Johns Hopkins University researchers describe recent findings. This trend article about Johns Hopkins University is an immediate alert from LawRx to identify developing directions of research.

Study 1: Targeting HIV prevention interventions based upon risk group membership alone fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs.

According to a recent study from the United States, “Injection drug use has accounted for more than one third of acquired immune deficiency syndrome cases in the United States. The purpose of this study was to compare the demographic characteristics, types, and frequency of human immunodeficiency virus (HIV)-risk behaviors among injection drug users (IDUs) recruited from a needle exchange program (NEP), methadone maintenance treatment (MMT), and detoxification (detox) program.”

“A cross-sectional, correlational design was used to determine whether the selected HIV-risk behaviors and demographic characteristics of IDUs varied by site of recruitment. Confidential questionnaires were completed by 445 IDUs in Philadelphia, Pennsylvania,” explained H.D. Mark and colleagues at Johns Hopkins University.

“Data analysis revealed that HIV sexual and injection-risk behavior varied by recruitment site. Subjects recruited from the NEP were more likely to engage in HIV-risk behaviors than subjects recruited from the MMT or detox sites,” reported investigators.

They concluded, “Interventions occurring in program and treatment sites need to be sensitive to various demographic characteristics and behaviors if they are to reach those at highest risk of HIV infection. Targeting HIV prevention interventions based upon risk group membership alone (e.g, IDUs) fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs.”

Mark and colleagues published their study in Public Health Nursing (Profiles of self-reported HIV-risk behaviors among injection drug users in methadone maintenance treatment, detoxification, and needle exchange programs. Public Health Nurs, 2006;23(1):11-19).

Objective: To describe prevalence and incidence of HIV-1. hepatitis C virus (HCV) and risk behaviours in a prospective cohort of injecting drug users (IDU).
Setting: Vancouver, which introduced a needle exchange programme (NEP) in 1988, and currently exchanges over 2 million needles per year.
Design: IDU who had injected illicit drugs within the previous month were recruited through street outreach. At baseline and semi-annually, subjects underwent serology for HIV-1 and HCV. and questionnaires on demographics, behaviours and NEP attendance were completed. Logistic regression analysis was used to identify determinants of HIV prevalence.
Results: 0f 1006 IDU, 65% were men, and either white (65%) or Native (27%). Prevalence rates of HIV-1 and HCV were 23% and 88%, respectively. The majority (92%) had attended Vancouver’s NEP, which was the most important syringe source for 78%. Identical proportions of known HIV-positive and HIV -negative IDU reported lending used syringes (40%). of HIV-negative IDU 39% borrowed used needles within the previous 6 months. Relative to HIV-negative IDU HIV-positive IDU were more likely to frequently inject cocaine (72% versus 62%; P< 0.001). Independent predictors of HIV-positive serostatus were low education. unstable housing. commercial sex, borrowing needles, being an established IDU. injecting with others, and frequent NEP attendance. Based on 24 seroconversion among 257 follow-up visits, estimated HIV incidence was 18.6 per 100 person-years (95% confidence interval, 11.1—26.0).
Conclusions: Despite having the largest NEP in North America, Vancouver has been experiencing an ongoing HIV epidemic. Whereas NEP is crucial for sterile syringe provision, they should be considered one component of a comprehensive programme including counselling, support and education.

Helsinki City has trained 40 drug addicts to assist their drug colleagues with supplying clean needles and giving first aid. This idea is from Belgium where it all started already in 1987. These addicts are called ‘jobist’ and their activities are funded by the support from the European Union. After their training. 5 evenings, they also get a small reward of abt US $200. The work is otherwise on a voluntary basis and they get 100 needles/day when looking for their friends. These jobists seem to be well motivated which is of course might be a first preliminary step towards seeking rehab. On the other hand it shows how cheap the society wants treat seriously ill people. This all seems again to fall under the popular theme of harm reduction.
The authorities are scared of next year when Estonia will join EU and the Estonians have a very serious HIV and Hepatitis problem. As you know the drug smuggling is taken care by the Estonians, who today even transport drugs to Finland via Sweden.

