ORCID Profile
0000-0002-9848-807X
Current Organisation
UNSW
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Informa UK Limited
Date: 14-05-2008
DOI: 10.1080/00918360801982264
Abstract: This study provides descriptive statistics on prevalence of testing, testing sites, and reasons for testing among lesbian women in the United States. It also provides qualitative data about the social meanings and specific circumstances of their HIV testing experiences. Analysis draws on a s le of lesbian women living in a single large southeastern city. An especially erse snowball and chain-referral s le of 162 lesbian women was given a questionnaire, and qualitative data were gathered from 24 women participating in three focus groups and from 67 women participating in depth-interviews. A large majority of women in the survey s le (80%) reported at least one test, and more than one in four women were tested five or more times. More than one in ten were tested during drug treatment or while incarcerated. The most common testing sites were clinics and hospitals, and the most common reason women gave was because they "thought they were at risk." Most tests were voluntary rather than mandatory occupational or institutional requirements. The subjective meanings associated with HIV testing, as well as the women's counseling needs before, during, and after testing are analyzed. The implications for a better understanding of lesbian women's sexual health are discussed.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.AJP.2015.06.002
Abstract: Because of the proximity of Persian Iran to Afghanistan, the main opium producer in the world, drug use especially opium use has a long history in Iran. Opium and its residues are the traditional drugs while heroin, heroin Kerack, norgesic, temgesic, and meth hetamine use and injection have emerged more recently. In recent decades, heroin smoking and injection have presented challenges to the Persian health policy makers to accept and develop the internationally-approved programs of drug use treatment and harm reduction. The current paper summarizes the overall picture of main drugs used and the history of establishing the nationwide movement of drug use treatment and harm reduction programs after the 1979 revolution until the end of 2014. The paper concludes that Persian Iran has a well-developed healthcare system in the provision of drug use treatment and harm reduction programs in the south-west of Asia especially the Persian Gulf region. These therapeutic and harm reduction-related programs are required to be strengthened by opium supply reduction and eradicating drug production in Afghanistan. The provision of prevention programs, drug education via mass-media, employment and inexpensive leisure activities are required in Iran. In addition, conducting household surveys of the prevalence of drug use and evaluating the clinical effectiveness and treatment outcomes of the provided drug treatment and harm reduction programs are required. National and regional collaborations are rigorously suggested to manage supply reduction along the borders and implement demand reduction inside the borders.
Publisher: Elsevier BV
Date: 05-2010
Publisher: Emerald
Date: 10-06-2014
DOI: 10.1108/IJPH-06-2013-0025
Abstract: – Prisoners have a high level of drug use prior to imprisonment. Many inmates report having injected drugs and using cannabis. Prison authorities employed a range of strategies to detect drugs and drug use in prison. However, it was unclear which supply reduction strategies operated, and the prevalence and types of drugs detected in Australian prisons. The purpose of this paper is to examine supply reduction strategies in Australian prisons. Information on searches for drugs, and from inmate urinalysis was collected. The study focussed on adults in fulltime custody in Australia in 2009. – A representative of all corrective services departments and justice health services was asked to complete a questionnaire on supply reduction strategies, including searches for drugs and drug testing of inmates. – The two main supply reduction strategies identified in all Australian prisons were the use of drug detection dogs and urinalysis programs. Despite an extensive use of drug searches and urinalysis, the detection of drugs was modest for both strategies. The most commonly used drug was cannabis with the detection of drugs such as hetamines and heroin being very low. – Prison inmates have a history of high levels of drug use prior to imprisonment. However, the supply reduction measures of drug detection dogs and urinalysis indicate that drug use was low in Australian prisons. – The paper recommends that urinalysis comprises targeting testing regimes and that random testing ceases in order to be a more cost effective use of resources for drug detection. – The study is the first report on the range of supply reduction measures in Australian prisons and, possibly in the world. Both measures were employed extensively across the country and finds of drugs and drug use were relatively low. Two possible conclusions can be drawn that either drug use was very low in prison or that it was well concealed from the authorities. A comparison of random testing with targeted testing of inmates, where the former yields fewer positive results shows drug use was likely to be low rather than well concealed.
Publisher: Wiley
Date: 24-09-2009
DOI: 10.1111/J.1440-1746.2009.05978.X
Abstract: Needlestick injuries are an occupational hazard for prison officers. This study aimed to assess the presence of hepatitis C virus (HCV) in syringes found in prisons. Sixty-nine syringes found in prisons were tested for HCV RNA using previously published methods. Three syringes tested positive for HCV RNA. Compared to the prevalence of HCV among injecting drug users in prisons, few syringes were found to contain HCV RNA. It is likely that conditions under which syringes are kept in prisons are not favorable for survival of detectable HCV RNA. Further work is needed to establish the risk of HCV transmission posed by needlestick injuries in prison settings.
Publisher: Elsevier BV
Date: 09-2016
Publisher: Mary Ann Liebert Inc
Date: 06-2015
Abstract: Women who inject drugs (WWID) are vulnerable to a range of harms, including exposure to sexually transmitted and blood-borne infections, abusive relationships, physical and sexual violence and mental health issues. Lesbians and bisexual women are at greater risk than heterosexual women for substance use disorders. This study aimed to compare a large s le of heterosexual, bisexual, and lesbian WWID and to identify correlates of sexual orientation. The Australian Needle and Syringe Program (NSP) Survey is an annual cross-sectional survey. People who inject drugs (PWID) who attend NSP services are invited to complete a brief self-administered questionnaire and provide a capillary dried blood spot. Of 22,791 survey respondents between 2004-2013, one third were women (n=7,604). Analyses were restricted to the first participation record for each respondent. Of the 5,378 in idual women, 4,073 (76%) identified as heterosexual, 1,007 (19%) identified as bisexual, and 298 (6%) identified as lesbian. HIV prevalence was low (<1.0%). More than half (56%) had been exposed to hepatitis C virus (HCV), with prevalence highest among bisexual women (59%). In adjusted analysis, bisexual women had significantly greater odds of initiating injection at a younger age (AOR 1.44, 95% CI 1.19-1.73), and reporting public injection (AOR 1.44, 95% CI 1.21-1.73) and receptive sharing of drug preparation equipment (AOR 1.20, 95% CI 1.00-1.44). Bisexual women (AOR 1.42, 95% CI 1.07-1.88) and lesbians (AOR 1.63, 95% CI 1.10-2.44) had significantly greater odds of reporting sex work than their heterosexual counterparts. Results contribute to the literature on HIV and HCV transmission risk among WWID. Analysis of the relationship between sexual orientation and risk behavior identified bisexual orientation as independently associated with increased risk. Services that target PWID need to recognise and address a broad range of sexual identities and behaviors. Future research should explore reasons for increased risk in sexual minority women.
