Syphilis in drug users in low and middle income countries.

Background: Genital ulcer disease (GUD), including syphilis, is an important cause of morbidity in low and middle income (LMI) countries and syphilis transmission is associated with HIV transmission.

Methods: We conducted a literature review to evaluate syphilis infection among drug users in LMI countries for the period 1995-2007. Countries were categorized using the World Bank Atlas method [The World Bank.

Comparison of injecting drug users who obtain syringes from pharmacies and syringe exchange programs in Tallinn, Estonia.

Background: Both syringe exchange programs (SEPs) and pharmacy sales of syringes are available in Estonia, though the current high incidence and high prevalence of HIV among injection drug users (IDUs) in Tallinn, Estonia requires large-scale implementation of additional harm reduction programs as a matter of great urgency. The aims of this report were to compare risk behavior and HIV infection and to assess the prevention needs among IDUs who primarily use pharmacies as their source of sterile syringes with IDUs who primarily use SEPs in Tallinn.

Methods: A cross-sectional study using respondent-driven sampling was used to recruit 350 IDUs for an interviewer-administered survey and HIV testing.

Doing harm reduction better: syringe exchange in the United States.

Objective: To trace the growth of syringe exchange programs (SEPs) in the United States since 1994-95 and assess the current state of SEPs.

Methods: Annual surveys of US SEPs known to North American Syringe Exchange Network (NASEN). Surveys mailed to executive directors with follow-up interviews by telephone and/or e-mail.

Using hepatitis C virus and herpes simplex virus-2 to track HIV among injecting drug users in New York City.

Objective: To explore the potential utility of hepatitis C virus (HCV) seroprevalence as a biomarker for injection risk, and herpes simplex virus-2 (HSV-2) as a biomarker for sexual risk among injecting drug users (IDUs). We examined the relationships between HCV and HIV and between HSV-2 and HIV among injecting drug users in New York City relative to the large-scale implementation of syringe exchange in the mid-1990s.

Methods: 397 injecting drug users were recruited from a drug detoxification program in New York from 2005 to 2007.

A meta-analysis of the hepatitis C virus distribution in diverse racial/ethnic drug injector groups.

Hepatitis C virus (HCV) is mostly transmitted through blood-to-blood contact during injection drug use via shared contaminated syringes/needles or injection paraphernalia. This paper used meta-analytic methods to assess whether HCV prevalence and incidence varied across different racial/ethnic groups of injection drug users (IDUs) sampled internationally. The 29 prevalence and 11 incidence studies identified as part of the HCV Synthesis Project were categorized into subgroups based on similar racial/ethnic comparisons.

Hazardous drinking and HIV sexual risk behaviors among injection drug users in developing and transitional countries.

Studies in North America and Western Europe have reported an association between hazardous drinking and HIV sexual risk behaviors among injection drug users (IDUs). However, we lack such studies from developing and transitional countries, where different cultural norms and contexts of drinking may change this association. We used a multi-site study using standard survey instruments and methods to examine whether hazardous drinking is associated with HIV sexual risk behaviors (defined as unprotected sex and having multiple sex partners) among IDUs in 12 cities across different developing and transitional countries.

Geographic approaches to quantifying the risk environment: drug-related law enforcement and access to syringe exchange programmes.

The concept of the "risk environment"--defined as the "space ...

Meta-regression of hepatitis C virus infection in relation to time since onset of illicit drug injection: the influence of time and place.

The authors examined the relation between time since onset of illicit drug injection (time at risk) and rates of hepatitis C virus (HCV) infection by using meta-regression. In 72 prevalence studies, median time since onset of injection was 7.24 years and median prevalence was 66.

The HCV Synthesis Project: scope, methodology, and preliminary results.

Background: The hepatitis C virus (HCV) is hyper-endemic in injecting drug users. There is also excess HCV among non-injection drug users who smoke, snort, or sniff heroin, cocaine, crack, or methamphetamine.

Methods: To summarize the research literature on HCV in drug users and identify gaps in knowledge, we conducted a synthesis of the relevant research carried out between 1989 and 2006.

Alternatives to the randomized controlled trial.

Public health researchers are addressing new research questions (e.g., effects of environmental tobacco smoke, Hurricane Katrina) for which the randomized controlled trial (RCT) may not be a feasible option.

HIV prevention for injecting drug users: the first 25 years and counting.

During the last three decades, both the injection of illicit psychoactive drugs and HIV infection among injecting drug users (IDUs) have spread throughout industrialized and developing countries. Extremely rapid transmission of HIV has occurred in IDU populations with incidence rates of 10 to 50/100 person-years. In sharp contrast, there are many examples of very effective HIV risk reduction for IDUs, both in preventing initial epidemics and in bringing existing epidemics under control.

Prevalence of hepatitis C virus infection among injection drug users in the United States, 1994-2004.

Objective: To examine hepatitis C virus (HCV) seroprevalence among injection drug users in 4 US cities from 1994 through 2004.

