the use of indexical language and displays of the membership categories 'PWID' and 'healthcare worker'. This research explicates how CHWs serve as an interface between PWID clients and conventional healthcare providers. CHWs deployment of IDU-specific language, membership knowledge, values and behaviours, enable them to interact in ways that foster transparent communication and client participation in

Air quality overview assessment of thermal power generation in Vancouver, BC

International Nuclear Information System (INIS)

Caton, R.B.; Brotherston, A.E.

1992-01-01

B.C. Hydro is preparing a 25 year utilization plan for Burrard Thermal Generating Plant, a 900 MW natural gas fired steam boiler facility near Vancouver. Historical emissions from the plant and ambient air quality in the region were reviewed to place plant operations in context of the technological modifications which have been made over the past 10 years. Environmental effects criteria and regulatory developments which may constrain planning were reviewed and evaluated. Unit emission rates at Burrard have been reduced by 40% since 1989, by extensive combustion modifications, to ca 40 ng/J of NOx. Nevertheless, anticipated regulatory requirements of emissions reductions nationally and in the Vancouver region will necessitate further reductions, or equivalent strategies, over the next ten years. The findings of the Burrard Thermal air quality review are summarized, including historical emissions in the Lower Mainland, transport and transformation of oxidants and acidic deposition, human health impacts, and vegetation impacts. The difficulties that arise in evaluating the imapct of an isolated source of NOx in an urban area are discussed. 30 refs., 5 figs., 6 tabs

The impact of visual air quality on tourism revenues in Greater Vancouver and the Lower Fraser Valley

Energy Technology Data Exchange (ETDEWEB)

McNeill, R. [Environment Canada, Vancouver, BC (Canada); Roberge, A.

2000-07-01

The Greater Vancouver area has been experiencing common episodes of poor visibility as a result of urban and agricultural sources of emissions. A study was conducted to determine the response of tourists in the Vancouver and Lower Fraser Valley Regions to visible air quality and to estimate the potential losses in tourist revenue due to poor visibility episodes. This was accomplished using an interactive survey of tourists in 1999. The results were statistically analyzed to develop visibility response functions. A simple economic model based on the visibility response function was then created to predict losses in tourist revenue. The group of tourists were shown four photographic slides of the Valley and Vancouver area depicting various stages of degradation in visibility. They were asked to rate each slide as either acceptable or unacceptable (if they would not make a return visit). Unacceptability rates for the four camera locations were statistically analyzed. The effect of clouds and the measurable visibility parameter was examined. The model predicts future tourist revenue losses in the amount of $7.45 million for the Greater Vancouver Area and $1.32 million in the Fraser Valley. It was recommended that further research should be conducted with more camera locations to provide a wider variety of viewpoints for assessment. This study can provide direction in setting policies to improve visibility in the region. 25 refs., 20 tabs., 4 figs., 3 appendices.

The impact of compulsory drug detention exposure on the avoidance of healthcare among injection drug users in Thailand.

Science.gov (United States)

Kerr, Thomas; Hayashi, Kanna; Ti, Lianping; Kaplan, Karyn; Suwannawong, Paisan; Wood, Evan

2014-01-01

Although Thailand has relied on the use of compulsory drug detention centres as a strategy to try to address problematic drug use, little is known about the effects of exposure to these centres on people who inject drugs (IDU). Therefore, we undertook this study to explore whether exposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU. Using Poisson regression analyses, we examined the relationship between compulsory drug detention exposure and avoiding healthcare among participants in the Mitsampan Community Research Project based in Bangkok. 435 IDU participated in this study, including 111 (25.5%) participants who reported avoiding healthcare. In multivariate analyses, avoiding healthcare was positively associated with exposure to compulsory drug detention (adjusted prevalence ratio [APR]=1.60; 95% confidence interval [CI]: 1.16-2.21), having been refused healthcare (APR=3.46; 95% CI: 2.61-4.60), and experiencing shame associated with one's drug use (APR=1.93; 95% CI: 1.21-3.09). Exposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU, suggesting that this system of detention may be contributing to the burden of preventable morbidity among IDU in this setting. Although further research is needed to confirm these findings, the results of this study reinforce previous calls to replace the system of compulsory drug detention with evidence-based public health interventions for IDU. Copyright © 2013 Elsevier B.V. All rights reserved.

Institutional ethical review and ethnographic research involving injection drug users: a case study.

Science.gov (United States)

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. Copyright © 2013 Elsevier Ltd. All rights reserved.

Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs

Science.gov (United States)

Platt, Lucy; Minozzi, Silvia; Reed, Jennifer; Vickerman, Peter; Hagan, Holly; French, Clare; Jordan, Ashly; Degenhardt, Louisa; Hope, Vivian; Hutchinson, Sharon; Maher, Lisa; Palmateer, Norah; Taylor, Avril; Bruneau, Julie; Hickman, Matthew

2017-01-01

Background Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs Needle syringe programmes (NSP) and opioid substitution therapy (OST) are the primary interventions to reduce hepatitis C (HCV) transmission in people who inject drugs. There is good evidence for the effectiveness of NSP and OST in reducing injecting risk behaviour and increasing evidence for the effectiveness of OST and NSP in reducing HIV acquisition risk, but the evidence on the effectiveness of NSP and OST for preventing HCV acquisition is weak. Objectives To assess the effects of needle syringe programmes and opioid substitution therapy, alone or in combination, for preventing acquisition of HCV in people who inject drugs. Search methods We searched the Cochrane Drug and Alcohol Register, CENTRAL, the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA), the NHS Economic Evaluation Database (NHSEED), MEDLINE, Embase, PsycINFO, Global Health, CINAHL, and the Web of Science up to 16 November 2015. We updated this search in March 2017, but we have not incorporated these results into the review yet. Where observational studies did not report any outcome measure, we asked authors to provide unpublished data. We searched publications of key international agencies and conference abstracts. We reviewed reference lists of all included articles and topic-related systematic reviews for eligible papers. Selection criteria We included prospective and retrospective cohort studies, cross-sectional surveys, case-control studies and randomised controlled trials that measured exposure to NSP and/or OST against no intervention or a reduced exposure and reported HCV incidence as an outcome in people who inject drugs. We defined interventions as current OST (within previous 6 months), lifetime use of OST and high NSP coverage (regular attendance at

HIV prevalence and risk among people who inject drugs in five South African cities.

Science.gov (United States)

Scheibe, Andrew; Makapela, David; Brown, Ben; dos Santos, Monika; Hariga, Fabienne; Virk, Harsheth; Bekker, Linda-Gail; Lyan, Olga; Fee, Nancy; Molnar, Margarete; Bocai, Alina; Eligh, Jason; Lehtovuori, Riku

2016-04-01

Policy and programming for people who inject drugs (PWID) in South Africa is limited by the scarcity of epidemiological data. We conducted a cross-sectional survey among 450 PWID (362 males and 88 females) from five South African cities in 2013, using outreach and peer referral to recruit participants. We carried out rapid HIV tests on participants' saliva and assessed drug-using and sexual practices by means of a questionnaire. We found that 26% of females and 13% of males reported to always share injecting equipment, while 49% of all participants had used contaminated injecting equipment the last time they injected. Only 6% of participants usually used bleach to clean their injecting equipment. We found that half of participants reported using a condom the last time they had sex. A quarter of participants reported symptoms of a sexually transmitted infection (STI) in the previous 12 months and 22% had ever worked as a sex worker (51% of females). HIV prevalence among participants was 14% (18% among females and 13% among males). In multivariate analysis HIV was significantly associated with being 25 years and older (adjusted odds ratio (aOR) 2.1, 95% confidence interval (CI) 1.0-4.6, p=0.06), belonging to a racial group other than white (aOR 4.2, 95% CI 1.9-9.4, p<0.001), coming from Gauteng province (aOR 2.3, 95% CI 1.1-5.5, p=0.023), having ever worked as a sex worker (aOR 3.4, 95% CI 1.7-7.2, p=0.001) and the presence of STI symptoms in the last 12 months (aOR 2.4, 95% CI 1.1-4.4, p=0.019). This study highlights the need for increased access to sterile injecting equipment, education around safer injecting practices and access to sexual and reproductive health services for PWID in South Africa. Programmes for PWID should also address the specific needs of female PWID, PWID who sell sex and PWID from previously disadvantaged communities. Copyright © 2016 Elsevier B.V. All rights reserved.

Development of self-forming doxorubicin-loaded polymeric depots as an injectable drug delivery system for liver cancer chemotherapy.

Science.gov (United States)

Nittayacharn, Pinunta; Nasongkla, Norased

2017-07-01

The objective of this work was to develop self-forming doxorubicin-loaded polymeric depots as an injectable drug delivery system for liver cancer chemotherapy and studied the release profiles of doxorubicin (Dox) from different depot formulations. Tri-block copolymers of poly(ε-caprolactone), poly(D,L-lactide) and poly(ethylene glycol) named PLECs were successfully used as a biodegradable material to encapsulate Dox as the injectable local drug delivery system. Depot formation and encapsulation efficiency of these depots were evaluated. Results show that depots could be formed and encapsulate Dox with high drug loading content. For the release study, drug loading content (10, 15 and 20% w/w) and polymer concentration (25, 30, and 35% w/v) were varied. It could be observed that the burst release occurred within 1-2 days and this burst release could be reduced by physical mixing of hydroxypropyl-beta-cyclodextrin (HP-β-CD) into the depot system. The degradation at the surface and cross-section of the depots were examined by Scanning Electron Microscope (SEM). In addition, cytotoxicity of Dox-loaded depots and blank depots were tested against human liver cancer cell lines (HepG2). Dox released from depots significantly exhibited potent cytotoxic effect against HepG2 cell line compared to that of blank depots. Results from this study reveals an important insight in the development of injectable drug delivery system for liver cancer chemotherapy. Schematic diagram of self-forming doxorubicin-loaded polymeric depots as an injectable drug delivery system and in vitro characterizations. (a) Dox-loaded PLEC depots could be formed with more than 90% of sustained-release Dox at 25% polymer concentration and 20% Dox-loading content. The burst release occurred within 1-2 days and could be reduced by physical mixing of hydroxypropyl-beta-cyclodextrin (HP-β-CD) into the depot system. (b) Dox released from depots significantly exhibited potent cytotoxic effect against human

High prevalence of latent tuberculosis infection among injection drug users in Tijuana, Mexico.

Science.gov (United States)

Garfein, R S; Lozada, R; Liu, L; Laniado-Laborin, R; Rodwell, T C; Deiss, R; Alvelais, J; Catanzaro, A; Chiles, P G; Strathdee, S A

2009-05-01

We studied prevalence and correlates of latent tuberculosis infection (LTBI) among injection drug users (IDUs) in Tijuana, Mexico, where tuberculosis (TB) is endemic. IDUs aged > or =18 years were recruited via respondent-driven sampling (RDS) and underwent standardized interviews, human immunodeficiency virus (HIV) antibody testing and LTBI screening using Quanti-FERON((R))-TB Gold In-Tube, a whole-blood interferon-gamma release assay (IGRA). LTBI prevalence was estimated and correlates were identified using RDS-weighted logistic regression. Of 1020 IDUs, 681 (67%) tested IGRA-positive and 44 (4%) tested HIV-positive. Mean age was 37 years, 88% were male and 98% were Mexican-born. IGRA positivity was associated with recruitment nearest the US border (aOR 1.64, 95%CI 1.09-2.48), increasing years of injection (aOR 1.20/5 years, 95%CI 1.07-1.34), and years lived in Tijuana (aOR 1.10/5 years, 95%CI 1.03-1.18). Speaking some English (aOR 0.38, 95%CI 0.25-0.57) and injecting most often at home in the past 6 months (aOR 0.68, 95%CI 0.45-0.99) were inversely associated with IGRA positivity. Increased LTBI prevalence among IDUs in Tijuana appears to be associated with greater drug involvement. Given the high risk for HIV infection among Tijuana's IDUs, interventions are urgently needed to prevent HIV infection and treat LTBI among IDUs before these epidemics collide.

