RESUMO
BACKGROUND: People who inject drugs (PWID) experience multiple risk factors for mortality; yet, we know little about causes of death among PWID in Tijuana, Mexico, an area with high levels of injecting and changes in policy/law enforcement responses to substance use. This study examines rates, causes, and predictors of mortality among Tijuana PWID. METHODS: Data come from a community-based cohort of PWID aged ≥18 who injected drugs in the past month. Mortality was confirmed by death certificate over 78 months during 2011-2018. Predictors of mortality were identified using time-updated Cox regression, controlling for age. RESULTS: Among 734 participants, there were 130 deaths (54 confirmed, 76 unconfirmed), with an incidence rate of 17.74 deaths per 1000 person-years for confirmed deaths (95% Confidence Interval (CI)=13.01, 22.48) and 39.52 for unconfirmed deaths (CI=32.72, 46.31). Confirmed deaths resulted from homicide/trauma (26%), overdose (26%), septic shock (18%) and HIV-related causes (9%). In multivariable analysis of confirmed deaths, baseline HIV seropositivity (adjusted Hazard Ratio [aHR]=6.77, CI=1.98, 23.17), incident HIV infection (aHR=3.19, CI=1.02, 9.96), and number of times being beaten by police in the past 6 months at baseline (aHR=1.08 per time, CI=1.04, 1.12) were predictive of death; whereas, injection cessation for 6+ months during time at risk (aHR=0.25, CI=0.33, 0.79) was protective. CONCLUSION: In addition to overdose and HIV prevention efforts, attention to structural conditions that potentiate mortality is needed, including improved access to medication-assisted treatment to support injection cessation and a shift from police as a source of harm to harm reduction.
Assuntos
Overdose de Drogas/epidemiologia , Infecções por HIV/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Causas de Morte , Overdose de Drogas/mortalidade , Feminino , Infecções por HIV/mortalidade , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Polícia/estatística & dados numéricos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/mortalidadeRESUMO
This study examines whether place of residence is a factor associated with reporting a positive HIV/AIDS, Hepatitis C (HCV), or Sexually Transmitted Disease (STD) status in a sample of 400 injection drug users (IDUs) residing on the Island of Puerto Rico (N=139) and in western Massachusetts (N=261). Logistic regression models revealed that IDUs residing in western Massachusetts were 66% less likely to be HIV positive compared to IDUs residing in Puerto Rico (p<.000) while IDUs residing in western Massachusetts were about 67% less likely to have a positive STD status than those residing in Puerto Rico (p<.000). Place of residence was not significantly associated with HCV status. Results indicate the need to develop prevention programs tailored to the unique socio-cultural context of Puerto Rican IDUs residing on the Island of Puerto Rico whose circumstances differ from those in the mainland US. To reduce drug use, HIV/AIDS, HCV, and STDs among Puerto Ricans in both locales, the Capacity Enhancement Model is proposed in order to develop more effective prevention programs.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Prevenção Primária/métodos , Abuso de Substâncias por Via Intravenosa/etnologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adolescente , Adulto , Distribuição por Idade , Análise de Variância , Intervalos de Confiança , Estudos Transversais , Feminino , Hepatite C Crônica/etnologia , Hepatite C Crônica/mortalidade , Hepatite C Crônica/prevenção & controle , Humanos , Incidência , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Razão de Chances , Probabilidade , Porto Rico/epidemiologia , Assunção de Riscos , Distribuição por Sexo , Infecções Sexualmente Transmissíveis/etnologia , Infecções Sexualmente Transmissíveis/mortalidade , Infecções Sexualmente Transmissíveis/prevenção & controle , Abuso de Substâncias por Via Intravenosa/mortalidade , Taxa de SobrevidaRESUMO
Drug users have been found to be at high risk of mortality but the mortality experience of Hispanic drug users remains understudied. This study assessed mortality among Puerto Rican injection drug users (IDUs) in New York City (NY), and in Puerto Rico (PR). Study subjects were 637 IDUs from NY and 319 IDUs from PR. Mortality was ascertained using data from the National Death Index. Annual mortality rate of the NY cohort was 1.3 per 100 person years compared to the PR cohort with a rate of 4.8. Compared to the Hispanic population of New York City, the standardized mortality ratio (SMR) of the NY cohort was 4.4. Compared to the population of Puerto Rico, the SMR of the PR cohort was 16.2. The four principal causes of death were: NY-HIV/AIDS (50.0%), drug overdoses (13.3%), cardiovascular conditions (13.3%), and pulmonary conditions (10.0%); PR-HIV/AIDS (37.0%), drug overdoses (24.1%), sepsis (13.0%), and homicide (11.1%). Modeling time to death using Cox proportional hazards regression, the relative risk of mortality of the PR cohort as compared to the NY cohort was 9.2. The other covariates found to be significantly associated with time to death were age, gender, education, social isolation, intoxication with alcohol, and HIV seropositivity. The large disparity in mortality rates found in this study suggests that health disparities research should be expanded to identify intra-group disparities. Furthermore, these results point to an urgent need to reduce excess mortality among IDUs in Puerto Rico.