Publisher: Mary Ann Liebert Inc
Date: 11-2011
Abstract: In the west, men are twice as likely as women to develop a drug problem, but female users have higher rates of morbidity than male users. Iran has the world highest per capita opiate consumption, but little is known about female drug users. In 2007, we established a free methadone clinic with ancillary services for female drug users in South Tehran. The aim was to explore the characteristics of female drug users seeking treatment for heroin dependence in Iran. Clients were interviewed about demographic characteristics, drug use and treatment history, and drug-related health problems. Urine and blood s les were collected and tested for morphine, HIV, hepatitis C virus (HCV), and sexually transmitted infections (STIs). Between August 2007 and October 2008, 78 women completed a baseline interview. The median age was 37 years, the main ethnic background was Persian (65%), and half of the clients were married. Opium and heroin and opium use was reported by 69% (n=54) and 87% (n=68) of clients, respectively. The mean duration of heroin use problems was 10.5 years, and only 20% of women reported ever having received drug treatment. HIV and HCV seroprevalence was 5% and 24%, respectively. Forty percent were sexually active when interviewed, and one third tested positive for an STI. Women had poor social functioning, high levels of depression, and poor general health. Our clients were dependent users with a multitude of problems who had little or no contact with treatment agencies before this study. Many clients had made a transition from using opium to using heroin, and some had commenced injecting, placing them at risk for HIV and HCV infection. More women-only drug treatment services are needed to facilitate women's entry into drug treatment.
Publisher: Wiley
Date: 15-01-2009
Publisher: Emerald
Date: 04-2009
DOI: 10.1080/17449200903343118
Abstract: Custodial settings are high‐risk environments for HIV. This paper examines publicly available data about the drug use and risk behaviours of Thai and Indonesian prisoners and outlines a process used to collect new data. In 2005, the Departments of Corrections in Thailand and Indonesia requested researchers examine HIV and drug use issues but the findings are too sensitive to publish. The Departments of Corrections in Thailand and Indonesia are using the results to develop public health responses.
Publisher: Public Library of Science (PLoS)
Date: 29-06-2016
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.AJP.2015.05.036
Abstract: Meth hetamine use is a new health concern in Iran, the most populated Persian Gulf country. However, there is no well-documented literature. The current study objectives were to systematically review all published English and Persian studies of the prevalence of meth hetamine use, the general physical and psychiatric-related harms and the availability of meth hetamine treatment and harm reduction services for adult users in Iran. A comprehensive search of the international peer-reviewed and gray literature was undertaken. Multiple electronic and scientific English and Persian databases were systematically searched from January 2002 to September 2014. Additionally, English and Persian gray literature on meth hetamine use was sought using online gray literature databases, library databases and general online searches over the same period of time. Nineteen thousand and two hundred and eight studies, reports and conference papers were identified but only 42 studies were relevant to the study objectives. They were mainly published in 2010-2014. The search results confirmed the seizures of meth hetamine (six studies), the prevalence of meth hetamine use among the general population (three studies), drug users (four studies), women (nine studies) and opiate users in opiate treatment programs (five studies). In addition, meth hetamine use had resulted in blood-borne viral infections (one study), psychosis and intoxication (ten studies). Different reasons had facilitated meth hetamine use. However, the Matrix Model, community therapy and harm reduction services (four studies) had been provided for meth hetamine users in some cities. The current situation of meth hetamine use necessitates more research on the epidemiology and health-related implications. These studies should help in identifying priorities for designing and implementing prevention and educational programs. More active models of engagement with Persian meth hetamine users and the provision of services that meet their specific treatment needs are required.
Publisher: Informa UK Limited
Date: 2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
Publisher: Wiley
Date: 17-05-2006
DOI: 10.1111/J.1440-1584.2006.00775.X
Abstract: Given the harms associated with injecting drug use to both in iduals and community and the paucity of such data from rural areas, the study aimed to compare: patterns of drug use, harms, and service access and utilisation among rural and metropolitan injecting drug users (IDU). Cross-sectional survey, using interviewer-administered structured questionnaire. One hundred and sixty-four rural and 96 metropolitan IDU from seven different New South Wales Area Health Services, recruited through needle and syringe programs (NSPs), snowballing techniques and advertisement. Age, gender, education and employment were similar for rural and metropolitan participants. Both s les reported use of a range of drugs, but rural participants were less likely than metropolitan participants to report daily heroin use (2% vs 10%), but more likely to report having injected morphine (50% vs 21%) in the last six months. Similar proportions reported using a needle/syringe after another person. Rural participants were less likely to report use of NSPs (36% vs 80%) and reported a number of barriers to NSP access and also to drug treatment services. Rural participants reported a significantly longer period of time between blood-borne virus testing. S les of rural IDU are similar to metropolitan, although report some differences in patterns of drug use. Service provision, including access to new injecting equipment, blood-borne virus testing and drug treatment was found to cause considerable problems for rural IDU. These issues warrant further consideration.
Publisher: European Centre for Disease Control and Prevention (ECDC)
Date: 09-12-2021
DOI: 10.2807/1560-7917.ES.2021.26.49.2002093
Abstract: People who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes. We aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe. Aggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006–2020 n = 52,368 HIV+/− n = 47,268 HCV+/−). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR. Univariable HIV OR ranged between 0.73 and 6.37 (median: 2.1 pooled OR: 1.92 95% CI: 1.52–2.42). Pooled PR was 1.66 (95% CI 1.38–1.98), giving a PAR of 25.8% (95% CI 16.7–34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70 pooled OR: 2.51 95% CI: 2.17–2.91). Pooled PR was 1.42 (95% CI: 1.28–1.58) and PAR 16.7% (95% CI: 11.8–21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe. In univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release (‘throughcare’).
Publisher: Elsevier BV
Date: 09-2016
Publisher: Wiley
Date: 09-2004
Publisher: Elsevier BV
Date: 09-2016
Publisher: Wiley
Date: 17-07-2008
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.JSAT.2016.08.001
Abstract: Opioid substitution therapy (OST) is an effective treatment for opioid dependence that is provided in many correctional settings, including New South Wales (NSW), Australia. In 2011, changes to the clinical governance of the NSW prison OST program were implemented, including a more comprehensive assessment, additional specialist nurses, and centralization of program management and planning. This study aimed to document the NSW prison OST program, and assess the impact of the enhanced clinical governance arrangements on retention in treatment until release, the provision of an OST prescription to patients at release, and presentation to a community OST clinic within 48 hours of release from custody. Data from the NSW prison OST program were obtained for the calendar years 2007-2013. Outcomes were analyzed quarterly using log binomial segmented regression. 8577 people were treated with OST in NSW correctional centers, 2007-2013. Over the entire study period, patients were retained in OST until release in 82% of treatment episodes a prescription for OST was able to be arranged prior to release in 90% of releases and patients presented to a community clinic within 48 hours of release in 94% of releases with prescriptions. Following the introduction of the changes to clinical governance, there was a significant increasing trend in retention in OST until release, and in provision of an OST prescription at release. There was an initial increase, followed by a decreasing trend, in presentation to a community clinic within 48 hours of release. This large prison-based OST program has high rates of retention in treatment and continuity of care as patients transition from custody to the community. Strengthened clinical governance arrangements were associated with increased retention in treatment until release and increased provision of an OST prescription at release, but did not improve clinic attendance following release from custody.
