RESUMO
PURPOSE OF REVIEW: The social networks of people who inject drugs (PWID) have long been studied to understand disease transmission dynamics and social influences on risky practices. We illustrate how PWID can be active agents promoting HIV, HCV, and overdose prevention. RECENT FINDINGS: We assessed drug users' connections and interactions with others at risk for HIV/HCV in three cities: New York City (NYC), USA (n = 539); Pereira, Colombia (n = 50); and St. Petersburg, Russia (n = 49). In all three cities, the majority of participants' network members were of a similar age as themselves, yet connections across age groups were also present. In NYC, knowing any opioid user(s) older than 29 was associated with testing HCV-positive. In NYC and St. Petersburg, a large proportion of PWID engaged in intravention activities to support safer injection and overdose prevention; in Pereira, PWID injected, had sex, and interacted with other key groups at risk. People who use drugs can be active players in HIV/HCV and overdose risk- reduction; their networks provide them with ample opportunities to disseminate harm reduction knowledge, strategies, and norms to others at risk. Local communities could augment prevention programming by empowering drug users to be allies in the fight against HIV and facilitating their pre-existing health-protective actions.
Assuntos
Overdose de Drogas/prevenção & controle , Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Hepatite C/prevenção & controle , Rede Social , Abuso de Substâncias por Via Intravenosa/complicações , Adolescente , Adulto , Colômbia , Feminino , Infecções por HIV/etiologia , Hepatite C/etiologia , Humanos , Masculino , Assunção de Riscos , Federação Russa , Estados Unidos , Populações Vulneráveis , Adulto JovemRESUMO
This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p < .001), and more New York IDUs lived in their own home (30% vs. 14%, p < .001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.
Assuntos
Soropositividade para HIV/etnologia , Características de Residência , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/etnologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Porto Rico/etnologia , Comportamento Sexual , Estados Unidos/epidemiologiaRESUMO
AIMS: To describe AIDS and malaria geography in Brazil, highlighting the role of injecting drug users (IDUs) in malaria outbreaks occurring in malaria-free regions, and the potential clinical and public health implications of malaria/HIV co-infection. DESIGN: Review of the available literature and original analyses using geoprocessing and spatial analysis techniques. FINDINGS: Both HIV/AIDS and malaria distribution are currently undergoing profound changes in Brazil, with mutual expansion to intersecting geographical regions and social networks. Very recent reports describe the first clinical case of AIDS in a remote Amazonian ethnic group, as well as malaria cases in Rio de Janeiro state (hitherto a malaria-free area for 20 years); in addition, two outbreaks of both infections occurred at the beginning of the 1990s in the most industrialized Brazilian state (São Paulo), due to the sharing of needles and syringes by drug users. Spatial data point to: (a) the expansion of HIV/AIDS towards malarigenic areas located in the centre-west and north of Brazil, along the main cocaine trafficking routes, with IDU networks apparently playing a core role; and (b) the possibility of new outbreaks of secondary malaria in urban settings where HIV/AIDS is still expanding, through the sharing of needles and syringes. CONCLUSIONS: New outbreaks of cases of HIV and malaria are likely to occur among Brazilian IDUs, and might conceivably contribute to the development of treatment-resistant strains of malaria in this population. Health professionals should be alert to this possibility, which could also eventually occur in IDU networks in developed countries.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por HIV/complicações , Malária/complicações , Saúde Pública , Abuso de Substâncias por Via Intravenosa/complicações , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Brasil/epidemiologia , Resistência a Medicamentos , Infecções por HIV/epidemiologia , Humanos , Malária/epidemiologia , Uso Comum de Agulhas e Seringas , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
OBJECTIVES: To identify factors associated with effective AIDS behavior change among injecting drug users (IDU) in different national settings. DESIGN: Cross-sectional surveys of IDU, with determination of HIV status. Trends in city HIV seroprevalence among IDU also used to validate effectiveness of behavior change. SETTING AND PARTICIPANTS: Subjects recruited from drug-use treatment programs and outreach efforts in Bangkok, Thailand (n = 601), Glasgow, Scotland (n = 919), New York City, USA (n = 2539), and Rio de Janeiro, Brazil (n = 466). RESULTS: Evidence for the effectiveness of self-reported risk reduction was available for all cities. Univariate followed by multiple logistic regression analyses were used to identify factors associated with self-reported AIDS behavior change. Separate analyses were conducted for each city. Talking about AIDS with drug-using friends was significantly associated with behavior change in all four cities. Talking with sex partners about AIDS, educational level, knowing that someone can be HIV-infected and still look healthy, and having been tested previously for HIV were each significantly associated with behavior change in three of the four cities. CONCLUSIONS: Despite the substantial differences in these national settings, there were common factors associated with effective risk reduction. In particular, risk reduction appears to occur through social processes rather than through individual attitude change. HIV prevention programs need to explicitly incorporate social processes into their work.