Souce: Botho Simolin, Drug Watch International delegate, Finland.

The transmission of drug-resistant HIV among intravenous drug users (IDUs) who participate in high-risk behaviors is high, according to a new study. In addition, such drug users were often prescribed less effective and not recommended HIV drugs.

Evidence of increasing rates of drug resistance among those recently infected with HIV “indicates a growing public health concern and warrants an examination of the problems from a prevention perspective write the Journal of Acquired Immune Deficiency Syndromes.

The researchers examined predictors of unprotected sex and needle sharing among 638 HIV-infected drug users who completed 2731 visits between 1996 and 2000 in an ongoing study in Baltimore, Maryland.

“After taking account other factors, HIV-infected individuals were significantly more likely to engage in unprotected sex if their sexual partners were also HIV-infected,” Dr. Sethi said in an interview with Reuters Health. “Also, HIV-infected women were twice as likely as men to report unprotected sex.”

Among IDUs who had injected recently, there was an independent association between sharing needles and homelessness, daily injection, and trading sex for drugs. “IDUs were at higher risk of HIV and drug-resistant HIV transmission at 19 percent and 6 percent of all visits, respectively,” the investigators write. Among subjects who were at high risk of HIV transmission, significant drug-resistant HIV was found at 14 percent of visits.

“Although highly active antiretroviral therapy (HAART) was widely available during the study period, less effective and not recommended regimens were prescribed to nearly half of IDUs who were potential transmitters of drug-resistant HIV,” Dr. Sethi told Reuters Health. “Transmission of resistance is one consequence of continued wide-use of non-HAART regimens.”

“It is likely that reducing high-risk behaviors by HIV-infected individuals would reduce the transmission of HIV, including drug-resistant HIV, to uninfected individuals,” Dr. Sethi said. “Clinicians can play an important role by counseling HIV-infected patients about the importance of reducing high-risk behaviors.”

Distributing nearly 3 million needles a year to drug addicts, Vancouver, Canada boasts the largest needle exchange program in North America. The program was established in 1988– 16 years ago– to prevent the spread of HIV and hepatitis C (HCV). A new study finds that co-infection with these two deadly viruses is “shocking” with 16% of study participants co-infected at the beginning of the study and 15% more becoming co-infected over the course of the study. The researchers note it took a median of 3 years for seroconversion to secondary infection.

NEW YORK (Reuters Health) Jun 28 – Coinfection with Hepatitis C virus (HCV) and HIV is prevalent in a “shocking” number of young injection drug users, according to Canadian researchers.

In the June 1st issue of the Journal of Acquired Immunodeficiency Syndromes, Dr. Carl L. Miller of the University of British Columbia, Vancouver and colleagues note that they sought to determine the incidence of such coinfections and to compare the socioeconomic characteristics of those infected.

The researchers used data from the Vancouver Injection Drug Users Study to identify 479 subjects aged 29 years or less. At baseline, 78 (16%) were coinfected and a further 45 (15%) became so over the course of the study.

Baseline infection was independently associated with factors including being female, being of aboriginal ancestry, being older and with the number of years of injecting.

Borrowing needles and injecting cocaine more than once a day were both among the factors associated with the time to secondary infection seroconversion. Having recently attended a methadone maintenance program was protective.

Across the categories of coinfected, monoinfected and HIV and HCV negative injection drug users, say the investigators, there were “clear trends for increasing proportions” of women, aboriginals, daily cocaine users and inhabitants of Vancouver’s 10-block injection drug use epicenter.

The researchers, who note that it took a median of 3 years for seroconversion to secondary infection, conclude that “appropriate public health interventions should be implemented immediately.”