Publisher: Springer Science and Business Media LLC
Date: 2005
Publisher: Springer Science and Business Media LLC
Date: 09-2004
Publisher: BMJ
Date: 18-06-1988
DOI: 10.1136/BMJ.296.6638.1717
Abstract: In 1987 experimental schemes for distributing injecting equipment to intravenous drug users to help prevent the spread of the human immunodeficiency virus were started by the government. After six months the schemes were found to have been reasonably successful in attracting clients but were less successful in keeping them. It has been shown that equipment can be distributed to drug users on an exchange basis. Many of the clients who were attracted to these schemes had had no treatment or other help for their drug problems.
Publisher: Wiley
Date: 26-10-2012
DOI: 10.1111/J.1360-0443.2011.03618.X
Abstract: People who use heroin are frequently incarcerated multiple times. Reducing re-incarceration of this group is important for reducing both health risks associated with incarceration and the costs of correctional administration. Opioid substitution treatment (OST) in prisons may help to reduce re-incarceration, but research findings on this topic have been mixed. In this study, we examined the effect of OST in prison and after release on re-incarceration. Longitudinal cohort study. SETTING, PARTICIPANTS AND MEASUREMENTS: Data on OST and incarceration were linked for a cohort of 375 male heroin users recruited originally in prisons in New South Wales, Australia. Data were linked for the period 1 June 1997-31 December 2006. Re-incarceration was examined using recurrent-event survival analysis models. Model 1 examined the effect of OST status at release from prison (i.e. in treatment versus out of treatment on the day of release) on re-incarceration. Model 2 considered the effect of remaining in OST after release on risk of re-incarceration. Ninety per cent of participants were re-incarcerated following their first observed release. Pre-incarceration cocaine use was associated with a 13% increase in the average risk of re-incarceration. There was no significant association between simply being in OST at the time of release and risk of re-incarceration however, in the model taking into account post-release retention in treatment, the average risk of re-incarceration was reduced by 20% while participants were in treatment. In New South Wales, Australia, opioid substitution treatment after release from prison has reduced the average risk of re-incarceration by one-fifth.
Publisher: Briefland
Date: 05-09-2016
DOI: 10.5812/IJHRBA.28815
Publisher: Wiley
Date: 12-1988
DOI: 10.1111/J.1360-0443.1988.TB02559.X
Abstract: In order to characterize the molecular events in the carcinogenesis of esophageal cancer and to identify biomarkers for the early detection of the disease, matched precancerous and cancerous tissues resected from 34 esophageal cancer patients in Chongqing of southern China were compared for the extent of loss of heterozygosity (LOH). Sixteen microsatellite markers on nine chromosome regions were used for the PCR-based LOH analysis. The overall frequency of LOH at the 16 microsatellite loci was significantly increased as the pathological status of the resection specimens changed from low-grade dysplasia (LGD) to high-grade dysplasia (HGD) and squamous cell carcinoma (SCC) (P < 0.001), indicating that tumorigenesis of the esophageal squamous epithelia is a progressive process involving accumulative changes of LOH. A total of eight markers showed LOH in the LGD s les, suggesting that these loci may be involved in the early-stage tumorigenesis of esophageal squamous cell carcinoma (ESCC) and that LOH analysis at these loci may help improve the early detection of this disease. In addition, heterozygosity was regained at four loci in the SCC s les of four patients compared with the HGD s les, suggesting the possibility of genetic heterogeneity in the tumorigenesis of esophageal cancer.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2015
Publisher: Emerald
Date: 03-2007
DOI: 10.1080/17449200701520149
Abstract: The study evaluated the introduction of naltrexone in an Australian prison system for imprisoned male heroin users. Treatment outcomes were analysed for two sub‐s les taken from an unsuccessful randomised controlled trial. The first s le comprised 68 participants who were randomly allocated to naltrexone treatment. The second s le comprised 47 participants who commenced opioid pharmacotherapy during the study period. Thirteen per cent of subjects started naltrexone, with only 7% retained in treatment at six months. Six‐month retention was significantly lower in naltrexone compared to methadone (p = 0.0007). Poor patient acceptability and retention did not support oral naltrexone maintenance in this treatment group.
Publisher: Wiley
Date: 21-06-2016
DOI: 10.1111/DAR.12442
Abstract: Opioid substitution treatment (OST) reduces drug-related harms in custody and after release. However, OST providers in prisons have reported that some patients prefer to cease treatment prior to release, placing them at risk of fatal overdose. We aimed to examine reasons for seeking OST in custody, and intentions regarding continuation or cessation of treatment prior to and following release. This qualitative study employed semi-structured interviews with opioid-dependent people currently incarcerated in New South Wales, Australia. Of 46 participants, 27 were currently in OST. Reported benefits of OST included withdrawal management and avoidance of high-risk injecting. Over a third of participants in OST stated their intention to withdraw from OST prior to release. Reasons included concerns that attending community OST clinics could lead to drug use or offending, family opposition, inconvenience of clinic attendance, stigma and a perception that prison provided an opportunity to withdraw from OST more easily than in the community. Nineteen participants had already ceased OST in custody or had declined it, citing preferences to 'be clean' and the long-term nature of OST. Balancing the preference of many patients to cease OST prior to release against patient safety post-release is a substantial challenge for opioid treatment providers in correctional settings. These findings indicate the need for research on how best to attract and retain opioid-dependent prisoners in treatment and the need to provide other interventions for prisoners uninterested in post-release OST, such as take-home naloxone. [Larney S, Zador D, Sindicich N, Dolan K. A qualitative study of reasons for seeking and ceasing opioid substitution treatment in prisons in New South Wales, Australia. Drug Alcohol Rev 2017 :305-310].
Publisher: Wiley
Date: 06-1999
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.DRUGPO.2014.10.012
Abstract: In 2011, over 10.1 million people were held in prisons around the world. HIV prevalence is elevated in prison and this is due to the over representation of people who inject drugs (PWID). Yet HIV prevention programs for PWID are scarce in the prison setting. With a high proportion of drug users and few prevention programs, HIV transmission occurs and sometimes at an alarming rate. This commentary focuses primarily on drug users in prison their risk behaviours and levels of infection. It also comments on the transmission of HIV including outbreaks and the efforts to prevent transmission within the prison setting. The spread of HIV in prison has substantial public health implications as virtually all prisoners return to the community. HIV prevention and treatment strategies known to be effective in community settings, such as methadone maintenance treatment, needle and syringe programs, condoms and antiretroviral therapy should be provided to prisoners as a matter of urgency.
