Psychoactive drugs in the Brazilian public health system: Use profile and associated factors

Abstract The purpose of this study is to estimate the prevalence of and characterize the use of psychoactive drugs among drug users in a Brazilian municipality, relating the findings to factors associated with the consumption of these substances. Through a cross-sectional design, 1,355 drug users from the public health systems community pharmacies were interviewed. Sociodemographic and health-related data were collected, as well as any other prescribed drugs. The prevalence of psychoactive drug use within the last month was 31.0%, with antidepressants and benzodiazepines being the most prescribed (53.5% and 24.6% respectively). Most psychoactive drug users were female (81.9%), lived with a partner (52.6%), had private health insurance (69.2%) and a monthly per-capita income up to one minimum wage (54.0%). The adjusted Odds Ratio (OR) confirmed the following factors to be positively associated with the use of psychoactive drugs: female gender (OR=2.06; 95% CI 1.44; 2.95), age ≥60 years old (OR=1.77; 95% CI 1.26; 2.48), follow-up with a psychologist (OR=4.12; 95% CI 1.84; 5.25), absence of regular physical activity (OR=1.59; 95% CI 1.13; 2.23), and smokers (OR=1.94; 95% CI 1.26; 2.97). Approximately one out of three individuals used at least one psychoactive drug. Health managers should focus the planning and actions aimed at their rational use for these groups, leading to increased overall treatment success

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region.

BACKGROUND: People who inject drugs may be at elevated SARS-CoV-2 risk due to their living conditions and/or exposures when seeking or using drugs. No study to date has reported upon risk factors for SARS-CoV-2 infection among people who inject drugs. METHODS AND FINDINGS: Between October, 2020 and June, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month underwent interviews and testing for SARS-CoV-2 RNA and antibodies. Binomial regressions identified correlates of SARS-CoV-2 seropositivity. RESULTS: Of 386 participants, SARS-CoV-2 seroprevalence was 36.3% (95% CI: 31.5%-41.1%); 92.1% had detectable IgM antibodies. Only 37.5% had previously been tested. Seroprevalence did not differ by country of residence. None tested RNA-positive. Most (89.5%) reported engaging in ≥1 protective behavior [e.g., facemasks (73.5%), social distancing (46.5%), or increasing handwashing/sanitizers (22.8%)]. In a multivariate model controlling for sex, older age, and Hispanic/Latinx/Mexican ethnicity were independently associated with SARS-CoV-2 seropositivity, as was engaging in sex work (AdjRR: 1.63; 95% CI: 1.18-2.27) and having been incarcerated in the past six months (AdjRR: 1.49; 95% CI: 0.97-2.27). Comorbidities and substance using behaviors were not associated with SARS-CoV-2 seropositivity. CONCLUSIONS: In this community-based study of people who inject drugs in the San Diego-Tijuana border region, over one third were SARS-CoV-2 seropositive, exceeding estimates from the general population in either city. We found no evidence that substance use behaviors were associated with an elevated risk of SARS-CoV-2 infection, but observed that circumstances in the risk environment, notably sex work and incarceration, were independently associated with higher SARS-CoV-2 seroprevalence. Our findings suggest that a binational policy response to COVID-19 mitigation is warranted beyond the closure of the U.S.-Mexico border. Furthermore, decriminalizing sex work and drug use could reduce the burden of COVID-19 among people who inject drugs.