"Vivo para consumirla y la consumo para vivir" ["I live to inject and inject to live"]: high-risk injection behaviors in Tijuana, Mexico.

Science.gov (United States)

Strathdee, Steffanie A; Fraga, Wendy Davila; Case, Patricia; Firestone, Michelle; Brouwer, Kimberly C; Perez, Saida Gracia; Magis, Carlos; Fraga, Miguel Angel

2005-09-01

Injection drug use is a growing problem on the US-Mexico border, where Tijuana is situated. We studied the context of injection drug use among injection drug users (IDUs) in Tijuana to help guide future research and interventions. Guided in-depth interviews were conducted with 10 male and 10 female current IDUs in Tijuana. Topics included types of drug used, injection settings, access to sterile needles, and environmental influences. Interviews were taped, transcribed verbatim, and translated. Content analysis was conducted to identify themes. Of the 20 IDUs, median age and age at first injection were 30 and 18. Most reported injecting at least daily: heroin ("carga", "chiva", "negra"), methamphetamine ("crico", "cri-cri"), or both drugs combined. In sharp contrast to Western US cities, almost all regularly attended shooting galleries ("yongos" or "picaderos") because of the difficulties obtaining syringes and police oppression. Almost all shared needles/paraphernalia ["cuete" (syringe), "cacharros" (cookers), cotton from sweaters/socks (filters)]. Some reported obtaining syringes from the United States. Key themes included (1) pharmacies refusing to sell or charging higher prices to IDUs, (2) ample availability of used/rented syringes from "picaderos" (e.g., charging approximately 5 pesos or "10 drops" of drug), and (3) poor HIV/AIDS knowledge, such as beliefs that exposing syringes to air "kills germs." This qualitative study suggests that IDUs in Tijuana are at high risk of HIV and other blood-borne infections. Interventions are urgently needed to expand access to sterile injection equipment and offset the potential for a widespread HIV epidemic.

Differential experiences of Mexican policing by people who inject drugs residing in Tijuana and San Diego.

Science.gov (United States)

Wood, Emily F; Werb, Dan; Beletsky, Leo; Rangel, Gudelia; Cuevas Mota, Jazmine; Garfein, Richard S; Strathdee, Steffanie A; Wagner, Karla D

2017-03-01

Research among people who inject drugs (PWIDs) in the USA and Mexico has identified a range of adverse health impacts associated with policing of PWIDs. We employed a mixed methods design to investigate how PWIDs from San Diego and Mexico experienced policing in Tijuana, and how these interactions affect PWIDs behavior, stratifying by country of origin. In 2012-2014, 575 PWIDs in San Diego, 102 of whom had used drugs in Mexico in the past six months, were enrolled in the STAHR-II study, with qualitative interviews conducted with a subsample of 20 who had recently injected drugs in Mexico. During this period, 735 PWIDs in Tijuana were also enrolled in the El Cuete-IV study, with qualitative interviews conducted with a subsample of 20 recently stopped by police. We calculated descriptive statistics for quantitative variables and conducted thematic analysis of qualitative transcripts. Integration of these data involved comparing frequencies across cohorts and using qualitative themes to explain and explore findings. Sixty-one percent of San Diego-based participants had been recently stopped by law enforcement officers (LEOs) in Mexico; 53% reported it was somewhat or very likely that they would be arrested while in Mexico because they look like a drug user. Ninety percent of Tijuana-based participants had been recently stopped by LEOs; 84% reported it was somewhat or very likely they could get arrested because they look like a drug user. Participants in both cohorts described bribery and targeting by LEOs in Mexico. However, most San Diego-based participants described compliance with bribery as a safeguard against arrest and detention, with mistreatment being rare. Tijuana-based participants described being routinely targeted by LEOs, were frequently detained, and reported instances of sexual and physical violence. Tijuana-based participants described modifying how, where, and with whom they injected drugs in response; and experienced feelings of stress, anxiety, and

Differential experiences of Mexican policing by people who inject drugs residing in Tijuana and San Diego

Science.gov (United States)

Wood, Emily F.; Werb, Dan; Beletsky, Leo; Rangel, Gudelia; Mota, Jazmine Cuevas; Garfein, Richard S.; Strathdee, Steffanie A.; Wagner, Karla D.

2017-01-01

Background Research among people who inject drugs (PWIDs) in the USA and Mexico has identified a range of adverse health impacts associated with policing of PWIDs. We employed a mixed methods design to investigate how PWIDs from San Diego and Mexico experienced policing in Tijuana, and how these interactions affect PWIDs behavior, stratifying by country of origin. Methods In 2012–2014, 575 PWIDs in San Diego, 102 of whom had used drugs in Mexico in the past six months, were enrolled in the STAHR-II study, with qualitative interviews conducted with a subsample of 20 who had recently injected drugs in Mexico. During this period, 735 PWIDs in Tijuana were also enrolled in the El Cuete-IV study, with qualitative interviews conducted with a subsample of 20 recently stopped by police. We calculated descriptive statistics for quantitative variables and conducted thematic analysis of qualitative transcripts. Integration of these data involved comparing frequencies across cohorts and using qualitative themes to explain and explore findings. Results Sixty-one percent of San Diego-based participants had been recently stopped by law enforcement officers (LEOs) in Mexico; 53% reported it was somewhat or very likely that they would be arrested while in Mexico because they look like a drug user. Ninety percent of Tijuana-based participants had been recently stopped by LEOs; 84% reported it was somewhat or very likely they could get arrested because they look like a drug user. Participants in both cohorts described bribery and targeting by LEOs in Mexico. However, most San Diego-based participants described compliance with bribery as a safeguard against arrest and detention, with mistreatment being rare. Tijuana-based participants described being routinely targeted by LEOs, were frequently detained, and reported instances of sexual and physical violence. Tijuana-based participants described modifying how, where, and with whom they injected drugs in response; and experienced

Trends in methamphetamine use in young injection drug users in San Francisco from 1998 to 2004: the UFO Study.

Science.gov (United States)

Inglez-Dias, Aline; Hahn, Judith A; Lum, Paula J; Evans, Jennifer; Davidson, Peter; Page-Shafer, Kimberly

2008-05-01

To describe temporal trends in methamphetamine use among young injection drug users (IDU) in San Francisco. Secondary analysis of cross-sectional baseline data collected for a longitudinal study of young IDU from 1998 to 2004. Participants were 1445 young IDU (<30 years old) who reported injection in the previous month, English-speaking, and recruited by street outreach methods. We examined trends for: lifetime (ever) and recent (30-day) methamphetamine use, including injected and non-injected, and by age group and sexual risk behaviour [men who have sex with men injecting drug users (MSM-IDU), male IDU (non-MSM) and female IDU]. In 1998, 1999, 2000, 2001, 2003 and 2004 we interviewed 237, 276, 431, 310, 147 and 44 participants, respectively. Overall, median age was 22 years [interquartile range (IQR) 20-25], 30.3% were women and median duration of injecting was 4.4 years (IQR 2-7). Prevalence of methamphetamine use was high, with 50.1% reporting recent injection, but overall there were no temporal increases in reported 'ever' injected use. Recent methamphetamine injection (past 30 days) increased significantly, and peaked at 60% in 2003. MSM-IDU had higher methamphetamine injection ever (92.3%) and recently (59.5%) compared to heterosexual male (non-MSM) IDU (81.6% and 47.3%, respectively) and to female IDU (78.4% and 46.1%, respectively). Despite reports of ubiquitous increases in methamphetamine use, there were no significant increases in 6 years in ever injecting methamphetamine overall among young IDU. MSM-IDU who reported the highest methamphetamine use overall reported some increases in recent injected use. The methamphetamine 'epidemic' was probably under way among young IDU earlier than other populations.

77 FR 4227 - Implantation or Injectable Dosage Form New Animal Drugs; Gonadotropin Releasing Factor Analog...

Science.gov (United States)

2012-01-27

... Factor Analog-Diphtheria Toxoid Conjugate AGENCY: Food and Drug Administration, HHS. ACTION: Final rule... extends the slaughter interval for intact male swine injected with gonadotropin releasing factor analog...-322 for IMPROVEST (gonadotropin releasing factor analog-diphtheria toxoid conjugate) Sterile Solution...

Impact of Conflict and Displacement on Risk Behaviours Amongst People Who Inject Drugs in Kabul, Afghanistan

Science.gov (United States)

Todd, Catherine S.; Nasir, Abdul; Stanekzai, Mohammad Raza; Fiekert, Katja; Sipsma, Heather L.; Strathdee, Steffanie A.; Vlahov, David

2015-01-01

Background Theoretical work posits that drug-related risk behaviour increases during armed conflict; however, few studies have been conducted in conflict settings. The objective of this analysis is to determine whether conflict or local displacement impact risk behaviours among people who inject drugs (PWID) in Kabul, Afghanistan. Methods Consenting PWIDs aged ≥18 years completed interviews at 3, 6, 9, 12, 18, and 24 months of follow-up. Quarters with peak conflict or local displacement exposure were defined and associations with injecting drug use and sexual risk behaviours analysed with generalized estimating equations. Results Of 483 PWID enrolled, 385 completed ≥1 follow-up visit (483.8 person-years) between 2007 and 2009. All participants were male, with 35% initiating injecting as a refugee. Sharing syringes (Odds Ratio (OR))=8.53, 95% Confidence Interval (CI): 2.58 – 28.2) and sexually transmitted infection (STI) symptoms (OR=1.72, 95% CI: 1.00 – 2.96) increased significantly during peak conflict quarters, while odds of STI symptoms (OR=0.06, 95% CI: 0.02 – 0.20) and arrest (OR=0.61, 95% CI: 0.40 – 0.93) were significantly lower during periods of displacement. Conclusion Syringe sharing significantly increased during peak conflict periods amongst PWID in Kabul. Programming should include instruction for coping with conflict and prepare clients for harm reduction needs during conflict. PMID:26303577

Use of synthetic cathinones and cannabimimetics among injection drug users in San Diego, California.

Science.gov (United States)

Wagner, Karla D; Armenta, Richard F; Roth, Alexis M; Maxwell, Jane C; Cuevas-Mota, Jazmine; Garfein, Richard S

2014-08-01

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. We used logistic regression analysis to identify correlates of SC and TH use among 485 IDUs enrolled from June 2012 to September 2013. 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. 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. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Perceived risk of HIV infection among deported male injection drug users in Tijuana, Mexico.

Science.gov (United States)

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.

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

Directory of Open Access Journals (Sweden)

sheard Laura

2007-10-01

Full Text Available Abstract 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.

Correlates of perceived risk of HIV infection among persons who inject drugs in Tijuana, Baja California, Mexico.

Science.gov (United States)

Armenta, Richard F; Abramovitz, Daniela; Lozada, Remedios; Vera, Alicia; Garfein, Richard S; Magis-Rodríguez, Carlos; Strathdee, Steffanie A

2015-01-01

We identified correlates of perceived risk of HIV infection among persons who inject drugs (PWID) in Tijuana. PWID ≥18 years of age who injected drugs in the past month were recruited between 2006-2007 and completed risk assessment interviews and serologic testing for HIV, syphilis, and tuberculosis. Logistic regression was used to determine factors associated with high-perceived risk of HIV infection. Among 974 PWID, HIV prevalence was 4.4%; 45.0% of participants perceived themselves to be more likely to become HIV infected relative to other PWID in Tijuana. Participants who reported high-perceived risk of HIV infection participated in high-risk behaviors such as injecting with used syringes, transactional sex, and were less likely to have had an HIV test. Recognition of HIV infection risk was associated with high risk behaviors and markers of vulnerability. Findings support efforts to encourage HIV testing and access to health care for this vulnerable population.