Publisher: Emerald
Date: 03-2008
DOI: 10.1080/17449200802264720
Abstract: Prison officers face multiple occupational hazards including needlestick injuries, which may result in the transmission of blood‐borne viral infections. This study aimed to assess the prevalence of needlestick injuries, the circumstances under which needlestick injuries occur and the responses of injured prison officers. Cross‐sectional data were collected from prison officers in two Australian jurisdictions between January and May 2006, using a self‐report questionnaire. Descriptive analyses were conducted. Of 246 prison officers who completed the survey, two‐thirds had found needles and syringes in the workplace. Seventeen officers (7%) reported having experienced a needlestick injury. Most injuries occurred during searches. Serological testing for blood‐borne viral infections following injury was common, but less than half the injured officers accessed support services. Needlestick injuries appear to be a relatively rare occurrence, but may be further reduced by improving search techniques and equipment and regulating needles and syringes in prisons.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2004
Publisher: Oxford University Press (OUP)
Date: 2018
Publisher: Wiley
Date: 08-1990
Publisher: Oxford University Press (OUP)
Date: 2018
Publisher: Oxford University Press (OUP)
Date: 2018
Abstract: Prisoners engage in a range of risk behaviors that can lead to the transmission of viral infections, such as HIV, hepatitis B and hepatitis C. In this review, we summarize the epidemiologic literature from 2007 to 2017 on 4 key risk behaviors for human immunodeficiency virus and hepatitis C virus among prisoners globally: drug injection, sexual activity, tattooing, and piercing. Of 9,303 peer-reviewed and 4,150 gray literature publications, 140 and 14, respectively, met inclusion criteria covering 53 countries (28%). Regions with high levels of injection drug use were Asia Pacific (20.2%), Eastern Europe and Central Asia (17.3%), and Latin America and the Caribbean (11.3%), although the confidence interval for Latin America was high. Low levels of injection drug use in prison were found in African regions. The highest levels of sexual activity in prison were in Europe and North America (12.1%) and West and Central Africa (13.6%) low levels were reported from the Middle East and North African regions (1.5%). High levels of tattooing were reported from Europe and North America (14.7%), Asia Pacific (21.4%), and Latin America (45.4%). Prisons are burdened with a high prevalence of infectious diseases and risk behaviors for transmission of these diseases, and, commonly, a striking lack of evidence-based infection control measures, even when such measures are available in the surrounding community. Given that most prisoners return to these communities, failure to implement effective responses has repercussions not only prisoner health but also for public health.
Publisher: Elsevier BV
Date: 10-2003
DOI: 10.1016/S0376-8716(03)00187-X
Abstract: The aim was to determine whether methadone maintenance treatment reduced heroin use, syringe sharing and HIV or hepatitis C incidence among prisoners. All eligible prisoners seeking drug treatment were randomised to methadone or a waitlist control group from 1997 to 1998 and followed up after 4 months. Heroin use was measured by hair analysis and self report drugs used and injected and syringe sharing were measured by self report. Hepatitis C and HIV incidence was measured by serology. Of 593 eligible prisoners, 382 (64%) were randomised to MMT (n=191) or control (n=191). 129 treated and 124 control subjects were followed up at 5 months. Heroin use was significantly lower among treated than control subjects at follow up. Treated subjects reported lower levels of drug injection and syringe sharing at follow up. There was no difference in HIV or hepatitis C incidence. Consideration should be given to the introduction of prison methadone programs particular where community based programs exist.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 05-2015
Publisher: Elsevier BV
Date: 05-1998
DOI: 10.1016/S0376-8716(98)00009-X
Abstract: A mathematical model was developed to estimate HIV incidence in NSW prisons. Data included: duration of imprisonment number of inmates using each needle lower and higher number of shared injections per IDU per week proportion of IDUs using bleach efficacy of bleach HIV prevalence and probability of infection. HIV prevalence in IDUs in prison was estimated to have risen from 0.8 to 6.7% (12.2%) over 180 weeks when using lower (and higher) values for frequency of shared injections. The estimated minimum (and maximum) number of IDU inmates, infected with HIV in NSW prisons was 38 (and 152) in 1993 according to the model. These figures require confirmation by seroincidence studies.
Publisher: Wiley
Date: 07-1992
DOI: 10.1111/J.1360-0443.1992.TB03116.X
Abstract: Measures taken to reduce HIV risk by injecting drug users have been reported in many countries, but a minority of injectors continue to engage in risky practices. In an ongoing cohort study, 207 drug injectors were interviewed and anonymously tested for HIV antibodies in saliva in 1989. Injectors reporting recent syringe sharing were compared with those not recently sharing injecting events where sharing did and did not take place were examined. Those recently sharing syringes differed significantly from the non-sharers on several factors, including: use of heroin, dihydrocodeine and temazepam injection of heroin, temazepam and prescribed methadone accommodation and contact with other injectors means of financial support and recent involvement in crime secondary sources of injecting equipment and unsafe disposal employment of HIV protective strategies treatment contact with general practitioners number of sexual partners and injecting status of sexual partners. The two groups were not significantly different in terms of attendance at syringe-exchange schemes and self-reported HIV antibody status. Syringe sharing would appear to be related to social circumstances and life-style factors rather than just in idual choices and motivation.
Publisher: Elsevier BV
Date: 09-2016
Publisher: Informa UK Limited
Date: 06-10-2014
Publisher: S. Karger AG
Date: 2009
DOI: 10.1159/000199046
Abstract: i Background/Aims: /i Opioid substitution treatment (OST) is an effective treatment for heroin dependence. The World Health Organization has recommended that OST be implemented in prisons because of its role in reducing drug injection and associated problems such as HIV transmission. The aim of this paper was to examine the extent to which OST has been implemented in prisons internationally. i Methods: /i Literature review. i Results: /i As of January 2008, OST had been implemented in prisons in at least 29 countries or territories. For 20 of those countries, the proportion of all prisoners in OST could be calculated, with results ranging from less than 1% to over 14%. At least 37 countries offer OST in community settings, but not prisons. i Conclusion: /i This study has identified an increase in the international implementation of OST in prisons. However, there remain large numbers of prisoners who are unable to access OST, even in countries that provide such programs. This raises issues of equivalence of care for prisoners and HIV prevention in prisons.
