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My first time: initiation into injecting drug use in Manipur and Nagaland, north-east India

My first time: initiation into injecting drug use in Manipur and Nagaland, north-east India

The questionnaire was based on one used previously to describe initiation into injecting in Melbourne, Australia [10], but was adapted for the local context and piloted. It was interviewer administered and the questions covered a range of topics: demographic information; detailed infor- mation regarding the circumstances of the first injection of illicit drugs – both what happened at the time of the injection specifically and what was happening in the per- son's life more generally; previous and current drug use; self-reported HIV and hepatitis C status; and initiation of others into injecting drug use. The questions were in Eng- lish but were translated into the local language as required. The appropriate phrasing of each question in the local language was thoroughly discussed with the bi-lin- gual interviewers during the training and piloting phases. Data collection
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Exploring associations between perceived HCV status and injecting risk behaviors among recent initiates to injecting drug use in Glasgow

Exploring associations between perceived HCV status and injecting risk behaviors among recent initiates to injecting drug use in Glasgow

The characteristics, injecting risk behaviors, and perceived HCV status of the study partici- pants are summarized in Table 1. The average age of participants was 27 years and the mean length of injecting career was 2.5 years. The majority of the sample were male (70.4%) and had ever been in treatment for drug use (84%), and more than half the sample was currently receiving treatment. Most respondents reported having injected heroin in the 6 months prior to interview (442, 89%), followed by cocaine (168, 34%) and temazepam (95, 19%). Over 50% reported having been imprisoned since commencing injecting drug use. The primary place of residence in the past 6 months varied, with the largest percentage of respondents reporting living in their own home, followed by someone else’s home, and a hostel for the homeless. Sixty-two percent of respondents reported injecting at least twice a day. The majority (80.5%) of respondents reported less than 30 minutes travel time to the nearest needle exchange. When asked to estimate the number of HCV-infected Glasgow IDUs out of 100, 60% of respondents estimated the prevalence to be 75% or greater.
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Injecting drug use in Manipur and Nagaland, Northeast India: injecting and sexual risk behaviours across age groups

Injecting drug use in Manipur and Nagaland, Northeast India: injecting and sexual risk behaviours across age groups

The response to HIV and injecting drug use in Manipur and Nagaland was historically punitive but is now guided by internationally recognized harm reduction principles [7]. The HIV prevention response is coordi- nated by the government through the National AIDS Control Organization (NACO) and the respective State AIDS Control Societies (SACS). Alongside this, Avahan (Bill & Melinda Gates Foundation in India) funded Project ORCHID to coordinate a range of local non-government organizations (NGOs) to implement HIV prevention in- terventions in selected districts of Manipur and Nagaland over a 10-year period (2004–14). Regardless of funding source, most of the targeted HIV prevention interventions in Manipur and Nagaland are delivered in the field by local NGOs. To evaluate the HIV prevention interven- tions, and to better understand the dynamics of the HIV epidemic, two surveys were conducted in separate districts of Manipur and Nagaland in 2009: the Integrated Behav- ioural and Biological Assessment (IBBA) [17] and the Be- havioural Tracking Survey (BTS) [16].
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Improved benchmark-multiplier method to estimate the prevalence of ever-injecting drug use in Belgium, 2000–10

Improved benchmark-multiplier method to estimate the prevalence of ever-injecting drug use in Belgium, 2000–10

For Belgium, the latest estimate of the ever-IDU preva- lence date from 1995 and was obtained adopting the BM approach using the HIV/AIDS register as benchmark [13]. However, the Belgium HIV/AIDS register suffers from missing risk factor information. Particularly, of all registered cases in 2000–10, 28.6% were reported without information on probably mode of HIV transmission (e.g. sexual contact, blood transfusion, injecting drug use). Simply discarding these cases from analysis would lead to an underestimation of the IDU prevalence. Simply ex- trapolating the risk factor fractions of the subpopulation for which the risk factors are known to the subpopula- tion for which they are unknown, would lead to overcon- fident results and would only lead to unbiased results under very strict assumptions (i.e. the Missing Com- pletely ad Random assumption). In addition, the national HIV/AIDS register lacks follow-up of the non-AIDS cases, implying absence of information on the vital status of the HIV + /AIDS – cases. Not accounting for the mortality among these cases would result in an overestimation of the number of alive seropositive IDUs, with the bias increasing as the time since the onset of the HIV-epidemic (mid- eighties) increases. The methodology proposed in [13] used
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Prevalence of injecting drug use in Estonia 2010–2015: a capture-recapture study

