Experiences of and attitudes towards injecting drug use among marginalised African migrant and refugee youth in Melbourne, Australia

Little is known about injecting drug use (IDU) among people from culturally and linguistically diverse backgrounds in Australia. We interviewed 18 young people of African ethnicity (6 current/former injectors, 12 never injectors) about exposure and attitudes to IDU. Exposure to IDU was common, with IDU characterised as unnatural, risky and immoral. IDU was highly stigmatised and hidden from family and friends. There is a need for culturally appropriate programs to promote open dialogue about substance use, in order to reduce stigma and prevent African youth who may use illicit drugs from becoming further marginalised

Self-reported recent testing and diagnosis for sexually transmitted infections among regular ecstasy users in Australia, 2011–2012

Background: Previous studies suggest that people who consume alcohol and drugs are at increased risk of sexually transmitted infections (STI). We examined the prevalence and predictors of self-reported STI testing and diagnosis among self-reported regular ecstasy users (REU). Methods: Nine hundred and fifty-five REUs from the 2011 and 2012 Ecstasy and Related Drugs Reporting System were included in the analysis. Bivariate and multivariate Poisson regression were used to identify predictors of recent STI testing, and logistic regression was used to identify predictors of recent STI diagnosis. Results: Forty-four per cent of REUs reported having a recent STI test, and 5% reported a recent diagnosis. Of the 421 REUs who reported a recent test, 10% reported a recent STI diagnosis. In multivariate analysis, REUs were more likely to report a recent STI test if they were female versus male [risk ratio (RR) = 1.56; 95% confidence interval (CI) = 1.36-1.80], aged 25–29 years versus 16–19 years (RR = 1.34; 95% CI = 1.05-1.72), or reported ≥2 casual sex partners versus no casual partners (RR = 1.48; 95% CI = 1.01–2.14). REUs reporting cannabis use in the past six months were 0.78 times less likely to report a recent STI test (95% CI = 0.66-0.94).There were no significant predictors associated with STI diagnosis. Conclusion: Encouragingly, REUs who reported having multiple casual partners in the past six months were more likely to report a recent test. However, younger REUs aged 16–19 years were least likely to test, suggesting health promotion needs to be directed to this age group. Further research is required to explain the lower testing among cannabis users

Age-related differences in patterns of criminal activity among a large sample of polydrug injectors in Australia

Background: The relationship between age and criminal activity among drug-using populations is poorly understood. Methods: Data from 10 years of repeat cross-sectional surveys of sentinel samples of regular people who inject drugs (PWID) across Australia (n=5844) were used to explore the relationship between age and past-month drug dealing, property crime and violent crime, and past-year arrest. Descriptive statistics were used to explore the prevalence and frequency of each outcome. The relationship between age and each outcome was measured using multivariable Poisson regression with robust error variance. Results: After adjusting for confounding factors, each 5-year increase in age was associated with significant reductions in drug dealing (adjusted incidence rate ratio [AIRR]: 0.90, 95% confidence interval [CI]: 0.87–0.94), property crime (AIRR: 0.85, 95% CI: 0.82–0.89) and violent crime (AIRR: 0.77, 95% CI: 0.70–0.85). Older participants were also significantly less likely to report being arrested in the past 12 months (AIRR: 0.91, 95% CI: 0.88–0.93). Conclusions: Younger PWID are more heavily involved in criminal activity compared with their older counterparts. This study highlights the need for early intervention programmes to prevent offending behaviour becoming entrenched, as well as continued efforts to redirect young PWID away from the criminal justice system and into treatment and education programmes

The Relationship between Initial Route of Heroin Administration and Speed of Transition to Daily Heroin Use