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.DRUGALCDEP.2007.05.026
Abstract: Hepatitis C virus (HCV) infection in Australia is predominantly transmitted through injecting drug use. A reduction in the heroin supply in Australia in late 2000 and early 2001 may have impacted the number of injecting drug users (IDUs) and consequently the number of new hepatitis C infections in Australia. This paper updates estimates of HCV incidence and prevalence between 1960 and 2005. Simple mathematical models were used to estimate HCV incidence among IDUs, migrants to Australia from high HCV-prevalence countries, and other HCV exposure groups. Recent trends in numbers of IDUs were based on indicators of injecting drug use. A natural history of HCV model was applied to estimate the prevalence of HCV in the population. The modelled best estimate of past HCV incidence showed a consistent increasing rate of HCV infections to a peak of 14,000 new seroconversions in 1999, followed by a decline in 2001-2002 coincident with the decline in heroin availability. HCV incidence was estimated to be 9700 (lower and upper limits of 6600 and 13,200) in 2005. Of these, 88.7% were estimated to be through injecting drug use, 7.2% among migrants and 4.1% through other transmission routes. An estimated 264,000 (lower and upper limits of 206,000 and 318,000) people were HCV antibody positive in 2005. Mathematical models suggest that HCV incidence in Australia decreased from a peak of 14,000 new infections in 1999 to 9700 new infections in 2005, largely attributable to a reduction in injecting drug use. The numbers of people living with HCV in Australia is, however, estimated to continue to increase.
Publisher: Wiley
Date: 09-2003
Publisher: Elsevier BV
Date: 10-2015
Publisher: Informa UK Limited
Date: 2003
Publisher: Emerald
Date: 16-03-2015
DOI: 10.1108/IJPH-02-2014-0005
Abstract: – The purpose of this paper is to compare the use of drugs and alcohol by Indigenous and non-Indigenous prisoners and examine relevant treatment in Australian prisons. – Prison authorities were surveyed about alcohol and drug use by prisoners prior to and during imprisonment and drug and alcohol treatment programs in prison. The literature was review for information on alcohol and drug use and treatment in Australian prisons. – In 2009, over 80 percent of Indigenous and non-Indigenous inmates smoked. Prior to imprisonment, many Indigenous and non-Indigenous inmates drank alcohol at risky levels (65 vs 47 percent) and used illicit drugs (over 70 percent for both groups). Reports of using heroin (15 vs 21 percent), ATS (21 vs 33 percent), cannabis (59 vs 50 percent) and injecting (61 vs 53 percent) were similarly high for both groups. Prison-based programs included detoxification, Opioid Substitution Treatment, counselling and drug free units, but access was limited especially among Indigenous prisoners. – Drug and alcohol use was a significant issue in Australian prisons. Prisoners were over five times more likely than the general population to have a substance use disorder. Imprisonment provides an important opportunity for rehabilitation for offenders. This opportunity is especially relevant to Indigenous prisoners who were more likely to use health services when in prison than in the community and given their vast over representations in prison populations. – Given the effectiveness of treatment in reducing re-offending rates, it is important to expand drug treatment and especially culturally appropriate treatment programs for Indigenous inmates. – Very little is known about Indigenous specific drug and alcohol programs in Australian prisons.
Publisher: Elsevier BV
Date: 02-2008
Publisher: American Society for Microbiology
Date: 15-11-6349
DOI: 10.1128/JVI.03717-14
Abstract: The interaction between hepatitis C virus (HCV) and cellular immune responses during very early infection is critical for disease outcome. To date, the impact of antigen-specific cellular immune responses on the evolution of the viral population establishing infection and on potential escape has not been studied. Understanding these early host-virus dynamics is important for the development of a preventative vaccine. Three subjects who were followed longitudinally from the detection of viremia preseroconversion until disease outcome were analyzed. The evolution of transmitted/founder (T/F) viruses was undertaken using deep sequencing. CD8 + T cell responses were measured via enzyme-linked immunosorbent spot (ELISpot) assay using HLA class I-restricted T/F epitopes. T/F viruses were rapidly extinguished in all subjects associated with either viral clearance ( n = 1) or replacement with viral variants leading to establishment of chronic infection ( n = 2). CD8 + T cell responses against 11 T/F epitopes were detectable by 33 to 44 days postinfection, and 5 of these epitopes had not previously been reported. These responses declined rapidly in those who became chronically infected and were maintained in the subject who cleared infection. Higher-magnitude CD8 + T cell responses were associated with rapid development of immune escape variants at a rate of up to 0.1 per day. Rapid escape from CD8 + T cell responses has been quantified for the first time in the early phase of primary HCV infection. These rapid escape dynamics were associated with higher-magnitude CD8 + T cell responses. These findings raise questions regarding optimal selection of immunogens for HCV vaccine development and suggest that detailed analysis of in idual epitopes may be required. IMPORTANCE A major limitation in our detailed understanding of the role of immune response in HCV clearance has been the lack of data on very early primary infection when the transmitted viral variants successfully establish the acute infection. This study was made possible through the availability of specimens from a unique cohort of asymptomatic primary infection cases in whom the first available viremic s les were collected approximately 3 weeks postinfection and at regular intervals thereafter. The study included detailed examination of both the evolution of the viral population and the host cellular immune responses against the T/F viruses. The findings here provide the first evidence of host cellular responses targeting T/F variants and imposing a strong selective force toward viral escape. The results of this study provide useful insight on how virus escapes the host response and consequently on future analysis of vaccine-induced immunity.
Publisher: Informa UK Limited
Date: 04-1993
DOI: 10.1080/09540129308258600
Abstract: In a study of 452 ex-prisoners in England in 1990, 66 people reported that they were tested for HIV antibodies when last in prison. The circumstances under which many of those who were tested were difficult: 36% found it an unpleasant experience, 17% had not taken the test voluntarily and 55% said they received no counselling. Further information was gathered about the experiences of those who were HIV positive or assumed to be. Most were accommodated in a 'special location', not allowed to associate with other prisoners and denied access to work or recreational facilities. These data highlight the difficulties arising from the policy of Viral Infectivity Restrictions, a set of regulations applied to the management of prisoners with HIV in English prisons. This policy created a distressing situation for those tested for HIV or identified as being HIV positive in prison. For the prison environment, these conditions may create a vicious circle reinforcing inaccurate beliefs and anxieties.
