scholarly journals Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth Buckingham ◽  
Ezra Schrage ◽  
Francine Cournos
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Drug Use ◽  
Mental Disorders ◽  
Hiv Infection ◽  
Injection Drug Use ◽  
People Who Inject Drugs ◽  
Injection Drug ◽  
Hiv Care ◽  
Hiv Positive

People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services.

scholarly journals 1315. Mind the Gap: Medical Trainees Require Training in Hepatitis C, Drug Use and Mental Health to Help Address the Opioid Crisis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S402-S402
Author(s):  
Kimberly Corace ◽  
Isabelle Ares ◽  
Nicholas Schubert ◽  
Jason Altenberg ◽  
Melanie Willows ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Hepatitis C ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Opioid Epidemic ◽  
Hcv Treatment ◽  
Medical Trainees ◽  
Opioid Crisis

Abstract Background Dramatic increases in acute hepatitis C (HCV) incidence is linked to the opioid epidemic and increased injection drug use. Over 50% of people with HCV also have a mental illness. IDSA/HIVMA calls for the integration of infectious diseases, addiction medicine, and mental health as key to addressing the opioid epidemic. Barriers identified include limited physician education and stigma. This study examined medical trainees’ gaps in training and attitudes toward HCV, drug use, and mental illness. Methods Medical students and residents (N = 98) at a large Canadian University completed questionnaires assessing stigma, attitudes, knowledge, and training related to HCV, drug use, and mental illness. Results Most participants were medical residents (71%). Within-subjects ANOVAs showed that trainees worked with more patients with mental illness (71%) than drug use (55%) or HCV (21%) (P’s < 0.001). Trainees reported less positive experiences with patients with drug use (34%) and HCV (36%) compared with those with mental illness (55%) (p’s < 0.05). They reported that injection drug use (68%), prescription opioids (66%), and heroin use (59%) were the most challenging substance use problems to treat (P < 0.001). They were less satisfied working with patients with drug use (40%) or HCV (40%) than mental illness (59%) (P’s < 0.01). Trainees reported they were more able to help patients with mental illness (83%) than HCV (65%) or drug use (73%) (P’s < 0.01). Only 34% saw HCV treatment as central to their professional role. Their training better prepared them to treat mental illness (58%) than drug use (41%) or HCV (19%) (P’s < 0.001). They were more interested in training in drug use (76%) and mental health (71%) than HCV (62%) (P’s < 0.01). Conclusion Medical trainees report being ill-equipped to treat patients with HCV and drug use (specifically opioids) and are less satisfied with this work. Many report attitudes that may be viewed by patients as stigmatizing. There is a large knowledge gap related to the effectiveness of HCV treatment. Addressing the opioid crisis requires a physician workforce that is prepared to integrate treatment for HCV, drug use, and mental illness. Infectious disease specialists can take a leadership role in building capacity to foster integration. Disclosures All authors: No reported disclosures.