INTRODUCTION AND AIMS: The effect of heroin administration route on speed of transition to regular use is unknown. This paper aims to determine whether the speed of transition from initiation of heroin use to daily heroin use differs by route of administration (injecting, chasing/inhaling or snorting). DESIGN AND METHODS: Privileged access interviewer survey of purposively selected sample of 395 current people who use heroin (both in and not in treatment) in London, UK (historical sample from 1991). Data on age and year of initiation, time from initiation to daily use and routes of administration were collected by means of a structured questionnaire. Generalised ordered logistic models were used to test the relationship between route of initial administration of heroin and speed of transition to daily heroin use. Analyses were adjusted for gender, ethnicity, daily use of other drug(s) at time of initiation, year of initiation and treatment status at interview. RESULTS: After adjustment, participants whose initial administration route was injecting had a 4.71 (95% confidence interval 1.34-16.5) increase in likelihood of progressing to daily use within 1-3 weeks of initiation, compared to those whose initial administration route was non-injecting. DISCUSSION AND CONCLUSIONS: The speed of transition from first use to daily heroin use is faster if the individual injects heroin at initiation of use. Those who initiate heroin use through injecting have a shorter time frame for intervention before drug use escalation. [Hines LA, Lynskey M, Morley KI, Griffiths P, Gossop M, Powis B, Strang J. The relationship between initial route of heroin administration and speed of transition to daily heroin use. Drug Alcohol Rev 2017;00:000-000]

High Burden of Prevalent and Recently Acquired HIV among Female Sex Workers and Female HIV Voluntary Testing Center Clients in Kigali, Rwanda

Objectives: To estimate HIV prevalence and risk factors in population-based samples of female sex workers (FSW) and female voluntary counseling and testing (VCT) clients in Rwanda. Methods: We conducted a cross-sectional survey of 800 FSW and 1,250 female VCT clients in Rwanda, which included interviewing and testing for HIV-1/2, HSV-2 and pregnancy, and BED-CEIA and Avidity Index (AI) to identify recent infections among HIV-infected women. Results: Prevalence of HIV-1, HSV-2, and pregnancy were 24% (95% CI: 21.0-27.0), 59.8% (56.4-63.2), and 7.6% (5.8-9.5) among FSW, and 12.8% (10.9-14.6), 43.2% (40.4-46.0), and 11.4% (9.7-13.3) among VCT clients, respectively. Thirty-five percent of FSW and 25% of VCT clients had never been HIV tested. Per national guidelines, 33% of newly HIV-diagnosed FSW and 36% of VCT clients were already eligible for ART based on CD4,350 cells/ml. Condom use at last sex was higher among FSW (74%) than VCT clients (12%). In age and district of residence-adjusted models, HIV-1 seropositivity was associated with HSV-2 co-infection; recent treatment for sexually transmitted infection (STI); genital symptoms; forced sex; imprisonment; widowhood; and alcohol consumption. Eleven percent of FSW and 12% of VCT clients had recently acquired HIV-1 per BED-CEIA and AI. HSV-2 infection and recent STI treatment were associated with recent HIV infection in both groups, and being married and vaginal cleansing were associated with recent infection before last sex among VCT clients. Conclusions: This population-based survey reveals a high HIV prevalence and incidence among FSW and female VCT clients in Kigali, the scale of which is masked by the low general-population HIV prevalence in Rwanda. HIV/STI and family planning services should be strengthene

Gamma hydroxybutyrate (GHB), gamma butyrolactone (GBL) and 1,4 butanediol (1,4-BD; BDO) : a literature review with a focus on UK fatalities related to non-medical use

Misuse of gamma hydroxybutrate (GHB) and gamma butyrolactone (GBL) has increased greatly since the early 1990s, being implicated in a rising number of deaths. This paper reviews knowledge on GHB and derivatives, and explores the largest series of deaths associated with their non-medical use. Descriptive analyses of cases associated with GHB/GBL and 1,4 butanediol (1,4-BD) use extracted from the UK’s National Programme on Substance Abuse Deaths database. From 1995 to September 2013, 159 GHB/GBL-associated fatalities were reported. Typical victims: White (92%), young (mean age 32 years); male (82%); with a drug misuse history (70%). Most deaths (79%) were accidental or related to drug use, the remainder (potential) suicides. GHB/GBL alone was implicated in 37%; alcohol 14%; other drugs 28%; other drugs and alcohol 15%. Its endogenous nature and rapid elimination limit toxicological detection. Post-mortem blood levels: mean 482 (range 0 - 6500; S.D. 758) mg/L. Results suggest significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, opiates, stimulants, and ketamine. More awareness is needed about risks associated with consumption.Peer reviewe