Publisher: Oxford University Press (OUP)
Date: 10-2003
DOI: 10.1093/IJE/DYG101
Abstract: To plan an appropriate public health response to the hepatitis C virus (HCV) epidemic requires that estimates of HCV incidence and prevalence, and projections of the long-term sequelae of infection, are as accurate as possible. In this paper, mathematical models are used to synthesize data on the epidemiology and natural history of HCV in Australia to estimate HCV incidence and prevalence in Australia to end 2001, and project future trends in the long-term sequelae of HCV infection. Mathematical models of the HCV epidemic in Australia were developed based on estimates of the pattern of injecting drug use. Estimates of HCV infections due to injecting drug use were then adjusted to allow for HCV infections resulting from other transmission routes. Projections of the long-term sequelae of HCV infection were obtained by combining modelled HCV incidence with estimates of the progression rates to these outcomes. It was estimated that there were 210 000 (lower and upper limits of 157 000 and 252 000) people in Australia living with HCV antibodies at the end of 2001, with HCV incidence in 2001 estimated to be 16 000 (11 000-19 000). It was estimated that 6500 (5000-8000) people were living with HCV-related cirrhosis in 2001, that 175 (130-210) people developed HCV-associated liver failure, and that there were 50 (40-60) incident cases of HCV-related hepatocellular carcinoma (HCC). It was estimated that in 2001 22 500 quality adjusted life years were lost to chronic HCV infection, the majority (77%) in people with early (stage 0/1) liver disease. Model-based estimates were broadly consistent with other sources of information on the HCV epidemic in Australia. These models suggest that the prevalence of HCV-related cirrhosis and the incidence of HCV-related liver failure and HCC will more than triple in Australia by 2020.
Publisher: Wiley
Date: 09-2001
DOI: 10.1046/J.1360-0443.2001.96912898.X
Abstract: To test the feasibility of conducting a definitive randomized controlled trial of dex hetamine substitution for hetamine dependent people and provide preliminary data. An open, two-group pre-post randomized controlled trial. Forty-one long-term, dependent hetamine users seeking treatment. Twenty subjects were offered weekly counselling. Twenty-one subjects were, in addition, prescribed up to 60 mg dex hetamine daily. Immunoassay and mass spectrometric urinalysis techniques were used to identify the presence of hetamine and methyl hetamine in urine. The Opiate Treatment Index and Severity of Dependence Scale were used to collect pre- and post-self-report data. Subjects were screened using the Composite International Diagnostic Interview. Reduced street hetamine use and hetamine dependence was observed both in subjects prescribed dex hetamine and subjects receiving counselling only. Treatment subjects appeared more likely to attend counselling. A definitive randomized controlled trial of dex hetamine substitution using the techniques and instruments piloted in this study is feasible. Users appeared to be attracted and retained in substitution treatment. The intervention also appeared to be acceptable to clinicians.
Publisher: Wiley
Date: 15-07-2021
DOI: 10.1111/ADD.12643
Abstract: To document the relationships between injecting drug use, imprisonment and hepatitis C virus (HCV) infection. Prospective cohort study. Multiple prisons in New South Wales, Australia. HCV seronegative prisoners with a life-time history of injecting drug use (IDU) were enrolled and followed prospectively (n = 210) by interview and HCV antibody and RNA testing 6-12-monthly for up to 4 years when in prison. HCV incidence was calculated using the person-years method. Cox regression was used to identify predictors of incident infection using time-dependent covariates. Almost half the cohort reported IDU during follow-up (103 subjects 49.1%) and 65 (31%) also reported sharing of the injecting apparatus. There were 38 HCV incident cases in 269.94 person-years (py) of follow-up with an estimated incidence of 14.08 per 100 py [confidence interval (CI) = 9.96-19.32]. Incident infection was associated independently with Indigenous background, injecting daily or more and injecting heroin. Three subjects were RNA-positive and antibody-negative at the incident time-point, indicating early infection, which provided a second incidence estimate of 9.4%. Analysis of continuously incarcerated subjects (n = 114) followed over 126.73 py, identified 13 new HCV infections (10.26 per 100 py, CI = 5.46-17.54), one of which was an early infection case. Bleach-cleansing of injecting equipment and opioid substitution treatment were not associated with a significant reduction in incidence. In New South Wales, Australia, imprisonment is associated with high rates of hepatitis C virus transmission. More effective harm reduction interventions are needed to control HCV in prison settings.
Publisher: Springer Science and Business Media LLC
Date: 10-03-2011
DOI: 10.1057/JPHP.2011.10
Abstract: In Iran women are less likely than men to use drugs, but suffer greater morbidity, are stigmatised, and are less likely to seek treatment. In 2007, we established a clinic in Tehran for drug using women. We report here on our study of the 97 women who registered in the first year of operation. We profiled these women: demographics, drug use, risk behaviour, and use of services. The clinic's services were heavily used. We interviewed clients and staff about the clinic and learned that intensive help is needed for women trying to recover from years of drug use. We conclude that female drug users will make use of harm reduction services if they are provided in a setting designed and operated for women.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.DRUGALCDEP.2006.01.010
Abstract: Although methadone maintenance treatment in community settings is known to reduce heroin use, HIV infection and mortality among injecting drug users (IDU), little is known about prison methadone programs. One reason for this is the complexity of undertaking evaluations in the prison setting. This paper estimates the cost-effectiveness of the New South Wales (NSW) prison methadone program. Information from the NSW prison methadone program was used to construct a model of the costs of the program. The information was combined with data from a randomised controlled trial of provision of prison methadone in NSW. The total program cost was estimated from the perspective of the treatment provider/funder. The cost per heroin free day, compared with no prison methadone, was estimated. Assumptions regarding resource use were tested through sensitivity analysis. The annual cost of providing prison methadone in NSW was estimated to be 2.9 million Australian dollars (or 3,234 Australian dollars per inmate per year). The incremental cost effectiveness ratio is 38 Australian dollars per additional heroin free day. From a treatment perspective, prison methadone is no more costly than community methadone, and provides benefits in terms of reduced heroin use in prisons, with associated reduction in morbidity and mortality.
Publisher: Wiley
Date: 09-2006
DOI: 10.1080/09595230600868512
Abstract: The value of hair analysis in measuring treatment outcome was examined in a randomised controlled trial (RCT) of an Australian state prison-based methadone programme between 1997 and 1998 (n = 382 male prisoners). Hair s les were analysed for morphine using immunoassay techniques. Agreement between hair analysis and self-report was tested using kappa, McNemar's test of symmetry and Pearson's correlation coefficient r. Hair analysis based on immunoassay was inadequate as the primary outcome measure for the RCT but had value in supplementing self-reported heroin use. There was a modest correlation (r = 0.31, p < 0.001) between self-reported frequency of heroin use and morphine concentrations in hair. Sectional hair analysis, a reflection of duration of drug use, was uninformative and generally impractical due to the length of hair sections needed.