Prevalência do uso de substâncias psicoativas em gestantes e puérperas / Prevalencia del consumo de sustancias psicoactivas en mujeres embarazadas y puérperas / Prevalence of psychoactive substance use in pregnant and puerperal women

Objetivo: investigar a prevalência do uso de substâncias psicoativas em gestantes e puérperas atendidas no ambulatório de um Hospital Escola. Método: pesquisa transversal, descritiva, com amostra de 174 gestantes e puérperas. Na coleta de dados, utilizou-se o instrumento padronizado Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) e um questionário sociodemográfico e gineco-obstétrico. A análise de dados foi realizada por meio da estatística descritiva. Resultados: a prevalência de uso de substâncias psicoativas entre as gestantes foi de 28,7 % e 1,1% entre as puérperas, com destaque para o álcool e tabaco. O tabaco constitui a substância com maior frequência de uso; que desencadeia maior desejo/urgência de consumo; maior taxa de tentativas de diminuição. Conclusão: o uso de substâncias psicoativas na gestação e puerpério constitui-se um desafio à saúde pública e para os profissionais de saúde, suscitando o desenvolvimento de ações educativas, bem como a captação precoce dessas mulheres.

Objective: to investigate the prevalence of psychoactive substance use in pregnant and puerperal women attended at an outpatient clinic in a teaching hospital. Method: A descriptive transversal research with a sample of 174 pregnant and puerperal women. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and a sociodemographic and obstetric-gynecologic survey were utilized in data collection. Data analysis was performed through descriptive statistics. Results: the prevalence of psychoactive substance use among pregnant women was of 28.7% and 1.1% among puerperal women, with alcohol and tobacco as highlights. Tobacco constitutes the substance with greater frequency of use, triggering greater desire/urgency of consummation and a higher rate of intake lowering attempts. Conclusion: the use of psychoactive substances among pregnant and puerperal women constitutes a challenge to public health and for health professionals, eliciting the development of educational actions as well as early identification of these women.

Objetivo: investigar la prevalencia del uso de sustancias psicoactivas en mujeres embarazadas y puérperas atendidas en el ambulatorio de un Hospital Escuela. Método: investigación transversal, descriptiva, con una muestra de 174 mujeres embarazadas y puérperas. En la recopilación de datos, se utilizó el instrumento estandarizadoAlcohol, Smoking and Substance Involvement Screening Test (ASSIST) y un cuestionario sociodemográfico y gineco-obstétrico. El análisis de los datos se realizó mediante estadísticas descriptivas. Resultados: la prevalencia del consumo de sustancias psicoactivas entre las embarazadas fue del 28,7%, mientras que entre las puérperas fuel del 1,1%, con destaque para el alcohol y el tabaco. El tabaco constituye la sustancia de mayor frecuencia de uso; que desencadena mayor deseo/urgencia de consumo; mayor tasa de tentativas de disminución. Conclusión: el uso de sustancias psicoactivas en elembarazo y el puerperio constituye un reto para la salud pública y para los profesionales de la salud, suscitando el desarrollo de acciones educativas, así como la captación temprana de estas mujeres.

Uso de sustancias psicoactivas en estudiantes de escuelas secundarias de Rosario (Argentina) / Psychoactive Drugs Use Among High-School Students In Rosario (Argentina)

Resumen El consumo de Sustancias psicoactivas (SPs) es un problema de salud mundial que afecta particularmente a los adolescentes. Por lo tanto, el conocimiento del contacto que los jóvenes tienen con las SPs, permitirá el desarrollo de políticas de prevención. El objetivo del trabajo fue evaluar el contacto con SPs de estudiantes secundarios de Rosario y alrededores. Entre el 2013 y el 2016, contestaron de forma anónima un cuestionario 1064 estudiantes, observándose un aumento significativo del consumo de SPs en el año 2016. Cuando se excluyen el consumo de tabaco y alcohol (SPs legales) el porcentaje permanece constante. El aumento observado se debe al consumo de SPs tales como alcohol y tabaco. Se observó una disminución de la edad de inicio así como un cambio en los porcentajes y patrones de consumo. La SP más consumida fue el alcohol seguida de tabaco o marihuana. Los cambios observados podrían estar relacionados con las edades y los años de cursado de los estudian tes encuestados.

