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

O trabalho investiga o contexto da primeira injecão de drogas e sua associacão com práticas atuais de injecão e infeccão pelo HCV (vírus da hepatite C). Usuários de drogas injetáveis (UDI) (N = 606) foram recrutados em cenas de uso (ruas, bares) do Rio de Janeiro, Brasil, entrevistados e testados (anti-HCV). A freqüência de compartilhamento de agulhas e seringas foi superior na primeira injecão (51,3 por cento), se comparada à atualmente referida (36,8 por cento). Usuários que iniciaram o uso injetável compartilhando agulhas/seringas relataram uma freqüência significativamente maior de compartilhamento direto/indireto de agulhas/seringas nos últimos seis meses. A infeccão pelo HCV foi quatro vezes mais prevalente entre UDI jovens (< 30 anos) que compartilharam agulhas e seringas na primeira injecão. A prevalência de anti-HCV foi 11 por cento entre UDI ativos (n = 272) e se mostrou independentemente associada à história de prisão e à duracão do uso de drogas injetáveis. A prevencão da disseminacão do HCV nesta populacão requer a adocão de medidas de reducão de riscos e danos associados à injecão de drogas já desde a primeira injecão ou, antes, um desestímulo à transicão do uso não injetável para injetável.

cost of unsafe injections in Pakistan and challenges for prevention program

The burden of disease associated with unsafe therapeutic injection practices in Pakistan is very high. The number of injection per person per year has been estimated to be in the range of 8.2 to 13.6, one of the highest in developing world. Extrapolating this number to the whole country would result in 1.5 billion injections per year. Approximately 4% [75 million] of these are administered for immunization while the remainders are used for therapeutic use. Of these, 94.2% are unnecessary. Average price of an injection [not the complete prescription] is Rs. 20.6 [US$ 0.34]. Under conservative estimate, over three billion rupees or 500 million dollars outof- pocket healthcare resources may be wasted each year. Appropriate use of injections would be highly cost effective. According to adjusted analysis, safe and appropriate use of injection in Pakistan would cost US$ 92 million each year with a high proportion that would be injection devices paid through out-of-pocket expenses. Behaviour change for reduction in number of injections require long-term multidimentional efforts. Interventions in the form of phasing out of convention disposable injection equipment and switching to reuse prevention devices for all injections could prevent the common practice of reuse, hence reducing the transmission of infections

Troca de seringas na cidade de São Paulo: uma estratégia de redução de danos para usuários de drogas injetáveis / Needle exchange in São Paulo city: a harm reduction strategy for injection drug users

Objetivo: Realizar uma revisão da literatura sobre a troca de seringas como estratégia de redução de danos (RD) e relatar a implantação de um programa desse tipo no município de São Paulo. Método: a) Busca: bases de dados como a Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scielo e Medline; livros; sites de Ministério da Saúde, Prefeitura Municipal de São Paulo, Google e Reduc; Jornal DST/AIDS - Cidade de São Paulo; Boletim Epidemiológico de AIDS do Município de São Paulo e informações de especialistas da área; b) entrevistas com três membros envolvidos no Projeto de Redução de Danos da Cidade de São Paulo, unidade Butantã (PRD Sampa). Resultados: A revisão da literatura sugere que os programas de troca de seringas realizados em outros países estão contribuindo para a diminuição da incidência de contaminação por HIV entre os usuários de drogas injetáveis. Embora os dados não tenham sido colhidos a partir de estudos sistematizados, os indicadores epidemiológicos da prefeitura de São Paulo sugerem redução do número de novos casos de HIV positivo após a implantação do programa. Conclusões: Faz-se necessária uma sistematização do processo de avaliação para comprovar a efetividade desse tipo de programa.

Trend of selected risk factors for hepatitis B infection among the drug addicts in Bangladesh: a five year statistics.

