Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta-analysis.

Aims: The Ethnic Minority Meta-Analysis (EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs (PWID) across various countries. This is the first report of the data.

Methods: Standard systematic review/meta-analysis methods were utilized, including searching for, screening and coding published and unpublished reports and meta-analytical statistics.

Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: patterns in the international data.

Background: Injecting drug use continues to be a primary driver of HIV epidemics in many parts of the world. Many people who inject drugs (PWID) are sexually active, so it is possible that high-seroprevalence HIV epidemics among PWID may initiate self-sustaining heterosexual transmission epidemics.

Methods: Fourteen countries that had experienced high seroprevalence (<20%) HIV epidemics among PWID and had reliable data for injection drug use (IDU) and heterosexual cases of HIV or AIDS were identified.

Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas.

Objective: There are multiple reasons why females who inject drugs may be more likely to become infected with HIV than males who inject drugs. Where this is the case, special HIV prevention programs for females would be needed.

Design: International systematic review and meta-analysis of studies across 14 countries.

Associations between herpes simplex virus type 2 and HCV With HIV among injecting drug users in New York City: the current importance of sexual transmission of HIV.

Objectives: We examined relationships between herpes simplex virus type 2 (HSV-2), a biomarker for sexual risk, and HCV, a biomarker for injecting risk, with HIV among injecting drug users (IDUs) who began injecting after large-scale expansion of syringe exchange programs in New York City.

Methods: We recruited 337 heroin and cocaine users who began injecting in 1995 or later from persons entering drug detoxification. We administered a structured interview covering drug use and HIV risk behavior and collected serum samples for HIV, HCV, and HSV-2 testing.

Induction of CXCR3- and CCR5-associated chemokines during acute hepatitis C virus infection.

Background & Aims: Characterization of inflammatory mediators, such as chemokines, during acute hepatitis C virus (HCV) infection might shed some light on viral clearance mechanisms.

Methods: Plasma levels of CXCR3 (CXCL9-11)- and CCR5 (CCL3-4)-associated chemokines, ALT, and HCV RNA were measured in nine injection drug users (median 26 samples/patient) before and during 10 acute (eight primary and two secondary) HCV infections. Using functional data analysis, we estimated smooth long-term trends in chemokine expression levels to obtain the magnitude and timing of overall changes.

Gender and age patterns in HSV-2 and HIV infection among non-injecting drug users in New York City.

Objective: To examine prevalence of and associations between herpes simplex virus type 2 (HSV-2) infection and HIV infection among never-injecting heroin and cocaine drug users (NIDUs) in New York City.

Methods: Subjects were recruited from patients entering the Beth Israel drug detoxification program. Informed consent was obtained, a structured questionnaire including demographics, drug use history, and sexual risk behavior was administered, and a blood sample was collected for HIV and HSV-2 antibody testing.

Evaluating recruitment among female sex workers and injecting drug users at risk for HIV using respondent-driven sampling in Estonia.

Few recent publications have highlighted theoretical and methodological challenges using respondent-driven sampling (RDS). To explore why recruitment with RDS may work in some populations and not in others, we assess the implementation of RDS to recruit female sex workers (FSWs) and injection drug users (IDUs) into a human immunodeficiency virus biological and risk behavior survey in Tallinn, Estonia. Recruitment of FSWs was slower and more challenging than that of IDUs.

Learning from HIV epidemics among injecting drug users.

HIV/AIDS was the defining issue for international harm reduction during its first twenty years. This issue was marked by strong contrasts: rapid HIV transmission in some populations of injecting drug users, and close to elimination of HIV in other populations; a formidable research base for designing effective HIV programmes and persistent political problems in implementing evidence-based programmes on a public health scale. Elevated rates of HIV infection among ethnic minority drug users have occurred in many different countries.

At-risk drinking and injection and sexual risk behaviors of HIV-positive injection drug users entering drug treatment in New York City.

We analyzed data from 1253 HIV-positive injection drug users (IDUs) entering detoxification or methadone maintenance treatment in New York City between 1990 and 2004 to assess HIV risk behaviors and their association with at-risk drinking (defined as more than 14 drinks per week for males or 7 drinks per week for females) and intoxication. Most (81%) of the participants were male, 50% were Hispanic, and 36% African American. The average age of respondents was 40 years.

HIV testing and treatment among at-risk drinking injection drug users.

Objective: To test the hypothesis that at-risk drinking is associated with a smaller probability of prior HIV testing and access to antiretroviral treatment (ART) among injection drug users (IDUs) entering treatment for drug abuse.

Methods: HIV infected IDUs (N = 643) entering detoxification or methadone maintenance treatment in New York City between 1997 and 2002 comprised the participants. Multivariate logistic regression was used to assess whether receiving ART was associated with at-risk drinking.

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.

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.

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.

Herpes simplex virus-2 and HIV among noninjecting drug users in New York city.

Objective: To examine the relationship between herpes simplex virus 2 (HSV-2) seroprevalence and human immunodeficiency virus (HIV) seroprevalence among noninjecting heroin and cocaine users in New York City.

Methods: Four hundred sixty-two noninjecting cocaine and heroin users were recruited from a drug detoxification program in New York City. Smoking crack cocaine, intranasal use of heroin, and intranasal use of cocaine were the most common types of drug use.

The transition from injection to non-injection drug use: long-term outcomes among heroin and cocaine users in New York City.

Aims: To characterize heroin and cocaine users in New York City who have changed from injection to non-injection drug administration and to identify factors associated with long-term non-injection use.

Design: Two cross-sectional studies of heroin and cocaine users in New York City.

Settings And Participants: New admissions were recruited at drug abuse treatment programs (2000-04) and respondent-driven sampling was used to recruit drug users from the community (2004).

Unstable housing as a factor for increased injection risk behavior at US syringe exchange programs.

Objective: To assess variation in injection risk behavior among unstably housed/homeless injecting drug users (IDUs) across programs in a national sample of US syringe exchange programs.

Methods: About 23 syringe exchange programs were selected through stratified random sampling of moderate to very large US syringe exchange programs operating in 2001-2005. Subjects at each program were randomly sampled.

Residual injection risk behavior, HIV infection, and the evaluation of syringe exchange programs.

This study assessed relationships between residual risk behavior (risk behavior among persons participating in effective HIV prevention programs) and HIV infection. Structured interviews and HIV tests were obtained from participants in six large U.S.

Respondent-driven sampling in a study of drug users in New York City: notes from the field.

Beth Israel Medical Center (BIMC), in collaboration with the Centers for Disease Control (CDC) and the New York State Department of Health (NYSDOH), used respondent-driven sampling (RDS) in a study of HIV seroprevalence among drug users in New York City in 2004. We report here on operational issues with RDS including recruitment, coupon distribution, storefront operations, police and community relations, and the overall lessons we learned. Project staff recruited eight seeds from a syringe exchange in Lower Manhattan to serve as the initial study participants.

Expansion of opiate agonist treatment: an historical perspective.

Untreated opiate addiction remains a major health care crisis in New York and in most other urban centers in America. Optimism for closing the gap between need and demand for treatment and its availability has greeted the recent approval of a new opiate medication for addiction, buprenorphine--which unlike methadone may be prescribed by independent, office-based practitioners. The likelihood of buprenorphine fulfilling its potential is assessed in the light of the massive expansion of methadone treatment more than 30 years earlier.