Abstract. Adolescence is characterized by anxiety, peer-pressure, identity search, etc. All these features contribute to experiment with Psychoactive Drugs (P.D.). P.D. use is a global health problem that has its onset during adolescence. The developing of prevention policies according to a specific population needs the knowledge of the levels and patterns of P.D. use. The goal of the present work was to evaluate P.D.'s level of contact and patterns of use among high school students in Rosario (Argentina). Between 2013 and 2016, a total of 1064 students were surveyed. The results showed that P.D. use (at least once in a lifetime) was significantly higher in 2016 compared to previous years. However, when the use of legal vs illegal P.D. was discriminated we found that such increase was due to higher use of alcohol and tobacco; while the illegal P.D. use remained constant. Moreover, in 2016 we found a decrease in the age of onset as well as a change in the patterns of P.D use. However, all these results must be analyzed taking into account intrinsic differences of the sample.

Perspectives About Treatment Services From People Who Use Illicit Drugs.

The objective of the current study was to describe the perspectives of people who use illicit drugs regarding the availability and effectiveness of drug treatment services. A total of 111 participants with illicit drug use experience were recruited from an inner city community in São Paulo, Brazil. Treatment services were considered to be essential and necessary by the majority of participants, whereas general hospitals and mental health services were considered to be the most highly available treatment options for illicit drug use. Participants also indicated that treatment led to positive changes in their lives, highlighting the importance of drug treatment services for promoting the rights and responsibilities of people who use illicit drugs. Results support the need for services that value and respect the fundamental rights of people who use illicit drugs. [Journal of Psychosocial Nursing and Mental Health Services, 58(4), 28-37.].

Internações decorrentes do uso de substâncias psicoativas: estudo em um hospital psiquiátrico / Hospitalizations due to the use of psychoactive substances: study in a psychiatric hospital / Internaciones derivadas del uso de sustancias psicoactivas: estudio en un hospital psiquiátrico

Objetivo: Analisar a ocorrência de internação por transtornos psiquiátricos decorrentes do uso de substâncias psicoativas em um hospital psiquiátrico de referência. Método: Estudo censitário, retrospectivo, analítico e de abordagem quantitativa, realizado a partir de 123 registros de internações. Resultados: Obteve-se que a média de idade dos pacientes internados em 2015 foi de 40,7, a maioria era do sexo masculino (66,7%), provenientes da zona urbana (78%) e com histórico de reinternações (52,8%). As múltiplas drogas e outras substâncias psicoativas (39,8%) constituíram-se como as principais substâncias de abuso pelos pacientes. Além disso, verificou-se que, entre os pacientes internados, houve presença de comorbidades psiquiátricas. Conclusão: Diante disso, evidencia-se a necessidade de estratégias voltadas para a prevenção e o tratamento adequado aos distúrbios ocasionados pelo uso de álcool e outras drogas

Objective: To analyze the occurrence of hospitalization for psychiatric disorders resulting from the use of psychoactive substances in a referral psychiatric hospital. Method: A census, retrospective, analytical and quantitative approach, based on 123 records of hospitalizations. Results: The mean age of hospitalized patients in 2015 was 40.7, the majority were male (66.7%), from the urban area (78%) and had a history of readmissions (52, 8%). Multiple drugs and other psychoactive substances (39.8%) were the main substances of abuse by patients. In addition, it was found that among hospitalized patients, there were psychiatric comorbidities. Conclusion: In view of this, it is evident the need for strategies aimed at prevention and appropriate treatment of disorders caused by the use of alcohol and other drugs

Objetivo: Analizar la ocurrencia de internación por trastornos psiquiátricos derivados del uso de sustancias psicoactivas en un hospital psiquiátrico de referencia. Metodo: Estudio censitario, retrospectivo, analítico y de abordaje cuantitativo, realizado a partir de 123 registros de internaciones. Resultados: Se obtuvo que la media de edad de los pacientes internados en 2015 fue de 40,7, la mayoría era del sexo masculino (66,7%), provenientes de la zona urbana (78%) y con histórico de reinternaciones (52, 8%). Las múltiples drogas y otras sustancias psicoactivas (39,8%) se constituyeron como las principales sustancias de abuso por los pacientes. Además, se verificó que, entre los pacientes internados, hubo presencia de comorbilidades psiquiátricas. Conclusión: Ante ello, se evidencia la necesidad de estrategias dirigidas a la prevención y el tratamiento adecuado a los disturbios ocasionados por el uso de alcohol y otras drogas

Estimating Hidden Population Sizes with Venue-based Sampling: Extensions of the Generalized Network Scale-up Estimator.

