The study found a high prevalence (69.4%) of HIV among 180 male injecting drug users in Chennai, India. Unsafe injection practices like sharing needles, multiple incarcerations, and tattooing were associated with higher odds of HIV infection. Incarceration exposed drug users to shared needle use and increased their risk of HIV. The study calls for urgent and comprehensive HIV prevention programs for injecting drug users, both in and out of prison, to curb further transmission.
A Study Regarding Knowledge of Anti Biotic Resistance among Engineering Stude...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Richard Garfein, Ph.D., M.P.H., of UC San Diego Department of Medicine, presents "HIV, HCV, and TB Infection among Injection Drug Users in San Diego" at AIDS Clinical Rounds
Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment fo...Dr.Samsuddin Khan
Abstract
BACKGROUND:
Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India.
METHODS:
A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation.
RESULTS:
The median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens.
CONCLUSIONS:
Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.
A Study Regarding Knowledge of Anti Biotic Resistance among Engineering Stude...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Richard Garfein, Ph.D., M.P.H., of UC San Diego Department of Medicine, presents "HIV, HCV, and TB Infection among Injection Drug Users in San Diego" at AIDS Clinical Rounds
Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment fo...Dr.Samsuddin Khan
Abstract
BACKGROUND:
Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India.
METHODS:
A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation.
RESULTS:
The median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens.
CONCLUSIONS:
Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.
— Rabies is an endemic zoonotic disease in India. Dog is the main reservoir of rabies in India and other developing countries? An estimated 20565 deaths are reported in India due to rabies annually. It is a universally fatal disease but preventable by timely post-exposure prophylaxis. The current study was undertaken to assess the knowledge, attitude and practices towards animal bites and rabies in an urban community catered to Urban Health Centre, Santa Cruz, North Goa. 150 adult family members, one from each randomly selected family from the urban community catered to Urban Health Centre, Santa Cruz, North Goa were interviewed using a semi-structured questionnaire regarding their personal details and their knowledge attitude and practices about animal bites and towards rabies. Out of the 150 study participants, 132 (88%) were aware of the disease rabies and majority i.e. 140 (93%) knew that dog bites lead to rabies. However only 60 (40%) were aware of other animal bites causing rabies. 116 (77%) of study subjects preferred a hospital for wound treatment. However a significant 34 (22%) preferred traditional remedy or healer. Nearly one third i.e. 44 (29%) of the study subjects preferred to observe the dog for at least ten days following dog bite before being advised the same at health facility. 47 (31.33%) of the study participants had been bitten by a dog in the past of which 35 (74.47%) were bitten by a stray dog. 62 (41.33%) owned a pet dog of which 32 (51%) were vaccinated.
The Epidemiology of Deliberate Self-Poisoning Presenting at a Tertiary Care ...Faizan Qaisar
Faizan Qaisar1*, Mohsin Shafi1, Ayesha Majeed1, DileepKumar1, Awais Memon1and Umer Memon1
1Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro,
Sindh, Pakistan
Drug use patterns among participants in a woman-focused RCT in GeorgiaIrma Kirtadze M.D.
The purpose of this poster presentation is to depict preliminary results from small-scale RCT IMEDI study and show the drug use patterns among women who use illicit substance and the rate of HIV infection.
Adverse Events among HIV/MDR-TB Co-Infected Patients Receiving Antiretroviral...Dr.Samsuddin Khan
Abstract
Background
Significant adverse events (AE) have been reported in patients receiving medications for multidrug- and extensively-drug-resistant tuberculosis (MDR-TB & XDR-TB). However, there is little prospective data on AE in MDR- or XDR-TB/HIV co-infected patients on antituberculosis and antiretroviral therapy (ART) in programmatic settings.
Methods
Médecins Sans Frontières (MSF) is supporting a community-based treatment program for drug-resistant tuberculosis in HIV-infected patients in a slum setting in Mumbai, India since 2007. Patients are being treated for both diseases and the management of AE is done on an outpatient basis whenever possible. Prospective data were analysed to determine the occurrence and nature of AE.
Results
Between May 2007 and September 2011, 67 HIV/MDR-TB co-infected patients were being treated with anti-TB treatment and ART; 43.3% were female, median age was 35.5 years (Interquartile Range: 30.5–42) and the median duration of anti-TB treatment was 10 months (range 0.5–30). Overall, AE were common in this cohort: 71%, 63% and 40% of patients experienced one or more mild, moderate or severe AE, respectively. However, they were rarely life-threatening or debilitating. AE occurring most frequently included gastrointestinal symptoms (45% of patients), peripheral neuropathy (38%), hypothyroidism (32%), psychiatric symptoms (29%) and hypokalaemia (23%). Eleven patients were hospitalized for AE and one or more suspect drugs had to be permanently discontinued in 27 (40%). No AE led to indefinite suspension of an entire MDR-TB or ART regimen.
Conclusions
AE occurred frequently in this Mumbai HIV/MDR-TB cohort but not more frequently than in non-HIV patients on similar anti-TB treatment. Most AE can be successfully managed on an outpatient basis through a community-based treatment program, even in a resource-limited setting. Concerns about severe AE in the management of co-infected patients are justified, however, they should not cause delays in the urgently needed rapid scale-up of antiretroviral therapy and second-line anti-TB treatment
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv...CrimsonpublishersCJMI
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv-1 DNA Quantification by Tuofu Zhu in Cohesive Journal of Microbiology & Infectious Disease
Change in Practice of using Inhalers for Outpatients have Chronic Obstructive...AI Publications
Objectives: To evaluate changes in the practice of using inhalers for outpatients have chronic obstructive pulmonary at Nam Dinh General Hospital after the intervention. To compare the effectiveness between intervention methods of direct consultation (DC) and direct counseling method incorporating information technology (DC – IT). Subject and method: Intervention study on two groups of patients, 30 patients have chronic obstructive pulmonary in each group with similar characteristics who were treated at Nam Dinh General Hospital from October 2019 to May 2020. Two research groups analyzed and compared the practice of patients at two times, the first time (T1) before the intervention and the second time (T2) after the intervention was 3 months with 3 consecutive interventions (each intervention was 1 month). One group intervened with the direct consultation method; one group intervened with the direct counseling method incorporating information technology. Data were collected by the observational method, using the inhaler procedure and entered and processed on SPSS 20.0 software. Results: The group of patients was intervened with the direct counseling method about practice using inhalers increased after the intervention, the average point of inhaler practice before the intervention was 6.50 ± 1.63 and after the intervention was 8.57 ± 0.63 with p <0.05. The group of patients who intervened with direct counseling method incorporating information technology about using an inhaler increased after the intervention from 6.70 ± 1.29 (before the intervention) to 8.80 ± 0.61 (after intervention), with p <0.05. The efficiency index of using the inhaler dose of (DC – IT) group was higher than the DC group at 63%. Conclusion: The average of the two groups increased significantly after the intervention. However, the intervention method of DC – IT was more effective than the DC method.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Prescribing practices of antibiotics in outpatient setting of a tertiary care...SriramNagarajan19
Antibiotic resistance is a form of drug resistance whereby certain sub-populations of a microorganism, usually a bacterial species, are able to survive after exposure to one or more antibiotics; pathogens resistant to multiple antibiotics are considered multidrug resistant (MDR) and the issue is the subject of ongoing investigation these days. The present study observed the rationality of antibiotics prescribed in an outpatient setting in a tertiary care hospital.
