Injection Drug Use

This lack of available treatment alternatives on the island has contributed to the "relocation" or "exporting" of injectable drug users to the continental U.S. in search of treatment, that sometimes resemble situations comparable to human trafficking. 12 Humiliation and Abuses in Drug "Treatment" Centers in Puerto Rico

Women who inject drugs (IDU) are at elevated risk for drug-related harms. While there has been growing interest in first injecting experiences of IDU, less attention has been given to broader socio-cultural, structural and environmental risk conditions in which marginalized women live and injection risk practices and addiction treatment engagement occur. For this thesis, I sought to build on previous research by using gender-based analysis (GBA) to describe the risk environment of IDU women and examine gender differences in circumstances surrounding first injecting experiences and addiction treatment engagement among IDU in Vancouver.

Отчёт «Исследования НП «ЭСВЕРО» в 2011 году» в рамках программы «Расширение доступа к профилактике и лечению ВИЧ путём развития услуг в сфере ВИЧ для потребителей инъекционных наркотиков в Российской Федерации», поддержанной Глобальным фондом для борьбы со СПИДом, туберкулёзом и малярией. Глобальный фонд для борьбы со СПИДом, туберкулёзом и малярией не несёт ответственности за предоставленную в настоящем издании информацию, использование любых содержащихся в нём сведений.

A PhD studentship is available for UK and EU citizens only. The studentship will attract an annual tax-free stipend of £14,777 for up to 3 years, subject to satisfactory progress and will cover the UK/EU tuition fees. You should hold a first degree equivalent to at least a UK upper second class honours degree in a relevant subject. This project would suit a student with a strong background in international health policy and systems. Candidate whose first language is not English must provide evidence that their English language is sufficient to meet the specific demands of their study, the Faculty minimum requirements are: • British Council IELTS-score of 6.5 overall, with no element less than 6.0 • TOEFL iBT-overall score of 92 with the listening and reading element no less than 21, writing element no less than 22 and the speaking element no less than 23.

Background: Policy and programming for people who inject drugs (PWID) in South Africa is limited by the scarcity of epidemiological data. Methods: We conducted a cross-sectional survey among 450 PWID (362 males and 88 females) from five South African cities in 2013, using outreach and peer referral to recruit participants. We carried out rapid HIV tests on participants' saliva and assessed drug-using and sexual practices by means of a questionnaire. Results: We found that 26% of females and 13% of males reported to always share injecting equipment, while 49% of all participants had used contaminated injecting equipment the last time they injected. Only 6% of participants usually used bleach to clean their injecting equipment. We found that half of participants reported using a condom the last time they had sex. A quarter of participants reported symptoms of a sexually transmitted infection (STI) in the previous 12 months and 22% had ever worked as a sex worker (51% of females). HIV prevalence among participants was 14% (18% among females and 13% among males). In multivariate analysis HIV was significantly associated with being 25 years and older (adjusted odds ratio (aOR) 2.1, 95% confidence interval (CI) 1.0-4.6, p = 0.06), belonging to a racial group other than white (aOR 4.2, 95% CI 1.9-9.4, p < 0.001), coming from Gauteng province (aOR 2.3, 95% CI 1.1-5.5, p = 0.023), having ever worked as a sex worker (aOR 3.4, 95% CI 1.7-7.2, p = 0.001) and the presence of STI symptoms in the last 12 months (aOR 2.4, 95% CI 1.1-4.4, p = 0.019).