BACKGROUND: Researchers use a variety of population size estimation methods to determine the sizes of key populations at elevated risk of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), an important step in quantifying epidemic impact, advocating for high-risk groups, and planning, implementing, and monitoring prevention, care, and treatment programs. Conventional procedures often use information about sample respondents' social network contacts to estimate the sizes of key populations of interest. A recent study proposes a generalized network scale-up method that combines two samples-a traditional sample of the general population and a link-tracing sample of the hidden population-and produces more accurate results with fewer assumptions than conventional approaches. METHODS: We extended the generalized network scale-up method from link-tracing samples to samples collected with venue-based sampling designs popular in sampling key populations at risk of HIV. Our method obviates the need for a traditional sample of the general population, as long as the size of the venue-attending population is approximately known. We tested the venue-based generalized network scale-up method in a comprehensive simulation evaluation framework. RESULTS: The venue-based generalized network scale-up method provided accurate and efficient estimates of key population sizes, even when few members of the key population were sampled, yielding average biases below ±6% except when false-positive reporting error is high. It relies on limited assumptions and, in our tests, was robust to numerous threats to inference. CONCLUSIONS: Key population size estimation is vital to the successful implementation of efforts to combat HIV/AIDS. Venue-based network scale-up approaches offer another tool that researchers and policymakers can apply to these problems.

Prevalence of HCV infection in a prison population of the greater Florianópolis area.

INTRODUCTION: The present study aimed to estimate the prevalence of Hepatitis C virus (HCV) infection in a prison population. METHODS: A total of 147 individuals were interviewed and subjected to venipuncture for collection of blood sample. The study population consisted of male individuals who attended the health unit of the state penitentiary of Florianópolis. RESULTS: The prevalence of HCV infection was 5.4%. Regarding behavioral variables, 95 (64.6%, p<0.0507) subjects reported consuming alcohol and 7 (4.8%, p<0.0476) reported having already used injectable drugs. CONCLUSIONS: The prevalence of HCV infection in the studied population was higher than that in the general populations.

Human T-cell lymphotropic virus 1/2 and human immunodeficiency virus antibodies identification among transactional sex workers and drug users in the Dominican Republic.

BACKGROUND: Human immunodeficiency virus (HIV) increases the risk of acquiring human T-cell lymphotropic virus (HTLV) and subsequently HTLV's progression to tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM). Existing data have exclusively reported generalized rates of HIV and HTLV-1 chronic viral infections in the Dominican Republic. To our knowledge, no published studies have focused on the rates of HTLV-1/2 in transactional sex workers and drug users, both higher risk groups, in the Dominican Republic. METHODS: From December 2012 to April 2013 we conducted a study to estimate the seroprevalence of HTLV-1/2 immunoglobulin G (IgG) and HIV antibodies among transactional sex workers and intravenous drug users in Santo Domingo, Dominican Republic. Serological status was analysed with behaviour and demographic data. RESULTS: We collected and analysed plasma from 200 participants with a mean age of 27.4 y in men and 25.2 y in women. The overall weighted seroprevalence of HTLV-1/2 IgG antibodies was 13.91% (95% CI 7.59 to 20.23) in men and 10.59% (95% CI 4.05 to 17.13) in women. The overall weighted seroprevalence of HIV-1 was 13.91% (95% CI 7.59 to 20.23%) in men and 17.65% (95% CI 9.55 to 25.75) in women. Male intravenous drug users had an exceptionally high rate of HTLV-positive HIV co-infection, at 75% (95% CI 44.99 to 105.01). Although there an association has been found between HTLV/HIV co-infections and sex work, the adjusted odds revealed a confounding role of HIV infection. CONCLUSIONS: The results highlight the urgent need for enhanced public health preventive strategies among high-risk populations in the Dominican Republic and other resource-constrained Caribbean settings, as well as global adoption of routine screening for HTLV-associated infections, particularly in these high-risk, underserved populations.