A prospective cohort study was conducted for 2 months on the patients who were prescribed antibiotics in a tertiary care hospital in outpatient setting. The prescriptions of patients were evaluated with respect to the medical condition of the patient. A total of 500 prescriptions were evaluated for rationality out of which 240 prescriptions (48%) were rational and 260 prescriptions (52%) were found to be irrational. The misuse of antibiotics continues to haunt the health care system of Pakistan and pose a threat of pandemic of bacterial resistance due to irrational use. Interventions by clinical pharmacists in the given situation are the need of the hour.
SuperClean, a self-claning coating solution for building and glassEnergica Co.,Ltd.
A maintenance reduction coating with self cleaning and antistatic fuction. Using antistatic together with superhydrophillic characteristic of the nano material from Japan.
— Rabies is an endemic zoonotic disease in India. Dog is the main reservoir of rabies in India and other developing countries? An estimated 20565 deaths are reported in India due to rabies annually. It is a universally fatal disease but preventable by timely post-exposure prophylaxis. The current study was undertaken to assess the knowledge, attitude and practices towards animal bites and rabies in an urban community catered to Urban Health Centre, Santa Cruz, North Goa. 150 adult family members, one from each randomly selected family from the urban community catered to Urban Health Centre, Santa Cruz, North Goa were interviewed using a semi-structured questionnaire regarding their personal details and their knowledge attitude and practices about animal bites and towards rabies. Out of the 150 study participants, 132 (88%) were aware of the disease rabies and majority i.e. 140 (93%) knew that dog bites lead to rabies. However only 60 (40%) were aware of other animal bites causing rabies. 116 (77%) of study subjects preferred a hospital for wound treatment. However a significant 34 (22%) preferred traditional remedy or healer. Nearly one third i.e. 44 (29%) of the study subjects preferred to observe the dog for at least ten days following dog bite before being advised the same at health facility. 47 (31.33%) of the study participants had been bitten by a dog in the past of which 35 (74.47%) were bitten by a stray dog. 62 (41.33%) owned a pet dog of which 32 (51%) were vaccinated.
The Epidemiology of Deliberate Self-Poisoning Presenting at a Tertiary Care ...Faizan Qaisar
Faizan Qaisar1*, Mohsin Shafi1, Ayesha Majeed1, DileepKumar1, Awais Memon1and Umer Memon1
1Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro,
Sindh, Pakistan
Drug use patterns among participants in a woman-focused RCT in GeorgiaIrma Kirtadze M.D.
The purpose of this poster presentation is to depict preliminary results from small-scale RCT IMEDI study and show the drug use patterns among women who use illicit substance and the rate of HIV infection.
Adverse Events among HIV/MDR-TB Co-Infected Patients Receiving Antiretroviral...Dr.Samsuddin Khan
Abstract
Background
Significant adverse events (AE) have been reported in patients receiving medications for multidrug- and extensively-drug-resistant tuberculosis (MDR-TB & XDR-TB). However, there is little prospective data on AE in MDR- or XDR-TB/HIV co-infected patients on antituberculosis and antiretroviral therapy (ART) in programmatic settings.
Methods
Médecins Sans Frontières (MSF) is supporting a community-based treatment program for drug-resistant tuberculosis in HIV-infected patients in a slum setting in Mumbai, India since 2007. Patients are being treated for both diseases and the management of AE is done on an outpatient basis whenever possible. Prospective data were analysed to determine the occurrence and nature of AE.
Results
Between May 2007 and September 2011, 67 HIV/MDR-TB co-infected patients were being treated with anti-TB treatment and ART; 43.3% were female, median age was 35.5 years (Interquartile Range: 30.5–42) and the median duration of anti-TB treatment was 10 months (range 0.5–30). Overall, AE were common in this cohort: 71%, 63% and 40% of patients experienced one or more mild, moderate or severe AE, respectively. However, they were rarely life-threatening or debilitating. AE occurring most frequently included gastrointestinal symptoms (45% of patients), peripheral neuropathy (38%), hypothyroidism (32%), psychiatric symptoms (29%) and hypokalaemia (23%). Eleven patients were hospitalized for AE and one or more suspect drugs had to be permanently discontinued in 27 (40%). No AE led to indefinite suspension of an entire MDR-TB or ART regimen.
Conclusions
AE occurred frequently in this Mumbai HIV/MDR-TB cohort but not more frequently than in non-HIV patients on similar anti-TB treatment. Most AE can be successfully managed on an outpatient basis through a community-based treatment program, even in a resource-limited setting. Concerns about severe AE in the management of co-infected patients are justified, however, they should not cause delays in the urgently needed rapid scale-up of antiretroviral therapy and second-line anti-TB treatment
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv...CrimsonpublishersCJMI
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv-1 DNA Quantification by Tuofu Zhu in Cohesive Journal of Microbiology & Infectious Disease
Change in Practice of using Inhalers for Outpatients have Chronic Obstructive...AI Publications
Objectives: To evaluate changes in the practice of using inhalers for outpatients have chronic obstructive pulmonary at Nam Dinh General Hospital after the intervention. To compare the effectiveness between intervention methods of direct consultation (DC) and direct counseling method incorporating information technology (DC – IT). Subject and method: Intervention study on two groups of patients, 30 patients have chronic obstructive pulmonary in each group with similar characteristics who were treated at Nam Dinh General Hospital from October 2019 to May 2020. Two research groups analyzed and compared the practice of patients at two times, the first time (T1) before the intervention and the second time (T2) after the intervention was 3 months with 3 consecutive interventions (each intervention was 1 month). One group intervened with the direct consultation method; one group intervened with the direct counseling method incorporating information technology. Data were collected by the observational method, using the inhaler procedure and entered and processed on SPSS 20.0 software. Results: The group of patients was intervened with the direct counseling method about practice using inhalers increased after the intervention, the average point of inhaler practice before the intervention was 6.50 ± 1.63 and after the intervention was 8.57 ± 0.63 with p <0.05. The group of patients who intervened with direct counseling method incorporating information technology about using an inhaler increased after the intervention from 6.70 ± 1.29 (before the intervention) to 8.80 ± 0.61 (after intervention), with p <0.05. The efficiency index of using the inhaler dose of (DC – IT) group was higher than the DC group at 63%. Conclusion: The average of the two groups increased significantly after the intervention. However, the intervention method of DC – IT was more effective than the DC method.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Prescribing practices of antibiotics in outpatient setting of a tertiary care...SriramNagarajan19
Antibiotic resistance is a form of drug resistance whereby certain sub-populations of a microorganism, usually a bacterial species, are able to survive after exposure to one or more antibiotics; pathogens resistant to multiple antibiotics are considered multidrug resistant (MDR) and the issue is the subject of ongoing investigation these days. The present study observed the rationality of antibiotics prescribed in an outpatient setting in a tertiary care hospital.