scholarly journals Injection drug use practices and HIV infection among people who inject drugs in Kigali, Rwanda: a cross-sectional study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Jean Olivier Twahirwa Rwema ◽  
Vianney Nizeyimana ◽  
Neia M. Prata ◽  
Nneoma E. Okonkwo ◽  
Amelia A. Mazzei ◽  
...  
Keyword(s):  
Drug Use ◽  
Hiv Infection ◽  
Injection Drug Use ◽  
People Who Inject Drugs ◽  
Cross Sectional Study ◽  
Injection Drug ◽  
People Who Use Drugs ◽  
Needle Sharing ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background In Rwanda, epidemiological data characterizing people who inject drugs (PWID) and their burden of HIV are limited. We examined injection drug use (IDU) history and practices, and HIV infection in a sample of PWID in Kigali. Methods From October 2019 to February 2020, 307 PWID aged ≥ 18 were enrolled in a cross-sectional study using convenience sampling in Kigali. Participants completed interviewer-administered questionnaires on IDU history and practices and HIV testing. We used Poisson regression with robust variance estimation to assess IDU practices associated with HIV infection and assessed factors associated with needle sharing in the six months preceding the study. Results The median age was 28 years (IQR 24–31); 81% (251) were males. Female PWID were more likely to report recent IDU initiation, selling sex for drugs, and to have been injected by a sex partner (p < 0.05). In the prior six months, heroin was the primary drug of choice for 99% (303) of participants, with cocaine and methamphetamine also reported by 10% (31/307) and 4% (12/307), respectively. In total, 91% (280/307) of participants reported ever sharing needles in their lifetime and 43% (133) knew someone who died from a drug-related overdose. HIV prevalence was 9.5% (95% CI 8.7–9.3). Sharing needles at least half of the time in the previous six months was positively associated with HIV infection (adjusted prevalence ratio (aPR) 2.67; 95% CI 1.23–5.78). Overall, 31% (94/307) shared needles and 33% (103/307) reused needles in the prior six months. Female PWID were more likely to share needles compared to males (aPR 1.68; 95% CI 1.09–2.59). Additionally, bisexual PWID (aPR 1.68; 95% CI 1.09–2.59), those who shared needles at the first injection (aPR 2.18; 95% CI 1.59–2.99), reused needles recently (aPR 2.27; 95% CI 1.51–3.43) and shared other drug paraphernalia (aPR 3.56; 95% CI 2.19–5.81) were more likely to report recent needle sharing. Conclusion HIV infection was common in this study. The high prevalence of needle reuse and sharing practices highlights significant risks for onward transmission and acquisition of HIV and viral hepatitis. These data highlight the urgent need for PWID-focused harm reduction services in Rwanda, including syringe services programs, safe injection education, naloxone distribution, and substance use disorder treatment programs and optimizing these services to the varied needs of people who use drugs in Rwanda.

scholarly journals Characteristics of new HIV diagnoses over 1995–2019: A clinic-based study in Montréal, Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258383
Author(s):  
Katia Giguère ◽  
Maliheh Vaziri ◽  
Clément Olivier ◽  
Louise Charest ◽  
Jason Szabo ◽  
...  
Keyword(s):  
Drug Use ◽  
Hiv Infection ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Health Clinic ◽  
Hiv Positive ◽  
Advanced Stage ◽  
Newly Diagnosed ◽  
Endemic Country ◽  
Public Health Response

Background Characterization of populations at risk of acquiring HIV is required to inform the public health response to HIV. To identify potential changing needs in HIV prevention and care cascade, we aim to describe how the demographic profiles and exposure categories of newly diagnosed HIV positive individuals attending a large sexual health clinic in Montréal (Canada) evolved since the beginning of the antiretroviral therapy era in the mid-1990s. Methods Using diagnosis data from participants of the Clinique médicale l’Actuel cohort of HIV-positive patients, we examined the distribution of exposure categories (sexual orientation, sexual behaviours, injection drug use, being born in an HIV-endemic country) by gender and year of diagnosis. Time trends in mean age and in the proportion of patients with late (CD4 <350 cells/μL) or advanced stage (CD4 <200 cells/μL) of HIV infection at diagnosis were assessed through meta-regressions. Results A total of 2,612 patients diagnosed with HIV between January 1st, 1995 and December 31st, 2019 were included. Overall, mean age was 35 years (standard deviation: 10 years) and remained stable over time. The proportion of patients with advanced stage of HIV infection decreased from 16% in 1995 to 4% in 2019. Although men who have sex with men (MSM) consistently accounted for the highest proportion of new diagnoses (77%, 2,022/2,612 overall), their proportion decreased since 2013. There was also a concomitant decrease in the proportion of people who inject drugs, with none of the newly diagnosed participants reporting injection drug use since 2017, and an important increase in the proportion of patients born in an HIV-endemic country (24%, 7/29 in 2019), especially among women. Compared to patients from non-endemic countries, those from HIV-endemic countries were characterized by higher proportions of heterosexuals (88% vs 17%) and of women (52% vs 7%), and were twice likely to get diagnosed at an advanced stage of HIV infection (32% vs 15%). Conclusions In absolute numbers, MSM continue to account for the largest exposure category. However, patients from HIV-endemic countries, who tend to be diagnosed at later stages of HIV infection, constitute an increasing proportion of newly diagnosed individuals. These persons could face distinct barriers to rapid diagnosis. Tailoring HIV testing strategies and other prevention interventions to the specific unmet prevention needs of these individuals is warranted.