Prevalence and Risk Factors associated with Homelessness among Drug Users in Puerto Rico.

OBJECTIVE: This study aimed to determine the association between years of drug injection and homelessness among drug users in rural Puerto Rico. METHODS: Respondent-driven sampling methods allowed us to obtain a sample of 315 intravenous drug users (IDUs) in rural Puerto Rico. Information about sociodemographic characteristics, drug use patterns, homelessness and risk behaviors was obtained through structured interviews. HIV and HCV statuses were assessed via rapid antibody tests. Frequency distributions were used to describe the study sample. Bivariate analysis and multivariate logistic regressions were used to assess covariates of homelessness. The study received IRB approval through the University of Nebraska-Lincoln and the University of Puerto Rico. RESULTS: Almost 91% of the study participants were males. The mean age was 41.7 years and the majority of the participants had not completed high school (47.6%). The prevalence of current homelessness was 21.9%. After controlling for sociodemographic characteristics, homelessness was strongly associated with the number of years of injection drug use. The odds of being homeless for IDUs with 21 years or more of drug injection was almost 3 times higher than were the odds of being homeless for IDUs with fewer than 10 years of injection (OR = 2.58 95%; CI=1.21,5.48). CONCLUSION: In rural Puerto Rico, the prevalence of current homelessness in IDUs was 21.7%. In the sample, 6.0% were HIV positive and 78.4% were HCV positive. Our results highlight the necessity of increasing accessibility to substance abuse treatment and establishing additional needle-exchange programs (currently, there is only 1) in rural Puerto Rico.

Intervention Reach and Sexual Risk Reduction of a Multi-level, Community-Based HIV Prevention Intervention for Crack Users in San Salvador, El Salvador.

This article examines the effects of a multi-level, community-based HIV prevention intervention for crack users residing in low-income neighborhoods in San Salvador, El Salvador conducted between August 2011 and June 2016. The intervention consisted of three components introduced sequentially: (1) rapid HIV testing in community settings; (2) a social network HIV testing intervention; and (3) small group interventions with crack users who were members of the same social network. The intervention was evaluated with an interrupted time series design in which we used respondent-driven sampling to conduct 7 cross-sectional surveys with crack users along a 3-4 month period for each assessment (total n = 1597). Results revealed a significant increase in exposure to the intervention over time with 50% of the participants reporting exposure to one or more of the three components. Getting an HIV test at the community site was associated with reductions in total times each individual had sex without a condom (p < 0.05) compared to those who had been exposed to no intervention components. Being referred by another crack user through the Social Network HIV intervention was also associated with reductions in total numbers of condomless sex (p < 0.05) The cumulative effect of being exposed to more than one intervention component was associated with reductions in total number of times individuals had condomless sex (p < 0.05). In spite of the high level of intervention reach and that self-reported exposure to intervention components was associated with lower sexual risk, reductions in sexual risk over time were not observed in the full sample, indicating that the penetration of HIV prevention components was not sufficient to produce population level change.

Prevalence of HCV infection in a prison population of the greater Florianópolis area

Abstract INTRODUCTION The present study aimed to estimate the prevalence of Hepatitis C virus (HCV) infection in a prison population. METHODS: A total of 147 individuals were interviewed and subjected to venipuncture for collection of blood sample. The study population consisted of male individuals who attended the health unit of the state penitentiary of Florianópolis. RESULTS: The prevalence of HCV infection was 5.4%. Regarding behavioral variables, 95 (64.6%, p<0.0507) subjects reported consuming alcohol and 7 (4.8%, p<0.0476) reported having already used injectable drugs. CONCLUSIONS: The prevalence of HCV infection in the studied population was higher than that in the general populations.