A prospective cohort study was conducted for 2 months on the patients who were prescribed antibiotics in a tertiary care hospital in outpatient setting. The prescriptions of patients were evaluated with respect to the medical condition of the patient. A total of 500 prescriptions were evaluated for rationality out of which 240 prescriptions (48%) were rational and 260 prescriptions (52%) were found to be irrational. The misuse of antibiotics continues to haunt the health care system of Pakistan and pose a threat of pandemic of bacterial resistance due to irrational use. Interventions by clinical pharmacists in the given situation are the need of the hour.
SuperClean, a self-claning coating solution for building and glassEnergica Co.,Ltd.
A maintenance reduction coating with self cleaning and antistatic fuction. Using antistatic together with superhydrophillic characteristic of the nano material from Japan.
Jesteśmy na samym krańcu przylądka wieków! Wczoraj umarły Czas i Przestrzeń. Żyjemy już w absolucie, stworzyliśmy już bowiem wieczną i wszechobecną prędkość.
Use all kinds of biomass pellets as fuel. Common burners only can burn wood pellets, but our burner break out the limitation. No need to stop burner and worry its slagging. Continuous operation, automatic discharging and cleaning.
Comment tester une application en 2016 ? L'évolution des techniques, l'intégration des testeurs dans les équipes, l'automatisation ont changé la donne depuis quelques années. Pour sortir le bon produit au bon moment il faut revoir (voire créer) une stratégie de test efficace. Pour chaque application, cette stratégie se doit d'être différente, comment choisir et appliquer la vôtre ?
Scientific Merit Paper Scoring GuideEvaluates the scientific mer.docxbagotjesusa
Scientific Merit Paper Scoring Guide
Evaluates the scientific merit of the article by analyzing how the research advances the scientific knowledge base. Evaluates the scientific merit of the article by analyzing how the research contributes to research theory and the field of study. Evaluates the scientific merit of the article by analyzing the scientific methods. Analyzes the validity and reliability of a selected research study and elaborates on how it contributes to scientific merit. Analyzes the effectiveness of strategies selected for addressing ethical concerns in the design of a research study. Communicates in a manner that is completely scholarly, professional, and consistent with expectations for members of the identified field of study, and uses APA style and formatting with few or no errors.
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International Journal of Drug Policy 21 (2010) 289–295
Contents lists available at ScienceDirect
International Journal of Drug Policy
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o
esearch paper
pportunities for enhancing and integrating HIV and drug services for
rug using vulnerable populations in South Africa
harles D.H. Parry a,b,∗, Petal Petersen a, Tara Carney a, Richard Needle c
Alcohol & drug Abuse Research Unit, Medical Research Council, South Africa
Department of Psychiatry, Stellenbosch University, South Africa
Pangaea Global AIDS Foundation, USA
r t i c l e i n f o
rticle history:
eceived 25 July 2009
eceived in revised form
0 November 2009
ccepted 24 November 2009
eywords:
apid assessment
llicit drugs
ex risk
IV
ntegrated services
outh Africa
a b s t r a c t
Background: Little has been done to improve the integration of drug use and HIV services in sub-Saharan
Africa where substance use and HIV epidemics often co-exist.
Methods: Data were collected using rapid assessment methods in two phases in Cape Town, Durban
and Pretoria, South Africa. Phase I (2005) comprised 140 key informant and focus group drug using
interviewees and 19 service providers (SPs), and Phase 2 (2007) comprised 69 drug using focus group
interviewees and 11 SPs.
Results: Drug users put themselves at risk for HIV transmission through various drug-related sexual
practices as well as through needle sharing. Drug users in both phases had limited knowledge of the
availability of drug treatment services, and those that had accessed treatment identified a number of
barriers, including affordability, stigma and a lack of aftercare and reintegration services. SPs identified
similar barriers. Drug users displayed a general awareness of both HIV transmission routes and prevention
strategies, but the findings also indicated a number of misperceptions, and problematic access to materials
such as condoms and safe injection equipment. Knowledge around HIV treatment was low, and VCT
experiences were mixed. SPs recognized the importance o.
A correlative study to assess the internet addiction and psychopathologies am...iosrjce
With the advancement in media and technologies internet has emerged as an effective tool in
eliminating human geographical barriers. However, excessive use of theInternet has resulted in negative
consequences especially among the regular users labeling it as an addiction. The objectives of the study were to
assess the prevalence of internet addiction and find a correlation between internet addiction and
psychopathologies among university students.A descriptive survey approach with cross sectional design was
adopted for the study. 264 students were selected by convenient sampling technique from the different colleges
of various streams like medicine, dental, nursing, pharmacology and agriculture, who are undergoing
graduation and fulfilling the sampling criteria. The data collection instruments used were Internet addiction test
(IAT) and Duke Health profile tool to assess the data. This study reveals that according to IAT score 85.5%
were normal & 14.5% were abnormal in 1st year, 95% were normal & 5% were abnormal in 2nd year ,68.9%
were normal & 31.1% were abnormal in 3rd year ,10.7% were normal & 89.2% were abnormal 56.2% normal
in 4th year.Study also shows IAT score among various disciplines, 69.2% were normal and 30.8% were
abnormal in medical college, 68% were normal and 32% were abnormal in nursing college, 50.5% were
normal and 49.5% were abnormal in pharmacology college, 57.5% were normal and 42.5% were abnormal in
dental college, 65.6% were normal and 34.4% were abnormal in agriculture college. Further it was observed
through the analysis that there is no statistically significant correlation between IAT score and
psychopathologies.