Background: Despite growing implementation of harm reduction programs internationally, unsafe injecting practices remain common among injection drug users (IDU). In response, nursing interventions such as safer injection education (SIE) have been called for. In Vancouver, a supervised injection facility (SIF), where IDU inject pre-obtained illicit drugs under nursing supervision, opened in 2003 in an effort to reduce the impacts of unsafe injecting. We sought to characterize the state of nursing SIE practice in Vancouver and prospectively examine SIE among SIF users. Methods: We examined correlates of receiving SIE among participants in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort. The SEOSI cohort was derived through random recruitment of SIF users. Characteristics of participants who reported receiving SIE from SIF nurses were examined using bivariate and multivariate generalized estimating equations. Results: 1087 SEOSI participants were surveyed between March 2004 and March 2005 and included in this analysis. Approximately one third of participants reported receiving SIE at baseline and an additional 13.3% reported receiving SIE during follow-up. Those receiving SIE from SIF nurses were more likely to be females (AOR = 1.55; 95% CI: 1.18-2.04), persons requiring injecting assistance (AOR = 1.52; 95% CI: 1.26-1.84), binge users (AOR = 1.37; 95% CI: 1.14-1.64), and those using the SIF for most of their injections (AOR = 1.47; 95% CI: 1.22-1.77). Conclusions: These findings provide evidence to support the need for nurse-delivered SIE in reaching IDU most at risk for injection-related harm. SIFs may afford unique opportunities to deliver SIE to high-risk populations. Individuals receiving SIE from Vancouver's SIF nurses were likely to possess characteristics associated with adverse health outcomes, including HIV infection.

The aim of this study was to investigate the effects of transitioning from non-injection heroin use to injection drug use on sexual risk behavior. Non-injecting heroin users age 16–30 were enrolled from 2002 to 2005, and were re-interviewed at 6-month intervals for up to three years; 561 participants completed at least one follow-up interview. The majority of participants were non-Hispanic (NH) Black (54 %), 23 % were Hispanic, and 21 % were NH white. During follow-up, 154 participants (27.5 %) transitioned to injecting drugs. Logistic regression analyses were conducted using generalized estimating equations (GEE) to estimate the effect of transition to injection drug use on changes in sexual risk behavior during follow-up. Transition to injection drug use during follow-up was associated with increased likelihood of sexual risk behavior, especially for men. Harm reduction efforts that focus on preventing initiation or return to injection among non-injecting drug users may also ameliorate HIV sexual risk behaviors.

Since 2013, North America has experienced a sharp increase in unintentional fatal overdoses: fentanyl, and its analogues, are believed to be primarily responsible. Currently, the most practical means for people who use drugs (PWUD) to avoid or mitigate risk of fentanyl-related overdose is to use drugs in the presence of someone who is in possession of, and experienced using, naloxone. Self-test strips which detect fentanyl, and some of its analogues, have been developed for off-label use allowing PWUD to test their drugs prior to consumption. We review the evidence on the off-label sensitivity and specificity of fentanyl test strips, and query whether the accuracy of fentanyl test strips might be mediated according to situated practices of use. We draw attention to the weak research evidence informing the use of fentanyl self-testing strips.

Background: The War on Drugs has raised the incarceration rates of racial minorities for non-violent drug-related crimes, profoundly stigmatized drug users, and redirected resources from drug prevention and treatment to militarizing federal and local law enforcement. Yet, while some states consider shifting their punitive approach to drug use, to one based on drug treatment and rehabilitation, nothing suggests that these policy shifts are being replicated in Puerto Rico. Methods: This paper utilizes data from 360 PWID residing in four rural towns in the mountainous area of central Puerto Rico. We initially recruited 315 PWID using respondent-driven sampling (RDS) and collected data about risk practices and conducted HIV and HCV testing. During a second phase, we conducted 34 micro-ethnographic assays, in which we randomly recruited 34 participants from the first phase and included their ego networks in this phase. Our ethnographic inquiry produced significant data regarding the effects of the war on drugs on the local drug trade, drug availability, and injectors' social networks. Results: Findings suggest that repressive policing has been ineffective in preventing drug distribution and use among those in our study. This type of law enforcement approach has resulted in the disproportionate incarceration of poor drug users in rural Puerto Rico, and mainly for nonviolent drug-related crimes. In addition, incarceration exposes PWID to a form of a cruel and unusual punishment: having to quit heroin "cold turkey" while the prison environment also represents a HIV/HCV risk. In turn, the war on drugs not only diverts resources from treatment but also shapes treatment ideologies, punishing non-compliant patients. Conclusion: Shifting the emphasis from repression to treatment and rehabilitation is likely to have a positive impact on the health and overall quality of life of PWID and their communities.