The present retrospective study was conducted by review of records of last five years from 1996 to 2000, among 1497 drug addicts, admitted in a selected drug addicts treatment centre in Dhaka, with an aim to find out the trend of occurrence of hepatitis B infection among the drug addicts, as well as the trend of the risk factors. It was found from the study that during the period of five years, among the total drug addicts, sixty-nine addicts were found to be hepatitis B positive as determined by HBsAg status. The main contributing risk factors were found to be history of exposure to the commercial sex workers (CWS), injecting drug use (IDUs) and needle sharing. It was also found that the trend of hepatitis B infection was gradually falling down among the drug addicts probably due to reduction of the risk factors, especially the injection of drugs. It can be recommended that as a considerable portion of (NUDS) have shown evidence of hepatitis B infection, especially those who were using and sharing needles with others. Therefore, for protecting them from this dreadful infection, drug addicts should be counseled to avoid the above high risk behavior.

Is human immunodeficiency virus/acquired immunodeficiency syndrome decreasing among Brazilian injection drug users? Recent findings and how to interpret them

We briefly review findings from Brazilian settings where the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic among injection drug users (IDUs) seems to be decreasing, highlighting recent findings from Rio de Janeiro and discussing methodological alternatives. Former analyses using serologic testing algorithm for recent HIV seroconversion have shown that HIV incidence has been low in IDUs recruited by two different surveys carried out in Rio, where low injection frequencies and infection rates have been found among new injectors. The proportion of AIDS cases among IDUs in Rio has been fairly modest, compared to São Paulo and especially to the southernmost states. Notwithstanding, the interpretation of findings from serial surveys constitutes a challenge, magnified in the assessment of HIV spread among IDUs due to the dynamic nature of the drug scenes and limitations of sampling strategies targeting hard-to-reach populations. Assessment of epidemic trends may profit from the triangulation of data, but cannot avert biases associated with sampling errors. Efforts should be made to triangulate data from different sources, besides exploring specific studies from different perspectives. In an attempt to further assess the observed trends, we carried out original analyses using data from Brazilian AIDS databank.

[HCV in intravenous drug users]

Hepatitis C [HCV] is increasing worldwide including Iran. HCV is more prevalent among intravenous drug abusers [IDU], especially if imprisoned, mostly due to needle sharing. We determined the rate of HCV seropositivity among IDU prisoners and compared it with those of non prisoners. A cross-sectional survey was done on consenting IDU inhabiting two prisons and attending three rehabilitation centers in Tehran, Iran. A questionnaire was completed for each subject and 5mL blood drawn. The samples were kept at 2-8°C until the sera were separated and stored at -70°C. HCV Ab [ELISA 1, third generation, DIA. PRO, Italy] with a sensitivity and specificity of 98% was checked by a single technician. Chi-square, Fisher's exact test and multivariable analysis were used where appropriate. Four-hundred and sixty seven subjects [346 [74.1%] prisoners; 425 [91%] male] were enrolled. Overall 66% tested positive for HCV Ab [287 male [67.5%], 21 female [50%], p<0.02]. HCV seropositivity was higher among prisoners [78.3% vs. 30.6%, p<0.001] and older IDU [76.9% vs. 62.9%, p=0.002]. Multivariable analysis showed association between HCV seropositivity and imprisonment [OR= 9.32, 95%CI: 5.60- 15.51], sharing syringes [OR=2.00, 95%CI: 1.27-3.17], duration of intravenous drug use annually [OR=1.16, 95%CI: 1.08-1.24] and male sex [OR=4.18, 95%CI: 2.02- 8.67]. HCV is rather common among IDU prisoners. Imprisonment is an independent risk factor. The infected IDU going back to the community may be an important source of HCV. Taking effective strategies [high risk group education, provision of sterile syringes, identification and treatment of infected IDU] to reduce the risk of this public health problem is needed urgently

Hepatitis C prevalence and risk behavior of injecting drug users in Sydney: a continuing concern.

