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Abstract
Background. A substantial decline of HIV prevalence has been observed in injection drug users (IDUs) from Rio de Janeiro, in recent years. Differential characteristics and behaviors of new (injecting for <6 years) and long-term (>=6 y) injectors may help to understand recent changes and to implement appropriate preven-tion strategies. Methods. Between October 1999 and December 2001, 609 active/ex-IDUs were recruited from different communities, interviewed, and tested for HIV. Contingency table analysis and t-tests were used to assess differences between new and long-term injectors. Multiple logistic regression was used to identify independent predictors of HIV serostatus for long-term and new injectors.
Results. HIV prevalence was 11.7% for 309 long-term injectors (95% CI 8.1–15.3) and 4.3% for 300 new injectors (95% CI 2.0–6.6). New injectors reported having engaged in treatment and having received syringes from needle exchange programs (NEPs) more frequently than long-term injectors in the last 6 months, but sharing behaviors remained frequent and even increased vis-à-vis long-term injectors. For male new injectors, “sexual intercourse with another man” was found to be the sole significant risk factor for HIV infection (Adj OR = 8.03; 95% CI 1.52–42.48). Among male long-term injectors, “to have ever injected with anyone infected with HIV” (Adj OR = 3.91; 95% CI 1.09–14.06) and to have “ever been in prison” (Adj OR = 2.56; 95% CI 1.05–6.24) were found to be significantly associated with HIV infection.
Discussion. New injectors are seeking help in drug treatment centers or needle exchange programs. They differ from long-term injectors in terms of their risk factors for HIV infection and have lower prevalence levels for HIV. Such differences may help to understand the recent dynamics of HIV/AIDS in this population and highlight the need to reinforce new injectors’ help-seeking behavior and to reduce current unacceptably high levels of unprotected sex and syringe sharing in new injectors despite attendance of prevention/treatment programs.
Resumen
Introducción. Se ha observado un descenso notable de la prevalencia del VIH en los usuarios de drogas inyectables (UDIs) de Río de Janeiro en los últimos años. Las características y los comportamientos específicos de los nuevos (uso de drogas inyectables <6 años) y antiguos (uso de drogas inyectables >=6 años) UDIs pueden ayudar a la comprensión de los recientes cambios y a la implementación de estrategias de prevención adecuadas. Métodos. Se han convocado, entrevistado y probado para el VIH, 609 ex-UDIs/UDIs en actividad de diferentes comunidades entre 10/1999 y 12/2001. Se han utilizado análisis de tables de contingencia y testes t para evaluar las diferencias entre los nuevos y antiguos UDIs. Se ha utilizado una regressión logística multivariada para identificar predictores de la infección por el VIH entre nuevos e antiguos UDIs. Resultados. La prevalencia para el VIH ha sido de 11.7% para los 309 antiguos UDIs (95%IC 8.1–15.3) y de 4.3% para los 300 nuevos UDIs (95%IC 2.0–6.6). Los nuevos UDIs han relatado estar bajo tratamiento y haber recibido jeringas en Programas de Cambio de Jeringas (PTS), en los últimos 6 meses, con mayor frecuencia que los antiguos, sin embargo el uso compartido de jeringas ha sido más frecuentemente relatado por los nuevos UDIs. Entre los nuevos UDIs del sexo masculino, se ha identificado la “relación sexual con otro varón” como el único factor de riesgo independiente para la infección por el VIH (AOR = 8.03; 95%IC 1.52–42.48). Entre los antiguos UDIs del sexo masculine “haberse inyectado con alguien infectado por el VIH” (AOR = 3.91; 95%IC 1.09–14.06) y “haber sido preso” (AOR = 2.56; 95%IC 1.05–6.24) se mostraran independientemente asociados a la infección por el VIH. Discusión. Los nuevos UDIs demandaran los centros de tratamiento para las drogas y PTS. Ellos difieren de los antiguos con relación a los factores de riesgo para la infección por el VIH e tienen niveles más bajos de prevalencia para el VIH. Esas diferencias ayudan a comprender la dinámica reciente del VIH/SIDA en ese grupo y apuntan para la necesidad de reforzar la búsqueda de tratamiento y de reducir los niveles elevados de sexo desprotegido y uso compartido de jeringas entre los nuevos UDIs, a pesar de su participación en programas de tratamiento y prevención.