Self-Medication of Anti-Biotics amongst University Students of Islamabad: Pre...IOSR Journals
The prevalence and pattern of self-medication with antibiotics among undergraduate and graduate community of students at different universities of Islamabad was evaluated using structured self-medication administered questionnaire. This cross-sectional, study was conducted in March 2013. A convenience sample was taken from 4 non-medical universities of the city of Islamabad, Pakistan. Data was analyzed using SPSS v14 and associations were tested using the Chi square test. A total of 210 questionnaires were randomly distributed with a respondent rate of 100%. The prevalence of self-medication was found to be 77.03% (Female: Male Ratio=1:1.14). The major reasons given for self-medicating with antibiotics were; 33.63% assumed knowledge on antibiotics (P=0.478), 26.64% prior experience on use (P=0.378), while 9.17% admitted lack of time to go for consultation (P=0.130). Majority of respondents however, self-medicate with antibiotics occasionally. The most reported antibiotic class (48.58%) was the β-lactams (as amoxicillin) while co-trimoxazole was rarely used (2.23%). The most reported condition for self-medication was respiratory tract infections (59%). About almost half of the respondents (46.79%) purchased the drugs from drug stores. These findings highlight the needs for planning interventions to promote the judicious use of antibiotics within the student population
Household Demographic Predictors of Drug and Substance Abuse among High Schoo...Premier Publishers
Purpose: The accessibility, affordability, and consumption of abused drugs by the youths have attracted great concern among public health personnel. This descriptive cross-sectional study investigated household demographic predictors of drugs and substance abuse among high school students in Kisumu East Sub-County, Kisumu County.
Methods: Sample size of 434 was calculated using Yamane formula and the participants selected through Snow ball, random, cluster and stratified sampling. Descriptive data was summarized using tables while inferential statistic done using Chi square and logistic regression. Data collection done through observation and semi- structured questionnaires. P value <0.05 was considered statistically significant.
Results: Overall, 219 (61.17%) students reported to have engaged in drug and illicit substance abuse with higher proportion reported among the Christians as compared to Islamic and Hinduism. Religion, Parental / guardian’s level of education and the person living with the student were found to significantly predict the abuse of drug and illicit substance among high school students (p<0.05).
Conclusion: Drug and illicit substance abuse remains a major public health problem among all age groups worldwide with several negative impacts. Due to its magnitude, it calls for concerted multi-sectorial effort by all stakeholders for the dream of drug free world to be achieved.
Mitochondrial Disease Community Registry: First look at the data, perspectiv...SophiaZilber
Patient-populated registries are an important component of rare disease communities for many
reasons, including their use as a tool for gathering opinions on specific topics. The Mitochondrial
Disease Community Registry (MDCR) was launched in 2014 for this purpose as well as to identify and
characterize mitochondrial disease patients from the patient perspective. Data collected over a four
year period and provided by adult mitochondrial disease patients and caregivers of pediatric
mitochondrial disease patients in response to a single survey are presented. Primary findings include
the importance of clinician-patient communication, need for treatment and cure, impact of the disease
on the entire life of a person, and quality of life as top issues as described by patients. Despite multiple
challenges, patients are hopeful about the future and thankful for the survey. Efforts should be made
to identify ways to better support patients, improve communication, and create more trusting and
healing relationships between patients and doctors. Additionally, data quality checks showed that more
clear and simple questions and shorter more-targeted surveys are needed in order to get accurate
and meaningful data that can be used for analysis and research in the future.
Adherence to Antiretroviral Therapy among HIVPositive Patients in Central Hos...Efe Clement Abel
Abstract: Adherence is the quantified level to which an individual follows a prescribed treatment and a low level of adherence to antiretroviral therapy(ART) adversely affects a patient’s treatment outcome and results in a rebound of plasma viraemia, development of resistant strains of HIV, more rapid immune deterioration, development of AIDS and death. This study is aimed at assessing the level of adherence to ART among HIV-positive patients assessing care in Central Hospital, Warri, Delta State, Nigeria. A descriptive cross-sectional study. Data were obtained using a semi-structured, interviewer-administered questionnaire and analysed using SPSS version 23. A total of 303 persons were recruited for the study. The mean age of respondents was 36.2±10.8years. Less than half of the subjects (45.5%) were adherent to their ART. Among the non-adherent subjects, the common reasons reported for missing doses of ART were forgetfulness (50.9%), too busy with other things (43.6%) and away from home (35.8%). This study showed that adherence to ART among the study population was poor. Forgetfulness, too busy with other things and being away from home were the most common reason for non-adherence. It is, therefore, recommended that; regular health education should be organised for HIV patients on ART on the importance of being adherent to their ART, regular assessment of adherence to ART should be carried out and a method of reminding patients who are non-adherent to ART on the need to take their ART as at when due should be considered as part of the routine services provided by ART centres.
RESEARCH ARTICLEWill Combined Prevention Eliminate Racia.docxronak56
RESEARCH ARTICLE
Will "Combined Prevention" Eliminate Racial/
Ethnic Disparities in HIV Infection among
Persons Who Inject Drugs in New York City?
Don Des Jarlais1*, Kamyar Arasteh1, Courtney McKnight1, Jonathan Feelemyer1,
Holly Hagan2, Hannah Cooper3, Aimee Campbell4, Susan Tross4, David Perlman1
1 The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York,
New York, United States of America, 2 College of Nursing, New York University, New York, New York,
United States of America, 3 Rollins School of Public Health at Emory University, Atlanta, Georgia, United
States of America, 4 Department of Psychiatry, Columbia University, New York, New York, United States of
America
* [email protected]
Abstract
It has not been determined whether implementation of combined prevention programming
for persons who inject drugs reduce racial/ethnic disparities in HIV infection. We examine
racial/ethnic disparities in New York City among persons who inject drugs after implementa-
tion of the New York City Condom Social Marketing Program in 2007. Quantitative inter-
views and HIV testing were conducted among persons who inject drugs entering Mount
Sinai Beth Israel drug treatment (2007–2014). 703 persons who inject drugs who began in-
jecting after implementation of large-scale syringe exchange were included in the analyses.