Publisher: Wiley
Date: 29-12-2014
DOI: 10.1002/ALR.21471
Abstract: Inadvertent injury to the internal carotid artery (ICA), if poorly managed, not only presents a risk of exsanguination but can also result in significant long-term morbidity. Through the implementation of a novel animal model of endoscopic carotid artery injury (CAI), effective techniques to manage this scenario have been developed. The Vascular Injuries Workshop has trained over 110 surgeons in these techniques. This study reviews events of major arterial hemorrhage managed by surgeons who completed this vascular injury workshop training. We report a retrospective multicenter case series of patients who required endoscopic management of intranasal major arterial hemorrhage. Delegates who had attended the course were contacted by e-mail and surveyed with regard to instances of major arterial bleeding and the management undertaken. Patient demographics, tumor type, factors influencing injury, management technique, and outcomes were reviewed. The cases reported herein are characterized as follows: 9 cases are reported in total, 3 male, 6 female age range 37 to 82 years 1 basilar artery, and 8 ICA injuries. Each case was successfully managed endoscopically with intraoperative muscle patch application. There were no deaths, 1 case of pseudoaneurysm with successful endovascular treatment, 2 cases of impaired carotid flow, and 1 carotid dissection was conservatively managed. There were no permanent neurological sequelae or other permanent morbidity. The Vascular Injuries Workshop arms surgeons with a structured approach to managing the surgical field and provides effective hemostatic techniques in the face of impending catastrophe. In comparison to the existing literature on ICA rupture, our results show trained surgeons are well equipped to achieve safe outcomes for their patients.
Publisher: Springer Science and Business Media LLC
Date: 24-01-2006
Abstract: This study aimed to examine drug use, drug treatment history and risk behaviour among a s le of Iranian drug users seeking treatment through a general practice clinic in Iran. Review of medical records and an intake questionnaire at a large general practice in Marvdasht, Iran, with a special interest in drug dependence treatment. Records from a random s le of injecting drug users (IDU), non-injecting drug users (DU) and non-drug using patients were examined. 292 records were reviewed (34% IDU, 31% DU and 35% non-drug users). Eighty-three percent were males all females were non-drug users. The mean age of the s le was 30 years. Of the IDU s le, 67% reported sharing a needle or syringe, 19% of these had done so in prison. Of those who had ever used drugs, being 'tired' of drug use was the most common reason for seeking help (34%). Mean age of first drug use was 20 years. The first drugs most commonly used were opium (72%), heroin (13%) and hashish/ other cannabinoids (13%). Three quarters reported having previously attempted to cease their drug use. IDU were more likely than DU to report having ever been imprisoned (41% vs 7%) and 41% to have used drugs in prison. This study has shown that there is a need for general practice clinics in Iran to treat drug users including those who inject and that a substantial proportion of those who inject have shared needles and syringes, placing them at risk of BBVI such as HIV and hepatitis C. The expansion of services for drug users in Iran such as needle and syringe programs and pharmacotherapies are likely to be effective in reducing the harms associated with opium use and heroin injection.
Publisher: Springer Science and Business Media LLC
Date: 22-10-2010
Publisher: Emerald
Date: 21-12-2015
DOI: 10.1108/IJPH-09-2014-0030
Abstract: – Injecting drug use is a global concern, with an estimated 16 million people who inject drugs (PWIDs) in over 148 countries. A number of Asian countries detain PWIDs for compulsory treatment. The paper aims to discuss this issue. – The authors reviewed the literature on compulsory drug treatment in seven Asian countries. – The authors identified 1,269 closed settings which held over 600,000 drug users in eight countries. The average detainee was aged from 20 to 30 years and was predominantly male. HIV risk behaviour continued in detention in some countries. In most countries treatment comprised physical labour, military drills. Methadone maintenance treatment and antiretroviral therapy were rarely available. No data were located to show detention in a closed setting treated drug dependency. Issues of concern were no due legal process for the detention of drug users, lack of evidence-based drug treatment, lack of HIV prevention and treatment, abusive conditions, forced labour and exercise, arbitrary exit procedures and very high relapse rates. – The review of compulsory treatment of drug users failed to find any evaluation of effective drug treatment for detainees. Instead serious breaches in human rights conditions were evident. Prominent international organisations have called for the compulsory treatment of drug users to cease. – Many countries are spending vast amounts of funding on ineffective treatments for drug users. – Funding should be directed to community-based drug treatments that have been shown to work. – This is the largest review of compulsory treatment of drug users to date.
Publisher: Oxford University Press (OUP)
Date: 15-05-2004
DOI: 10.1086/383279
Publisher: Wiley
Date: 20-05-2005
DOI: 10.1111/J.1360-0443.2005.01050.X
Abstract: To examine the long-term impact of methadone maintenance treatment (MMT) on mortality, re-incarceration and hepatitis C seroconversion in imprisoned male heroin users. The study cohort comprised 382 imprisoned male heroin users who had participated in a randomized controlled trial of prison-based MMT in 1997/98. Subjects were followed-up between 1998 and 2002 either in the general community or in prison. All-cause mortality, re-incarceration, hepatitis C and HIV serostatus and MMT retention. There were no deaths recorded while subjects were enrolled in MMT. Seventeen subjects died while out of MMT, representing an untreated mortality rate of 2.0 per 100 person-years (95% CI, 1.2-3.2). Re-incarceration risk was lowest during MMT episodes of 8 months or longer (adjusted hazard ratio 0.3 (95% CI, 0.2-0.5 P < 0.001), although MMT periods 2 months or less were associated with greatest risk of re-incarceration (P < 0.001). Increased risk of hepatitis C seroconversion was significantly associated with prison sentences of less than 2 months [adjusted hazard ratio 20 (95% CI, 5-76 < P = 0.001)] and MMT episodes less than 5 months [adjusted hazard ratio 4.2 (95% CI, 1.4-12.6 P = 0.01)]. Subjects were at greatest risk of MMT dropout during short prison sentences of 1 month or less (adjusted hazard ratio 10.4 (95% CI, 7.0-15.7 P < 0.001). HIV incidence was 0.3 per 100 person-years (95% CI, 0.03-0.99). Retention in MMT was associated with reduced mortality, re-incarceration rates and hepatitis C infection. Prison-based MMT programmes are integral to the continuity of treatment needed to ensure optimal outcomes for in idual and public health.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.ADDBEH.2008.07.005
Abstract: This cross-sectional survey examined IDUs' understanding of HCV, their knowledge of virus transmission, clinical markers, symptoms and treatment. IDUs were recruited through and interviewed at a range of settings in inner-city, suburban and regional sites of New South Wales, Australia 149 IDUs were recruited. Recent HCV testing was reported by 74% of participants, but a number of IDUs were confused about the results of the various tests, e.g. 19% of participants who stated they had HCV believed they could not infect others or were immune. Significant gaps in IDUs' knowledge of HCV were uncovered with respect to transmission risks (48% believed HCV could be contracted from re-using one's own, unshared needle), symptoms and clinical markers (42% believed HCV antibodies gave protection against HCV infection), and treatment. Findings warrant further development of, and research into, strategies to improve IDUs' understanding of HCV.