Prevalence of injecting drug use in Estonia 2010–2015: a capture-recapture study

50% [11] to 60% [12]. For Estonia, the most recent esti- mate of the size of the PWID population originates from 2009 [8]. An analysis of changes in the size of PWID population over the period 2004–2009 suggested that the number of PWID in Estonia is decreasing [8]. This finding is in agreement with other studies from Estonia, where it has been observed that the average age of PWID has been increasing (most participants were less than 25 years old in 2005 [13] vs. most were over 30 in 2016 [11]) in parallel with the average number of years they have been injecting (26% up to 3 years in 2005 [14] vs. 12% up to 5 years in 2016 [11]), suggesting that fewer people are starting injecting, potentially leading to a decrease in the number of PWID. Although the demo- graphics of PWID in these studies have changed, the main drug injected by PWID remains a synthetic opi- oid—fentanyl. In the 2016 study conducted by Uusküla et al., it was found that most PWID (76%) used opioids during the last 6 months (A. Uusküla, unpublished data). In this paper, we extend the analysis of the number of PWID in Estonia for the years 2010 to 2015 and explore different modelling strategies to minimise over-coverage-induced bias in capture-recapture estimates.
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Injecting drug use and unstable housing: Scope for structural interventions in harm reduction

Injecting drug use and unstable housing: Scope for structural interventions in harm reduction

Evidence links unstable housing, and especially homelessness, with elevated health harm among drug users, including riskier drug injecting practices. We undertook 45 in-depth qualitative interviews with injecting drug users (IDUs) in Bristol and London in 2006. IDUs were recruited through drug user networks and drug agencies. Temporary accommodation and hostels for the homeless may provide a ‘safe haven’ from street-based drug use and public injecting environments, and are characterised as a retreat from the ‘chaos’ of the street. But hostels may also constitute ‘risk environments’ in facilitating drug using and risk networks, transitions to new patterns of use, including increased frequency of injecting. For some, homelessness was positioned as ‘safer’ than temporary housing with regards to managing drug use. Stable housing emerges as a key structural factor in creating enabling environments for health. We emphasise that temporary accommodation hostels have potential for harm-reduction interventions, but may also be associated with the production of risk related to drug use and injecting.
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The rise of injecting drug use in East Africa: a case study from Kenya

The rise of injecting drug use in East Africa: a case study from Kenya

SB found that the terminology used by members of the sub-culture of heroin users changes rapidly, so outsiders cannot readily gain entry to this group. As Ramos [26] found amongst Chicanos, ability to converse in this semi- secret language confers an insider status. The use of obscure terminology also assists heroin users in conduct- ing their illegal and socially sanctioned activities within the midst of mainstream society. Heroin users in this Ken- yan setting use a mixture of Swahili and English loan words to talk about injecting in particular and heroin use in general [10]. Most of these terms are slang and are not readily understood by Swahili-speakers who are not part of the heroin-using sub-culture. However, some terms such as 'junkie', 'shoot' or 'shooter' are understandable to drug users throughout the English-speaking world. Other terms are common to networks of heroin users within East Africa. Indeed, many words, such as tapeli ('scam') seem to originate from mainstream Tanzanian dialects of Swahili and have been diffused into Kenyan drug slang. Other ter- minology, such as kubwenga meaning 'to inject', or noma meaning 'a bad or dangerous incident' (such as being chased by the police), appears to be specific to the speech of heroin users at the Kenya Coast. However, such terms are likely to spread quickly into general street talk [27]. Injecting practice
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Correlates of property crime in a cohort of recently released prisoners with a history of injecting drug use

Correlates of property crime in a cohort of recently released prisoners with a history of injecting drug use