Factors independently associated with being HIV seropositive were identified and a pub-
lished model was used to estimate HIV infections due to sexual transmission. Overall HIV
prevalence was 4%; Whites 1%, African-Americans 17%, and Hispanics 4%. Adjusted
odds ratios were 21.0 (95% CI 5.7, 77.5) for African-Americans to Whites and 4.5 (95% CI
1.3, 16.3) for Hispanics to Whites. There was an overall significant trend towards reduced
HIV prevalence over time (adjusted odd ratio = 0.7 per year, 95% confidence interval (0.6–
0.8). An estimated 75% or more of the HIV infections were due to sexual transmission. Ra-
cial/ethnic disparities among persons who inject drugs were not significantly different from
previous disparities. Reducing these persistent disparities may require new interventions
(treatment as prevention, pre-exposure prophylaxis) for all racial/ethnic groups.
Introduction
Significant racial/ethnic disparities in HIV infection among persons who inject drugs (PWID)
have been observed in many countries, with ethnic minority group members [1] and females
[2] typically having higher HIV prevalence. There are effective interventions to reduce HIV
transmission among PWID, and the logic of “combined” prevention programming is that
PLOS ONE | DOI:10.1371/journal.pone.0126180 May 12, 2015 1 / 11
OPEN ACCESS
Citation: Des Jarlais D, Arasteh K, McKnight C,
Feelemyer J, Hagan H, Cooper H, et al. (2015) Will
"Combined Prevention" Eliminate Racial/Ethnic
Disparities in HIV Infection among Persons Who
Inject Drugs in New York City? PLoS ONE 10(5):
e0126180. doi:10.1371/journal.pone.0126 ...
1. Social Medicine (www.socialmedicine.info) Volume 6, Number 1, March 2011- 29 -
ORIGINAL RESEARCH
Unsafe injection practices among male injecting
drug users in Chennai city, Tamil Nadu state,
India associated with high HIV prevalence
Chandra Pauline Dinakar, Roshanara Begum, and Gifty Immanuel
Abstract
The intertwined epidemics of HIV/AIDS and
injecting drug use are among the most emerging
public health problems in India. Injecting Drug
Usage (IVDU) was found to be more prevalent
among ex-prisoners who were attended by World
Vision of India. The objective of this study was to
determine the prevalence and correlates of HIV
infection among a sub-sample of frequently
incarcerated community-based injecting drug users
(IVDU) in Chennai city, India. 180 injecting drug
users were recruited and interviewed using a
structured questionnaire regarding their socio-
demographics and HIV risk characteristics. Data
was analyzed using 2
and multiple logistic
regression to estimate the odds ratios (OR) and 95%
confidence intervals (CI). The prevalence of HIV
infection was found to be 69.4% among male
injecting drug users. In the multivariable analysis, a
history of shared drug injection inside prison (OR,
2.45; 95% CI, 1.01-4.3), multiple incarcerations
(OR, 4.15; 95%CI, 1.08-8.03), and tattooing (OR,
2.9; 95% CI, 1.80 -3.78) were associated with
significantly higher prevalence of HIV infection.
This study indicates that incarceration-related
exposure and tattooing are the main correlates of
HIV-1 infection for this population. Urgent and
comprehensive HIV prevention programs and cost
effective rehabilitation centers for injecting drug
users in and out of prison are of prime importance to
prevent further transmission of HIV infection.
Key Words:
HIV, injecting drug users (IVDUs), intravenous
drug use (IvDU), incarceration or detention in
prison
Introduction
Since the late 1980s, Asia has experienced the
twin epidemics of injecting drug use (IVDU) and
explosive rates of HIV/AIDS. Estimates suggest
there are 13.2 million injecting drug users (IVDUs)
worldwide and according to UNAIDS, Asia is likely
to have the most injecting drug related HIV cases in
the world (Aceijas et al., 2004). The primary
precipitate for this epidemic is the boom in drug
production in several Asian countries and drug-
using populations that grow rapidly along drug
trafficking routes, creating new drug markets and
new HIV threats in host countries. The new 2006
estimates released recently by the National AIDS
Control Organization (NACO), supported by
UNAIDS and WHO, indicate that national adult
HIV prevalence in India is approximately 0.36%,
which corresponds to an estimated 2 million to 3.1
million people living with HIV in the country.
However, the 2006 surveillance figures show an
increase in HIV infection among several groups,
such as people who inject drugs and men who have
sex with men (Bull et al., 2002; Panda et al., 2005).
The HIV positivity status among injecting drug
users has been found to be significantly high in the
cities of Chennai, Delhi, Mumbai and Chandigarh.
In addition, the states of Orissa, Punjab, West
Bengal, Uttar Pradesh and Kerala also show high
prevalence among this group (UNODC and MSJE,
2004)
In India, the HIV infection crisis continues to
deepen, as it becomes clearer that the epidemic is
affecting all sectors of Indian society, with an
increasing prevalence among the injecting drug
Chandra Pauline Dinakar Health Activist,
People’s Health Movement, New York, USA. Email :
cpauline123@gmail.com
Roshanara BegumController of examinations, J.B.A.S
College, University of Madras, India.
Gifty Immanuel Director, Center for AIDS and
Antiviral Research, Tuticorin, India
Submitted:9/28/2010 Accepted: 2/20/2011
Conflicts of Interest: None declared.
2. Social Medicine (www.socialmedicine.info) Volume 6, Number 1, March 2011- 30 -
users and prisoners. Drug abuse is alarmingly on the
rise in India. Friedman from the CDC (Centers for
Disease Control and Prevention) reports 66%
(297/447) of the IVDU estimates were reported
without technical information in Manipur, India.
Although IVDU behavior was known to be more
prevalent in northeast India, it is now on an all-time
high in south India as well. Injecting drug users
inject drugs into veins. Drug injecting is often a
group activity among IVDUs. The common practice
is to use the same syringe and needle for all the
members of the group (World Health Organization,
2007). If one member of the group has the HIV
infection, the infection would readily enter the other
members. The chances of transmitting infection
through the injecting route are much higher than the
sexual route of transmission (Heimer et al., 1995).
Thus, once HIV enters into the circuit of IVDU, the
spread within the IVDU community is rapid. Intake
of illicit drugs is strongly disapproved in India and
in many other countries where drug abuse is a
criminal act and punishable under law.
Criminalization of illicit drug-use makes the IVDUs
a hard to reach population. The Injecting Drug Users
are often incarcerated as they get involved in
criminal activities such as thefts, pickpocketing,
chain snatching, burglary, and attempts to commit
murder in pursuit of money to buy the injectable
drugs. The relationship between drug abuse and
incarceration has been well established in this study.