Epidemiology of HIV and AIDS in the state of Rio Grande do Sul, Brazil, 1980-2015. / Epidemiologia do HIV e aids no estado do Rio Grande do Sul, 1980-2015.

OBJECTIVE: to describe the HIV/AIDS epidemic in the state of Rio Grande do Sul and the metropolitan region of Porto Alegre (MRPA), Brazil, in the period 1980-2015. METHODS: this was a descriptive study using data from Ministry of Health information systems. RESULTS: 83.313 AIDS cases were recorded in the state; during the periods 1980-1990, 1991-2000 and 2001-2015, the detection rates in the state were 1.1, 17.2 and 40.3/100,000 inhab., respectively, and in the MRPA the detection rates were 2.4, 33.6 and 66.9/100,000 inhabitants, while mortality rates were 0.5, 8.5 and 12.6/100,000 inhab. in the state, and 1.3, 17.3 and 21.7/100,000 inhab. in the MRPA; in 2001-2015, the detection rate of HIV+ pregnant women per 1.000 live births in the state was 8.1 and 13.7 in the MRPA, while injecting drug users in the state (8.2%) and in the MRPA (8.9%) also stood out. CONCLUSION: the epidemic is generalized in the MRPA and with greater magnitude in relation to the state.

HIV-1 infection among crack cocaine users in a region far from the epicenter of the HIV epidemic in Brazil: Prevalence and molecular characteristics.

Brazil has the largest cocaine market in South America, and crack cocaine use is closely associated with HIV-1 infection. This study investigated the prevalence, risk factors, and HIV-1 subtypes, including recombinant forms and mutations associated with drug resistance, among crack cocaine users in Central-West Brazil. We recruited 600 crack cocaine users admitted to a referral hospital in Goiânia for psychiatric disorders. The participants were interviewed; blood samples were collected for anti-HIV-1/2 serological screening. HIV-1 pol gene sequences (entire protease [PR] and partial reverse transcriptase [RT]) were obtained from plasma RNA. HIV-1 subtypes, recombinant viruses, transmitted drug resistance (TDR), and secondary drug resistance mutations were investigated. The median participant age was 30 years (range, 18-68 years); most were male, single, unemployed, and of mixed races. Among them, 2.8% (17/600) were HIV-1 positive: 2.2% of men (11/507) and 6.5% of women (6/93). The main predictors of HIV-1 seropositivity were a sexual partner with HIV infection, irregular condom use, and previous homelessness. HIV-1 pol sequences (12/17) indicated the predominance of subtype B (n = 7), followed by recombinant forms FPR/BRT (n = 1) and BPR/FRT (n = 2) and subtypes F1 (n = 1) and C (n = 1). TDR prevalence was 58.3% (7/12). Isolates from two participants showed mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) only (M41L, T125C, T125F, M184V), while an isolate from one patient who had received antiretroviral therapy (ART) since 2008 had a mutation associated with resistance to non-NRTI (G190S). Five isolates had secondary mutations to protease inhibitors (K20M, L10V, L33I, A71T, A71V). In conclusion, the findings of HIV-1 circulation, TDR to NRTI, and secondary mutations to protease inhibitors in ART-naïve crack cocaine users support the importance of monitoring this population in regions far from the epicenter of the HIV epidemic.

Tuberculosis infection among cocaine crack users in Brazil.