Background: Women who inject drugs (WWID) are at heightened risk for HIV due to biological, behavioral, and structural factors. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for WWID. However, little is known about WWID awareness of PrEP, which is a necessary step that must occur before PrEP uptake. We report factors associated with greater awareness among WWID to identify efficient means of awareness dissemination.

Background: This paper explores injection drug users' (IDUs) relationships with non-drug using family members in order to understand the potential opportunities for, and challenges to, having these family members provide harm reduction services (e.g., clean syringes). Methods: The qualitative data for this paper were drawn from a larger study of IDUs' relationships with key individuals in their lives (e.g., friends, family members). Interviews were conducted with 115 IDUs from across Atlantic Canada living in both urban and rural areas. Results: IDUs report that their relationships with family members are variable and dynamic, often changing over time. IDUs and family members engage in a variety of strategies to protect themselves from the multiple harms associated with drug use. Several strategies of self-protection (e.g., discontinuing all contact) are antithetical to the provision of harm reduction supports by family members. However, other strategies are based on continued contact, providing a potential opportunity for the integration of harm reduction approaches. Some family members not only have contact but provide supports (e.g., emotional support, housing) thus potentially facilitating the integration of harm reduction. In a few instances, family members already provide harm reduction supports (e.g., safe space to use). Conclusions: Conceptualizing addictions as a health and social justice issue, and providing appropriate interventions, may reduce some of the harms experienced by users and family members thus encouraging sustained relationships and greater integration of harm reduction approaches into the relationship. Targeted education to family members about harm reduction may also further encourage their involvement in such efforts. Likewise, supporting family members who are already providing harm reduction supports will likely assist in the scaling-up of harm reduction efforts.

This study demonstrates an ethnographically critically informed process evaluation of piloting an HIV intervention program targeting injection drug users. The authors used systematic ethnographic methods to identify and evaluate the factors that facilitated or inhibited message diffusion. Findings indicated that communication patterns and strategies advocated in training sessions did not translate immediately into the outreach encounter in the drug use

Корнилова М.С., Ерицян К.Ю., Акулова М.В., Одинокова В.А. Сравнение поведенческих рисков и распространенности ВИЧ-инфекции в группе лиц, употребляющих наркотики инъекционно, в зависимости от типа наркотика//Сборник тезисов Пятой конференции по ВИЧ/СПИДу в Восточной Европе и Центральной Азии, 23-25 марта 2016; под ред. Лиознова Д.А, Карнауховой Е.Ю. г Москва, 2016; с 225 – 226.


ВВЕДЕНИЕ:
В последние годы в России, наряду с ростом ВИЧ-инфекции отмечается рост употребления новых видов наркоти-
ков, таких как мефидрон, метилон и их произволные, более известные как «соли для ванн». Во многих эмпириче-
ских исследованиях, (напр. Eritsyan et al., 2013), было показано, что риски инфицирования ВИЧ могут существенно
различаться в зависимости от типа употребляемого наркотика.
ЦЕЛЬ ИССЛЕДОВАНИЯ:
Целью нашего анализа стала оценка специфических характеристик группы потребителей «солей».
МАТЕРИАЛЫ И МЕТОДЫ:
Одномоментное анонимное связанное био-поведенческое исследование в группе лиц старше 15 лет, употребляв-
щих наркотические вещества в немедицинских целях инъекционным путем в течение 4-х недель, предшество-
вавших исследованию. Выборка составила 525 человек. Сбор данных проводился в ноябре–декабре 2014 г. в пяти
городах России (Абакан, Барнаул, Набережные Челны, Волгоград, Пермь) при помощи выборки, управляемой ре-
спондентами. Исследование включало в себя интервью со сбором поведенческих данных и лабораторное тести-
рование крови методом ИФА на ВИЧ, ВГС, ВГВ и сифилис. Статистический анализ данных произведен в SPSS 13.0.