Randomized Clinical Trial of Periarticular Drug Injection used in combination Patient-Controlled Analgesia versus Patient-Controlled Analgesia Alone in Total Knee Arthroplasty

Directory of Open Access Journals (Sweden)

MN Sabran

2008-11-01

Full Text Available This is a prospective randomized clinical trial to compare use of a combination of periarticular drug injection with patient- controlled analgesia (PCA to PCA alone in post-total knee arthroplasty (TKA. Thirty patients who were admitted for unilateral total knee arthroplasty were selected randomly into an Injection group or a Standard group. The periarticular injection contained Ropivacaine, Ketorolac and Adrenaline, given intra-operatively. The mean amount of opioid used was 22.87 mmol/L in the Injection group as compared to 39.78 mmol/L in the Standard group (p = 0.026. The Injection group had lower pain score at rest and during exercise (p=0.021, p=0.041, respectively, as well as better return to function (p=0.026 and shorter hospital stay (6.1 days, Injection; 7.5 days, Standard, p=0.027. Overall, the group receiving periarticular drugs injection had less pain, less narcotic usage, earlier return to function, similar experience of adverse effects and shorter hospital stays.

Sexual violence from police and HIV risk behaviours among HIV-positive women who inject drugs in St. Petersburg, Russia - a mixed methods study.

Science.gov (United States)

Lunze, Karsten; Raj, Anita; Cheng, Debbie M; Quinn, Emily K; Lunze, Fatima I; Liebschutz, Jane M; Bridden, Carly; Walley, Alexander Y; Blokhina, Elena; Krupitsky, Evgeny; Samet, Jeffrey H

2016-01-01

Police violence against people who inject drugs (PWID) is common in Russia and associated with HIV risk behaviours. Sexual violence from police against women who use drugs has been reported anecdotally in Russia. This mixed-methods study aimed to evaluate sexual violence from police against women who inject drugs via quantitative assessment of its prevalence and HIV risk correlates, and through qualitative interviews with police, substance users and their providers in St. Petersburg, Russia. Cross-sectional analyses with HIV-positive women who inject drugs (N=228) assessed the associations between sexual violence from police (i.e. having been forced to have sex with a police officer) and the following behaviours: current drug use, needle sharing and injection frequency using multiple regression models. We also conducted in-depth interviews with 23 key informants, including PWID, police, civil society organization workers, and other stakeholders, to explore qualitatively the phenomenon of sexual violence from police in Russia and strategies to address it. We analyzed qualitative data using content analysis. Approximately one in four women in our quantitative study (24.1%; 95% CI, 18.6%, 29.7%) reported sexual violence perpetrated by police. Affected women reported more transactional sex for drugs or money than those who were not; however, the majority of those reporting sexual violence from police were not involved in these forms of transactional sex. Sexual violence from police was not significantly associated with current drug use or needle sharing but with more frequent drug injections (adjusted incidence rate ratio 1.43, 95% CI 1.04, 1.95). Qualitative data suggested that sexual violence and coercion by police appear to be entrenched as a norm and are perceived insurmountable because of the seemingly absolute power of police. They systematically add to the risk environment of women who use drugs in Russia. Sexual violence from police was common in this cohort of

Using drugs in un/safe spaces: Impact of perceived illegality on an underground supervised injecting facility in the United States.

Science.gov (United States)

Davidson, Peter J; Lopez, Andrea M; Kral, Alex H

2018-03-01

Supervised injection facilities (SIFs) are spaces where people can consume pre-obtained drugs in hygienic circumstances with trained staff in attendance to provide emergency response in the event of an overdose or other medical emergency, and to provide counselling and referral to other social and health services. Over 100 facilities with formal legal sanction exist in ten countries, and extensive research has shown they reduce overdose deaths, increase drug treatment uptake, and reduce social nuisance. No facility with formal legal sanction currently exists in the United States, however one community-based organization has successfully operated an 'underground' facility since September 2014. Twenty three qualitative interviews were conducted with people who used the underground facility, staff, and volunteers to examine the impact of the facility on peoples' lives, including the impact of lack of formal legal sanction on service provision. Participants reported that having a safe space to inject drugs had led to less injections in public spaces, greater ability to practice hygienic injecting practices, and greater protection from fatal overdose. Constructive aspects of being 'underground' included the ability to shape rules and procedures around user need rather than to meet political concerns, and the rapid deployment of the project, based on immediate need. Limitations associated with being underground included restrictions in the size and diversity of the population served by the site, and reduced ability to closely link the service to drug treatment and other health and social services. Unsanctioned supervised injection facilities can provide a rapid and user-driven response to urgent public health needs. This work draws attention to the need to ensure such services remain focused on user-defined need rather than external political concerns in jurisdictions where supervised injection facilities acquire local legal sanction. Copyright © 2017 Elsevier B.V. All

COMMUNICATING RISK IN THE CONTEXT OF METHADONE FORMULATION CHANGES: A QUALITATIVE STUDY OF OVERDOSE WARNING POSTERS IN VANCOUVER, CANADA

Science.gov (United States)

Markwick, Nicole; McNeil, Ryan; Anderson, Solanna; Small, Will; Kerr, Thomas

2015-01-01

BACKGROUND British Columbia, Canada’s provincial methadone program recently replaced their existing methadone formulation with a formulation ten times more concentrated. The transition raised concerns about heightened risk of accidental overdose, leading two organizations to disseminate methadone overdose warning posters during the transitional period. This study explores people who use drugs’ (PWUD) perceptions of these warning posters. METHODS Qualitative interviews were conducted with thirty-four PWUD enrolled in methadone maintenance treatment in Vancouver. Participants were recruited from ongoing cohort studies of drug-using individuals. Interview transcripts were analyzed thematically, focusing on participants’ perceptions of the warning posters and potential impacts on drug-related risks. RESULTS Overdose warning posters constituted a key source of information about the methadone formulation change, but did not provide adequate information for all participants. Participants articulated a preference for descriptive language, focusing on changes in concentration rather than “strength”, and universal hazard symbols to effectively communicate overdose risks. CONCLUSION Participants indicated that warnings employing descriptive language more effectively communicated risk of methadone overdose. Future overdose warnings for drug-using populations must provide adequate information for the intended audience, and be communicated to PWUD through multiple channels. PMID:26644025

Injection Drug Use and Hepatitis C as Risk Factors for Mortality in HIV-Infected Individuals

DEFF Research Database (Denmark)

May, Margaret T; Justice, Amy C; Birnie, Kate

2015-01-01

BACKGROUND: HIV-infected individuals with a history of transmission through injection drug use (IDU) have poorer survival than other risk groups. The extent to which higher rates of hepatitis C (HCV) infection in IDU explain survival differences is unclear. METHODS: Adults who started...

Risk factors for HIV infection in injection drug users and evidence for onward transmission of HIV to their sexual partners in Chennai, India.

Science.gov (United States)

Panda, Samiran; Kumar, M Suresh; Lokabiraman, S; Jayashree, K; Satagopan, M C; Solomon, Suniti; Rao, Usha Anand; Rangaiyan, Gurumurthy; Flessenkaemper, Sabine; Grosskurth, Heiner; Gupte, Mohan D

2005-05-01

Determining HIV prevalence in injection drug users (IDUs) and their regular sex partners in Chennai, India. A total of 226 IDUs and their regular sex partners were enrolled during April-July 2003. After informed consent was obtained, a semistructured questionnaire was administered and serum was tested for HIV antibody. The HIV seroprevalence was 30% (68/226) in IDUs and 5% in their regular sex partners (11/226). While in 25% of couples only the male partner was HIV positive, 5% of the couples were concordant for HIV infection and 70% were HIV negative. Fifty-seven percent of the HIV-positive IDUs and 45% of the HIV-infected women thought that they had "no chance" or "very little chance" of getting HIV, reflecting low HIV risk perception. More than 20% IDUs reported borrowing or lending of injection equipment. In univariate analyses "sex" and "condom use" with sex workers had no bearing but "more than twice a day injecting frequency," "history of incarceration," "tattoos," "recruitment from northern part of the city," and ever-injecting drugs in drug-selling places had significant association with HIV infection in IDUs. In an adjusted model, the odds of HIV infection were 2 times higher among IDUs who had ever injected drugs in drug-selling places and 6 times higher in those who were recruited from the northern part of central Chennai. Reducing sharing of injection equipment and unsafe tattooing through targeted and environmental interventions, increasing HIV risk perception, and promoting safer sex practices among IDUs and their sex partners are urgent program needs.

Diverse HIV epidemics among people who inject drugs in Thailand: Evidence from respondent-driven sampling surveys in Bangkok and Chiang Mai☆

Science.gov (United States)

Prybylski, Dimitri; Manopaiboon, Chomnad; Visavakum, Prin; Yongvanitjit, Kovit; Aramrattana, Apinun; Manomaipiboon, Parnrudee; Tanpradech, Suvimon; Suksripanich, Orapin; Pattanasin, Sarika; Wolfe, Mitchell; Whitehead, Sara J.

2016-01-01

Background Thailand’s long-standing HIV sero-sentinel surveillance system for people who inject drugs (PWID) is confined to those in methadone-based drug treatment clinics and representative data are scarce, especially outside of Bangkok. Methods We conducted probability-based respondent-driven sampling (RDS) surveys in Bangkok (n = 738) and Chiang Mai (n = 309) to increase understanding of local HIV epidemics and to better inform the planning of evidence-based interventions. Results PWID had different epidemiological profiles in these two cities. Overall HIV prevalence was higher in Bangkok (23.6% vs. 10.9%, p Chiang Mai, HIV infections appear to be more recently acquired and PWID were younger and had higher levels of recent injecting and sexual risk behaviors with lower levels of intervention exposure. Methamphetamine was the predominant drug injected in both sites and polydrug use was common although levels and patterns of the specific drugs injected varied significantly between the sites. In multivariate analysis, recent midazolam injection was significantly associated with HIV infection in Chiang Mai (adjusted odds ratio = 8.1; 95% confidence interval: 1.2–54.5) whereas in Bangkok HIV status was not associated with recent risk behaviors as infections had likely been acquired in the past. Conclusion PWID epidemics in Thailand are heterogeneous and driven by local factors. There is a need to customize intervention strategies for PWID in different settings and to integrate population-based survey methods such as RDS into routine surveillance to monitor the national response. PMID:25640153

Diverse HIV epidemics among people who inject drugs in Thailand: evidence from respondent-driven sampling surveys in Bangkok and Chiang Mai.

Science.gov (United States)

Prybylski, Dimitri; Manopaiboon, Chomnad; Visavakum, Prin; Yongvanitjit, Kovit; Aramrattana, Apinun; Manomaipiboon, Parnrudee; Tanpradech, Suvimon; Suksripanich, Orapin; Pattanasin, Sarika; Wolfe, Mitchell; Whitehead, Sara J

2015-03-01

Thailand's long-standing HIV sero-sentinel surveillance system for people who inject drugs (PWID) is confined to those in methadone-based drug treatment clinics and representative data are scarce, especially outside of Bangkok. We conducted probability-based respondent-driven sampling (RDS) surveys in Bangkok (n=738) and Chiang Mai (n=309) to increase understanding of local HIV epidemics and to better inform the planning of evidence-based interventions. PWID had different epidemiological profiles in these two cities. Overall HIV prevalence was higher in Bangkok (23.6% vs. 10.9%, pChiang Mai, HIV infections appear to be more recently acquired and PWID were younger and had higher levels of recent injecting and sexual risk behaviors with lower levels of intervention exposure. Methamphetamine was the predominant drug injected in both sites and polydrug use was common although levels and patterns of the specific drugs injected varied significantly between the sites. In multivariate analysis, recent midazolam injection was significantly associated with HIV infection in Chiang Mai (adjusted odds ratio=8.1; 95% confidence interval: 1.2-54.5) whereas in Bangkok HIV status was not associated with recent risk behaviors as infections had likely been acquired in the past. PWID epidemics in Thailand are heterogeneous and driven by local factors. There is a need to customize intervention strategies for PWID in different settings and to integrate population-based survey methods such as RDS into routine surveillance to monitor the national response. Published by Elsevier Ireland Ltd.