Our sample demonstrated a pattern of problematic poly-drug use common among samples of PWID. Two specific patterns of substance use were associated with property crime in multivariable analyses: daily injecting and illicit benzodiazepine use. As found by others [13, 17], property crime among these participants is likely to be driven by the need to finance their drug use, particularly among those injecting daily or more often. To the best of our knowledge, this is the first study to identify an associ- ation between illicit benzodiazepine use and property crime among people recently released from prison. This finding is consistent with Australian data showing a greater likelihood of illegally sourced income and arrest or imprisonment in the previous year among detainees reporting illicit benzodiazepine use [18]. High prevalence benzodiazepine use reported among PWID in Australia, Europe and the USA [7, 19–23] has given rise to in- creasing concerns about the adverse consequences of co-occurring opioid and benzodiazepine use [24]. The financial pressure of funding drug purchases combined with benzodiazepine-driven disinhibited criminal be- haviours reported by PWID [25] suggests a need for targeted actions for crime prevention. Pre- and post- release programmes for those with substance depend- ence histories should focus on interventions to reduce poly-drug use alongside cautious pharmaceutical pre- scribing practices. Recent Australian research showed a majority of PWID reporting non-prescription initiation of benzodiazepines, with medical practitioners as their usual current source of benzodiazepines [26]. The pur- ported ‘over-prescribing’ of benzodiazepines in Australia, their potential diversion within populations of PWID and the associated health risks (e.g. overdose) have prompted calls for more cautious benzodiazepine prescribing and improved prescription monitoring [25, 27, 28]. The associ- ation with criminal activity should also factor into such considerations.
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Drug use and risk behaviours among injecting drug users: a comparison between sex workers and non-sex workers in Sydney, Australia

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

There were no significant differences in drug types used by SW and N-SW, however SW initiated injecting drug use at a younger age. Again, these results are consistent with the literature that suggests that earlier age of initiation has been associated with a range of adverse outcomes later in life. Evidence suggests that those who have begun sub- stance use by an early age are more likely to develop prob- lematic substance use [29-32], engage in risky sexual behaviour [31,33], become involved in criminal activity [31], and complete fewer years of education [34]. Earlier initiates to substance use are also more likely to become more dependent, use for a longer time and have more drug-related problems. [35-40]. In the current study, among an already marginalised group of regular IDU, earlier initiation to drug use appeared to be associated with an additional risky behaviour – sex work. Research in Australia has illustrated these risks, with sex workers (par- ticularly those who are street based) being more vulnera- ble to adverse contact with law enforcement, subject to
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Adherence to response guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: the ACTIVATE study

Adherence to response guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: the ACTIVATE study

While PEG-IFN based therapies have recently been re- placed by new DAA therapies in many settings, data on the adherence to HCV therapies among PWID is still needed. In many countries, concerns still exist regarding the adherence to therapy among active PWID [10, 23]. As a result many countries have restricted the use of DAA therapies to those without current injecting [23–25]. A better understanding of adherence among active injectors is therefore needed to inform policy and remove the re- strictions placed on DAA therapies. This data also high- lights the positive effect of shortened therapy on treatment completion in this population as pushes to fur- ther shorten HCV therapy continue. This study includes data on adherence to self-administered ribavirin, providing some insight into adherence of an oral twice-daily antiviral therapy. Given the increased tolerability and simplicity DAA regimens compared to PEG-IFN and ribavirin-based therapies, adherence should be comparable, if not better, than that observed with twice-daily ribavirin, Further data is needed to assess adherence to DAA-based therapy among people with ongoing injecting drug use.
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A systematic review of current knowledge of HIV epidemiology and of sexual behaviour in Nepal

A systematic review of current knowledge of HIV epidemiology and of sexual behaviour in Nepal

The HIV/AIDS situation in Nepal has been described as an impending crisis (Seddon 1998). Concern has been fuelled by rapidly rising HIV-1 seroprevalence associated with high-risk behaviour and extensive migration patterns. Nepal is one of the poorest nations in the world with poor health and development indicators (Table 1) and would be devastated by an extensive AIDS epidemic. Current HIV/ AIDS control in Nepal focuses on risk reduction within ‘high-risk groups’, namely injecting drug users and female commercial sex workers (FCSWs). Drug use in Nepal is a long-standing phenomenon. Alcohol and cannabis have been used for centuries (Shrestha 1992; Dixon 1999). Their disinhibiting effects and socio-economic consequences may influence HIV spread. However, of more direct influence on HIV transmission is injecting drug use (IDU), which
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Infectious diseases, NSW: May 1998

Infectious diseases, NSW: May 1998

Between 1995 and 1997, there was a large increase in the number of persons newly diagnosed with HIV infection for whom risk factors were not reported and, in contrast to other exposure groups, no decline in persons reporting heterosexual exposure to the virus. In addition, the decline in new AIDS diagnoses was least among persons reporting heterosexual contact and there was an increase in persons reporting injecting drug use (Table 1). These differences involve only relatively small numbers, but suggest that persons who acquire HIV infection through injecting drug use or heterosexual contact may be somewhat more difficult to reach with interventions.
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A review of the evidence for the effectiveness of primary prevention interventions for Hepatitis C among injecting drug users