РЕЗУЛЬТАТЫ:
Распространенность употребления «солей» среди лиц, употребляющих наркотики (ЛУН) варьировала от 0% (Аба-
кан) до 58,1% (Пермь). Для данной группы по сравнению с ЛУН, не употреблявшими эти вещества в течение послед-
него месяца, характерен более молодой возраст (в среднем 32 года против 34 лет; p ≤ 0,001) при таком же стаже
наркопотребления, и более низкие показатели социальной адаптации. Они значимо чаще используют для получе-
ния дохода нелегальные и криминальные формы деятельности (торговлю наркотиками (p ≤ 0,001), воровство (p ≤
0,05), нищенствование (p ≤ 0,01)) или живут на средства партнера (p ≤ 0,05) и существенно реже имеют какую-либо
официальную занятость (p ≤ 0,01). Также у потребителей «солей» чаще, чем у других ЛУН отсутствуют полис меди-
цинского страхования (p ≤ 0,05) и паспорт (p ≤ 0,01). Идентифицированные факторы более высокого риска ВИЧ-ин-
фицирования для группы «солевых» потребителей связаны с характеристиками наркопотребления (более высокая
частота инъекций (p ≤ 0,001), большая распространенность совместного употребления наркотиков в компании с
ВИЧ-положительными (62,2% против 48,4%) и более частое использование инъекционного инструментария после
ВИЧ-инфицированных (25,0% против 13,0%; p ≤ 0,001)), а также меньшим охватом профилактическими воздействи-
ями (информированность о профилактических программах для ЛУН (p ≤ 0,001), тестированием на ВИЧ (p ≤ 0,05)) и
более низкой информированностью о вирусных гепатитах (p ≤ 0,001). В исследовании не было выявлено каких-ли-
бо особенностей сексуального поведения потребителей «солей», существенных в отношении риска ВИЧ-инфици-
рования. Результаты серологического обследования показали, что для потребителей «солей» характерна более
высокая, чем для других ЛУН пораженность ВИЧ-инфекцией (48,9% против 31,0%, p ≤ 0,001) и гепатитом В (28,2%
против 14,5%, p ≤ 0,001), пораженность гепатитами С и сифилисом находится на том же уровне, что и у других ЛУН
(67,5% и 10,6% соответственно).
ЗАКЛЮЧЕНИЕ/ВЫВОДЫ:
Распространение таких видов наркотиков как «соли» может представлять серьезную угрозу в плане ускорения
темпов роста эпидемии ВИЧ-инфекции в Российской Федерации, поскольку потребители «солей» представляют
собой менее доступную для профилактических программ и более уязвимую в социальном и эпидемиологическом
отношении подгруппу ЛУН. Для «солевых» ЛУН характерно более рискованное инъекционное поведение и более
высокая распространенность ВИЧ и вирусного гепатита вкупе с более низким охватом профилактикой, тестирова-
нием и информированностью. Данная подгруппа ЛУН требует пристального и немедленного внимания со стороны
программ профилактики ВИЧ, а также социальных и медицинских служб.

Статията представя резултати от проучване на знанията и поведението на инжекционно употребяващи наркотици относно туберколозата, и бариерите за достъп до здравни услуги. Проучването е проведено в рамките на проект „Овластяване на публично здравната система и гражданското общество в борбата с епидемията от туберкулоза сред уязвими групи”.

Peer interventions are likely to take on a growing importance among initiatives aimed at the prevention of HIV transmission. The success of such interventions rests upon the participation of the individuals and groups concerned. Yet, few studies have documented the experiences of participation of individuals who are considered to be particularly vulnerable to HIV, for example street-based female sex workers who inject drugs, who have participated in a peer intervention project focused on the prevention of HIV. The qualitative results of the Projet LUNE, a participatory action research project conducted in Quebec City between 2007 and 2010, are presented in this article. The article discusses the characteristics of the 20 women who were interested in being involved in the peer-helper intervention, their motivations, the factors enabling and hindering their participation as well as the benefits of their involvement for themselves and their community. Results indicate that the women considered themselves to be capable of helping their peers based on their knowledge and experience. Their motivations for being involved evolved throughout the 3-year duration of the project, starting from activism oriented towards supporting their peers then moving to a more personal quest for benefits. Different realities closely linked with drug use seem to have been major impediments to the participation of several women, whereas feelings of being accepted, respected and considered integral to the project facilitated participation. The women who maintained sustained participation in the peer intervention stated that their participation enabled them to introduce some structure and discipline in their life, to learn to know and understand each other better, to acquire skills and to improve their self-esteem. The conclusion includes recommendations for practice that are formulated based on observations of the processes and changes that occurred during the project.

Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.

Objective: To explore the process of initiation to injection drug use from the point of view of initiators. Methods: Semi-structured, in-depth qualitative interviews were conducted at a harm reduction program in Toronto, Canada. Twenty participants who had injected drugs in the last 30 days and who reported ever having initiated another person to injection drug use were recruited. A narrative analytic approach was used to explore the spectrum of narratives surrounding their experiences initiating others to injection drug use. Results: Initiation events arise in a complex interplay of individual circumstances and social contexts. People who inject may assist with a first injection for a variety of reasons, from conceding to social pressure, to wanting to help reduce a perceived risk of harm, to assisting because it provides a sense of pride at possessing a skill or of having helped someone achieve a desired state, to assisting to obtain drugs or to cope with withdrawal, or a mix of several of these reasons at once. Conclusions/Importance: Narratives reveal that preventing all instances of initiation is unrealistic. Combining elements from existing interventions that focus on enhancing reluctance to assist with initiation with safer injection training has the potential to reduce initiations and perhaps reduce injection related harm for novices if initiation occurs.

In the United States, political and social environments have shaped public health response to injecting drug use, and New York City represents a salient example. The history of " harm reduction " in New York City is characterized within changing historical periods and in relation to the actions of stakeholders. The expansion is traced over four periods: (i) 1984–1989: emergence , activism, and science; (ii) 1990–1994 reckoning: syringe exchange legislation and consolidation; (iii) 1995–1999: bureaucratization, opposition, and challenges to institutional control; and (iv) 2000–2010 revi-talization: expansion of syringe access and harm reduction. It is clear from this review that the leadership of activism and the work of advocates catalyzed syringe access policy and practice. Without this " push, " it is unlikely that New York City would have experienced the dramatic decline in HIV infection among drug in-jectors in the 1990s. Second, successful arguments for expanding syringe access in New York City were based on the high HIV/AIDS infection rates. Thus, program developments were advocated as HIV prevention interventions , rather than as expanded services for addressing broader health and social issues of injecting drug use.

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and noninjection drug users in Baltimore Maryland. The present study used a subset (N = 651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ 2 = 19.71, p < .01), cigarette (χ 2 = 11.05, p < .01), marijuana (χ 2 = 10.83, p < .01), and polysubstance use (χ 2 = 23.48, p < .01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR = 1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR = 1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR = 2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset alcohol and polysubstance use is an important risk factor for IDU in adulthood.

Injection drug user can be the gateway of various disease transmission such as hepatitis andHIV - AIDS. Many of injection drug users did therapy, but in fact there are still users who return to usedrug called recurrence or relapse. An important factor to help and save the drug users in order to getrid of the addicted is coping eff ort consisted of problem management and emotional regulation.The aimof this study was to fi nd out the relationship between coping eff ort with the eff ort of injection drug usersto recover theirself in Surabaya Orbit Foundation. This study used an observational study design andcross sectional study. The sample of this research determined by simple random sampling. Informationobtained through the questionnaire that read to the 34 respondents. The majority of respondents inthe study is male and work as a private employee, especially in the drugs area. Respondents aged areproductive and follow therapy 1–5 years. Respondents have a good coping eff ort and ver...