Having multiple sexual partners among Iranian Injection Drug Users

Directory of Open Access Journals (Sweden)

Shervin eAssari

2014-10-01

Full Text Available Background: Transmission of HIV from intra-venous drug users (IDUs to the community occurs predominantly through high-risk sexual behaviors. Limited information exists regarding the high-risk sexual behaviors of IDUs in Iran. Aim. The aim of this study was to determine the prevalence and factors associated with having multiple sexual partners among Iranian IDUs. Methods. This is a national survey on drug-dependent adults. Participants were sampled from medical centers, prisons, and streets of capitals of 29 provinces in Iran, between May 2007 and February 2008. We analyzed data of 1,416 current IDUs. Socio-demographics and drug use characteristics were entered into a binary logistic regression model to determine predictors of having multiple sexual partners. Results. Having multiple sexual partners in the past or at the time of survey was reported by 56.4% of Iranian IDUs. Multivariate analysis showed that the likelihood of having multiple sexual partners in IDUs decreased by being married (odds ratio [OR], 0.38; P < .001 and increased by female gender (OR, 13.44; P = .02, having illegal income (OR, 1.72; P = .003, higher monthly family income (OR, 1.01; P = .003, pleasure, curiosity, and recreation as cause of first drug use (OR, 1.37; P = .04, ruins as usual place for injection (OR, 1.89; P = .001, and history of syringe sharing (OR, 1.50; P = .02. Conclusions. Having multiple sexual partners was reported by majority of Iranian IDUs, and this was linked to socio-demographics, initiation data, and other risk behaviors. This information should be considered in prevention efforts to reduce sexual transmission of HIV infection in Iran.

HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey

Directory of Open Access Journals (Sweden)

Slobodyanyuk Pavel

2009-08-01

Full Text Available Abstract Background Ukraine has experienced an increase in injection drug use since the 1990s. An increase in HIV and hepatitis C virus infections has followed, but not measures of prevalence and risk factors. The purposes of this study are to estimate the prevalence of HIV, HCV, and co-infection among injection drug users (IDUs in central Ukraine and to describe risk factors for HIV and HCV. Methods A sample of 315 IDUs was recruited using snowball sampling for a structured risk interview and HIV/HCV testing (81.9% male, 42% single, average age 28.9 years [range = 18 to 55]. Results HIV and HCV antibodies were detected in 14.0% and 73.0%, respectively, and 12.1% were seropositive for both infections. The most commonly used drug was hanka, home-made from poppy straw and often mixed with other substances including dimedrol, diazepines, and hypnotics. The average period of injecting was 8.5 years; 62.5% reported past-year sharing needles or injection equipment, and 8.0% shared with a known HIV-positive person. More than half (51.1% reported multiple sexual partners, 12.9% buying or selling sex, and 10.5% exchanging sex and drugs in the past year. Those who shared with HIV positive partners were 3.4 times more likely to be HIV positive than those who did not. Those who front- or back-loaded were 4 times more likely to be HCV positive than those who did not. Conclusion Harm reduction, addiction treatment and HIV prevention programs should address risk factors to stop further spread of both HIV and HCV among IDUs and to the general population in central Ukraine.

HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey.

Science.gov (United States)

Dumchev, Kostyantyn V; Soldyshev, Ruslan; Qian, Han-Zhu; Zezyulin, Olexandr O; Chandler, Susan D; Slobodyanyuk, Pavel; Moroz, Larisa; Schumacher, Joseph E

2009-08-23

Ukraine has experienced an increase in injection drug use since the 1990s. An increase in HIV and hepatitis C virus infections has followed, but not measures of prevalence and risk factors. The purposes of this study are to estimate the prevalence of HIV, HCV, and co-infection among injection drug users (IDUs) in central Ukraine and to describe risk factors for HIV and HCV. A sample of 315 IDUs was recruited using snowball sampling for a structured risk interview and HIV/HCV testing (81.9% male, 42% single, average age 28.9 years [range = 18 to 55]). HIV and HCV antibodies were detected in 14.0% and 73.0%, respectively, and 12.1% were seropositive for both infections. The most commonly used drug was hanka, home-made from poppy straw and often mixed with other substances including dimedrol, diazepines, and hypnotics. The average period of injecting was 8.5 years; 62.5% reported past-year sharing needles or injection equipment, and 8.0% shared with a known HIV-positive person. More than half (51.1%) reported multiple sexual partners, 12.9% buying or selling sex, and 10.5% exchanging sex and drugs in the past year. Those who shared with HIV positive partners were 3.4 times more likely to be HIV positive than those who did not. Those who front- or back-loaded were 4 times more likely to be HCV positive than those who did not. Harm reduction, addiction treatment and HIV prevention programs should address risk factors to stop further spread of both HIV and HCV among IDUs and to the general population in central Ukraine.

Ongoing incident hepatitis C virus infection among people with a history of injecting drug use in an Australian prison setting, 2005-2014: The HITS-p study.

Science.gov (United States)

Cunningham, E B; Hajarizadeh, B; Bretana, N A; Amin, J; Betz-Stablein, B; Dore, G J; Luciani, F; Teutsch, S; Dolan, K; Lloyd, A R; Grebely, J

2017-09-01

Hepatitis C virus (HCV) transmission is high in prisons. This study investigated trends in HCV incidence and associated factors among a cohort of prisoners with a history of injecting drug use in New South Wales, Australia. Data were available from the Hepatitis C Incidence and Transmission Study-prisons (HITS-p) from 2005 to 2014. Temporal trends in HCV incidence were evaluated. Factors associated with time to HCV seroconversion among people with ongoing injecting was assessed using Cox proportional hazards. Among 320 antibody-negative participants with a history of injecting drug use (mean age 26; 72% male), 62% (n=197) reported injecting drug use during follow-up. Overall, 93 infections were observed. HCV incidence was 11.4/100 person-years in the overall population and 6.3/100 person-years among the continually imprisoned population. A stable trend in HCV incidence was observed. Among the overall population with ongoing injecting during follow-up, ≥weekly injecting drug use frequency was independently associated with time to HCV seroconversion. Among continuously imprisoned injectors with ongoing injecting during follow-up, needle/syringe sharing was independently associated with time to HCV seroconversion. This study demonstrates that prison is a high-risk environment for acquisition of HCV infection. Needle and syringe sharing was associated with HCV infection among continually imprisoned participants, irrespective of frequency of injecting or the type of drug injected. These findings highlight the need for the evaluation of improved HCV prevention strategies in prison, including needle/syringe programmes and HCV treatment. © 2017 John Wiley & Sons Ltd.

Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region.

Science.gov (United States)

Strathdee, Steffanie A; Lozada, Remedios; Martinez, Gustavo; Vera, Alicia; Rusch, Melanie; Nguyen, Lucie; Pollini, Robin A; Uribe-Salas, Felipe; Beletsky, Leo; Patterson, Thomas L

2011-04-25

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. 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. 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%, psocial 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.

Personal characteristics associated with injecting drug use among Latinas in the United States of America

Directory of Open Access Journals (Sweden)

Jorge Delva

1998-11-01

Full Text Available This study examines nonmedical injecting drug use (IDU among Latinas aged 12 years and older in a nationally representative sample of U.S. households. Data from the 1990-1995 National Household Surveys on Drug Abuse disclosed 154 Latinas with self-reported histories of IDU out of 18 335 Latinas who responded. Hypotheses about correlates of IDU were tested by using the conditional form of multiple logistic regression to compare the characteristics of these IDUs with those of 602 noninjecting Latinas matched on neighborhood of residence. In the USA, an estimated 1% of Latinas age 12 years and older have injected drugs for non-medical purposes on at least one occasion. IDU was 4.6 to 6.5 times greater for adult Latinas (18-44 years old when compared to Latinas aged either 12 through 17 years (P < 0.05 or older than 44 years. IDU was an estimated 7.1 times greater for Latinas who reported marijuana use and 5.4 times greater for Latinas who reported inhalant use when compared to Latinas not using these drugs (P < 0.01. In light of recent studies indicating that IDU is a serious public health problem for Latinas in the United States, the observed associations represent first steps in an effort to understand the Latina subgroups most affected by IDU and the underlying risk factors or causes of this behavior.

[Professional practice evaluation of injectable drug preparation and administration in neonatology].

Science.gov (United States)

Morin, P; Guillois, B; Gloanec, L; Chatelier, N; Saint-Lorant, G

2017-09-01

Adverse drug events are a daily concern in neonatology departments. The aim of this study was to assess the professional practices of preparation and administration of injectable forms of medications in neonatology. A professional practice evaluation with regard to the preparation and administration of various injectable forms of medications in different neonatology units within a given department was conducted by a pharmacy intern based on an assessment grid comprising ten criteria. Following an initial assessment, the results were presented to the care team, which validated the corrective measures put forward by a multiprofessional work group. A second assessment was conducted following the same methodology. Fifty of the department's 76 pediatric nurses were assessed during the first round of the audit and 21 during the second round. Two improvement priorities were identified: taking account of the dead volume of medication in needles and syringe hubs, together with complete identification of syringes used to administer medication. During the second round, these two aspects were improved, progressing from 38% to 100% and from 59% to 89%, respectively. To improve drug administration in neonatology and consequently, to improve patient safety, professional practice evaluation is an essential tool that requires close collaboration between the paramedical team, physicians and pharmacists. Its main value lies in the mobilization of the entire team around the subject in question, hence generating improved understanding and application of corrective measures. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Interest in low-threshold employment among people who inject illicit drugs: implications for street disorder.

Science.gov (United States)

Debeck, Kora; Wood, Evan; Qi, Jiezhi; Fu, Eric; McArthur, Doug; Montaner, Julio; Kerr, Thomas

2011-09-01

Income generation opportunities available to people who use illicit drugs have been associated with street disorder. Among a cohort of injection drug users (IDU) we sought to examine street-based income generation practices and willingness to forgo these sources of income if other low-threshold work opportunities were made available. Data were derived from a prospective community recruited cohort of IDU. We assessed the prevalence of engaging in disorderly street-based income generation activities, including sex work, drug dealing, panhandling, and recycling/salvaging/vending. Using multivariate logistic regressions based on Akaike information criterion and the best subset selection procedure, we identified factors associated with disorderly income generation activities, and assessed willingness to forgo these sources of income during the period of November 2008 to July 2009. Among our sample of 874 IDU, 418 (48%) reported engaging in a disorderly income generation activity in the previous six months. In multivariate analyses, engaging in disorderly income generation activities was independently associated with high intensity stimulant use, as well as binge drug use, having encounters with police, being a victim of violence, sharing used syringes, and injecting in public areas. Among those engaged in disorderly income generation, 198 (47%) reported a willingness to forgo these income sources if given opportunities for low-threshold employment, with sex workers being most willing to engage in alternative employment. Engagement in disorderly street-based income generation activities was associated with high intensity stimulant drug use and various markers of risk. We found that a high proportion of illicit drug users were willing to cease engagement in these activities if they had options for causal low-threshold employment. These findings indicate that there is a high demand for low-threshold employment that may offer important opportunities to reduce drug

Injectable-antineoplastic-drug practices in Michigan hospitals.

Science.gov (United States)

Cohen, I A; Newland, S J; Kirking, D M

1987-05-01

Practices related to parenteral (injectable) antineoplastic drugs (PADs) in Michigan hospitals were surveyed. All hospitals in Michigan were surveyed to assess compliance with American Society of Hospital Pharmacists (ASHP) and Occupational Safety and Health Administration (OSHA) recommendations related to PADs. Other PAD-related practice issues not covered within those guidelines were also studied. Surveys were mailed to the pharmacy directors of the state's 192 acute-care hospitals. Included were questions concerning policies and procedures for ordering, storing, preparing, handling, labeling, transporting, administering, and disposing of PADs. Questions concerning staff education, spill cleanup, and personnel issues were also included. A total of 169 questionnaires were returned, yielding a response rate of 88%. Of those respondents, 132 indicated that they prepare PAD doses for inpatients. Adherence rates were high for several of the PAD-preparation recommendations, including handwashing (97%) and gloving (98.5%). Rates for gowning (71.2%), labeling of PAD doses as biohazards (chemical hazards) (73.5%), and use of Class II biological-safety cabinets (71.2%) were less favorable. Practice areas with relatively poor adherence rates included use of plastic-backed absorbent pads under PAD preparation areas (53.8%), storing PADs separately from other drugs (48.5%), informing prospective employees of potential risks of handling PADs (36.4%), availability of spill kits (36.4%), and attaching and priming i.v. tubing before adding PADs to i.v. containers (5.4%). Many pharmacy departments in Michigan hospitals can substantially improve their adherence to ASHP and OSHA recommendations related to PADs.

