HIV/AIDS, hepatitis and sexually-transmitted infection prevention among Egyptian substance users

This thesis explores cultural influences in high-risk behaviour among Egyptian substance users in the Middle Eastern, conservative, male-dominated and predominantly Muslim society in which they live. It investigates why they practice unprotected sex despite the risk of infection by blood-borne viruses (BBVs) and sexually-transmitted infections (STIs), and the factors influencing their risk practices. The study seeks to inform policy and to improve methods of preventing BBVs/STIs among Egyptian substance users, particularly through health/sex education in peer groups and schools and through the media, civil society organisations and the criminal justice system. Data was collected via a questionnaire surveying the knowledge, attitudes and practices (KAP) of 410 substance users. Responses were compared according to the gender, age and education of the respondents and whether they took their drugs via intravenous injection. Four focus group discussions were held with twenty-four substance users, including female commercial sex workers (FCSWs), men who have sex with men (MSM), intravenous drug users (IVDUs), and people living with HIV (PLHIV), as well as in-depth interviews with fourteen policymakers. Most respondents had little or moderate knowledge about the hepatitis C and/or B viruses and little knowledge about HIV or its association with sex and drug injection. Knowledge about risky sexual behaviour connected with BBV/STI infection among substance users was low. The respondents’ attitudes and practices regarding sex and intravenous drug use indicated that they were at high risk of infection. They had negative attitudes towards PLHIV, towards each other in the substance-user population and towards other overlapping subgroups of most-at-risk populations (MARPs), i.e. FCSWs, MSM and IVDUs. Respondents with higher education and older people were found to have greater knowledge of safer sex practices. Males and IVDUs had significantly higher scores for KAP regarding IV drug use than females and non-IVDUs. The females’ KAP regarding safe sex tended to be better than that of the males. Stigma, gender and religion had a significant influence on substance use and sexual behaviour. These three factors embedded in the culture form a taboo about drugs and sex, impair substance users’ quality of life and deprive them, especially the females, of their rights, including the rights to education, employment, medical treatment, marriage and children. These factors also affect the substance users’ families, the judiciary system, healthcare institutions and society at large. HIV-related stigmatisation was greater than that for other BBVs/STIs. HIV-related stigmatisation with regard to infection via gay sex was greater than that due to heterosexual sex or IV drug use. The media potentiates the stigmatisation of substance users and PLHIV by showing negatives images of these groups, causing them to suffer strongly from public shaming, desertion, seclusion, imprisonment and unemployment. Recovery is harder for female than for male substance users due to the harsher stigmatisation. Religion plays a pivotal role in Egyptians’ lives, and most of the participants were fatalists. The participants said that they would prefer the following preventive interventions: a) sex education programmes to be introduced in drug rehabilitation programmes, police stations and prisons; b) the launch of opioid substitution therapy programmes in drug detoxification centres; c) police referral of arrested active substance users to drug detoxification and rehabilitation centres; d) a free rehabilitation service for poor and illiterate substance users; e) a greater number of wide-ranging rehabilitation programmes for MARPs

Assessment of Knowledge, Attitude, and Practice of Risky Sexual Behavior Leading to HIV and Sexually Transmitted Infections among Egyptian Substance Abusers: A Cross-Sectional Study

Background. Rapidly growing youth population with changing sexual trend in Egypt raised HIV potential. The aim of this study is to assess knowledge, attitude, and practice regarding unsafe sexual behavior among Egyptian drug abusers. Methods. This cross-sectional study was conducted in 2008 in the Freedom Drugs and HIV Program on 410 drug abusers in Egypt. Included respondents were subanalyzed by gender, age, education, and intravenous drug usage. Results. KAP average scores on safe sexual behavior were low compared to the maximum possible denoting low awareness and action of drug addicts towards avoidance of infection. Respondents with higher education had significantly better knowledge about safe sexual behavior. Significant positive correlation was shown between age and knowledge of safe sexual behavior. Older age groups were predicted to know more about safe sex, while gender; educational level and intravenous drug usage were not. Similarly, females and intravenous drug users were predicted to have higher attitude for safe sex while age and educational level did not. Conclusion. KAP of safe sexual behavior were low among drug addicts in Egypt increasing potential towards infection with STDs including HIV. The more the age and education level, the better the knowledge towards safe sexual behavior

Cross-Sectional Comparison of Behavioral Risk Factors for HIV/HCV in People Who Inject Drugs (PWID) in Egypt