Résumé
Introduction. La prevalence du VIH a diminue de facon important chez les utilisateurs de drogue par injection (UDI) de Rio de Janeiro depuis les dernieres annees. Les differences de characteristiques et de comportments a risque entre injecteurs recents (<6 annees de injection) et de longue date (>=6) peuvent aider a expliquer ces changements et a implementer des strategies de preventions adequates. Methodes. 609 UDI (ex/actifs) ont ete recrutes de different communautes, interviewes et testes pour le VIH entre entre octobre 1999 et decembre 2001. Des tableaux de contingeance et t-tests ont ete utilises pour comparer injecteurs recents et de longue date. Des analyses logistiques multivariees ont ete utilisees pour identifier des les facteurs de risque independement associe avec le statut VIH dans chaque groupe d’ injecteurs. Resultats. La prevalence du VIH etait de 11.7% (95% IC 8.1–15.3) pour les 309 injecteurs de longue date et 4.3% (95% IC 2.0–6.6) pour les 300 injecteurs recents. Les injecteurs recents rapportaients avoir commence des traitements et obtenu des seringues des programmes d’echange (PES) plus souvent que les injecteurs de longue date dans les derniers 6 mois, bien que leurs habitudes de partage soient demeurees frequentes, et meme augmentees comparativement aux injecteurs de longues dates. Chez les hommes, les relations sexuelles avec d’autres hommes etaient le seul facteur de risque associe avec le statut de VIH chez les injecteurs recents (ORaj = 8.03; 95% IC 1.52–42.48). Parmi les injecteurs de longue date, ≪avoir deja injecte arec un seropositif≫ (ORaj = 3.91; 95% IC: 1.09–14.06) et≪avoir deja ete en prison≫ (ORaj:2.56; 95% IC 1.05–6.24) etaient significativement associes avec le status de VIH. Discussion. Les injecteurs recents semblent chercher de 1’aide dans les centers de traitement d’UDI ou dans les PES. Leurs facteurs de risque sont differents de ceux des injecteurs de longue date et leur prevalence du VIH plus faible. Les differences entre injecteurs recents et de longue date peuvent aider a expliquer la recente dynamique du VIH/AIDS chez les UDI. Elles mettent egalement en evidence le besoin de favoriser les comportements de recherche d’aide afin de diminuer la frequence elevee de relations sexuelles nonprotegees et de partage de seringues parmi les injecteurs recents, meme parmi ceux participant aux programmes de prevention et traitement.
Resumo
Introdução. Um declínio substancial da prevalência do HIV vem sendo observado em usuários de drogas injetáveis (UDI) do Rio de Janeiro nos últimos anos. As características e os comportamentos específicos de novos (uso de drogas injetáveis <6 anos) e antigos (uso de drogas injetáveis >=6 anos) UDIs podem ajudar a entender as recentes mudanças e a implementar estratégias de prevenção apropriadas. Métodos. Entre 10/1999 e 12/2001, 609 ex-UDIs/UDIs em atividade foram recrutados de diferentes comunidades, entrevistados e testados para o HIV. Análises de tabelas de contingência e testes t foram utilizados para avaliar as diferenças entre novos e antigos UDIs. A regressão logistica multivariada foi utilizada para identificar preditores da infecção pelo HIV entre novos e antigos UDIs. Resultados. A prevalência de HIV foi de 11.7% para os 309 antigos UDIs (95%IC 8.1–15.3) e 4.3% para os 300 novos UDIs (95%IC 2.0–6.6). Os novos UDIs relataram engajamento em tratamento e terem recebido seringas em Programas de Trocas de Seringas (PTS), nos últimos 6 meses, com maior freqüência do que os antigos, porém o compartilhamento de seringas foi mais freqüentemente relatado pelos novos UDIs. Para os novos UDIs masculinos a “relação sexual com outro homem” foi identificada como o único fator independente de risco para a infecção pelo HIV (AOR = 8.03; 95%IC 1.52–42.48). Entre os antigos UDIs masculinos “ter injetado com alguém infectado pelo HIV” (AOR = 3.91; 95%IC 1.09–14.06) e “ter sido preso” (AOR = 2.56; 95%IC 1.05–6.24) se mostraram independentemente associados à infecção pelo HIV. Discussão. Os novos UDIs demandaram os centros de tratamento para drogas e PTS. Eles diferem dos antigos em relação aos fatores de risco para a infecção pelo HIV e apresentam níveis mais baixos de prevalência para o HIV. Estas diferenças ajudam a compreender a dinâmica recente do HIV/AIDS nesta população e apontam para a necessidade de reforçar a procura por tratamento e reduzir os níveis elevados de sexo desprotegido e compratilhamento de seringas entre os novos UDIs, a despeito de sua participação em programas de tratamento e prevenção.