Effect of liposomes on rheological and syringeability properties of hyaluronic acid hydrogels intended for local injection of drugs.

Science.gov (United States)

El Kechai, Naila; Bochot, Amélie; Huang, Nicolas; Nguyen, Yann; Ferrary, Evelyne; Agnely, Florence

2015-06-20

The aim of this work was to thoroughly study the effect of liposomes on the rheological and the syringeability properties of hyaluronic acid (HA) hydrogels intended for the local administration of drugs by injection. Whatever the characteristics of the liposomes added (neutral, positively or negatively charged, with a corona of polyethylene glycol chains, size), the viscosity and the elasticity of HA gels increased in a lipid concentration-dependent manner. Indeed, liposomes strengthened the network formed by HA chains due to their interactions with this polymer. The nature and the resulting effects of these interactions depended on liposome composition and concentration. The highest viscosity and elasticity were observed with liposomes covered by polyethylene glycol chains while neutral liposomes displayed the lowest effect. Despite their high viscosity at rest, all the formulations remained easily injectable through needles commonly used for local injections thanks to the shear-thinning behavior of HA gels. The present study demonstrates that rheological and syringeability tests are both necessary to elucidate the behavior of such systems during and post injection. In conclusion, HA liposomal gels appear to be a promising and versatile formulation platform for a wide range of applications in local drug delivery when an injection is required. Copyright © 2015 Elsevier B.V. All rights reserved.

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting.

Science.gov (United States)

Landsberg, Adina; Shannon, Kate; Krüsi, Andrea; DeBeck, Kora; Milloy, M-J; Nosova, Ekaterina; Kerr, Thomas; Hayashi, Kanna

2017-08-01

Previous research indicates that criminalization of sex work is associated with harms among sex workers. In 2013, the Vancouver Police Department changed their sex work policy to no longer target sex workers while continuing to target clients and third parties in an effort to increase the safety of sex workers (similar to "end-demand sex work" approaches being adopted in a number of countries globally). We sought to investigate the trends and correlates of rushing negotiations with clients due to police presence among 359 sex workers who use drugs in Vancouver before and after the guideline change. Data were derived from three prospective cohort studies of people who use drugs in Vancouver between 2008 and 2014. We used sex-stratified multivariable generalized estimating equation models. The crude percentages of sex workers who use drugs reporting rushing client negotiations changed from 8.9% before the guideline change to 14.8% after the guideline change among 259 women, and from 8.6 to 7.1% among 100 men. In multivariable analyses, there was a significant increase in reports of rushing client negotiation after the guideline change among women (p = 0.04). Other variables that were independently associated with increased odds of rushing client negotiation included experiencing client-perpetrated violence (among both men and women) and non-heterosexual orientation (among women) (all p sex workers who use drugs. It was also associated with client-perpetrated violence and other markers of vulnerability. These findings lend further evidence that criminalizing the purchase of sexual services does not protect the health and safety of sex workers.

Injection Drug User Quality of Life Scale (IDUQOL: Findings from a content validation study

Directory of Open Access Journals (Sweden)

Palepu Anita

2007-07-01

Full Text Available Abstract 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.

Changing drug use and HIV prevalence among injecting drug users in Ukraine: evidence from biobehavioral surveys

Directory of Open Access Journals (Sweden)

Dumchev, Kostyantyn

2012-07-01

Full Text Available BACKGROUND: Integrated biobehavioral surveys (IBBS have been used to evaluate the impact of HIV prevention efforts among most-at-risk groups in Ukraine since 2007. Harm reduction program coverage among injecting-drug users (IDUs increased substantially from 96,000 in 2008 to 170,000 in 2010 with support from the Global Fund, and IBBS have shown declining HIV prevalence. Aim of the study was to examine the changes in HIV prevalence, drug use patterns and risky behaviors in IDUs on national and city level.METHODS: For this analysis, three IDU-IBBS datasets were combined – 2008 (N=3711, 2009 (N=3962, and 2011 (N=9069. The analysis included 25 cities that participated in either 2008 or 2009, and 2011. Changes in HIV prevalence, drug use, and risk behaviors were compared between 2008/9 and 2011.RESULTS: The surveyed IDU population in 2011 was older than in 2008/9 (31.0 vs. 32.8 years; p<.0001, and included more females (23.5% vs. 25.5%; p=.0038, with substantial variation across cities.Overall HIV prevalence in the sample declined slightly (22.9% to 21.6%; p=.05. In eight cities, HIV prevalence decreased significantly (-5% to -18%, while significant increases were seen in five cities (8% to 15%. Prevalence among IDUs younger than 25 years declined (9.9% to 7.2%; p=.0078.The combined dataset showed no difference in opioid or stimulant past-30-day use, with variation at city level. Clean needle/syringe use during last injection increased significantly (88.8% to 97.0%; p<.0001, with no opposing trend in any city. Three cities had an increase in past-30-day needle/syringe sharing; nine – in container sharing; twelve – in use of preloaded syringes. Changes in condom use were not significant (54.1% to 54.9%, p=.32.CONCLUSIONS: IDUs in Ukraine are ageing and HIV seroprevalence among IDUs continues to decline, especially among young IDUs. However, prevention programming needs to respond to significant regional variations in risk behaviors and HIV

Colonization and Community: the Vancouver Island coalfield and the making of the British Columbian working class

Energy Technology Data Exchange (ETDEWEB)

John Douglas Belshaw [University College of the Cariboo, Kamloops, BC (Canada). Department of Philosophy, History, and Politics

2002-04-01

In the nineteenth century coal-miners imported from Europe, Asia, and eastern North America burrowed beneath the Vancouver Island towns of Nanaimo, Wellington, and Cumberland. The book looks at British Columbia's first working class, the men, women, and children beneath and beyond the pit-head. Beginning with an exploration of emigrant expectations and ambitions, it investigates working conditions, household wages, racism, industrial organization, gender, schooling, leisure, community building, and the fluid identity of the British mining colony, the archetypal west coast proletariat. By connecting the story of Vancouver Island to the larger story of Victorian industrialization, the author delineates what was distinctive and what was common about the lot of the settler society.

Adventure Education and the Acculturation of First-Generation Chinese Canadians in Vancouver, Canada

Science.gov (United States)

Lo, Simon; Gidlow, Bob; Cushman, Grant

2014-01-01

This article reports on research that demonstrates how parents in first-generation Chinese families in Vancouver, Canada, most of them from Hong Kong, control their children's involvement in local adventure education (AE) programs and in so doing minimize the likelihood of intergenerational culture conflict involving those children. The research…

Immigrants as Active Citizens: Exploring the Volunteering Experience of Chinese Immigrants in Vancouver

Science.gov (United States)

Guo, Shibao

2014-01-01

Despite the fact that immigration has played an important role in transforming Canada into an ethno-culturally diverse and economically prosperous nation, immigrants themselves are often criticised as passive citizens. This study attempts to deconstruct this myth by investigating the volunteering experiences of Chinese immigrants in Vancouver. The…

EMPLOYMENT-BASED ABSTINENCE REINFORCEMENT PROMOTES OPIATE AND COCAINE ABSTINENCE IN OUT-OF-TREATMENT INJECTION DRUG USERS

OpenAIRE

Holtyn, August F.; Koffarnus, Mikhail N.; DeFulio, Anthony; Sigurdsson, Sigurdur O.; Strain, Eric C.; Schwartz, Robert P.; Silverman, Kenneth

2014-01-01

We examined the use of employment-based abstinence reinforcement in out-of-treatment injection drug users, in this secondary analysis of a previously reported trial. Participants (N = 33) could work in the therapeutic workplace, a model employment-based program for drug addiction, for 30 weeks and could earn approximately $10 per hr. During a 4-week induction, participants only had to work to earn pay. After induction, access to the workplace was contingent on enrollment in methadone treatmen...

Necrotizing Soft Tissue Fasciitis after Intramuscular Injection

Directory of Open Access Journals (Sweden)

Angelica Abbate

2018-01-01

Full Text Available Necrotizing soft tissue fasciitis (NSTIs or necrotizing fasciitis is an infrequent and serious infection. Herein, we describe the clinical course of a female patient who received a diagnosis of NSTIs after gluteus intramuscular injection. We also report the results of our review of published papers from 1997 to 2017. Since now, 19 cases of NSTIs following intramuscular injections have been described. We focus on the correlation between intramuscular injection and NSTIs onset, especially in immunosuppressed patients treated with corticosteroids, suffering from chronic diseases or drug addicted. Intramuscular injections can provoke severe tissue trauma, representing local portal of infection, even if correctly administrated. Otherwise, it is important not to inject drug in subcutaneous, which is a less vascularized area and therefore more susceptible to infections. Likewise, a proper injecting technique and aspiration prior to injection seem to be valid measure to prevent intra-arterial or para-arterial drug injection with the consequent massive inflammatory reaction. Necrosis at the infection site appears to be independent of the drug, and it is a strong additional risk factor for NSTIs.

A Thixotropic Polyglycerol Sebacate-Based Supramolecular Hydrogel as an Injectable Drug Delivery Matrix

Directory of Open Access Journals (Sweden)

Hongye Ye

2016-04-01

Full Text Available We have developed a “self-healing” polyglycerol sebacate—polyethylene glycol methyl ether methacrylate (PGS-PEGMEMA/α-Cyclodextrin (αCD hydrogel which could be sheared into a liquid during injection and has the potential to quickly “heal” itself back into gel post-injection. This hydrogel was shown to be biocompatible and biodegradable and therefore appropriate for use in vivo. Furthermore, the storage and loss moduli of the hydrogels could be tuned (by varying the concentration of αCD between a fraction of a kPa to a few 100 kPa, a range that coincides with the moduli of cells and human soft tissues. This property would allow for this hydrogel to be used in vivo with maximal mechanical compatibility with human soft tissues. In vitro experiments showed that the hydrogel demonstrated a linear mass erosion profile and a biphasic drug (doxorubicin release profile: Phase I was primarily driven by diffusion and Phase II was driven by hydrogel erosion. The diffusion mechanism was modeled with the First Order equation and the erosion mechanism with the Hopfenberg equation. This established fitting model could be used to predict releases with other drugs and estimate the composition of the hydrogel required to achieve a desired release rate.

Cigarette smoking and quit attempts among injection drug users in Tijuana, Mexico.

Science.gov (United States)

Shin, Sanghyuk S; Moreno, Patricia Gonzalez; Rao, Smriti; Garfein, Richard S; Novotny, Thomas E; Strathdee, Steffanie A

2013-12-01

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. 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. 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). 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.

Potential Risks of Ecological Momentary Assessment Among Persons Who Inject Drugs.

Science.gov (United States)

Roth, Alexis M; Rossi, John; Goldshear, Jesse L; Truong, Quan; Armenta, Richard F; Lankenau, Stephen E; Garfein, Richard S; Simmons, Janie

2017-06-07

Ecological momentary assessment (EMA)-which often involves brief surveys delivered via mobile technology-has transformed our understanding of the individual and contextual micro-processes associated with legal and illicit drug use. However, little empirical research has focused on participant's perspective on the probability and magnitude of potential risks in EMA studies. To garner participant perspectives on potential risks common to EMA studies of illicit drug use. We interviewed 38 persons who inject drugs living in San Diego (CA) and Philadelphia (PA), United States. They completed simulations of an EMA tool and then underwent a semi-structured interview that systematically explored domains of risk considered within the proposed revisions to the Federal Policy for the Protection of Human Subjects or the "Common Rule." Interviews were transcribed verbatim and coded systematically to explore psychological, physical, social, legal, and informational risks from participation. Participants perceived most risks to be minimal. Some indicated that repetitive questioning about mood or drug use could cause psychological (i.e., anxiety) or behavioral risks (i.e., drug use relapse). Ironically, the questions that were viewed as risky were considered motivational to engage in healthy behaviors. The most cited risks were legal and social risks stemming from participant concerns about data collection and security. Improving our understanding of these issues is an essential first step to protect human participants in future EMA research. We provide a brief set of recommendations that can aid in the design and ethics review of the future EMA protocol with substance using populations.