Chronic skin and soft tissue infections (SSTI) among people who inject drugs (PWID) can lead to AA-amyloidosis: a serious, yet neglected, multi-organ disease. We aim to synthesise findings on the epidemiology, risk factors, clinical outcomes, screening recommendations, and challenges to treatment for AA-amyloidosis among PWID. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the following bibliographic databases in July 2017: CINAHL Plus, Embase, Global Health, MEDLINE, PsycEXTRA, PsycINFO, and SCOPUS. Studies were included if they investigated AA-amyloidosis in PWID. Studies were not restricted to location, study type, year, or language of publication. Study heterogeneity precluded meta-analysis (I2: 86%); we present a narrative review of the literature. Thirty-seven papers from eight countries met inclusion criteria. A total of 781 PWID are reported on, of whom 177 had AA-amyloidosis. ...

Background: Pre-exposure prophylaxis (PrEP) to reduce the risk of HIV was approved in 2012 and post-exposure prophylaxis (PEP) in 2005. We report the differences in awareness of PrEP/PEP and factors associated with awareness by examining 3 risk groups (men who have sex with men (MSM), people who inject drugs, and high-risk heterosexuals). Methods: National HIV Behavioral Surveillance system data collected in New York City (NYC) and Long Island, NY in 2011– 2013 were used. Logistic regressions by region were developed to estimate adjusted associations [Adjusted Odds Ratios (AOR)] and determine differences in awareness of PrEP/PEP. Results: Awareness of PrEP/PEP was low for all groups. In multivariate analysis controlling for sociodemographic factors, non-injection drug use, HIV status, and exposure to HIV prevention, males who inject drugs in NYC had significantly decreased odds of PrEP/ PEP awareness [AOR: 0.45; confidence interval (CI): 0.25 to 0.81] compared with MSM. MSM aged 18–29 years had increased awareness of PrEP (AOR: 2.94; 95% CI 1.11 to 7.80). On Long Island, females who inject drugs (AOR: 0.18; 95% CI: 0.05 to 0.62), males who inject drugs (AOR: 0.14; 95% CI: 0.05 to 0.39), female heterosexuals (AOR: 0.25; 95% CI: 0.11 to 0.59), and male heterosexuals (AOR: 0.32; 95% CI: 0.14 to 0.73) had significantly decreased odds of PrEP/PEP awareness. Black MSM had increased awareness of PrEP (AOR: 4.08 CI:1.21 to 13.73). Conclusions: Large proportions of groups at-risk for HIV were unaware of PrEP/PEP. When comparing risk groups to MSM, we found MSM to have greater awareness in both regions. On Long Island, people who inject drugs and heterosexuals were far less likely to have PrEP/PEP awareness than in NYC. On Long Island, Black MSM had increased PrEP awareness and in NYC MSM aged 18-29 had increased PrEP awareness. These findings suggest that awareness may be spreading through networks and highlight the importance of targeted educational and prevention efforts by group and region.

An epidemiological cohort study of injection drug users in Montreal documented a significant statistical association between HIV seroconversion and needle exchange patronage from 1989 to 1995. The polemics generated by this counterintuitive quantitative data demonstrate the urgent need for a cross-methodological dialogue between epidemiology and ethnography. Participant observation on the streets of Montreal documented the multiple HIV risks associated with the compulsive behavior and emotional craving often accompanying cocaine injection. Needle exchange programs by themselves cannot be expected to stem HIV infection in cities where intravenous cocaine is the drug of choice. Are there unintended consequences (effets pervers) to public health interventions? We need an open debate to improve risk-reduction strategies. Public health should expand its scientific paradigm to include ethno-graphic documentation of the daily lives of vulnerable street addicts. On a deeper theoretical level, needle exchange polemics illustrate how power relations frame both HIV risk taking and science.. She is the Co-Principal Investigator of a multidisciplinary study of syringe access and HIV risk in Montreal and Vancouver funded by the National Institute on Drug Abuse and has published extensively in public health journals and the popular press on the Canadian experience with needle exchange.