Assuntos
Abuso de Substâncias por Via Intravenosa/etnologia , Abuso de Substâncias por Via Intravenosa/mortalidade , Adulto , Fatores Etários , Feminino , Infecções por HIV/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Fatores Sexuais , Fatores SocioeconômicosRESUMO
Injection drug users (IDUs) continue to comprise a major risk group for HIV infection throughout the world and represent the focal population for HIV epidemics in Asia and Eastern Europe/Russia. HIV prevention programs have ranged from HIV testing and counseling, education, behavioral and network interventions, drug abuse treatment, bleach disinfection of needles, needle exchange and expanded syringe access, as well as reducing transition to injection and primary substance abuse prevention. With the advent of highly active antiretroviral therapy (HAART) in 1996, dramatic clinical improvements have been seen. In addition, the treatment's impact on reducing HIV viral load (and therefore transmission by all routes) provides a stronger rationale for an expansion of the focus on prevention to emphasize early identification and treatment of HIV infected individuals. However, treatment of IDUs has many challenges including adherence, resistance and relapse to high risk behaviors, all of which impact issues of access and ultimately effectiveness of potent antiretroviral treatment. A major current challenge in addressing the HIV epidemic revolves around an appropriate approach to HIV treatment for IDUs.
Assuntos
Terapia Antirretroviral de Alta Atividade/normas , Infecções por HIV/tratamento farmacológico , Cooperação do Paciente/psicologia , Abuso de Substâncias por Via Intravenosa/complicações , Fármacos Anti-HIV/provisão & distribuição , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Terapia Antirretroviral de Alta Atividade/psicologia , Brasil/epidemiologia , Farmacorresistência Viral , Medicina Baseada em Evidências , Infecções por HIV/mortalidade , Infecções por HIV/psicologia , Humanos , Programas de Troca de Agulhas , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/mortalidade , Abuso de Substâncias por Via Intravenosa/psicologiaRESUMO
This paper presents AIDS incidence and mortality among injecting drug users (IDUs) reached by the AjUDE-Brasil II Project. From a cross-sectional survey, 478 IDUs were interviewed in three Brazilian cities: Porto Alegre, São José do Rio Preto, and Itajaí. The cohort was followed up in the Brazilian surveillance database for AIDS and mortality during 2000 and 2001. AIDS incidence was 1.1 cases per 100 person-years, and the mortality rate was 2.8 deaths per 100 person-years. AIDS cases only occurred in IDUs who reported ever having shared injecting equipment. Female gender (RR = 5.30), homelessness (RR = 6.16), and report of previous sexual relations with same-sex partners (RR = 6.21) were associated with AIDS. Deaths occurred only among males. Homelessness (RR = 3.00), lack of income (RR = 2.65), HIV seropositive status (RR = 4.52), and no history of incarceration (RR = 3.71) were also associated with death. These findings support evidence that gender and socioeconomic conditions are both determinants of morbidity and mortality in Brazilian IDUs.
Assuntos
Síndrome da Imunodeficiência Adquirida/mortalidade , Abuso de Substâncias por Via Intravenosa/mortalidade , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Uso Comum de Agulhas e Seringas/efeitos adversos , Programas de Troca de Agulhas , Fatores Sexuais , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
Este estudo apresenta a incidência de AIDS e a mortalidade em usuários de drogas injetáveis (UDIs) participantes do Projeto AjUDE-Brasil II. Uma coorte de 478 indivíduos entrevistados nas cidades de Porto Alegre ¡ Rio Grande do Sul ¡, São José do Rio Preto ¡ São Paulo ¡ e Itajaí ¡ Santa Catarina ¡ foi acompanhada nos sistemas de vigilância brasileiros entre 2000 e 2001. Encontrou-se incidência de AIDS de 1,1 caso por 100 pessoas/ano e taxa de mortalidade de 2,8 óbitos por 100 pessoas/ano. Casos de AIDS ocorreram somente em UDI que relataram compartilhar seringas. Sexo feminino (RR = 5,30), relato de ausência de local para morar (RR = 6,16) e de relacões sexuais com pessoas do mesmo sexo (RR = 6,21) estiveram associados à ocorrência de AIDS. Relato de ausência de local para morar (RR = 3,00) e de fonte de renda (RR = 2,65), ser HIV soropositivo (RR = 4,52) e nunca ter sido encarcerado (RR = 3,71) se associaram aos óbitos, que ocorreram somente em homens. Esses achados parecem confirmar que diferencas de gênero e condicões econômicas são determinantes para a morbi-mortalidade de UDIs brasileiros.
Assuntos
Abuso de Substâncias por Via Intravenosa/mortalidade , Homossexualidade , Síndrome da Imunodeficiência Adquirida/epidemiologia , Incidência , Fatores SocioeconômicosRESUMO
Cocaine consuming patterns are changing among young drug users who live in "The Villa," a shantytown located in Greater Buenos Aires. After years of drug injection dominance, cocaine snorting became the preferred drug consuming practice while deep and fast structural and cultural transformations have been taken place as part of the neoliberal program implemented in Argentina during the 1990s and the final economic default in 2001-2002. In this article, I analyze how drug users understand and explain these changing practices, including the following aspects: deteriorating economic conditions, the transformations of survival strategies, moral codes, social network organization, violence regulating mechanisms, criminal activity, and police repression. Based on an ethnographic study carried out during the last eight months in "The Villa," I suggest that intense and generalized cocaine injection in shantytowns has logistic, organizational, and structural requirements that cocaine snorting does not have. Particularly, I explore two main aspects associated with these changing cocaine consumption practices: the consequences of the many Acquired Immunodeficiency Syndrome (AIDS)-related deaths, which occurred among older drug injectors, and the progressive social fragmentation tied to the extreme economic deprivation, deepened social exclusion, and growing everyday violence.