BACKGROUND: WHO recommends treatment for latent tuberculosis infection (LTBI) in the homeless and people who use drugs (PWUD). The optimal test for LTBI screening is uncertain. METHODS: A cross-sectional study was conducted among the homeless and drug-rehabilitation clinic clients chronically using crack in Western Brazil. Participants were interviewed and offered HIV testing plus tuberculin skin testing (TST) and QuantiFeron®-Gold-in-Tube (QFT). We considered LTBI when either TST or QFT were positive. Factors associated with LTBI were adjusted in a multivariate model. RESULTS: Among 372 subjects with at least one valid test, 216 (58%) had LTBI. TST was not read in 18.4%; QFT was indeterminate in 2.5%. TST detected 27 (26%) extra LTBI cases among 75 QFT-negative individuals. PWUD had over three-fold odds for LTBI. TST was 4.5 times more likely to be positive in BCG-vaccinated individuals. CONCLUSION: Given the high risk of progression to disease in this population, the high rates of loss to TST reading and the possibility of false-positive TST results from BCG vaccination, we endorse current CDC recommendations to use QFT for LTBI screening among the homeless and PWUD. However, because adding TST to a negative QFT increased LTBI detection considerably, TST should be considered in QFT-negative individuals.

HIV infection, high-risk behaviors and substance use in homeless men sheltered in therapeutic communities in Central Brazil.

Homeless men present high vulnerability to HIV infection, mainly due to sexual risk behaviors and substance use. The objective was to estimate the prevalence of HIV infection, risk behaviors and substance use in homeless men. A cross-sectional study was conducted in 481 homeless men recruited in four therapeutic communities in the Goiás State, Central Brazil. All were interviewed about sociodemographic characteristics, substance use, and risk behaviors. Furthermore, all were tested for HIV. Poisson regression was used to verify factors associated with HIV infection. HIV prevalence was 1.24% (95.0% CI: 0.57 to 2.69%). Previous HIV testing (adjusted prevalence ratio [APR]: 10.0; 95.0% CI: 1.86-55.8) and years of education (APR: 0.76; 95.0% CI: 0.60-0.97) were factors associated with HIV infection. Participants had high rates of hazardous alcohol use and illicit drug use. The prevalence of HIV infection among homeless men was higher than that found in the Brazilian male population and we identified a high rate of risk behaviors for HIV among the homeless men investigated. Thus, it is necessary to expand HIV prevention measures in Brazil, such as health education, condom availability, regular HIV testing and increased testing coverage in this population, and treatment for alcohol and/or illicit drug dependence/abuse.

Young Drug Users: a Vulnerable Population and an Underutilized Resource in HIV/HCV Prevention.

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.

Risk behaviors for sexually transmitted infections in noninjecting drug users: A cross-sectional study.

The objective of this study was to investigate risk behaviors for sexually transmitted infections (STIs) in noninjecting drug users (NIDUs), using STI diagnosis history as an indicator. A cross-sectional study was conducted in 323 NIDUs of two facilities for alcohol and/or drug dependence treatment in the Goiás State, Central Brazil. All participants were interviewed about risk behaviors and STI history. Multivariable analysis was performed in order to identify predictors of STIs. Adjusted prevalence ratio (APR) with confidence intervals of 95% was obtained using a Poisson regression model. Prevalence of self-reported STIs in the previous 12 months was 25.4% (95% confidence interval [95% CI]: 21.0-30.4%). A multivariable model verified that age (APR: 1.01; 95% CI: 1.00-1.01), sexual contact with partners diagnosed with STIs (APR: 1.27; 95% CI: 1.12-1.45) and injecting drug users (IDUs) (APR: 1.14; 95% CI: 1.14; 95% CI: 1.01-1.31), exchange sex for money and/or drugs (APR: 1.12; 95% CI: 1.02-1.21), and a history of sexual violence (APR: 1.04; 95% CI: 1.04-1.32) were predictors of STIs. Elevated rates of STI history and risk behaviors were observed in NIDUs, supporting the vulnerability of this group for these infections. Public policies and health outreach should be intensified in this population, principally regular STI testing of individuals in treatment for drug dependence and their sexual partners.

Non-injection Drug Use and Injection Initiation Assistance among People Who Inject Drugs in Tijuana, Mexico.

Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39-4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98-21.78), heroin (AOR = 4.00, 95% CI = 1.88-8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16-3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.