Methods: Demographic characteristics, behaviors, and prevalence of HCV antibody among 5088 injection drug users aged 18-40 years from Baltimore, Maryland; Chicago, Illinois; Los Angeles, California; and New York, New York, enrolled in 3 related studies--Collaborative Injection Drug User Study (CIDUS) I (1994-1996), CIDUS II (1997-1999), and CIDUS III/Drug User Intervention Trial (2002-2004)--were compared using the chi(2) and Mantel-Haenszel tests of significance. Trends over time were assessed by logistic regression.

Social support and response to AIDS and severe acute respiratory syndrome.

Negative public reactions to emerging infectious diseases can adversely affect population health. We assessed whether social support was associated with knowledge of, worry about, and attitudes towards AIDS and severe acute respiratory syndrome. Our findings suggest that social support may be central to our understanding of public responses to emerging infectious diseases.

Positive deviance control-case life history: a method to develop grounded hypotheses about successful long-term avoidance of infection.

Background: Prevalence rates for long-term injection drug users in some localities surpass 60% for HIV and 80% for HCV. We describe methods for developing grounded hypotheses about how some injectors avoid infection with either virus.

Subjects: 25 drug injectors who have injected drugs 8 - 15 years in New York City.

Exploring drug users' attitudes and decisions regarding hepatitis C (HCV) treatment in the U.S.

Individuals with a history of injecting drugs are at the highest risk of becoming infected with the hepatitis C virus (HCV), with studies of patients in methadone maintenance treatment programmes (MMTPs) reporting that 60-90 percent of intravenous drug users (IDUs) have the virus. Fortunately, HCV therapy has been shown to be effective in 42-82 percent of all patients with chronic HCV infection, including IDUs. While the decision to start HCV therapy requires significant consideration, little research exists that explores the attitudes of drug users toward HCV therapy.

High-prevalence and high-estimated incidence of HIV infection among new injecting drug users in Estonia: need for large scale prevention programs.

Objective: To examine HIV risk behavior and HIV infection among new injectors in Tallinn, Estonia. Design and methods Data from two cross-sectional surveys of injecting drug users (IDUs) recruited from a syringe exchange program (N = 162, Study 1) or using respondent driven sampling (N = 350, Study 2). Behavioral surveys were administered; serum samples were collected for HIV testing.

Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug.

Background: Scientific consensus holds that if, at the outset of the HIV/AIDS epidemic, injection drug users (IDUs) had had better access to sterile syringes, much of the epidemic among IDUs in the U.S. could have been prevented.

Ethical and regulatory considerations in HIV prevention studies employing respondent-driven sampling.

Objective: To review the scientific, ethical, and regulatory literature because no official guidance exists on remuneration for participant-driven recruitment or on investigators' responsibilities for informing participants of their discordant partnerships.

Methods: We reviewed the studies that used RDS to recruit injection-drug users (IDUs), 1995-2006, and the relevant scientific, ethical, and regulatory literature that shed light on arguments for and against practices that can be used in studies employing RDS.

Results: Concerns that payments can be used to buy drugs or can subvert altruistic motivations for study participation are not supported by the literature.

Alcohol and HIV sexual risk behaviors among injection drug users.

We analyzed data from 6341 injection drug users (IDUs) entering detoxification or methadone maintenance treatment in New York City between 1990 and 2004 to test the hypothesis that alcohol use and intoxication is associated with increased HIV sexual risk behaviors. Two types of associations were assessed: (1) a global association (i.e.

Reducing HIV infection among new injecting drug users in the China-Vietnam Cross Border Project.

Objectives: To assess an HIV prevention programme for injecting drug users (IDU) in the crossborder area between China and Vietnam.

Design: Serial cross-sectional surveys (0, 6, 12, 18, 24 and 36 months) of community-recruited current IDU.

Methods: The project included peer educator outreach and the large-scale distribution of sterile injection equipment.

Erectile dysfunction in male heroin users, receiving methadone and buprenorphine maintenance treatment.

Erectile dysfunction (ED) is common among people in treatment for heroin addiction. The purpose of the study was to examine the frequency of ED among methadone and buprenorphine maintenance therapy patients, and to identify factors associated with ED. Patients - recruited from 7 centres in Italy - underwent: (i) a structured interview on socio-demographic characteristics, drug use and sexual behaviour; (ii) IIEF-15 test, a test of sexual function; (iii) Zung test for depression.

Predictors of the degree of drug treatment coverage for injection drug users in 94 metropolitan areas in the United States of America.

Aims: A prior study concluded that drug treatment coverage, defined as the percentage of injection drug users in drug treatment, varied from 1 percent to 39 percent (median 9 percent) in 96 metropolitan statistical areas (MSAs) in the United States. Here, we determine which metropolitan area characteristics are associated with drug treatment coverage.

Methods: We conducted secondary analysis of official data, including the number of injection drug users in treatment and other variables, for 94 large US MSAs.