The supply of drugs in the prison is related to the
consistent demand from incarcerated addicts, which
has not been brought to a halt despite the strict
administration of the prison authorities.
The objective of this study is to highlight the
inter-relationship of unsafe injection practices,
frequency of incarceration and incidence of HIV
infection among IVDU male population (Injecting
Drug Users) in Chennai city, Tamil Nadu.
Methods
The survey was conducted in north Chennai city,
in a relatively poor area where there is a high
concentration of drug users, with a primary focus on
users who visit the ‘drop-in centers’ (mini-clinics)
of the World Vision of India. In June 2005, a
consecutive sample of 200 injecting drug users was
recruited at the drop-in center and at parks and
streets in Chennai city of Tamil Nadu. Out of the
200 selected IVDU, only 80 ex-users were willing to
participate in the study. The 80 ex-injecting drug
users were key informants in bringing in the other
identified and unidentified IVDU in Chennai city
until a suitable sample size of 180 subjects was
reached. This sampling technique is termed as the
Snowball sampling technique, which is most
appropriate for the hard-to–reach populations
(Schwartlander B et al., 2001). The research
protocol was approved by the Ethical Committee of
the institution.
The investigator explained the aspects of the
study to the recruits in their native language of
Tamil. Those willing to participate were asked to
sign the ‘Informed consent form.’ Each respondent
was interviewed using a structured questionnaire
that aimed to capture socio-demographic
characteristics, drug-use characteristics, history of
IVDU, incarceration, and tattooing. The
questionnaire was developed based on the findings
of the pilot study. Participants were asked if they
had ever used a shared needle or syringe for drug
injection (receptive sharing of needle or syringe),
were ever incarcerated in their lifetime, and if they
ever used a shared injection device (needle, syringe,
or handmade injection device) while incarcerated.
All interviews were conducted verbally in the Tamil
language, since the majority of the IVDU population
was illiterate. Most were dropouts from school,
abandoned and homeless.
Upon completion of the interview, the
participants were recommended to undertake free
serum HIV testing available at the drop-in center, to
obtain a confirmative clinical diagnosis. Pre-test
counseling and post-test counseling was provided
for the subjects who consented to the HIV test. A
phlebotomist tested the blood samples twice for
HIV-1 with enzyme-linked immunosorbent assay,
and repeatedly reactive enzyme-linked immuno-
sorbent assay samples were confirmed using a
Western blot test. Informed consent was obtained
separately for the interview and the HIV test. No
personal identifiers were recorded on the
questionnaires.
Statistical analysis was performed using SPSS
for Windows; Chi-squared or Fisher exact tests were
performed to determine bivariate associations
between HIV-1 status and the categorical variables.
Variables were entered into a multivariable model if
their association with HIV-1 infection by bivariate
analyses had a p value ≤ 0.10 or if they were
considered epidemiologically important. Multi-
variable logistic regression analysis was used to
examine the associations of independent variables
with the outcome, simultaneously adjusting for
3. Social Medicine (www.socialmedicine.info) Volume 6, Number 1, March 2011- 31 -
potential confounders, and to estimate adjusted odds
ratios (OR) and 95% confidence intervals (CI).
Results
Out of the 200 injecting drug users who were
invited to participate in the study, 20 men refused to
be tested for HIV. 180 IVDUs consented to
participate in this study. All participants were tested
for HIV. Two categories of injecting drug users
were identified from the field data. They were
classified as ‘current injectors’ (subjects who had
injected illicit drugs in the last 6 months) and ‘ex-
injectors’ (subjects who had recovered from
injection drug addiction or had not used injectible
drugs in the last one year). The subjects were also
categorized based on their HIV seropositivity.
Socio-demographic Characteristics
The median age of male IVDU was 32.0 and
61.1% were recruited from the drop-in center, while
38.9% were recruited from neighboring parks and
streets. 29.6% had never attended school, 65%
IVDU had attended primary school, and only 5.6%
of IVDU had reached high school. About 46% of
the IVDUs were married, of which only 15.6% were
living with their spouse (Table.1). At the time of
interview, 75.6% were unemployed and forty
percent (72/180) had no place other than parks,
streets, or abandoned buildings to live.
Drug Use Characteristics and HIV prevalence
Cannabis (Ganja), Heroin and Buprenorphine are
the commonly injected drugs in Chennai city. Ganja
is widely available in India and is highly (71.1%)
used by the IVDUs in this study. Heroin was
reported to be used by 61.1% (110/180).
Propoxyphene and Buprenorphine were used by
51% and 54% of the IVDU participants,
respectively. About 8% of IVDUs reported that they
started drug use via injecting. Drugs that were
reported to be generally used by IVDUs were
Cannabis, Heroin, Propoxyphene (Spasmo-
proxyvon* -Dextro-propoxyphene plus Dicyclo-
mine), Buprenorphine alone or in combination with
other drugs; injectible opiates like Morphine,
Pethidine and Pentazocine (Fortwin*), Diazepam
(Calmpose*), Promethazine (Phenergan*), and
Chlorpheniramine (Avil*). The most commonly
reported mixture of drugs was the combination of
Buprenorphine (Tidigesic), Avil and Phenergan. The
IVDUs reported injecting these drugs directly into
their blood stream. The chance of HIV infection
through the injecting route is much higher than
sexual route of HIV transmission. The drug use
pattern of the IVDUs in this study coincided with
the findings of the Rapid Assessment Survey of
drug abuse in India .
Results in Table 2 show that of the 45.6%
(82/180) of the IVDUs who had reported having
injected illicit drugs within the last six months
(current IVDUs) 75.6% were infected with HIV; the
HIV positivity rate of the 54.4% (98/180) of the
IVDUs who were termed ex-IVDUs (last time of
taking injectible drugs was more than 6 months to
one year) was 64.3% (OR,0.114;95%CI, 0.02-0.53).
