Correlates of sharing of needles and syringes among people who inject drugs in Dhaka city, Bangladesh

Introduction: This paper examines the correlates of needle and syringe sharing among People Who Inject Drugs in Dhaka city, Bangladesh, which is currently experiencing a steep increase in HIV prevalence despite the ongoing presence of Needle Exchange Programs. Methodology: This was a retrospective chart review with cross-sectional design that extracted data from 783 male People Who Inject Drugs enrolled into five Opioid Substitution Treatment clinics in Dhaka city between April 2010 and January 2016. Data were retrieved from the program’s electronic database. Needle and syringe sharing constituted the borrowing or lending of needles and syringes from others within the past month preceding data collection. Results: Buprenorphine was the preferred injection drug and 44.6% shared needles and syringes within the past month. Multivariate analysis indicated that People Who Inject Drugs who were homeless (OR = 8.1, 95% CI = 1.4-44.9, p < 0.05), living with friends (OR = 6.8, 95% CI = 2.5-18.2, p < 0.001), injecting 2-3 times/day (OR = 4.8, 95% CI = 1.2-19.7, p < 0.05), injecting more than three times/day (OR = 4.8, 95% CI = 1.1-20.0, p < 0.05), not using condom with non-commercial female sex partners (OR = 3.3, 95% CI = 1.8-6.0, p < 0.05), bought sex from female sex workers (OR = 2.9, 95% CI = 1.0-8.3, p < 0.05), and did non-suicidal self-injury (OR = 1.8, 95% CI = 1.0-3.0, p < 0.05) were more likely to share needles and syringes. Conclusions: This study demonstrates that operating a standalone harm reduction approach that just provides sterile needles and syringes may not adequately curb needle and syringe sharing among People Who Inject Drugs.

High levels of used syringe use and unsafe sex among people who inject drugs in Kumasi, Ghana: an urgent call for a comprehensive harm reduction approach

Background Drug use is a growing concern in Ghana. People who inject drugs (PWID) are highly vulnerable to HIV and other infectious diseases. Ghana’s National Strategic Plan for HIV/AIDS 2016–2020 identifies PWID as a key population, but efforts to address the needs of PWID have lagged behind those targeting sex workers and men who have sex with men. Lack of information about PWID is a critical barrier to implementing effective HIV prevention and treatment. We aimed to learn more about the vulnerability of the PWID population in order to inform much-needed harm reduction interventions. Methods From April to July 2018, we conducted a mixed methods study in Kumasi, Ghana, to identify all major drug using locations, count the numbers of PWID to obtain rough population size estimations, and administer anonymous surveys to 221 PWID regarding drug use and sexual behavior. We also tested for HIV, HCV, and HBV from syringes used by survey participants. Results Key informants identified five major drug using locations and estimated the total PWID population size to be between 600 and 2000. Enumerators counted between 35 and 61 individuals present at each of the five bases. Sharing syringes and reusing discarded syringes are common practices. Over half of survey participants (59%) reported past-month syringe sharing (34% used a used syringe and 52% gave away a used syringe). Individuals with higher injection frequency (≥ 21 times weekly) and who injected with four or more people had higher odds of syringe sharing. Of the survey participants reporting sex in the last month (23%), most reported having one partner, but only 12% used condoms. Nearly all women (11/13) reported exchanging sex for drugs and 6/13 reported exchanging sex for money in the last six months. Fifteen percent of participants (all men) reported paying for sex using drugs or money. Of the used syringes, prevalence estimates were 3% (HIV), 2% (HCV), and 9% (HBV). Conclusions Our findings confirm the urgent need to implement harm reduction interventions targeting PWID and to build a strong and enabling legal and policy environment in Ghana to support these efforts.

Association of Substance Abuse, Violence, HIV/AIDS (SAVA) Syndrome with STI and HIV-Infection Among Injecting Drug Users in Six Cities of Russian Federation