Background

Studies of individuals in treatment for substance use have found high rates of psychiatric disorders, however little is known about the mental health of drug users not in treatment. This study aimed to assess the prevalence of lifetime and recent substance use and psychiatric disorders among young injection drug users (IDU) outside of a treatment setting.
Methods

Participants were recruited through outreach and respondent-driven sampling. Trained interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Interviews were conducted at two field stations operated by Community Outreach Intervention Projects in Chicago. Participants were 570 young adults (18–25 years) who injected drugs in the previous 30 days. Heroin was the primary drug used in this sample. Past 12-month and lifetime substance use disorders and primary and substance-induced mental disorders were based on DSM-IV diagnostic criteria.
Results

Nearly all participants met the criteria for heroin dependence. Multiple substance use disorders were common; cannabis was the most common substance involved after heroin, followed by alcohol and cocaine. Major depression, alcohol dependence, antisocial personality disorder, and borderline personality disorder were highly prevalent. Other psychiatric disorders were observed at levels consistent with other young adult samples.
Conclusions

Young IDU experience major depression, alcohol dependence, anti-social personality disorder, and borderline personality disorder at high rates, and multiple substance use disorders are common. Anxiety disorders in this population appear to be similar in prevalence to young adults in general.

Since the 1980s, the landscape of illegal drug use has changed in Morocco. This has come about through the introduction of new drugs and new modes of consumption. Morocco's geographical position has actively contributed to facilitating the transit of cocaine from the Sahel; heroin arriving through the two enclaves of Sebta and Melilla; and psychotropic drugs from Europe or those transiting through Algeria. The 2000s were marked by the "democratization" of certain drugs with the massive arrival in Morocco of cocaine and heroin, which had until then been reserved for a wealthy clientele. Thus "kahla/heroin", introduced in the north at a price of around 20 dirhams (2 Euros) per gram, generated a considerable number of injecting drug users, with all the attendant public health problems (HIV). Using the city of Tangier as a working space, this article attempts to understand the process of heroin addiction, and tries to answer the following questions: how do people become junkies? How it feels to break the social link ?How do they experience the user-sick position?

Background. People who inject drugs (PWID) and have mental health conditions, such as major depression, an anxiety disorder, or antisocial or borderline personality disorder, may have elevated risk for HIV/HCV infection. This study examined the associations between psychiatric disorders and risky injection behavior in an out-of-treatment sample of young PWID. Design. We recruited participants through outreach and respondent-driven sampling. Participants completed a computer-assisted self-interview, and a psychiatric interview. Methods. Interviews took place at a community-based field site of the Community Outreach Intervention Projects. Participants were 570 young adults (18-25 years) who injected drugs in the previous 30 days. Psychiatric diagnoses were based on interviews using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Injection behavior was classified into three categories: receptive syringe sharing, other equipment sharing only, and no sharing. Associations between injection risk behavior and psychiatric diagnoses were tested using RDS-weighted multinomial regressions. Results. Substance-induced lifetime and past year major depression, and borderline personality disorder were significantly associated with a greater likelihood of receptive syringe sharing (p < .001). Substance-induced major depression in the past year was also associated with non-syringe equipment sharing (p < .01). Primary major depression, antisocial personality disorder, and anxiety disorders other than post-traumatic stress disorder were slightly more prevalent among injectors who shared syringes, however the associations were not statistically significant. Conclusions. Substance-induced major depression and borderline personality disorder are common among young people who inject drugs and are associated with risky injection behavior.

Background-Studies of individuals in treatment for substance use have found high rates of psychiatric disorders, however little is known about the mental health of drug users not in treatment. This study aimed to assess the prevalence of lifetime and recent substance use and psychiatric disorders among young injection drug users (IDU) outside of a treatment setting. Methods-Participants were recruited through outreach and respondent-driven sampling. Trained interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Interviews were conducted at two field stations operated by Community Outreach Intervention Projects in Chicago. Participants were 570 young adults (18-25 years) who injected drugs in the previous 30 days. Heroin was the primary drug used in this sample. Past 12-month and lifetime substance use disorders and primary and substance-induced mental disorders were based on DSM-IV diagnostic criteria. Results-Nearly all participants met the criteria for heroin dependence. Multiple substance use disorders were common; cannabis was the most common substance involved after heroin, followed by alcohol and cocaine. Major depression, alcohol dependence, antisocial personality disorder, and borderline personality disorder were highly prevalent. Other psychiatric disorders were observed at levels consistent with other young adult samples. Conclusions-Young IDU experience major depression, alcohol dependence, antisocial personality disorder, and borderline personality disorder at high rates, and multiple substance use disorders are common.