Additional information
Notes on contributors
Mariana A. Hacker
Mariana A. Hacker, MPH, (Brazil) graduated in statistics in 2000, taking additional courses in physics. She joined Oswaldo Cruz Foundation (FIOCRUZ) Health Information Department (DIS-CICT) as a trainee in June 2000 and applied in the same year for the FIOCRUZ MPH course. She started her MPH course in 2001, working as a statistician of the WHO Drug Injection Study Phase II. The present article is part of her dissertation. Francisco I. Bastos, local coordinator of the WHO Study, was her dissertation advisor. Both have been working on such database in cooperation with the other Brazilian co-authors and with Sam Friedman, senior researcher, from New York. Currently, the DIS-CICT/FIOCRUZ team has been dedicated to the analysis of Brazilian major databanks in the field of HIV/AIDS, in cooperation with the Imperial College, UK, profiting also from a formative grant from NIH, USA.
Samuel R. Friedman
Samuel R. Friedman, Ph.D., (USA) is a Senior Research Fellow and the Director of the Social Theory Core in the Center for Drug Use and HIV Research at National Development and Research Institutes, Inc., New York City. Dr. Friedman is an author of over 300 publications on HIV, STI, and drug use epidemiology and prevention. His substantive areas of expertise include sociobehavioral science, social epidemiology, HIV interventions, and drug users’ organizations.
Paulo Roberto Telles
Paulo Roberto Telles, M.D., Ph.D., (Brazil) is Head of the Rio de Janeiro Harm Reduction Project, State University of Rio de Janeiro. Dr. Telles is a clinical psychiatrist and epidemiologist, with a Ph.D. in Biomedical Engineering. His dissertation assessed HIV spread in different Brazilian regions, using spatial-temporal modeling.
Sylvia Lopes Teixeira
Sylvia Lopes Teixeira, M.Sc., (Brazil) received her M.Sc. in Molecular Biology in 2002 and is currently a Ph.D. student at the Oswaldo Cruz Foundation. Her main areas of interest are HIV diversity and resistance to antiretroviral medicines. Her former M.Sc. dissertation, advised by Mariza G. Morgado and Francisco I. Bastos, received an award delivered by the Rio de Janeiro Research Council.
Vera Bongertz
Vera Bongertz, Ph.D., (Brazil) is a senior researcher at the Laboratory of AIDS and Molecular Immunology, Department of Immunology, Oswaldo Cruz Foundation. She has published extensively on neutralizing antibodies, HIV diversity, and the immunology of mother-to-child transmission of HIV.
Mariza G. Morgado
Mariza G. Morgado, Ph.D., (Brazil) is the Head of the Laboratory of AIDS and Molecular Immunology, Department of Immunology, Oswaldo Cruz Foundation. She has published extensively in the field of HIV diversity, resistance to antiretroviral medicines, and coinfections. She is currently a member of the Brazilian AIDS Advisory Board and the Brazilian AIDS Vaccines Taskforce.
Francisco Inácio Bastos
Francisco Inácio Bastos, M.D. Ph.D., (Brazil) is a senior researcher at the Department of Health Information, Oswaldo Cruz Foundation Dr. Bastos is an author of over 100 papers and book chapters on the epidemiology and prevention of HIV, blood-borne infections, and drug use. He has also been working as an editor of books and supplements, including a special issue of the Brazilian journal Cadernos de Saúde Pública on HIV/AIDS epidemiology and two special issues of International Journal of Drug Policy, the latter a comprehensive assessment of needle exchange programs worldwide.