Sexual violence from police and HIV risk behaviours among HIV-positive women who inject drugs in St. Petersburg, Russia – a mixed methods study

Science.gov (United States)

Lunze, Karsten; Raj, Anita; Cheng, Debbie M; Quinn, Emily K; Lunze, Fatima I; Liebschutz, Jane M; Bridden, Carly; Walley, Alexander Y; Blokhina, Elena; Krupitsky, Evgeny; Samet, Jeffrey H

2016-01-01

Introduction Police violence against people who inject drugs (PWID) is common in Russia and associated with HIV risk behaviours. Sexual violence from police against women who use drugs has been reported anecdotally in Russia. This mixed-methods study aimed to evaluate sexual violence from police against women who inject drugs via quantitative assessment of its prevalence and HIV risk correlates, and through qualitative interviews with police, substance users and their providers in St. Petersburg, Russia. Methods Cross-sectional analyses with HIV-positive women who inject drugs (N=228) assessed the associations between sexual violence from police (i.e. having been forced to have sex with a police officer) and the following behaviours: current drug use, needle sharing and injection frequency using multiple regression models. We also conducted in-depth interviews with 23 key informants, including PWID, police, civil society organization workers, and other stakeholders, to explore qualitatively the phenomenon of sexual violence from police in Russia and strategies to address it. We analyzed qualitative data using content analysis. Results Approximately one in four women in our quantitative study (24.1%; 95% CI, 18.6%, 29.7%) reported sexual violence perpetrated by police. Affected women reported more transactional sex for drugs or money than those who were not; however, the majority of those reporting sexual violence from police were not involved in these forms of transactional sex. Sexual violence from police was not significantly associated with current drug use or needle sharing but with more frequent drug injections (adjusted incidence rate ratio 1.43, 95% CI 1.04, 1.95). Qualitative data suggested that sexual violence and coercion by police appear to be entrenched as a norm and are perceived insurmountable because of the seemingly absolute power of police. They systematically add to the risk environment of women who use drugs in Russia. Conclusions Sexual violence

Weighing the Consequences: Self-Disclosure of HIV-Positive Status among African American Injection Drug Users

Science.gov (United States)

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…

Going Social at Vancouver Public Library: What the Virtual Branch Did Next

Science.gov (United States)

Cahill, Kay

2011-01-01

Purpose: The purpose of this paper is to follow up on the 2009 publication "Building a virtual branch at Vancouver Public Library (VPL) using Web 2.0 tools" and to explore the work that VPL has been doing in the social media space over the past two years. Design/methodology/approach: Following the launch of its new web site in 2008,…

High Throughput Screening Method for Systematic Surveillance of Drugs of Abuse by Multisegment Injection-Capillary Electrophoresis-Mass Spectrometry.

Science.gov (United States)

DiBattista, Alicia; Rampersaud, Dianne; Lee, Howard; Kim, Marcus; Britz-McKibbin, Philip

2017-11-07

New technologies are urgently required for reliable drug screening given a worldwide epidemic of prescription drug abuse and its devastating socioeconomic impacts on public health. Primary screening of drugs of abuse (DoA) currently relies on immunoassays that are prone to bias and are not applicable to detect an alarming array of psychoactive stimulants, tranquilizers, and synthetic opioids. These limitations impact patient safety when monitoring for medication compliance, drug substitution, or misuse/abuse and require follow-up confirmatory testing by more specific yet lower throughput instrumental methods. Herein, we introduce a high throughput platform for nontargeted screening of a broad spectrum of DoA and their metabolites based on multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS). We demonstrate that MSI-CE-MS enables serial injections of 10 samples within a single run (high resolution MS with full-scan data acquisition. Unambiguous drug identification was achieved by four or more independent parameters, including comigration with a deuterated internal standard or in silico prediction of electromigration behavior together with accurate mass, most likely molecular formula, as well as MS/MS as required for confirmation testing. Acceptable precision was demonstrated for over 50 DoA at 3 concentration levels over 4 days (median coefficient of variance = 13%, n = 117) with minimal ion suppression, isobaric interferences, and sample carry-over (screening cutoff levels in human urine while allowing for systematic surveillance, specimen verification, and retrospective testing of designer drugs that elude conventional drug tests.

Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users.

Science.gov (United States)

Budambula, Valentine; Matoka, Charles; Ouma, James; Ahmed, Aabid A; Otieno, Michael F; Were, Tom

2018-01-30

Substance use is increasingly becoming prevalent on the African continent, fueling the spread of HIV infection. Although socio-demographic factors influence substance consumption and risk of HIV infection, the association of these factors with HIV infection is poorly understood among substance users on the African continent. The objective of the study was to assess socio-demographic and sexual practices that are associated with HIV infection among injection drug users (IDUs), non-IDUs, and non-drug users (DUs) at an urban setting of coastal Kenya. A cross-sectional descriptive study was conducted among 451 adults comprising HIV-infected and -uninfected IDUs (n = 157 and 39); non-IDUs (n = 17 and 48); and non-DUs (n = 55 and 135); respectively at coastal, Kenya. Respondent driven sampling, snowball and makeshift methods were used to enroll IDUs and non-IDUs. Convenience and purposive sampling were used to enroll non-DUs from the hospital's voluntary HIV testing unit. Participant assisted questionnaire was used in collecting socio-demographic data and sexual practices. Binary logistic regression analysis indicated that higher likelihood of HIV infection was associated with sex for police protection (OR, 9.526; 95% CI, 1.156-78.528; P = 0.036) and history of sexually transmitted infection (OR, 5.117; 95% CI, 1.924-13.485; P = 0.001) in IDUs; divorced, separated or widowed marital status (OR, 6.315; 95% CI, 1.334-29.898; P = 0.020) in non-IDUs; and unemployment (OR, 2.724; 95% CI, 1.049-7.070; P = 0.040) in non-drug users. However, never married (single) marital status (OR, 0.140; 95% CI, 0.030-0.649; P = 0.012) was associated with lower odds for HIV infection in non-drug users. Altogether, these results suggest that socio-demographic and sexual risk factors for HIV transmission differ with drug use status, suggesting targeted preventive measures for drug users.

Rise in needle sharing among injection drug users in Pakistan during the Afghanistan war.

Science.gov (United States)

Strathdee, Steffanie A; Zafar, Tariq; Brahmbhatt, Heena; Baksh, Ahmed; ul Hassan, Salman

2003-07-20

The war in Afghanistan in 2001 may have had direct or indirect effects on drug users' behaviors in nearby Pakistan. We studied drug use patterns and correlates of needle sharing among injection drug users (IDUs) in Lahore, Pakistan, before and after the beginning of the Afghanistan war. Between August and October 2001, 244 drug users registering for needle exchange and other services underwent an interviewer-administered survey on sociodemographics, drug use and HIV/AIDS awareness. chi(2)-tests were used to compare drug use behaviors among subjects interviewed before and after October 6th, 2001, coinciding with the start of the Afghanistan war. Correlates of needle sharing among IDUs were identified using logistic regression. Comparing IDUs interviewed before and after October 6th, 2001, levels of needle sharing were significantly higher after the war (56% versus 76%, respectively; P=0.02). Factors independently associated with needle sharing included registering after the war began (adjusted odds ratio, AOR=3.76 (95% CI: 1.23-11.48)), being married (AOR=0.36), being homeless (AOR=3.91), having been arrested (AOR=6.00), and re-using syringes (AOR=6.19). Expansion of needle exchange, drug treatment and supportive services is urgently needed to avoid an explosive HIV epidemic in Pakistan.

Prevalence and predictors of depressive symptoms among HIV-positive men who inject drugs in Vietnam.

Science.gov (United States)

Levintow, Sara N; Pence, Brian W; Ha, Tran Viet; Minh, Nguyen Le; Sripaipan, Teerada; Latkin, Carl A; Vu, Pham The; Quan, Vu Minh; Frangakis, Constantine; Go, Vivian F

2018-01-01

HIV infection is common among people who inject drugs (PWID), and HIV-positive PWID may be particularly vulnerable to depression. This study measured the prevalence of depressive symptoms and the factors associated with severe symptoms among 455 HIV-positive PWID in Thai Nguyen, Vietnam. We used cross-sectional data from PWID in a randomized controlled trial of an intervention to reduce high-risk injecting and sexual behaviors in Thai Nguyen from 2009-2013. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). We used logistic regression to assess demographic, clinical, and psychosocial predictors of severe depressive symptoms (CES-D≥23) with prevalence odds ratios (POR) and 95% confidence intervals (CI). The prevalence of severe depressive symptoms (CES-D≥23) was 44%. 25% of participants had mild to moderate depressive symptoms (16≤CES-D<23), and 31% experienced no depressive symptoms (CES-D<16). Not being married, self-rated poor health, greater frequency of injection drug use, history of overdose, no alcohol use, and daily cigarette smoking were positively associated with severe depressive symptoms in unadjusted models and remained predictive in a multivariable model. The strongest predictors of depressive symptoms were self-reported poor health (POR = 2.94, 95% CI: 1.82, 4.76), no current alcohol use (POR = 2.35, 95% CI: 1.47, 3.77), and not currently married or cohabitating (POR = 2.21, 95% CI = 1.40, 3.47). Severe depressive symptoms were common among HIV-positive PWID in Thai Nguyen and were strongly associated with demographic, clinical, and psychosocial factors. Interventions that promote social support from family and reduce drug dependence may particularly benefit PWID experiencing severe depressive symptoms. Greater recognition and treatment of depressive symptoms has the potential to enhance quality of life and improve HIV clinical outcomes for PWID.

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

Science.gov (United States)

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.

Analysis of clinical records of dental patients attending Jordan University Hospital: Documentation of drug prescriptions and local anesthetic injections

Directory of Open Access Journals (Sweden)

Najla Dar-Odeh

2008-08-01

Full Text Available Najla Dar-Odeh1, Soukaina Ryalat1, Mohammad Shayyab1, Osama Abu-Hammad21Department of Oral and Maxillofacial Surgery Oral Medicine and Periodontics, Faculty of Dentistry, University of Jordan, Jordan; 2Department of Prosthetic Dentistry, Faculty of Dentistry, University of Jordan, JordanObjectives: The aim of this study was to analyze clinical records of dental patients attending the Dental Department at the University of Jordan Hospital: a teaching hospital in Jordan. Analysis aimed at determining whether dental specialists properly documented the drug prescriptions and local anesthetic injections given to their patients.Methods: Dental records of the Dental Department at the Jordan University Hospital were reviewed during the period from April 3rd until April 26th 2007 along with the issued prescriptions during that period.Results: A total of 1000 records were reviewed with a total of 53 prescriptions issued during that period. Thirty records documented the prescription by stating the category of the prescribed drug. Only 13 records stated the generic or the trade names of the prescribed drugs. Of these, 5 records contained the full elements of a prescription. As for local anesthetic injections, the term “LA used” was found in 22 records while the names and quantities of the local anesthetics used were documented in only 13 records. Only 5 records documented the full elements of a local anesthetic injection.Conclusion: The essential data of drug prescriptions and local anesthetic injections were poorly documented by the investigated group of dental specialists. It is recommended that the administration of the hospital and the dental department implement clear and firm guidelines for dental practitioners in particular to do the required documentation procedure.Keywords: dental records, documentation, prescriptions, local anesthesia

A randomized study of contingency management and spirometric lung age for motivating smoking cessation among injection drug users.