Introduction. Described at the beginning of HIV epidemics in the USA syndrome (or syndemia) of substance abuse, violence and AIDS (SAVA) still continue to be an important risk factor for HIV-infection acquisition. The goal of this study was to analyze association between SAVA and STI and also new cases of HIV infection among IDU in six cities in Russian Federation. Materials and methods. Analysis is based on the data from bio-behavioral survey conducted in six Russian cities with help of respondent-driven sampling. Results. It was found no statistically significant association between SAVA and STI after correction for sampling, but without correction STI prevalence in group without SAVA was 4.1% and in group with SAVA and binge drinking – 9,2% (р=0.04). Stratified analysis showed that it is impossible to combine data from males and females and in case of separate analysis statistically significant association between SAVA and STI exists in females (р=0,027). Analysis with adjustment for interview site, gender and age SAVA with binge drinking significantly elevates STI risk (OR=2.69 [95%CI=1.21... 5.99], р=0.016). Study of association between SAVA components and new cases of HIV found that experience of physical and/or sexual violence combined with binge drinking increase risk of HIV acquisition (adjusted for interview site, gender, age, needle/syringe sharing, education and sex work OR=4.03 [95%CI=1.19...13.69], р=0.026). Experience of physical and/or sexual violence combined with binge drinking was significantly associated with such HIV risk factors as needle and syringe sharing (OR=3.07 [95%CI=1.02...9.24], p=0.046) and sex work (OR=17.29 [95%CI=3.83...77.96], p<0.001). Conclusion. SAVA existence should be taken into account when planning preventive measures in Russian Federation and existing programs of comprehensive prevention should have components designed to decrease consequences of syndemia.

Knowledge, Attitude and Practice about Hepatitis B, Hepatitis C and Human Immunodeficiency Virus among Barbers of Sylhet, Bangladesh

Introduction:This study was designed to see the knowledge, attitude and practice of barbers regarding transmission of hepatitis B, C and HIV viral infections. Materials and Methods: Barbers from Sylhet were interviewed with a predesigned questionnaire. Positive answers for blood transfusion, syringe sharing, use of contaminated shaving instruments and unsafe sex as way of transmission were taken as correct. Statistical analysis was done using SPSS 20 version. Result: Total 403 barbers, age from 14 years to 69 years (mean 27.11) were interviewed. In this group 232 (57.6%) had education illiterate to class five level. Among them 245 (60.3%) had income below 10 thousand per month. Blood transfusion could transmit HBV, HCV and HIV was known to 136 (33.7%), 129 (32.00%) and 247 (61.30%), contaminated syringe sharing could transmit HBV, HCV and HIV respectively was known to 131 (32.5%), 127 (31.50%) and 278 (69.0%) barbers, unsafe sex could transmit HBV, HCV and HIV was known to 166 (41.2%), 158(39.2%) and 317 (78.70%) barbers respectively and Contaminated shaving instruments could transmit HBV, HCV and HIV was known to 101 (25.1%), 96 (23.8%) and 156 (38.7%) barbers respectively. In this series 84 (20.84%) barbers answered correctly. This answers differed significantly within different level of education. Their knowledge of sterilization of shaving instruments was poor. Conclusion: Knowledge of our barbers regarding transmission of HBV, HCV and HIV and sterilisatioin of shaving instruments are inadequate. Institutional education and structured professional training may improve their services and decrease transmission of blood borne viral diseases. Medicine Today 2020 Vol.32(2): 117-121

The Impact of Syringe Services Program Policy on Risk Behaviors Among Persons Who Inject Drugs in 3 US Cities, 2005-2015

Objectives The impact of a syringe services program (SSP) policy on risk behaviors and its durability are not as well studied as the impact of the SSPs themselves. We examined whether trends in syringe sharing among persons who inject drugs (PWID) were associated with changes to syringe access policies in 3 US cities: Denver, New Orleans, and Philadelphia. Methods PWID were surveyed through National HIV Behavioral Surveillance System surveys in each city in 2005, 2009, 2012, and 2015. We assessed changes in syringe sharing from 2005 to 2015 by city. We used multivariable stepwise logistic regression analysis to measure the associations among syringe sharing and injection works sharing, time, and SSP access. Results From 2005 to 2015, syringe sharing decreased significantly from 49.1% to 33.1% in Denver ( P < .001), increased significantly from 32.0% to 50.5% in New Orleans ( P < .001), and remained unchanged in Philadelphia (30.4% to 31.5%; P = .87). Compared with persons who obtained syringes from any nonsterile source, the adjusted odds of syringe sharing among PWID were significantly lower in each city if syringes were obtained from sterile sources only: Denver adjusted odds ratio (aOR) = 0.23 (95% confidence interval [CI], 0.18-0.30; New Orleans aOR = 0.26 (95% CI, 0.19-0.35), and Philadelphia aOR = 0.43 (95% CI, 0.33-0.57). Conclusions The lowest proportion of PWID reporting syringe sharing was in Philadelphia, which has a long-standing legal SSP. Implementation of a legal SSP in Denver in 2012 corresponded to a decrease in sharing, whereas the lack of a legal SSP in New Orleans corresponded to an increase in sharing. Universal long-term access to legal SSPs could further the progress made in HIV prevention among PWID.