scholarly journals Hepatitis C Virus Seroconversion among Hiv-Positive Men Who Have Sex with Men with No History of Injection Drug Use: Results from a Clinical Hiv Cohort

2015 ◽  
Vol 26 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Ann N Burchell ◽  
Sandra L Gardner ◽  
Tony Mazzulli ◽  
Michael Manno ◽  
Janet Raboud ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hiv Care ◽  
Hiv Positive ◽  
History Of ◽  
Sex With Men ◽  
Hiv Positive Men

BACKGROUND: Internationally, there is a growing recognition that hepatitis C virus (HCV) may be sexually transmitted among HIV-positive men who have sex with men (MSM).OBJECTIVE: To report the first Canadian estimate of HCV seroincidence in 2000 to 2010 and its risk factors among HIV-positive MSM with no known history of injection drug use.METHODS: Data from the Ontario HIV Treatment Network Cohort Study, an ongoing cohort of individuals in HIV care in Ontario, were analyzed. Data were obtained from medical charts, interviews and record linkage with the provincial public health laboratories. The analysis was restricted to 1534 MSM who did not report injection drug use and had undergone ≥2 HCV antibody tests, of which the first was negative (median 6.1 person-years [PY] of follow-up; sum 9987 PY).RESULTS: In 2000 to 2010, 51 HCV seroconversions were observed, an overall incidence of 5.1 per 1000 PY (95% CI 3.9 to 6.7). Annual incidence varied from 1.6 to 8.9 per 1000 PY, with no statistical evidence of a temporal trend. Risk for seroconversion was elevated among men who had ever had syphilis (adjusted HR 2.5 [95% CI 1.1 to 5.5) and men who had acute syphilis infection in the previous 18 months (adjusted HR 2.8 [95% CI 1.0 to 7.9]). Risk was lower for men who had initiated antiretroviral treatment (adjusted HR 0.49 [95% CI 0.25 to 0.95]). There were no statistically significant effects of age, ethnicity, region, CD4 cell count or HIV viral load.CONCLUSIONS: These findings suggest that periodic HCV rescreening may be appropriate in Ontario among HIV-positive MSM. Future research should seek evidence whether syphilis is simply a marker for high-risk sexual behaviour or networks, or whether it potentiates sexual HCV transmission among individuals with HIV.

HIV Infection in Young Men in Northern Thailand, 1991–1998: Increasing Role of Injection Drug Use

2002 ◽  
Vol 29 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Kenrad E. Nelson ◽  
Sakol Eiumtrakul ◽  
David D. Celentano ◽  
Chris Beyrer ◽  
Noya Galai ◽  
...  
Keyword(s):  
Drug Use ◽  
Hiv Infection ◽  
Injection Drug Use ◽  
Young Men ◽  
Injection Drug ◽  
Northern Thailand

Outpatient Medical Care of Injection Drug Use Related HIV

1992 ◽  
Vol 3 (2) ◽  
pp. 96-100 ◽  
Author(s):  
R P Brettle ◽  
S M Gore ◽  
A McNeil
Keyword(s):  
Infectious Disease ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hiv Positive ◽  
Initial Increase ◽  
Medical Clinic ◽  
Loss To Follow Up ◽  
Disease Unit