A review of the evidence for the effectiveness of primary prevention interventions for Hepatitis C among injecting drug users

An example of this was the contentious debate following the outbreak of HIV in Vancouver, Canada in 1994 [24]. The rapid rise in HIV prevalence was preceded by the introduction of an NEP in 1989. Prior to the outbreak Vancouver had a low HIV prevalence rate and it was assumed that this was due to the effectiveness of the NEP. The outbreak led to several observational studies which sought to explore a possible causal link between the NEP and the HIV outbreak. An initial outbreak investigation in 1995 found an independent association between needle sharing, and social determinants (such as unstable hous- ing) and HIV seroconversion [25]. This led to a prospec- tive cohort study of 1006 IDUs. Whilst the limited number of HIV seroconverters precluded a formal early statistical analysis, multivariate analysis of baseline data documented an independent association between HIV- positive serostatus and frequent (>once per week) NEP attendance. NEPs were thus criticised for promoting unsafe injecting drug use behaviour (or at the very least condoning injecting drug use). It was postulated that the NEP could act as a focus for forming social networks con- ducive to the initiation into unsafe injecting practice. Political ramifications were highlighted in the USA where the results were interpreted as evidence of a causal link
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The filter of choice: filtration method preference among injecting drug users

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

Drug preparations are commonly filtered by illicit drug users before injection in order to eliminate impurities of the drug containing solution. Several complications aris- ing from injecting drug use depend on the characteris- tics of the filter used [1]. Amongst these is the introduction of insoluble particles into the blood stream. Various complications, ranging from minor to severe, are associated with the intromission of these foreign bodies. At the site of injection, sterile abscesses, cellu- lites and ulcers can occur, which increase the risk of infection at these sites [2,3]. After injection, insoluble particles such as talc and cellulose will stay intact and move along with the blood stream, blocking the first vessels too small to pass. Repeated administration can thus lead to severe pulmonary and cardiac complications
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Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran

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

The current drug policy responses in Iran depart from the anti-trafficking focus and draconian measures of the past, and give an indication of the plausibility of implementing the typology-suggested interventions and a more public health approach to addiction. The government is embrac- ing a harm reduction response to the epidemic of injecting drug use [50]. The progressive efforts to address many of the social and health effects of drug use in Iran are being driven by leadership that appears to grasp the reality and enormity of the domestic drug use problem, and the potential for an injecting-driven HIV epidemic in Iran. Over the past 6 to 8 years, their efforts are notable: the expansion of therapeutic communities, Narcotics Anony- mous, and outpatient clinics; sponsoring pilot substitu- tion treatment programs (methadone and buprenorphine) and support of their expansion in princi- ple and in action (in Spring of 2005, the parliament voted to allow any doctor in Iran to dispense methadone, under strict monitoring guidelines); implementation of out- reach programs and enlarging the network of existing out- reach mechanisms, such as the more than sixty "Triangular Clinics" that are devoted to the health con- cerns of high-risk individuals like sex workers and drug users; support of needle exchange and pharmacy-sold syringes programs to operate and vend syringes legally to drug users (see January 2005 decree of the judicial branch of the Islamic Republic of Iran supporting needle exchange and warning against interference with these 'needed and fruitful' public health interventions) [3]; piloting prison-based NEP programs; and liberalizing drug-sentencing guidelines (see Justice Minister Ayatollah Mohammad Esmail Shoshtari's letter to prosecutors to ignore the current laws on the books and to defer to Iran's Health Ministry to counter the spread of AIDS and hepa- titis C) [50]; and subsidizing the cost of treatment for sub- stitution therapies for drug users as well as antiretroviral therapy for those who are HIV positive. The openness to many of these individual and social structural responses indicate that there is a unique window of opportunity for remarkable reduction in drug-related harm in Iran, pro- vided that the momentum can be maintained and that rig- orous evaluations are undertaken to objectively gauge effectiveness.
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Double jeopardy--drug and sex risks among Russian women who inject drugs: initial feasibility and efficacy results of a small randomized controlled trial

Double jeopardy--drug and sex risks among Russian women who inject drugs: initial feasibility and efficacy results of a small randomized controlled trial