Science.gov (United States)

Drummond, Michael B; Astemborski, Jacquie; Lambert, Allison A; Goldberg, Scott; Stitzer, Maxine L; Merlo, Christian A; Rand, Cynthia S; Wise, Robert A; Kirk, Gregory D

2014-07-28

Even after quitting illicit drugs, tobacco abuse remains a major cause of morbidity and mortality in former injection drug users. An important unmet need in this population is to have effective interventions that can be used in the context of community based care. Contingency management, where a patient receives a monetary incentive for healthy behavior choices, and incorporation of individual counseling regarding spirometric "lung age" (the age of an average healthy individual with similar spirometry) have been shown to improve cessation rates in some populations. The efficacy of these interventions on improving smoking cessation rates has not been studied among current and former injection drug users. In a randomized, factorial design study, we recruited 100 active smokers from an ongoing cohort study of current and former injection drug users to assess the impact of contingency management and spirometric lung age on smoking cessation. The primary outcome was 6-month biologically-confirmed smoking cessation comparing contingency management, spirometric lung age or both to usual care. Secondary outcomes included differences in self-reported and biologically-confirmed cessation at interim visits, number of visits attended and quit attempts, smoking rates at interim visits, and changes in Fagerstrom score and self-efficacy. Six-month biologically-confirmed smoking cessations rates were 4% usual care, 0% lung age, 14% contingency management and 0% for combined lung age and contingency management (p = 0.13). There were no differences in secondary endpoints comparing the four interventions or when pooling the lung age groups. Comparing contingency management to non-contingency management, 6-month cessation rates were not different (7% vs. 2%; p = 0.36), but total number of visits with exhaled carbon monoxide-confirmed abstinence were higher for contingency management than non-contingency management participants (0.38 vs. 0.06; p = 0.03), and more contingency management

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

OpenAIRE

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.

2016-01-01

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 co...

Quality of life, depression, anxiety and suicidal ideation among men who inject drugs in Delhi, India

Science.gov (United States)

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

A Case of Sublingual Ranula That Responded Successfully to Localized Injection Treatment with OK-432 after Healing from Drug Induced Hypersensitivity Syndrome

Directory of Open Access Journals (Sweden)

Kunio Yoshizawa

2016-01-01

Full Text Available A ranula is a mucus retention cyst or pseudocyst caused by leakage of mucus from the sublingual gland and generally occurs in the oral floor. In addition, drug induced hypersensitivity syndrome (DIHS is a rare but well-recognized serious adverse effect characterized by fever, skin rashes, generalized lymphadenopathy, hepatitis, and hepatosplenomegaly and oral stomatitis. This paper presents the first case of successfully treated sublingual ranula with localized injection of OK-432 after healing from drug induced hypersensitivity syndrome, which has previously been unreported in the literature. We present the case of a 38-year-old Japanese woman with sublingual ranula that responded successfully to localized injection treatment with OK-432 after healing from drug induced hypersensitivity syndrome. She was affected with cutaneous myositis and interstitial lung disease when she was 26 years old. At the age 34 years, she received additional oral treatment of diaminodiphenyl-sulfone due to deterioration of the cutaneous myositis, which resulted in drug induced hypersensitivity syndrome (DIHS with severe oral stomatitis. Local injection of OK-432 to the ranula may be a very safe and useful treatment method even if the patient has a history of drug allergy and has connective tissue disease such as cutaneous myositis.

Factors associated with patterns of mobile technology use among persons who inject drugs.

Science.gov (United States)

Collins, Kelly M; Armenta, Richard F; Cuevas-Mota, Jazmine; Liu, Lin; Strathdee, Steffanie A; Garfein, Richard S

2016-01-01

New and innovative methods of delivering interventions are needed to further reduce risky behaviors and increase overall health among persons who inject drugs (PWID). Mobile health (mHealth) interventions have potential for reaching PWID; however, little is known about mobile technology use (MTU) in this population. In this study, the authors identify patterns of MTU and identified factors associated with MTU among a cohort of PWID. Data were collected through a longitudinal cohort study examining drug use, risk behaviors, and health status among PWID in San Diego, California. Latent class analysis (LCA) was used to define patterns of MTU (i.e., making voice calls, text messaging, and mobile Internet access). Multinomial logistic regression was then used to identify demographic characteristics, risk behaviors, and health indicators associated with mobile technology use class. In LCA, a 4-class solution fit the data best. Class 1 was defined by low MTU (22%, n = 100); class 2, by PWID who accessed the Internet using a mobile device but did not use voice or text messaging (20%, n = 95); class 3, by primarily voice, text, and connected Internet use (17%, n = 91); and class 4, by high MTU (41%, n = 175). Compared with low MTU, high MTU class members were more likely to be younger, have higher socioeconomic status, sell drugs, and inject methamphetamine daily. The majority of PWID in San Diego use mobile technology for voice, text, and/or Internet access, indicating that rapid uptake of mHealth interventions may be possible in this population. However, low ownership and use of mobile technology among older and/or homeless individuals will need to be considered when implementing mHealth interventions among PWID.

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

Directory of Open Access Journals (Sweden)

Richard Lowry

2014-01-01

Full Text Available 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.

High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study.

Science.gov (United States)

Bazazi, Alexander R; Zelenev, Alexei; Fu, Jeannia J; Yee, Ilias; Kamarulzaman, Adeeba; Altice, Frederick L

2015-07-01

Overdose is the leading cause of death among opioid users, but no data are available on overdose among people who inject drugs in Malaysia. We present the first estimates of the prevalence and correlates of recent non-fatal overdose among people who inject drugs in Malaysia. In 2010, 460 people who inject drugs were recruited using respondent-driven sampling (RDS) in Klang Valley to assess health outcomes associated with injection drug use. Self-reported history of non-fatal overdose in the previous 6 months was the primary outcome. Sociodemographic, behavioral and structural correlates of non-fatal overdose were assessed using multivariable logistic regression. All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Most injected daily (91.3%) and were male (96.3%) and ethnically Malay (90.4%). Overall, 20% of participants had overdosed in the prior 6 months, and 43.3% had ever overdosed. The RDS-adjusted estimate of the 6-month period prevalence of overdose was 12.3% (95% confidence interval [CI] 7.9-16.6%). Having injected for more years was associated with lower odds of overdose (adjusted odds ratio [AOR] 0.6 per 5 years of injection, CI: 0.5-0.7). Rushing an injection from fear of the police nearly doubled the odds of overdose (AOR 1.9, CI: 1.9-3.6). Alcohol use was associated with recent non-fatal overdose (AOR 2.1, CI: 1.1-4.2), as was methamphetamine use (AOR 2.3, CI: 1.3-4.6). When adjusting for past-month drug use, intermittent but not daily methadone use was associated with overdose (AOR 2.8, CI: 1.5-5.9). This study reveals a large, previously undocumented burden of non-fatal overdose among people who inject drugs in Malaysia and highlights the need for interventions that might reduce the risk of overdose, such as continuous opioid substitution therapy, provision of naloxone to prevent fatal overdose, treatment of polysubstance use, and working with police to improve the risk environment. Copyright © 2014 Elsevier B

Building a Virtual Branch at Vancouver Public Library Using Web 2.0 Tools

Science.gov (United States)

Cahill, Kay

2009-01-01

Purpose: The purpose of this paper is to demonstrate the work undertaken by Vancouver Public Library (VPL) in an effort to convert its website into a true virtual branch, both through the functionality of the website itself and by extending its web presence on to external social networking sites. Design/methodology/approach: VPL worked with its…

Epidemiology of HIV and hepatitis C infection among women who inject drugs in Northeast India: a respondent-driven sampling study.

Science.gov (United States)

McFall, Allison M; Solomon, Sunil S; Lucas, Greg M; Celentano, David D; Srikrishnan, Aylur K; Kumar, Muniratnam S; Mehta, Shruti H

2017-08-01

Despite extensive research on HIV and hepatitis C (HCV) among people who inject drugs (PWID), there remains a gap in knowledge on the burden among women who inject drugs and their unique contexts and risk factors. This analysis compares HIV and HCV prevalence in female and male PWID and estimates injection and sexual risk correlates of prevalent HIV and HCV infection among women in Northeast India. Cross-sectional sample accrued using respondent-driven sampling. Seven cities in Northeast India, 2013. A total of 6457 adult PWID. Participants completed an interviewer-administered survey. HIV infection was diagnosed on-site and HCV antibody testing was performed on stored specimens. HIV and HCV prevalence estimates were stratified by gender. Among women, the association of risk correlates with HIV and HCV were estimated using multi-level logistic regression models. A total of 796 (15.9%) of the PWID were women, of whom 52.9% [95% confidence interval (CI) = 49.3-56.5%] were HIV-infected and 22.3% (CI = 19.9-24.7%) were HCV-infected. HIV and HCV prevalence among men was 17.4% (CI = 16.9-24.7%) and 30.4% (CI = 31.2-32.0%), respectively. Among women, correlates of HIV were widowhood [adjusted odds ratio (aOR) versus currently married = 4.03, CI = 2.13-7.60] and a higher number of life-time sexual partners (aOR ≥8 versus none = 3.08, CI = 1.07-8.86). Correlates of HCV were longer injection duration (aOR per 10 years = 1.70, CI = 1.25-2.27), injecting only heroin and a combination of drugs (aOR versus pharmaceuticals only = 5.63, CI = 1.68-18.9 and aOR = 2.58, CI = 1.60-4.16, respectively), sharing needles/syringes (aOR = 2.46, CI = 1.29-4.56) and a larger PWID network (aOR ≥ 51 versus 1-5 = 4.17, CI = 2.43-7.17). Women who inject drugs in Northeast India have a high HIV prevalence, which was more than double their hepatitis C (HCV) prevalence, an opposite pattern than is observed typically among male PWID. HIV infection is

HIV risk-taking behaviour among injecting drug users currently, previously and never enrolled in methadone treatment.

Science.gov (United States)

Baker, A; Kochan, N; Dixon, J; Wodak, A; Heather, N

1995-04-01

This study compares the injecting and sexual risk-taking behaviour among injecting drug users (IDUs) currently, previously and never enrolled in methadone maintenance treatment (MMT). All subjects had injected during the 6 months prior to the day of interview. The current MMT group showed significantly lower injecting risk-taking behaviour subscale scores on the HIV Risk-taking Behaviour Scale (HRBS) of the Opiate Treatment Index than the previous MMT and non-MMT groups together. The current MMT group differed from the other two groups in the frequency of injecting and cleaning of injection equipment with bleach. There was no difference between the current MMT group and the other two groups combined in sexual risk-taking behaviour scores on the HRBS. There were no differences between the previous MMT and non-MMT groups in injecting and sexual risk-taking behaviour. HIV seroprevalence was low and there was no difference in seroprevalence between groups. Thus, IDUs currently enrolled in MMT are at reduced risk for HIV infection when compared with IDUs who have previously or never been enrolled in MMT. However, the absence of a difference between the current MMT and other two groups in frequency of sharing behaviours suggests the need for additional strategies among MMT clients to reduce needle-sharing. Possible strategies include the application of relapse prevention interventions and the availability of sterile injecting equipment in MMT clinics. Further research is needed to identify factors which increase attraction and retention of IDUs to MMT.

Increased risk for hepatitis C associated with solvent use among Canadian Aboriginal injection drug users

Directory of Open Access Journals (Sweden)

Jolly Ann M

2010-07-01

Full Text Available Abstract 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.

Controlled drug release from a novel injectable biodegradable microsphere/scaffold composite based on poly(propylene fumarate).