History of incarceration
As high as 98% of male IVDUs had a history of
incarceration in their lifetime, with over 85% having
Table 1: Socio- demographic characteristics of
male injecting drug users recruited from drop-in
centers and its neighboring areas in Chennai
city in 2006 (n =180)
Characteristics n (%)
Recruitment site
Drop-in center 110 (61.1)
Park/street 70 (38.9)
Age at interview (years)
<30 51 (28.3)
30-39 109 (60.6)
>40 20 (11.1)
Education
Uneducated 53 (29.4)
Primary school or less 117 (65)
High school or more 10 (5.6)
Marital status
Never married 97 (53.9)
Married (not living with spouse) 55 (30. 6)
Married (living with spouse) 28 (15.6)
Place of residence
Residential place (family/friends) 55 (30.6)
Park/street/abandoned building 72 (40)
Rehabilitation units 20 (11.1)
Group living 33 ( 18.3)
Job situation
Employed 44 (24. 4)
Unemployed 136 (75. 6)
4. Social Medicine (www.socialmedicine.info) Volume 6, Number 1, March 2011- 32 -
*p values based on χ2
test of proportions unless otherwise specified: p < 0.01 –** Highly significant:
p>0.05 - NS
Not Significant; †z-test –Two-tailed Fisher exact test.
# Odd Ratio(OR) and 95% Confidence Interval(CI) was calculated for specific risk factors to be subjected
for multivariate analysis to identify association with HIV infection
Table 2
Risk Characteristics Of Male Injecting Drug Users in Chennai City, Tamil Nadu State, India
HIV-1
POSITIVECharacteristics N (%)
N %
Odd
Ratio#
(95% CI)
Chi
square
value
p value
Overall 180 125 69 - -
Time from last drug injection (months) <6 82 (45.6) 62 75.6 1.0
>6 98(54.4) 63 64.3
0.114
(0.024-0.53)
2.698 NS
Length of continual injecting (years) <6 60(33.3) 23 38
>6 120(66.7) 102 85
- 149.878 p 0.01
Frequency of daily injecting during addiction
Once a day
36 (20) 15 41.6
1.0
1.33(0.15-
1.69)
Twice a day or more 144 (80) 110 76.4
74.255 p 0.01
Incarceration /history of arrests
Yes
178(98.9) 125 70.2 -
No 2(1.1) 0 0
4.597
p 0.05
4.3513†
Frequency /no. of times incarcerated <2 34(19.1) 8 23.5 1.0
2-5 99(55.6) 75 75.6 3.9(1.4-4.1)
>5 45(25.3) 42 93.3
5.1(1.5-
15.1)
48.397 p 0.01
Total length of incarceration (years)
<2
30(16.9) 7 23.3 1.0
2-5 96(53.9) 71 74 2.4(1.6-4.1)
>5 52(29.2) 47 90.4 4.4(1.9-5.0)
42.295
p 0.01
Ever injected a drug inside prison
Yes
26(14.6) 24 92.3 2.1(1.2-3.3)
No 152(85.4) 100 65.8 1.0
9.789 p 0.01
Shared needle while injecting drugs in prison
Yes
26(14.6) 24 92.3 2.8 (1.0-4.51)
No 152(85.4) 101 66.4 1.0
7.101 p 0.01
Shared needle while injecting drugs outside prison
Yes
180(100) 125 69.4 -
No 0 0
6.934 p 0.01
No. of needle sharing IVDU partners
<2
5 (2.8) 1 20 -
2-5 24(13.3) 10 41.6
>5 151(83.9) 114 82.1
71.738 p 0.01
Ever Tattooed
No
7(3.9) 2 28.6 1.0
Yes (never inside prison) 92(51.1) 50 54.3 1.8(0.8-2.5)
Yes (inside prison) 81(45) 73 90.1 3.2(1.8-4.1)
5.734 p 0.05
Tattoo artist used same needle for tattooing all
clients: Yes
174(96.7) 123 70.7 -
No 6 (3.3) 2 33.3
5.734 p 0.05
No. of clients tattooed along with you
<2
8(4.6) - - -
2-5 137(78.7) 94 68.6
>5 29(16.7) 29 100
34.225 p 0.01
Ever had sex with another man : Yes 16 3 18.5 0.49(0.4-1.4)
No 164 42 25 1.0
0.5453NS
NS
5. Social Medicine (www.socialmedicine.info) Volume 6, Number 1, March 2011- 33 -
experienced 2 or more prior incarcerations (multiple
incarcerations). Of those who were ever
incarcerated, the median number and length of
lifetime incarcerations were six and eight months,
respectively.
The results of Fisher exact test and students ‘t’
test indicated a significantly higher prevalence of
HIV infection among IVDUs with incarceration
records when compared to those who did not have
any record of incarceration (70.2 % vs. 0%;
z=4.3513, p <0.05). Subjects who had been
incarcerated more than two times (75.6%) to more
than five times (93.3%) were associated with
significantly higher prevalence of HIV infection as
compared to 23.5% of HIV positivity rate among
subjects who were imprisoned for less than two
times. The length of the incarceration period was
highly associated with HIV prevalence (2= 42.295;
p value < 0.01). The HIV prevalence was highest
(above 90%) for subjects who had been incarcerated
more than five times (OR, 5.1; 95% CI, 1.5- 15.1).
Among those with a history of incarceration,
14.6% had reported having ever injected a drug
inside prison. 73.1% of them were found to be HIV
positive (2= 9.789; p value < 0.01; OR, 2.1; 95%
CI, 1.2-3.3). Of the 14.6% IVDUs who reported
sharing injection devices (needles, syringes, or
handmade injection devices) at some time during
their incarceration period, 96.2% tested positive for
HIV infection ( 2= 7.101; p value < 0.01; OR,2.8 ;
95% CI, 1.0-4.51),compared to 69.4% of the subjects
who had shared needles outside prison.
Tattooing
Tattooing was another factor associated with
HIV-infection. About 96% of the IVDUs recruited
for the study had tattoos on their hands, legs and
chest. Up to 45% of ever-incarcerated IVDUs
reported being tattooed inside prison, and of them
90% tested positive for HIV ( 2= 5.734; p value <
0.05 ; OR, 3.2; 95% CI, 1.8-5.1 ); out of 51% of the
IVDUs who reported being tattooed outside of the
prisons 54.3% were HIV sero-positive (OR,1.8;
95% CI, 0.8-2.5).
The subjects reported being tattooed on the
streets of Chennai city. Observation of some of
these street-based tattoo artists indicated the re-use
of needle on their clients. The tattoo artists used
contaminated sharps and unsafe injection practices.
Battery-operated and manual tattooing was carried
out using rusted sharps, reused needles and a dye
bottle that contained residues of bloodstains of the
previous client. One of the IVDUs reported being
the fifth person in the line to receive his tattoo. It
was observed that the needle was not immersed in
any kind of disinfectant. In an adjusted analysis
(Table 3), having a tattoo indicated a significant
association with HIV-infection (=5.734, p≤ 0.05;
OR, 2.9; 95% CI, 1.80 -3.78), which suggests that
HIV probably is being transmitted via this route. If
this is the case, then IVDUs with tattoos are at a
higher risk for HIV infection.