Research suggests a high correlation between sex risk behaviors and drug use [14,16]. Among IDUs, for exam- ple, drug use may impair judgment and increase risky sex behaviors, including unprotected sex, having multi- ple sex partners, or exchanging sex for drugs and every- day necessities [17]. In addition, injecting drug use has been reported to be a major factor in the increase of commercial sex workers in Russia [11]. Studies show that 15-50% of female IDUs in Russia engage in com- mercial sex work for money and/or drugs [8,11,18], yet some women also trade sex only for drugs. Evidence suggests that sexually active female IDUs, whether com- mercial sex workers or not, are a most-at-risk popula- tion in St. Petersburg and urgently need HIV prevention interventions.
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Temporal differences in gamma-hydroxybutyrate overdoses involving injecting drug users versus recreational drug users in Helsinki: a retrospective study

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

A used GHB/GBL with alcohol and overdosed during weekend nights in night-clubs and discos (public places). On the other hand, the majority of the patients in group B had a history of injecting drug use, overdosed in the middle of the week or in the early evenings and were encountered more often in private residences and out- doors (Tables 1, Figures 5 and 6). Injecting drug users also had more often repeated GHB/GBL overdoses in comparison to non injecting drug users. Similar differ- ences in the relative location of the overdose have been noted when comparing GHB- and heroin overdose patients previously [1].
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FACTORS ASSOCIATED WITH HEPATITIS B AND C CO-INFECTION AMONG PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS IN VIETNAM

FACTORS ASSOCIATED WITH HEPATITIS B AND C CO-INFECTION AMONG PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS IN VIETNAM

This study employed the Social Ecological Model (SEM) as a theoretical perspective that focused on multiple levels (personal and environmental) of factors and their complex interplay that influence specific behavior. Total of 12 variables was analyzed in this study, which was categorized into four levels, including intrapersonal levels (age, sex, education, marital status, employment status, sexual orientation, experience of injecting drug use and duration of ARV treatment); interpersonal levels (practicing unsafe sex and partner’s history of injecting drugs); organizational level (place of residence); and community level (tattooing).Descriptive statistic was used to describe the general characteristics of the respondents (frequencies and percentages). Multivariate analysis (Binary logistic regression) was carried out to identify the risk factors for the co-infections (HIV co-infection with HBV or HCV).There are 2 models, each model is appropriate with each dependent variable (HIV and HBV co- infection, HIV and HCV co-infection). STATA software version 14 was used for all statistical analyses.
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Infectious diseases, NSW: November 1998

Infectious diseases, NSW: November 1998

The public health benefits of the NSW Needle and Syringe Program, first implemented in NSW in 1988, are significant. Unsafe drug injecting is a major route of HIV infection; however, the HIV prevalence amongst injecting drug users (IDUs) in Australia has remained one of the lowest in the world, at less than two per cent. This compares favourably with those countries without needle and syringe programs, where HIV prevalence among IDU can be as high as 50 per cent. In many countries, unsafe drug injecting behaviour such as needle sharing now accounts for more HIV infections that unprotected sex. In Malaysia, Vietnam, south-west China, north-east India and Myanmar, 75 per cent of HIV cases are among IDUs. The World Health Organisation estimated that in 1997 injecting drug use was responsible for approximately 43 per cent of the total AIDS cases in the European region. 1
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Differences in sociodemographic, drug use and health characteristics between never, former and current injecting, problematic hard-drug users in the Netherlands

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

Results: Results indicate that IDUs represented a separate group of problematic hard-drug users, with distinct sociodemographic and drug use characteristics. Overall, IDUs appeared to be the group with least favourable characteristics (unstable housing/homelessness, illegal activities, polydrug use) and NIDUs appeared to have the most favourable characteristics (stable housing, help with debts, less polydrug use). The FIDU group lies somewhere in between. The three groups did not differ significantly in terms of health. Regarding injecting practices, results showed that majority of IDUs had injected drugs for over 10 years and IDUs injected heroin, cocaine, amphetamine and/or methadone in the past 6 months. Sharing syringes was not common. A quarter reported public injecting. Conclusions: Unstable housing and homelessness are related to (former) injecting drug use, and stable housing is related to never-injecting drug use. Our study suggests that the number of ‘ new ’ IDUs is low. However, public injecting among IDUs is not uncommon and is associated with unstable housing. This emphasizes the potential of housing projects as a component of harm reduction measures. Therefore, prevention of (risks associated with) injecting drug use and supported housing programmes for problematic hard-drug users deserve the continuous attention of policymakers and professionals in low-threshold addiction care.
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