Detection of hepatitis C virus in the nasal secretions of an intranasal drug-user

BACKGROUND: One controversial source of infection for hepatitis C virus (HCV) involves the sharing of contaminated implements, such as straws or spoons, used to nasally inhale cocaine and other powdered drugs. An essential precondition for this mode of transmission is the presence of HCV in the nasal secretions of intranasal drug users. METHODS: Blood and nasal secretion samples were collected from five plasma-positive chronic intranasal drug users and tested for HCV RNA using RT-PCR. RESULTS: HCV was detected in all five blood samples and in the nasal secretions of the subject with the highest serum viral load. CONCLUSIONS: This study is the first to demonstrate the presence of HCV in nasal secretions. This finding has implications for potential transmission of HCV through contact with contaminated nasal secretions

What's in a name ? La construction sociale du risque du sida chez les consommateurs de drogue à Harlem

What's in a Name ?La construction sociale du risque du sidachez les consommateurs de drogue à HarlemCet essai trace l'histoire de vie de cinq personnes vivant à Harlem, une communauté appauvrie caractérisée par des taux élevés d'usage de drogue et de prévalence du VIH/sida ; ces personnes s'injectent toutes de la drogue par voie intraveineuse. Chaque portrait tente de documenter la façon dont est perçu le risque de l'infection par le VIH relativement à d'autres sortes de danger, ainsi que la manière dont ce risque est géré face à d'autres types de besoin. L'article explore la signification de ces correspondances, les situe dans le tissu social global de la communauté, notamment par rapport à la pauvreté, et en étudie les conséquences pour l'intervention en matière de sida.What's in a Name ?The Social Construction of Riskfor AIDS in the Moral Imaginationof IV Drug Users in HarlemThis essay profiles the life stories of five individuals from Harlem in New York City, an impoverished community with high levels of drug use and HIV seroprevalence. AU are intravenous drug users, and each profile is concerned with documenting the way in which risk for HIV infection is perceived relative to other kinds of dangers, as well as the way it is managed relative to other kinds of needs. The paper explores the significance of thèse correspondences, locales thèse ideas within the larger social fabric of the community, particularly as they relate to poverty, and explores the implications of thèse correspondences for AIDS intervention

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

During the past year, a group has argued that unsafe injections are a major if not the main mode of HIV-1 transmission\ud in sub-Saharan Africa. We review the main arguments used to question the epidemiological interpretations on the lead\ud role of unsafe sex in HIV-1 transmission, and conclude there is no compelling evidence that unsafe injections are a\ud predominant mode of HIV-1 transmission in sub-Saharan Africa. Conversely, though there is a clear need to eliminate\ud all unsafe injections, epidemiological evidence indicates that sexual transmission continues to be by far the major\ud mode of spread of HIV-1 in the region. Increased efforts are needed to reduce sexual transmission of HIV-1

Prevalence and temporal trends of crack injection among injection drug users in eastern central Canada

Background: Little is known about crack injection and its temporal trends in North America. This article describes the extent of crack injection and examines temporal trends among injection drug users (IDUs) recruited from 2003 to 2010 in the SurvUDI network. Methods: IDUs who injected recently (past 6 months) were recruited in harm reduction and health programs in eastern central Canada. Trend analyses were performed using generalized estimating equations. Some IDUs participated multiple times; first interview was retained for the descriptive analyses, while first interview per year was retained for the trend analyses. Results: Of the 4088 IDUs recruited, 15.2% (621) reported crack injection; large variations across sites were noted (range: 0.3%-39.5%). Trend analyses were limited to Ottawa (449 crack injectors) and Montréal (121). For Ottawa, a significant decline was observed, from 48.3% to 36.9%, with a prevalence ratio (PR) of 0.97 per year (95%CI: 0.94-0.99). For Montréal, a significant rise was observed, from 6.0% to 18.4%, with a PR of 1.29 per year (95%CI: 1.19-1.40). Conclusions: Strong variations in crack injection exist throughout the SurvUDI network, and reversed temporal trends have been observed in Ottawa and Montréal. These data will be useful to local harm reduction programs to evaluate the need to distribute items required by crack injectors and to develop prevention messages

Methamphetamine Use among Newly Diagnosed HIV-Positive Young Men in North Carolina, United States, from 2000 to 2005

Methamphetamine (MA) is a new arrival to the Southeastern United States (US). Incidence of HIV is also increasing regionally, but data are limited regarding any association between this trend and MA use. We examined behavioral data from North Carolina (NC) residents newly diagnosed with HIV, collected by the Department of Health between 2000-2005.Among 1,460 newly diagnosed HIV-positive young men, an increasing trend was seen from 2000-2005 in MA use (p = 0.01, total n = 20). In bivariate analyses, users of MA had significantly greater odds of reporting other substance use, including alcohol, powder or crack cocaine, marijuana, and methylenedioxymethamphetamine (MDMA, "ecstasy"). They were also more likely to have reported sexual activity while traveling outside NC; sex with anonymous partners; and previous HIV testing. In a predictive model, MA use had a negative association with nonwhite race, and strong positive associations with powder cocaine, "ecstasy," or intravenous drug use and being a university student.Similar to trends seen in more urban parts of the US, MA use among newly diagnosed, HIV-positive young men is increasing in NC. These data are among the first to demonstrate this relationship in a region with a burgeoning epidemic of MA use. Opportunities exist for MA-related HIV risk-reduction interventions whenever young men intersect the healthcare system

Treatment of Hepatitis C as Prevention: A Modeling Case Study in Vietnam

Background: Treatment of hepatitis C (HCV) is very effective, achieving a cure in 50–90 % of patients. Besides its own good for individuals, this most likely translates in reduced transmission, but this phenomenon has yet to be fully explored. Methods and Findings: In this mathematical modeling study done in the context of Vietnam, we estimated the public health benefit that HCV therapy for injecting drug users (IDUs) may achieve. Treatment coverage of 25, 50 and 75 % of chronically HCV-infected IDUs (4 years into infection) is predicted to reduce the chronic HCV viremia prevalence respectively by 21, 37 and 50%, 11 years after full scale up to the intended coverage. At a constant 50 % coverage level, earlier treatment, 3, 2, and 1 year into infection is predicted to reduce the chronic HCV viremia prevalence by 46, 60 and 85%. In these later 3 scenarios, for every 100 treatment courses provided, a total of respectively 50, 61 and 94 new infections could be averted. These benefits were projected in the context of current low coverage of methadone maintenance therapy and needles/ syringes exchange programs, and these services expansion showed complementary preventive benefits to HCV therapy. The program treatment commitment associated with the various scenarios is deemed reasonable. Our model projections are robust under adjustment for uncertainty in the model parameter values. Conclusions: In this case study in Vietnam, we project that treatment of HCV for injecting drug users will have a preventative herd effect in addition to curing patients in need for therapy, achieving a substantial reduction in HCV transmission an