Multivariable Analysis
The variables related to the history of shared
drug injection inside prisons, multiple incarcerations
(>2 times) and tattooing were selected as the main
incarceration-related exposures to be included in the
multivariable model. In the multivariable analysis,
controlling for basic socio-demographic
characteristics, it was shown that HIV-1 infection
remained associated with a history of shared drug
injection inside prisons (adjusted OR, 2.45; 95% CI,
1.01-4.3); multiple incarcerations (adjusted OR,
4.15; 95%CI, 1.08-8.03); and been tattooed in a
prison (OR,2.9;95% CI, 1.80 -3.78) (Table 3).
No significant relationship was observed
between the HIV positive status and MSM (men
having sex with men) behavior of IVDUs in prison.
The results could reflect underreporting of same-
gender sexual practices inside prison, or other
confounding factors inside prison, such as violence,
which would also be contributing factors for
transmission of HIV infection in prisons.
Discussion
This study investigated the prevalence of HIV
infection and its correlates among community-based
IVDU in Chennai city. Out of the 180 subjects
screened for HIV, 125 subjects were confirmed HIV
positive (69.4%). Findings show that the HIV
prevalence detected in Chennai city was at a record
high and that it was potentially correlated with a
history of shared drug injection inside prison,
multiple incarcerations and tattooing.
The association between HIV infection and a
history of shared drug injection inside prison has
been reported in other countries and was found in
our earlier study among IVDU who visited
treatment centers in Chennai city. This association is
also supported by our qualitative data that showed
that although drugs are available in some prisons,
they are much more expensive than those purchased
outside of prison in Chennai city. Having obtained
6. Social Medicine (www.socialmedicine.info) Volume 6, Number 1, March 2011- 34 -
Table 3
Multivariable analysis on the association between HIV-1 infection and risk characteristics of
injecting drug users recruited from a drop-in center and its neighboring area in Chennai city in 2006.
Characteristics Adjusted OR 95% CI P
Ever injected using a
shared device in prison
2.45 1.01- 4.3 0.007
History of multiple
incarcerations (>2 times)
4.15 1.08- 8.03 0.000
Ever had sex with another man 0.49 0.40- 1.83 0.370
Ever tattooed inside prison 2.90 1.80 -3.78 0.016
an expensive drug inside prison where drug use is
apparently prohibited, the most cost-effective and
concealing way for drug users to consume their
drugs is by injecting. Meanwhile, an extreme
shortage of needles and syringes inside prisons has
lead incarcerated IVDU to share needles/syringes or
handmade injection devices with a large number of
partners, which, as shown in this study, puts them at
great risk of HIV infection.
The prevalence of tattooing behavior was also
found to be 96% among the recruited IVDU. All the
injecting drug users (100%; 180/180 IVDUs) in this
study reported that they were not aware of ‘HIV
transmission via tattooing’ during their initial visit
to the street side tattoo parlor. The results in Table 2
show an HIV positivity rate of 71% (123 tattooed
IVDUs were out of the total 173 IVDUs who had
tattoos) with significantly higher incidence (90%)
among subjects who reported tattooing in prison.
The IVDUs reported using crude means such as
razor blades or broken syringes to tattoo themselves
or their friends. This was an alarming finding, and
the consequence of the lack of awareness on issues
related to health, hygiene and especially HIV/AIDS
with regard to IVDU prisoners.
The ex-prisoners reported that the prevalence of
peer pressure in the prison and imposition of MSM
behavior (Men having sex with men) adds to the
likelihood of increased incidence of HIV among
incarcerated IVDUs. Thus, when the court of
justice penalizes an IVDU for criminal activities,
adequate measures must be executed to check the
‘needle-sharing behavior’ of the IVDUs, which
generally persists even behind bars as per the
findings of this study. The urgent need for health
care provision in prisons is underscored by this
study, which points out the startling fact that 98.8 %
(178/180) of the frequently incarcerated IVDU
tested positive for HIV in Chennai city. The need
for safe injection practices followed in tattoo parlors
and street corners in Chennai city as part of the
harm reduction program for injecting drug users is
mandatory.
The present study established evidence of same-
gender sexual practice among drug users in
Chennai, with 18.5% of IVDUs having reported a
history of having sex with another man in their
lifetime. Although this practice did not show any
additional risk for HIV infection, health authorities
in Chennai city should be encouraged to address
same-gender sexual practices of IVDU and to start
identifying appropriate sexual risk reduction
strategies.
This study had some limitations. The design of
this study was cross-sectional, which precludes us
from determining the exact temporal relationship
between risk behaviors and HIV infection. The
findings of this study are representative of the south
Indian IVDU population. The socio-demographic
characteristics of the IVDU participants in this
study, such as age, gender composition, ethnicity,
and employment rate were comparable with those of
IVDUs who participated in a similar study carried
out by Zamani et al., 2004 in Tehran. However, the
proportion of homeless IVDU was high among the
IVDUs (approximately 50%) in the present study
which could be inclusive of the 18.3% who reported
living with IVDU partners (‘group living’) but
complained that they had to vacate and remain
homeless if they could not pay for the house-rent or
drugs. Results reveal that 60% of the homeless
IVDU indicated clinical symptoms of depression
and inclination to be ‘victimizers’ (expressed a
purposive inclination to infect others with HIV
either by sharing injections or having sexual
encounters).
The self-reported risk behaviors that could be
biased as a result of recall ability or social
desirability, given the social context where many of
the HIV risk behaviors are highly stigmatized. The
7. Social Medicine (www.socialmedicine.info) Volume 6, Number 1, March 2011- 35 -
results reveal a startling high number in the
prevalence of HIV infection among the IVDU in
Chennai (69.4%) when compared to a similar study
conducted in Tehran, Iran where the prevalence of
HIV-1 infection was 23.2% (48 of 207) among male
injecting drug users ( Zamani et al., 2004).
Conclusion:
Results show that HIV prevalence has reached
significantly higher proportions (69.4% vs. 30% in
2005 as per findings of Panda et al., 2005). It is
critical to extend an extremely structured and
effective rehabilitation programs to the marginalized
IVDU population, with special reference to IVDUs
living in prisons and in the community of Chennai
city, India. India must come up with effective HIV
awareness programs highlighting ‘blood-exposures
to HIV’ such as tattooing which was a significant
risk factor among the injecting drug users in this
study.
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