But a new study published in the Journal of Psychoactive Drugs finds that sex “accounts for nearly all the infection among” new injection drug users. Likewise, nearly half of HIV infections among long term injection drug users, (44.3 percent) are not attributed to sharing dirty needles. New injection drug users, in fact, had a similar rate of HIV infection as non-injection drug users.

Studies have found that substance abuse is a significant factor for high risk sexual behavior and HIV acquisition. Needle exchange, therefore, does not eliminate the risks for HIV infection for drug abusers, but rather enables addicts to abuse the drugs that impair their judgment, thereby increasing risk for HIV infection. The debate over needle exchange distracts from the real HIV prevention issues for drug abusers, which is preventing substance abuse and treating addiction.

Needle exchange programs (NEPs) are designed to prevent human immunodeficiency virus (HIV) transmission among Injecting drug users. Although most studies report beneficial effects in terms of behavior modification, a direct assessment of the effectiveness of NEPs in preventing HIV infection has been lacking. A cohort study was conducted to assess the association between risk behaviors and HIV seroprevalence and seroincidence among injecting drug users in Montreal, Canada. The association between NEP use and HIV Infection was examined in three risk assessment scenarios using intensive covariate adjustment for empirical confounders: a cross-sectional analysis of NEP use at entry as a determinant of seroprevalence, a cohort analysis of NEP use at entry as a predictor of subsequent seroconversion, and a nested case-control analysis of NEP participation during follow-up as a predictor of seroconversion. From September 1988 to January 1995, 1,599 subjects were enrolled with a baseline seroprevalence of 10.7%. The mean follow-up period was 21.7 months. The adjusted odds ratio for HIV seroprevalence in injection drug users reporting recent NEP use was 2.2 (95% confidence interval 1.5-3.2). In the cohort study, there were 89 incident cases of HIV infection with a cumulative probability of HIV seroconversion of 33% for NEP users and 13% for nonusers (p <0.0001). In the nested case-control study, consistent NEP use was associated with HIV seroconversion during follow-up (odds ratio = 10.5. 95% confidence interval 2.7-41.0). Risk elevations for HIV infection associated with NEP attendance were substantial and consistent in all three risk assessment scenarios in our cohort of injecting drug users, despite extensive adjustment for confounders. In summary, in Montreal, NEP users appear to have higher seroconversion rates then NEP nonusers.

Objective: to describe prevalence and incidence of HIV-1, hepatitis C virus (HCV) and risk behaviours in a prospective cohort of injecting drug users (IDU).

Setting: Vancouver, which introduced a needle exchange programme (NEP) in 1988, and currently exchanges over 2 million needles per year.

Design: IDU who had injected illicit drugs within the previous month were recruited through street outreach. At baseline and semi-annually, subjects underwent serology for HIV-1 and HCV, and questionnaires on demographics, behaviours and NEP attendance were completed. Logistic regression analysis was used to identify determinants of HIV prevalence.
Results: Of 1006 IDU, 65% were men, and either white (65%) or Native (27%). Prevalence rates of HIV-1 and HCV were 23 and 88%, respectively. The majority (92% had attended Vancouver’s NEP, which was the most important syringe source for 78%. Identical proportions of known HIV-positive and HV-negative IDU reported lending used syringes (40%) Of HIV negative IDU. 39% ,.. borrowed used needles within the previous 6 months. Relative to HIV-negative lDU, HIV-positive IDU were more likely to frequently inject cocaine (72 versus 62%; p <0.001). Independent predictors of HIV-positive serostatus were low education, unstable housing, commercial sex, borrowing needles, being an established IOU, injecting with others, and frequent NEP attendance. Based on 24 seroconversions among 257 follow-up visits, estimated HIV incidence was 18.6 per 100 person-years (95% confidence interval, 11.1—26.0).

Conclusions: Despite having the largest NEP in North America, Vancouver has been experiencing an ongoing HIV epidemic. Whereas NEP are crucial for sterile syringe provision, they should be considered one component of a comprehensive programme including counseling, support and education.