Science.gov (United States)

Kempen, Diederik H R; Lu, Lichun; Kim, Choll; Zhu, Xun; Dhert, Wouter J A; Currier, Bradford L; Yaszemski, Michael J

2006-04-01

The ideal biomaterial for the repair of bone defects is expected to have good mechanical properties, be fabricated easily into a desired shape, support cell attachment, allow controlled release of bioactive factors to induce bone formation, and biodegrade into nontoxic products to permit natural bone formation and remodeling. The synthetic polymer poly(propylene fumarate) (PPF) holds great promise as such a biomaterial. In previous work we developed poly(DL-lactic-co-glycolic acid) (PLGA) and PPF microspheres for the controlled delivery of bioactive molecules. This study presents an approach to incorporate these microspheres into an injectable, porous PPF scaffold. Model drug Texas red dextran (TRD) was encapsulated into biodegradable PLGA and PPF microspheres at 2 microg/mg microsphere. Five porous composite formulations were fabricated via a gas foaming technique by combining the injectable PPF paste with the PLGA or PPF microspheres at 100 or 250 mg microsphere per composite formulation, or a control aqueous TRD solution (200 microg per composite). All scaffolds had an interconnected pore network with an average porosity of 64.8 +/- 3.6%. The presence of microspheres in the composite scaffolds was confirmed by scanning electron microscopy and confocal microscopy. The composite scaffolds exhibited a sustained release of the model drug for at least 28 days and had minimal burst release during the initial phase of release, as compared to drug release from microspheres alone. The compressive moduli of the scaffolds were between 2.4 and 26.2 MPa after fabrication, and between 14.9 and 62.8 MPa after 28 days in PBS. The scaffolds containing PPF microspheres exhibited a significantly higher initial compressive modulus than those containing PLGA microspheres. Increasing the amount of microspheres in the composites was found to significantly decrease the initial compressive modulus. The novel injectable PPF-based microsphere/scaffold composites developed in this study

ZEUS contributions to the Real-Time 93 conference, Vancouver, Canada

International Nuclear Information System (INIS)

1993-07-01

This is a collection of the eight contributions of the ZEUS Data Acquisition group, presented at the Eighth Conference on Real-Time Computer Applications in Nuclear, Particle and Plasma Physics, Vancouver, Canada, June 8-11, 1993. This note describes the major parts of the ZEUS Data Acquisition system and the experience gained since the first HERA running in April 1992. Note that the papers are appended in the order of recommended reading, which does not reflect the order of importance. The presenters for the papers are listed in the following. (orig.)

Embracing a New Understanding of the City: The Museum of Vancouver's Vision in Action

Science.gov (United States)

Gosselin, Viviane

2013-01-01

The Museum of Vancouver recently undertook a major rethinking of its role in the city. New interplays are being proposed between emerging conceptions of urbanity and civic participation, and the museum's collection and function as facilitator and advocate. This short paper provides a brief overview of the museum's recent transformation, situates…

Drug use patterns among Thai illicit drug injectors amidst increased police presence

Directory of Open Access Journals (Sweden)

Suwannawong Paisan

2009-07-01

Full Text Available Abstract Thailand has traditionally pursued an aggressive enforcement-based anti-illicit drug policy in an effort to make the country "drug-free." In light of this ongoing approach, we sought to assess impacts of enforcement on drug use behaviors among a cohort of injection drug users (IDU in Thailand. We examined drug use patterns among IDU participating in a cross-sectional study conducted in Bangkok (n = 252. Participants were asked to provide data regarding patterns of drug use in the previous six months, including types of drugs consumed, method of consumption, frequency of use, and weekly income spent on drugs. We also conducted bivariate analyses to identify a possible effect of a reported increase in police presence on measures of drug use and related risk behaviors among study participants. One hundred fifty-five (61.5% individuals reported injection heroin use and 132 (52.4% individuals reported injection midazolam use at least daily in the past six months. Additionally, 86 (34.1% individuals reported at least daily injection Yaba and Ice (i.e., methamphetamine use. Participants in our study reported high levels of illicit drug use, including the injection of both illicit and licit drugs. In bivariate analyses, no association between increased police presence and drug use behaviors was observed. These findings demonstrate high ongoing rates of drug injecting in Thailand despite reports of increased levels of strict enforcement and enforcement-related violence, and raise questions regarding the merits of this approach.

Modelling the force of infection for hepatitis B and hepatitis C in injecting drug users in England and Wales

Directory of Open Access Journals (Sweden)

Hope VD

2006-06-01

Full Text Available Abstract Background Injecting drug use is a key risk factor, for several infections of public health importance, especially hepatitis B (HBV and hepatitis C (HCV. In England and Wales, where less than 1% of the population are likely to be injecting drug users (IDUs, approximately 38% of laboratory reports of HBV, and 95% of HCV reports are attributed to injecting drug use. Methods Voluntary unlinked anonymous surveys have been performed on IDUs in contact with specialist agencies throughout England and Wales. Since 1990 more than 20,000 saliva samples from current IDUs have been tested for markers of infection for HBV, HCV testing has been included since 1998. The analysis here considers those IDUs tested for HBV and HCV (n = 5,682 from 1998–2003. This study derives maximum likelihood estimates of the force of infection (the rate at which susceptible IDUs acquire infection for HBV and HCV in the IDU population and their trends over time and injecting career length. The presence of individual heterogeneity of risk behaviour and background HBV prevalence due to routes of transmission other than injecting are also considered. Results For both HBV and HCV, IDUs are at greatest risk from infection in their first year of injecting (Forces of infection in new initiates 1999–2003: HBV = 0.1076 95% C.I: 0.0840–0.1327 HCV = 0.1608 95% C.I: 0.1314–0.1942 compared to experienced IDUs (Force of infection in experienced IDUs 1999–2003: HBV = 0.0353 95% C.I: 0.0198–0.0596, HCV = 0.0526 95% C.I: 0.0310–0.0863 although independently of this there is evidence of heterogeneity of risk behaviour with a small number of IDUs at increased risk of infection. No trends in the FOI over time were detected. There was only limited evidence of background HBV infection due to factors other than injecting. Conclusion The models highlight the need to increase interventions that target new initiates to injecting to reduce the transmission of blood-borne viruses

Epidemiological bridging by injection drug use drives an early HIV epidemic

Directory of Open Access Journals (Sweden)

Erik Volz

2010-09-01

Full Text Available The risk of acquiring sexually transmitted infections (STIs depends on individual behavior and the network of risky partnerships in which an individual participates. STI epidemics often spread rapidly and primarily among individuals central to transmission networks; and thus they often defy the mass-action principle since incidence is not proportional to the infectious fraction of the population. Here, we estimate the contact network structure for an Atlanta, Georgia community with heterogeneous sexual and drug-related risk behaviors and build a detailed transmission model for HIV through this population. We show that accurate estimation of epidemic incidence requires careful measurement and inclusion of diverse factors including concurrency (having multiple partners, the duration of partnerships, serosorting (preference for partners with matching disease state, and heterogeneity in the number and kinds of partners. In the focal population, we find that injection drug users (IDUs do not directly cause many secondary infections; yet they bridge the heterosexual and men-who-have-sex-with-men (MSM populations and are thereby indirectly responsible for extensive transmission. Keywords: HIV, Networks, Serosorting, Concurrency

Validated ¹H and 13C Nuclear Magnetic Resonance Methods for the Quantitative Determination of Glycerol in Drug Injections.

Science.gov (United States)

Lu, Jiaxi; Wang, Pengli; Wang, Qiuying; Wang, Yanan; Jiang, Miaomiao

2018-05-15

In the current study, we employed high-resolution proton and carbon nuclear magnetic resonance spectroscopy (¹H and 13 C NMR) for quantitative analysis of glycerol in drug injections without any complex pre-treatment or derivatization on samples. The established methods were validated with good specificity, linearity, accuracy, precision, stability, and repeatability. Our results revealed that the contents of glycerol were convenient to calculate directly via the integration ratios of peak areas with an internal standard in ¹H NMR spectra, while the integration of peak heights were proper for 13 C NMR in combination with an external calibration of glycerol. The developed methods were both successfully applied in drug injections. Quantitative NMR methods showed an extensive prospect for glycerol determination in various liquid samples.

21 CFR 522.1660 - Oxytetracycline injectable dosage forms.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Oxytetracycline injectable dosage forms. 522.1660 Section 522.1660 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... § 522.1660 Oxytetracycline injectable dosage forms. ...

Practical considerations in clinical strategy to support the development of injectable drug-device combination products for biologics.

Science.gov (United States)

Li, Zhaoyang; Easton, Rachael

2018-01-01

The development of an injectable drug-device combination (DDC) product for biologics is an intricate and evolving process that requires substantial investments of time and money. Consequently, the commercial dosage form(s) or presentation(s) are often not ready when pivotal trials commence, and it is common to have drug product changes (manufacturing process or presentation) during clinical development. A scientifically sound and robust bridging strategy is required in order to introduce these changes into the clinic safely. There is currently no single developmental paradigm, but a risk-based hierarchical approach has been well accepted. The rigor required of a bridging package depends on the level of risk associated with the changes. Clinical pharmacokinetic/pharmacodynamic comparability or outcome studies are only required when important changes occur at a late stage. Moreover, an injectable DDC needs to be user-centric, and usability assessment in real-world clinical settings may be required to support the approval of a DDC. In this review, we discuss the common issues during the manufacturing process and presentation development of an injectable DDC and practical considerations in establishing a clinical strategy to address these issues, including key elements of clinical studies. We also analyze the current practice in the industry and review relevant and status of regulatory guidance in the DDC field.

Employment-Based Reinforcement of Adherence to Oral Naltrexone Treatment in Unemployed Injection Drug Users

OpenAIRE

Dunn, Kelly; Defulio, Anthony; Everly, Jeffrey J.; Donlin, Wendy D.; Aklin, Will M.; Nuzzo, Paul A.; Leoutsakos, Jeannie-Marie S.; Umbricht, Annie; Fingerhood, Michael; Bigelow, George E.; Silverman, Kenneth

2012-01-01

Naltrexone has high potential for use as a relapse prevention pharmacotherapy for opiate dependence; however suffers from notoriously poor adherence when prescribed for oral self-administration. This study evaluated whether entry to a therapeutic workplace could be used to reinforce adherence with oral naltrexone. Opiate-dependent and cocaine-using injection drug users were detoxified, inducted onto oral naltrexone, and randomly assigned to a Contingency (n=35) or Prescription (n=32) group fo...

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

Science.gov (United States)

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

21 CFR 522.1662 - Oxytetracycline hydrochloride implantation or injectable dosage forms.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Oxytetracycline hydrochloride implantation or injectable dosage forms. 522.1662 Section 522.1662 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... INJECTABLE DOSAGE FORM NEW ANIMAL DRUGS § 522.1662 Oxytetracycline hydrochloride implantation or injectable...

Determination of drugs in biological fluids by direct injection of samples for liquid-chromatographic analysis.

Science.gov (United States)

Mullett, Wayne M

2007-03-10

The analysis of drugs in various biological fluids is an important criterion for the determination of the physiological performance of a drug. After sampling of the biological fluid, the next step in the analytical process is sample preparation. The complexity of biological fluids adds to the challenge of direct determination of the drug by chromatographic analysis, therefore demanding a sample preparation step that is often time-consuming, tedious, and frequently overlooked. However, direct on-line injection methods offer the advantage of reducing sample preparation steps and enabling effective pre-concentration and clean-up of biological fluids. These procedures can be automated and therefore reduce the requirements for handling potentially infectious biomaterial, improve reproducibility, and minimize sample manipulations and potential contamination. The objective of this review is to present an overview of the existing literature with emphasis on advances in automated sample preparation methods for liquid-chromatographic methods. More specifically, this review concentrates on the use of direct injection techniques, such as restricted-access materials, turbulent-flow chromatography and other automated on-line solid-phase extraction (SPE) procedures. It also includes short overviews of emerging automated extraction-phase technologies, such as molecularly imprinted polymers, in-tube solid-phase micro-extraction, and micro-extraction in a packed syringe for a more selective extraction of analytes from complex samples, providing further improvements in the analysis of biological materials. Lastly, the outlook for these methods and potential new applications for these technologies are briefly discussed.

Investigation of Plasma Treatment on Micro-Injection Moulded Microneedle for Drug Delivery

Directory of Open Access Journals (Sweden)

Karthik Nair