Background Egypt has the greatest HCV prevalence worldwide at 15% and a concentrated HIV epidemic in male people who inject drugs (PWID) at 6.8%, who are at a high risk for HCV infection as well. Injection drug use is criminalized in Egypt, and there is limited availability of harm reduction programs. Drug-use and sexual risk behaviors between PWID and the general population have not been studied there. Methods To address this gap, a cross-sectional HIV/HCV epidemiological study of 632 consenting injection drug users in Cairo and Alexandria was conducted. Bivariate logistic regression analysis was done to evaluate the associations between HIV/HCV and needle sharing or sexual practices using SAS 9.4. Results 10.6% (63/ 604) of the study population tested positive for HIV and 61.5% (384/624) tested positive for HCV. Sharing needles with more than 10 people was associated with HIV and HCV infection (OR=3.65, p-val=0.001; OR=2.05, p-val=0.02, respectably). Age was associated with both HIV and HCV (p-val=0.03 and Conclusions The results indicate that the growing epidemic among PWID in Egypt may place the general population at risk for HIV and HCV primarily through sexual contact. In Russia, repressive policies toward PWID allowed HIV to spread to the general population at the start of the epidemic in 2000. Now, 48% of HIV is heterosexually transmitted in Russia and the country contributes \u3e80% of the HIV cases in Eastern Europe and Central Asia. In response to the epidemic, even more punitive laws and regulations were introduced in Russia, and their HIV prevalence has seen a 49% increase between 2005 and 2015. A similar trajectory can be expected for Egypt if preventative measures are not taken. Common-sense harm reduction programs like clean needle exchanges and decriminalization of injection drug use should be part of a comprehensive plan to control the spread of HIV and HCV in Egypt

Assessment of Knowledge, Attitude, and Practice of Risky Sexual Behavior Leading to HIV and Sexually Transmitted Infections among Egyptian Substance Abusers: A Cross-Sectional Study

Background. Rapidly growing youth population with changing sexual trend in Egypt raised HIV potential. The aim of this study is to assess knowledge, attitude, and practice regarding unsafe sexual behavior among Egyptian drug abusers. Methods. This crosssectional study was conducted in 2008 in the Freedom Drugs and HIV Program on 410 drug abusers in Egypt. Included respondents were subanalyzed by gender, age, education, and intravenous drug usage. Results. KAP average scores on safe sexual behavior were low compared to the maximum possible denoting low awareness and action of drug addicts towards avoidance of infection. Respondents with higher education had significantly better knowledge about safe sexual behavior. Significant positive correlation was shown between age and knowledge of safe sexual behavior. Older age groups were predicted to know more about safe sex, while gender; educational level and intravenous drug usage were not. Similarly, females and intravenous drug users were predicted to have higher attitude for safe sex while age and educational level did not. Conclusion. KAP of safe sexual behavior were low among drug addicts in Egypt increasing potential towards infection with STDs including HIV. The more the age and education level, the better the knowledge towards safe sexual behavior

Association of sociodemographic factors with needle sharing and number of sex partners among people who inject drugs in Egypt

People who inject drugs (PWID) are at a high risk for HIV. We conducted an evaluation of socio-demographic factors associated with injecting and sexual behaviour among PWID who had two or more visits at a drug outreach clinic in Cairo, Egypt from 2013 to 2017. Routinely collected information on socio-demographics and HIV risk behaviours were abstracted from client records. Bivariate analysis and logistic regression were conducted to evaluate associations between socio-demographics and HIV risk factors. All PWID who tested HIV-positive at the initial visit were excluded from analyses. PWID who were married were more likely to share needles or syringes in the last month of their baseline visit [adjusted odds ratio (aOR) = 4.3, 95% confidence interval (CI) = 1.4-13.1] as were unemployed PWID [aOR = 3.9, 95% CI = 1.5-10.3]. Married PWID were less likely to discontinue sharing needles/syringes [aOR = 0.4, 95% CI = 0.2-0.8] as were those living outside of the Shobra, downtown, and Imbabah districts within Greater Cairo [aOR = 0.2, 95% CI = 0.1-0.5]. No significant associations were found between socio-demographics and number of sex partners in the six months prior to the initial visit. At follow-up visit, 4.4% tested HIV-positive for an incidence rate of 3.9 per 100 person years. Sociodemographic factors should be considered when designing preventive services for PWID