To study the prevalence of sexual risk behaviour and to identify factors associated with inconsistent condom use of Finnish injecting drug users (IDUs), and thus to examine the potential of sexual transmission of HIV within and from this population.
HIV-positive (n = 89) and HIV-negative (n = 207) IDUs from the Helsinki metropolitan area were interviewed using a standardized questionnaire. Determinants of inconsistent condom use in the past 6 months were analyzed with logistic regression.
Inconsistent condom use was reported by 63% (39) of HIV-positive and 80% (144) of HIV-negative sexually active IDUs. Unprotected sex was more common in steady relationships (OR 5.6, CI 2.4-13.4). Inconsistent condom use was also associated with recent inpatient addiction treatment especially in the HIV-positive group (OR 15.7, 95% CI 1.7-143.0). Inpatient or outpatient addiction treatment was reported by 72% of the participants. Inconsistent condom use was not associated with age, gender, drug use frequency or markers of marginalization (unstable living, unemployment).
Inconsistent condom use allows for the spread of HIV and other sexually transmitted infections among Finnish IDUs. Addiction treatment programmes should include interventions focused on sexual behaviour to all of their clients. Partners of IDUs should be actively offered HIV counselling and testing.
[Show abstract][Hide abstract] ABSTRACT: Injecting use of heroin has been the highest risk substance use behavior for HIV since the beginning of the pandemic. These risks extend beyond individual levels to networks of drugs users and to wider social contexts that have been referred to collectively as the risk environment. Investigations of individual, network, and risk environment level associations with heroin availability, use, and subsequent spread among injecting drug users (IDUs) have been conducted in multiple settings, but much less is known about the world's center of illicit opium production and heroin exports-Afghanistan. Recent outbreaks of injecting drug use and of HIV infection attributed to IDUs in several African countries suggest that heroin use is expanding into new regions. This article explores the epidemiology of HIV among drug users in several risk environments, the epidemiology of heroin and its associations with HIV outbreaks among IDUs in Central Asia and the Commonwealth of Independent States, and the drug use and IDUs outbreaks now emerging in Africa. The dearth of targeted, evidence-and human rights-based responses to these epidemics is explored as a structural driver of HIV spread in these settings.
[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence of parvovirus 4 infection and its clinical and sociodemographic correlations in Finland, we used virus-like particle-based serodiagnostic procedures (immunoglobulin [Ig] G, IgM, and IgG avidity) and PCR. We found 2 persons with parvovirus 4 primary infection who had mild or asymptomatic clinical features among hepatitis C virus-infected injection drug users.
[Show abstract][Hide abstract] ABSTRACT: We set out to identify factors associated with unprotected sex among HIV-positive patients on methadone maintenance therapy (MMT) in China.
We conducted a cross-sectional study in 60 MMT clinics in Yunnan, Sichuan, Guizhou, Guangxi, and Xinjiang provinces, China, with a total of 2742 participants.
The median age of participants was 35 years (range, 19-63 years), and 78.3% were male. More than half (1471/2742; 53.6%) were married, 6.4% (176/2742) had a regular sex partner, and 3.5% (95/2742) had 1 or more occasional sex partners. Among married participants, 64.6% (950/1471) had a spouse who was HIV negative or of unknown HIV status. Among them, 62.8% (597/950) reported sex in the past 30 days, and 31.0% (185/597) reported unprotected sex in the past 30 days. Multivariate logistic regression identified 3 factors associated with an increased risk of unprotected sex: receiving MMT in Guangxi (odds ratio [OR], 3.72 [2.05-6.75]; P < 0.001) or Xinjiang (OR, 2.23 [1.33-3.73]; P < 0.01), having a spouse that is a current or former drug user (OR, 1.80 [1.12-2.90]; P < 0.05), and having dropped out of MMT in the past 6 months (OR, 3.05 [1.63-5.71]; P < 0.001); it also identified 2 factors associated with a decreased risk of unprotected sex: being male (OR, 0.46 [0.26-0.79]; P < 0.01) and being aware of one's own HIV serostatus (OR, 0.16 [0.10-0.27]; P < 0.001).
Many HIV-positive opioid-dependent individuals attending MMT continue to engage in high-risk sexual behaviors. Future efforts should focus on increasing awareness of HIV serostatus, retaining patients in MMT, and addressing the specific needs of female patients on MMT.
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