By the end of March 1990 470 HIV positive patients, 77% injection drug use (IDU) related, had attended the outpatient department of the Regional Infectious Disease Unit with a cumulative loss to follow-up of only 20%. Coincident with the prescribing of oral methadone and a specific all-day IDU-related HIV medical clinic the total number of appointments increased from 28/month in May 1986 to 300/month in May 1989 ( P< 0.001) and the number of defaulted appointments decreased from a maximum of 60% (17/28) to 16% (48/294, P<0.001) in these months. There was a significant initial increase in the number of defaulted appointments for the infectious disease (ID) clinics from 11% (77/726) to 16% (124/797, P<0.01) which returned to previous levels once a specific IDU-related HIV clinic was established. There was also a significant decline in the number of new patients referred which was greater for the urinary tract infection clinics (108 to 56 per 6 months, P<0.0001) than for the ID clinics (119 to 88 per 6 months, P<0.05).

Incidence and predictors of Gram-negative bacilli in hospitalized people who inject drugs with injection drug use-attributable infections

2021 ◽  
Author(s):  
Megan C. Kelly ◽  
Samantha D. Yeager ◽  
Mahmoud A. Shorman ◽  
Laurence R. Wright ◽  
Michael P. Veve
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
People Who Inject Drugs ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Injection Drug ◽  
Gram Positive ◽  
Gram Negative ◽  
Multivariable Regression ◽  
Infection Types

Objective: Quantify incidence and determine predictors of Gram-negative bacilli (GNB) in people who inject drugs (PWID) with injection-drug use (IDU)-related infections. Design: Retrospective cohort of hospitalized PWID from 1/2017-12/2019. Methods: Inclusion criteria: age ≥18 years, active IDU, treated IDU-attributable infection, organism growth from microbiology cultures. Infection types: infective endocarditis (IE), acute bacterial skin/skin structure infection (ABSSSI), osteoarticular infection (OAI), other bloodstream infections (BSI). Primary outcome was GNB identification from microbiologic culture; descriptive statistics were used to describe the cohort. Multivariable regression was used to identify variables associated with GNB infection. Results: 230 PWID included; 65 (28%) GNB infections, 165 (72%) Gram-positive infections. The median (IQR) population age was 38 (31-45) years. Most patients were women (56%); 37% had no insurance. Infection types were: IE (41%), ABSSSI (37%), OAI (20%), other BSI (2%). 278 organisms were isolated from 230 patients; most common organisms were methicillin-resistant Staphylococcus aureus (43%), Streptococcus spp. (19%), methicillin-susceptible S. aureus (17%), Serratia marcescens (8%); 10% were mixed GNB and Gram-positive infections. 80% of patients received empiric Pseudomonas aeruginosa coverage; only 7% had P. aeruginosa infections. In multivariable regression, age >50 years (adjOR, 2.9; 95%CI; 1.2-7.2), prior hospitalization within 90-days (adjOR, 2.2; 95%CI; 1.2-4.3), and OAI (adjOR, 3.2; 95%CI; 1.5-6.6) were associated with GNB infection. Conclusions: GNB in PWID with IDU-attributed infections were more frequently observed in recently hospitalized, older patients with OAI. The majority of patients received empiric anti-pseudomonal antibiotic coverage, but P. aeruginosa was infrequent. PWID are a potential population to target improved empiric antibiotic use.

scholarly journals Injection drug use, unknown HIV positive status, and self-reported current PrEP use among Black men who have sex with men attending U.S. Black pride events, 2014–2017

2020 ◽  
Vol 207 ◽  
pp. 107808 ◽  
Author(s):  
Jessica L. Maksut ◽  
Rachel E. Gicquelais ◽  
Kevon-Mark Jackman ◽  
Lisa A. Eaton ◽  
M. Revel Friedman ◽  
...  
Keyword(s):  
Drug Use ◽  
Black Men ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hiv Positive ◽  
Sex With Men ◽  
Black Pride
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