Assuntos
Síndrome da Imunodeficiência Adquirida/psicologia , Comportamento , Infecções por HIV/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Síndrome da Imunodeficiência Adquirida/etiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Adulto , Brasil , Estudos Transversais , Feminino , Infecções por HIV/etiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Cidade de Nova Iorque , Análise de Regressão , Escócia , Comportamento Sexual , TailândiaRESUMO
To determine risk factors for HIV-1 among drug injectors in Rio de Janeiro, where cocaine is the dominant drug of injection, subjects were recruited using the criteria and interview instrument of the World Health Organization's Cross-National Study of HIV infection and risk behaviour in injecting drug users. HIV antibody test results were derived both from serum tests and from self-reports of previous tests (documented evidence of self-reported seropositivity was required). The analytical sample consists of 123 subjects, recruited both at drug abuse treatment sites and at street locations. Of 27 subjects with both serological and self-reported antibody status data, 20 reported previous negative tests; of these three had positive sera and may have seroconverted. Seven subjects reporting prior positive serostatus all tested positive. For the 123 subjects, seroprevalence was 34%. Independent significant risk factors in multivariate logistic regression with backwards elimination are: years of injection greater than 5; being a male who has had sex with men in the previous 5 years; and not having taken deliberate steps to protect oneself against AIDS. These findings indicate that homosexual/bisexual male drug injectors may be a bridge group through which HIV is entering drug-injecting networks in Rio de Janeiro. Efforts by drug injectors to reduce their risk of infection seem to have protective effects. This underscores the importance of HIV prevention efforts aimed at drug injectors.
Assuntos
Cocaína , Soropositividade para HIV/epidemiologia , HIV-1 , Abuso de Substâncias por Via Intravenosa/complicações , Brasil/epidemiologia , Comorbidade , Soropositividade para HIV/complicações , Soropositividade para HIV/diagnóstico , Humanos , Masculino , Fatores de Risco , Autoavaliação (Psicologia)RESUMO
Questionnaire data from almost 12,000 street-recruited drug injectors in 19 cities were analyzed to determine racial differences that may affect transmission of the human immunodeficiency virus (HIV). Self-reported sexual behaviors of drug injectors differ by city-type. White male drug injectors reported less unprotected vaginal sex than black or Latino males in multicultural--black/white/Mexican-origin and biracial cities. Black drug users of both sexes were less likely than white or Latino drug users to report unprotected and sex in multicultural--black/white/Mexican-origin and multicultural--black/white/Puerto Rican cities. The reported percentage of sex acts in which a condom was used was similar for black, white, and Puerto Rican men, and for black and white women, in all city types, but Puerto Rican women reported more condom use than black women. Mexican-origin drug injectors of each gender were least likely to report using condoms in multicultural--black/white/Mexican-origin cities. Black drug injectors are particularly likely to report having sex partners who do not inject drugs, as are Puerto Rican men and as are whites in multicultural--black/white/Mexican-origin cities. High-risk sex without condoms is widely reported among all groups of drug injectors studied: Each racial/gender group in each city-type averaged 15 or more episodes of unprotected vaginal sex per month, and 10% of most subgroups report having anal sex within the past 6 months. At least 45% of subjects in each city-type reported sex with noninjectors of the opposite gender. Without continued and expanded intervention, these data are consistent with HIV spreading to drug injectors, their sexual partners, and their future children, in all racial/ethnic groups.
Assuntos
Síndrome da Imunodeficiência Adquirida/transmissão , Negro ou Afro-Americano/psicologia , Comparação Transcultural , Hispânico ou Latino/psicologia , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/psicologia , População Urbana , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/psicologia , Adulto , Preservativos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Americanos Mexicanos/psicologia , Porto Rico/etnologia , Fatores de Risco , Parceiros Sexuais/psicologia , Meio Social , Abuso de Substâncias por Via Intravenosa/complicações , População Branca/psicologiaRESUMO
Data from various countries show considerable variation in the rate of spread of the human immunodeficiency virus (HIV) among drug injectors. Although further research is needed to predict the rate of increase of seroprevalence at Rio de Janeiro, preliminary data confirm the presence of the virus, with a seroprevalence of about 33 per cent in 1990. Issues arising from research into the probable determinants of viral spread among the thousands of drug injectors in the city are outlined in the present paper. Even before the research is completed, however, it is clear that interventions are needed to reduce further viral transmission both among drug injectors and from them to their sexual partners and offspring. Efforts should be made to prevent the population at risk from initiating the practice of drug injection, and to promote a major expansion in drug abuse treatment facilities. Drug injectors should also be encouraged to reduce the risk of their becoming infected or passing on the virus to others, through educational outreach, through the distribution of supplies that facilitate risk reduction (bleach, syringes, condoms), and through innovative approaches to behaviour change.