Publisher: Wiley
Date: 07-1996
Publisher: Wiley
Date: 19-12-2002
DOI: 10.1046/J.1360-0443.2003.00266.X
Abstract: To examine the veracity of reports of a substantial decrease in the availability of heroin in Sydney in January 2001. Cross-sectional survey. Sydney, Australia. Forty-one injecting drug users (IDUs) and 10 key informants (KIs). Almost all IDUs (93%) reported that heroin was harder to obtain at the time of interview (mid-February 2001) than it was before Christmas 2000 and KIs concurred. IDUs (83%) and KIs (70%) also reported that the price of heroin had increased since Christmas, and that the purity of heroin had decreased (IDUs 73% KIs 80%). Almost all IDUs reported a reduction in their heroin use and a subsequent increase in other drug use, particularly cocaine, benzodiazepines and cannabis. Similar reports about IDUs came from nine of the 10 KIs. Over half the KIs reported an increase in both property and violent crime as a result of the heroin shortage. This crime was reportedly occurring mainly between heroin suppliers and/or IDUs. Reports from other Australian jurisdictions suggest that the shortage was not specific to Sydney. The reduction in the availability of heroin provides a unique opportunity to investigate the impact of supply reduction.
Publisher: Elsevier BV
Date: 2007
Publisher: Informa UK Limited
Date: 03-03-2016
Publisher: Wiley
Date: 04-1993
DOI: 10.1080/09595239300185561
Abstract: Syringe-exchange attenders (n = 86) and a comparison group of injectors not attending exchanges (n = 121) were recruited and interviewed in 1989 to examine HIV risk behaviour and HIV antibody status. In 1990, 59% of attenders and 50% of non-attenders were re-contacted and re-interviewed to examine changes over time. Re-interviewed subjects did not differ demographically or in drug use from those not re-interviewed. At first interview, all were injecting, and 35% of attenders and 42% of non-attenders reported recent syringe-sharing. One year later, levels of HIV-risk were similar for both groups, but risk reduction had been achieved by different routes. At Time 2, 16% of attenders were injecting and sharing (IS), 70% injecting and not sharing (INS), and 14% not injecting (NI), compared to non-attenders, 22% IS, 47% INS and 31% NI. Attenders were more likely to continue injecting (86%) with low sharing (18% of those still injecting). Non-attenders were less likely to continue injecting (69%), but continuing injectors had higher sharing rates (32% of those still injecting). More non-attenders than attenders stopped injecting, but non-attenders who continued to inject were at a higher risk of HIV infection than attenders who continued to inject. Baseline HIV prevalence was 2.5% and there were no sero conversions. The levels of sharing for both groups were lower than levels in the UK before HIV prevention programmes commenced and are lower than 1990 sharing rates in the USA. The study indicates the importance of tracking in idual change over time, and of measuring outcomes additional to changes in sharing.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2005
Publisher: Springer Science and Business Media LLC
Date: 15-06-2005
Publisher: Springer Science and Business Media LLC
Date: 19-01-2010
DOI: 10.1007/S10654-009-9421-0
Abstract: To determine hepatitis C incidence and the demographic and behavioural predictors in seronegative drug injecting prisoners. Prisoners in New South Wales, Australia who: were aged 18 years and over reported IDU had been continuously imprisoned had a documented negative HCV antibody test result in prison in the last 12 months provided written informed consent. Subjects were interviewed about their demographic characteristics and detailed risk factors for transmission prior to, and since, imprisonment. A blood s le was collected to screen for HCV antibodies by ELISA and RNA by PCR. Of 253 inmates recruited, 120 were continuously imprisoned and included in this analysis. Sixteen acquired HCV infection indicating an incidence of 34.2 per 100 person years (CI: 19.6-55.6). Risk factors for transmission included prior imprisonment, methadone treatment and greater than 10 years of education. Although the frequency of injecting was reduced in prison, 33.6% continued to inject drugs, most commonly meth hetamine, and 90% of these reported sharing injecting equipment. Prison inmates were at high risk of HCV infection, despite some reduction in high-risk behaviours and access to prevention services. To prevent HCV transmission in prisons, better prevention strategies are required.
Publisher: Public Library of Science (PLoS)
Date: 07-07-2014
Publisher: Oxford University Press (OUP)
Date: 2018
Publisher: Wiley
Date: 11-1988
DOI: 10.1111/J.1360-0443.1988.TB03033.X
Abstract: Community-acquired extended-spectrum beta-lactamase E coli (ESBLEC) have not been previously described in Honolulu. Its emergence as a community-acquired pathogen is concerning. This case series describes three patients who were diagnosed with community-acquired ESBLEC bacteriuria in 2010.
Publisher: Informa UK Limited
Date: 1989
DOI: 10.1080/09540128908260235
Abstract: The sexual behaviour of 142 clients of syringe-exchange schemes was measured using a questionnaire interview based survey method. Two to four months later the questionnaire was repeated to provide measures of behavioural change. The majority of these clients were sexually active, 77% having one or more sexual partners in the 3 months prior to the first interview. Many of these clients (46% of those sexually active) had sexual partners who did not inject drugs. There is evidence that this group modified their sexual behaviour towards reducing their own risk of HIV infection, with more having no sexual partners (from 23% to 31%), a reduction in those having multiple partners (from 26% to 21%) and a slight increase in those with regular partners (from 49% to 52%). Not all clients in this group reduced their risk of infection by modifying their sexual behaviour. Some clients continued to engage in high risk sexual behaviour, having multiple partners (21%) and not using condoms (79%). Whilst overall there is evidence of changes in the sexual behaviour of the clients towards a reduced risk of infection, we have identified an associated increase in risk of transmission from them to their sexual partners. Drug injectors who continued to have sexual partners were more likely to have sexual partners who did not inject drugs.
Publisher: Wiley
Date: 15-01-2003
DOI: 10.1046/J.1360-0443.2003.00309.X
Abstract: Journal publications and conference presentations on prison-based syringe exchange (PSE) programmes were identified by a comprehensive search of electronic databases. Experts involved with development and evaluation of current PSE programmes or policy were contacted for reports, documents and unpublished material. Spanish information on PSE was translated for this review. We identified 14 papers specifically on PSE programmes in Switzerland (six papers), Germany (four) and Spain (four). The first PSE programme started in 1992 in Switzerland. As of December 2000, seven PSEs were operating in Switzerland, seven in Germany and five in Spain. There have been six evaluations of prison syringe exchange programmes and all have been favourable. Reports of drug use decreased or remained stable over time. Reports of syringe sharing declined dramatically. No new cases of HIV, hepatitis B or hepatitis C transmission were reported. The evaluations found no reports of serious unintended negative events, such as initiation of injection or of the use of needles as weapons. Staff attitudes were generally positive but response rates to these surveys varied. Overall, this review indicated that prison syringe exchange programmes are feasible and do provide benefit in the reduction of risk behaviour and the transmission of blood-borne infection without any unintended negative consequences.
Publisher: Informa UK Limited
Date: 06-01-2003
No related grants have been discovered for Kate Dolan.