This study examines patterns of injecting drug use and hepatitis C (HCV) risk behavior among injecting drug users. A survey of injecting drug users attending needle and syringe programs (NSPs) in the Sydney metropolitan area and members of NSW Users and AIDS Association (NUAA) yielded 336 responses. Demographic, behavioral and drug-use information was collected from injecting drug users aged from 14 to 64 years. The majority of respondents (66%) were HCV positive, 28% had tested negative and 5% did not know their status. Prevalence was higher among men than among women (54% vs 44%). Two thirds of respondents (72%) reported frequent heroin injection. Multivariate analysis identified the following significant risk factors for hepatitis C: being more than 30 years of age, an injecting history of five years or more, and having shared drug injecting equipment with a HCV positive user. The most significant factor associated with needle sharing was having unprotected sex with sexual partners and having a positive hepatitis C test result. Early identification of these factors should be a component of HCV prevention programs. Our data indicate that the promotion of safer injecting continues to be an important public health issue with regard to reducing HCV infections.

Perfil epidemiológico de 70 usuários de drogas injetáveis de São José do Rio Preto - São Paulo / Epidemiology prolife of 70 injecting users in São José do Rio Preto, São Paulo state

Para conhecimento do perfil epidemiológico dos usuários de drogas injetáveis (UDIs) de São José do Rio Preto, agentes selecionados e treinados aplicaram um questionário a uma amostra de 70 UDIs no período de janeiro a setembro de 1997. A alta proporção de soropositivos aliada ao baixo uso de preservativos e ao alto nível de compartilhamento de seringas, confirma a grande importância deste grupo de risco na epidemiologia da AIDS

Risk factors for shooting gallery use among drug injectors in Puerto Rico

Needle sharing is one of the principal risk behaviors leading to HIV transmission among injection drug users (IDUs). Shooting galleries, a social context where IDUs rent, share, and borrow needles, are locations usually found near drug markets. This study, which interviewed 1,700 IDUs from May 1989 to June 1990, assesses sociodemographic characteristics and HIV risk behaviors among shooting gallery users in Puerto Rico. Multivariate analyses showed that shooting gallery use is associated with speedball (a concoction of heroin and cocaine) injection, income from illegal activities and previous drug treatment. Shooting gallery users were more likely to rent, share, and borrow needles, and less likely to always use bleach and water to clean needles. Strategies to reduce shooting gallery use among drug injectors are discussed

Condiçöes psicossociais e exposiçäo ao risco de infecçäo pelo HIV entre usuários de drogas infetáveis, em uma comunidade marginalizada de Salvador-Bahia / Psycho-social conditions and exposure to risk of infection with HIV among intravenous drug users in a poor comminity of Salvador-Bahia

"Condiçöes psicossociais e exposiçäo ao risco de infecçöes pelo HIV entre usuarios de drogas injetáveis em uma comunidade marginalizada de Salvador-Bahia". Por se tratar de uma prática ilegal e socialmente discriminada, o uso de drogas injetáveis é de pouca visibilidade. Entretanto, à medida que ele tem sido um dos principais responsáveis, em inúmeros países, pelo aumento do número de casos de AIDS entre os usuários de drogas injetáveis (UDIs) e destes, para outras populaçöes, principalmente mulheres e crianças, torna-se imperativo o conhecimento de sua cultura, dos seus aspectos sócio-demográficos, psicológicos e comportamentais. Alguns países desenvolvidos, fundamentados nas pesquisas que realizam, têm implementado, com sucesso, medidas de prevençäo da infecçäo pelo HIV entre UDIs. No Brasil, os UDIs se constituem ainda uma populaçäo numericamente desconhecida. Entretanto, os poucos estudos existentes, inclusive na Bahia, revelam índices de soroprevalência dos maiores do mundo. Com o objetivo de verificar a existência de associaçöes entre condiçöes psicossociais e exposiçäo ao risco de infecçäo pelo HIV entre UDIs em uma comunidade marginalizada de Salvador, foi realizado um estudo epidemiológico do tipo exploratório, associado a um estudo etnográfico dos UDIs e da populaçäo local. Foram aplicados questionários a cem UDIs contactados pela técnica de "bola-de-Neve" (Snowball Sampling) no centro Histórico da cidade de Salvador-Bahia; 16 deles participaram de entrevistas näo-estruturadas. Foram feitas observaçöes etnográficas entre os UDIs e entre uma amostra näo selecionada da populaçäo do Centro Histórico. Os principais resultados quantitativos encontrados foram: ...