PIP: Data from various countries show considerable variation in the rate and extent of HIV spread among IV drug users (IVDU). More than 11,000 people have been diagnosed as having AIDS in Brazil, of whom 1700 were in Rio de Janeiro. 82 of these 1700 people were heterosexual IVDUs and 16 were homosexual or bisexual IVDUs. Although additional research is needed to predict the level and rate of increase of HIV seroprevalence in Rio de Janeiro, preliminary data suggest that as many as 33% of IVDUs in 1990 may have been HIV-seropositive. Such data clearly warrant interventions to reduce HIV transmission within this population and from them to their sex partners and offspring. This paper outlines issues arising from research into the probable determinants of viral spread among the thousands of drug injectors in the city. Efforts need to be made to prevent the population at risk from beginning to use injecting drugs and to promote a major expansion in drug abuse treatment facilities. Drug injectors should also be encouraged to reduce the risk of their becoming infected or passing the virus to others. Approaches could include educational outreach; the distribution of supplies which facilitate risk reduction such as bleach, syringes, and condoms; and innovative approaches to behavior change.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/etiologia , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Soroprevalência de HIV , Vigilância da População , Abuso de Substâncias por Via Intravenosa/complicações , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Brasil/epidemiologia , Preservativos , Desinfecção , Previsões , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Comportamentos Relacionados com a Saúde , Humanos , Agulhas , Educação de Pacientes como Assunto , Administração em Saúde Pública , Pesquisa , Fatores de Risco , Centros de Tratamento de Abuso de Substâncias , Abuso de Substâncias por Via Intravenosa/prevenção & controle , População UrbanaRESUMO
There is now evidence from a wide variety of geographic areas that many intravenous drug users will change their behavior in order to reduce their risk of developing AIDS. There is even evidence from some areas that the behavior change has led to relative stabilization of seroprevalence rates, although longer-term studies will be needed to establish this definitively. AIDS behavior change in the area of sexual risk reduction appears to be much more difficult than change of drug injection behavior. Conceptual models of AIDS-related behavior change are needed, particularly models that can incorporate the injection of different drugs and variation in social and psychological characteristics among drug injectors. There is increasing evidence for a wider spectrum of HIV-related morbidity and mortality among intravenous drug users than is captured by the current surveillance definition for AIDS, again emphasizing the need for effective prevention programs.
PIP: Topics concerning intravenous drug use and AIDS are reviewed. Topics include seroprevalence of HIV among users worldwide, evidence that iv drug users will alter behavior to avoid AIDS, results of safer injections programs, no evidence for reduction in high-risk behavior regarding sexual transmission of AIDS by users, diversity in HIV prevalence among users, and clinical aspects of their disease. Seroprevalence of HIV among drug users has remained at about 30% in the U.S. and parts of Europe, while lower in Asia and South America. There is now evidence from several places in Europe and the U.S. that many iv drug users will change drug injecting behavior to avoid AIDS. A conceptual model of new social norms needed to change behavior involves 3 stages: knowing the dangers of AIDS, having the means to change behavior (treatment or clean syringes), and a mechanism to reinforce the new behavior (perceived efficacy or social approval). There is no evidence that safer injection programs either keep users from going to treatment or increase numbers of users. In contrast, there is no evidence for improved sexual risk-taking behaviors among users, a fact which argues for stronger efforts to prevent already infected users from spreading HIV. The public, policy-markers, and researchers are unaware that seroprevalence of HIV varies with the type of drug injected (cocaine; heroin; amphetamine), and with socioeconomic status of the user (ethnic minority; majority). The clinical presentation, infection rate, persistence of infection, and mortality rate among iv drug users differs from that of the general AIDS population. Endocarditis, tuberculosis and bacterial pneumonias are 3 of the common findings in drug users. Even "non-AIDS" deaths apparently due to immunosuppression are reported in drug users. There may be undiscovered co-factors in HIV infection in this population.