Since 2013, North America has experienced a sharp increase in unintentional fatal overdoses: fentanyl, and its analogues, are believed to be primarily responsible. Currently, the most practical means for people who use drugs (PWUD) to avoid or mitigate risk of fentanyl-related overdose is to use drugs in the presence of someone who is in possession of, and experienced using, naloxone. Self-test strips which detect fentanyl, and some of its analogues, have been developed for off-label use allowing PWUD to test their drugs prior to consumption. We review the evidence on the off-label sensitivity and specificity of fentanyl test strips, and query whether the accuracy of fentanyl test strips might be mediated according to situated practices of use. We draw attention to the weak research evidence informing the use of fentanyl self-testing strips.

Distinct physical and chemical types of street heroin exist worldwide, but their impact on behavior and disease acquisition is not well understood or documented. This article presents a hypothesis to explain the unequal diffusion of HIV among injection drug users in the United States by examining the distribution and use of one type of heroin—''Mexican black tar.'' Drawing on ethnographic, clinical, epidemiological, and laboratory data, we suggest that the chemical properties of black tar heroin promote the following safer

Bringing quantitative and qualitative methodologies and perspectives into a collaborative dialog among cross-disciplinary researchers highlights the fact that clinical practice must go beyond simple racial or cultural categories. A clinical social science approach provides insights into how sociocultural processes are mediated by historically rooted and institutionally enforced power relations. Recognizing the logical underpinnings of ethnically specific behavioral patterns of street-based injectors is the foundation for cultural competence and for successful clinical relationships. It reduces the risk of suboptimal medical care for an exceptionally vulnerable and challenging patient population. Social science approaches can also help explain larger-scale patterns of health disparities; inform new approaches to structural and institutional-level public health initiatives; and enable clinicians to take more leadership in changing public policies that have negative health consequences.

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and noninjection drug users in Baltimore Maryland. The present study used a subset (N = 651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ 2 = 19.71, p < .01), cigarette (χ 2 = 11.05, p < .01), marijuana (χ 2 = 10.83, p < .01), and polysubstance use (χ 2 = 23.48, p < .01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR = 1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR = 1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR = 2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset alcohol and polysubstance use is an important risk factor for IDU in adulthood.

Objectives: To evaluate whether a behavioral intervention, which taught peer education skills, could reduce injection and sexual risk behaviors associated with primary HIV and hepatitis C virus infection (HCV) among young injection drug users (IDU).

Aims  This study conducted a secondary analysis to examine injection cessation and decreasing frequency of injection during a multi-site randomized controlled HIV prevention intervention trial that sought to reduce sexual and injection risk behavior among young injection drug users.
Design and Setting  A six-session, cognitive–behavioral skills-building intervention in which participants were taught peer education skills [peer education intervention (PEI)] was compared with a time-equivalent attention control. Follow-up interviews were conducted at 3 and 6 months post-baseline.
Participants  Trial participants were HIV and hepatitis C virus (HCV) antibody-negative injection drug users aged 15–30 years. Participants who had at least one follow-up interview and reported injecting drugs in the previous 3 months at baseline were eligible for the present analysis (n = 690).
Measurements  At each interview, data were collected on the number of times participants injected drugs over the previous 3 months.
Findings  Twenty-seven per cent of participants reported at least one 3-month period of injection cessation. In a multivariate, zero-inflated negative binomial regression adjusting for prior injection frequency, time of follow-up and psychosocial variables, PEI trial arm and smaller session size were associated significantly with injection cessation. Trial arm had no effect on the frequency of injection among those who continued to inject.
Conclusions  HIV prevention interventions that encourage injection drug users to take on the role of peer educator may have the additional benefit of increasing the likelihood of injection cessation. Intervention group size is also an important consideration, with smaller groups having higher rates of cessation.