Rapid spread of HIV among injecting drug users in north-eastern states of India

Manipur, a north-eastern state of India bordering Myanmar, has experienced very rapid transmission of the human immunodeficiency virus (HIV) among its vast drug-injecting population. Seroprevalence among intravenous drug users increased from 0 per cent in September 1989 to 50 per cent within six months. With a minimum injecting population of 15,000 and seropositivity of over 50 per cent, the infection quickly spread to the population at large. One per cent of antenatal mothers tested seropositive by 1991. Forming part of the area of South-East Asia known as the Golden Triangle, and producing opium and its derivatives, Myanmar shares a long international border with four States of the region, and populations with a common language and culture move freely across borders. Two other north-eastern states of India bordering Myanmar have faced a similar epidemic within a short period of time. As a result of serosurveillance for HIV since 1986, the epidemic could be detected at an early stage. The present paper provides an account of the results of ongoing comprehensive studies conducted in the north-eastern states of India on drug-related HIV infection, already a serious problem, but possibly still restricted to that region of the country. The prevalence of intravenous drug users, their HIV serological status, the demographic profile, risk behaviour, the spread of the infection to other groups and the problems of harm minimization are also covered.     

HIV/AIDS-related behavior change among injecting drug users in different national settings

1. The ability of airway epithelial cells to produce insulin-like growth factor I may be important in the pathogenesis of subepithelial fibrosis observed in the airways of patients with asthma. We determined whether human airway epithelial cells are capable of producing polypeptide mediators that could induce fibroblast proliferative activity, in particular insulin-like growth factor I. 2. We examined 12 primary cultures of human airway epithelial cells grown to confluence on collagen gel-coated dishes. Using a colorimetric assay based on the uptake and subsequent release of Methylene Blue, increased proliferation of human fetal lung fibroblasts was detected in conditioned media from airway epithelial cells. The median stimulation of fibroblast proliferation was 49.9% (range 25.6-113.3%) above control values (observed at 1:2 dilution of media). 3. A neutralizing antiserum to insulin-like growth factor I partly inhibited fibroblast proliferation induced by epithelial cell conditioned media by 52.2% (49.9-109%; n = 5). 4. Radioimmunoassay for insulin-like growth factor I in conditioned media demonstrated a median concentration of 54.1 ng/ml (32.4-96.8 ng/ml). 5. Insulin-like growth factor I mRNA was detected in epithelial cell monolayers by Northern blot analysis using an insulin-like growth factor I cDNA probe. 6. The insulin-like growth factor I gene is expressed in cultured human airway epithelial cells, which also secrete insulin-like growth factor I protein. Insulin-like growth factor I also accounts for the major mitogenic activity for fibroblasts of cultured human epithelial cell conditioned media. Insulin-like growth factor I may function in a paracrine manner to modulate fibroblast behaviour and may be involved in airway processes, such as those occurring in asthma.     

Use of an inpatient HIV unit by injecting drug users

A case of partial traumatic division of a Dupuytren's band in a 56-year-old man with known Dupuytren's disease is described. Management consisted of exploration of the wound and limited fasciectomy, with excision of the diseased fascia, the pretendinous band, the lateral cord and the spiral cord. Postoperative recovery was uneventful, and the patient returned to work. He remains well two years after the injury.     

Modelling the spread of HIV in social networks of injecting drug users

OBJECTIVE: To explore the risk of a future rise of HIV prevalence in populations of injecting drug users (IDU) with low HIV prevalence but continuing risk behaviour, and to study the potential influence of prevention measures on HIV incidence. METHODS: A stochastic simulation model was used to describe a network of long-term buddy relationships in a population of IDU. HIV transmission took place when borrowing injecting equipment from an infected buddy or stranger. The probability of transmission depended on the duration of infection. Individuals remained in the population on average for 10 years. Two surveys amongst IDU in The Netherlands containing information about risk behaviour were used to estimate model parameters. We investigated the effect of different prevention strategies. RESULTS: Below a threshold sharing frequency the epidemic never takes off; above the threshold there is a large stochastic variation in prevalence. After reduction of risk behaviour, HIV prevalence decreases very slowly. Reducing sharing with strangers is more effective than reducing the overall sharing frequency. Prevention focused on new IDU greatly reduces HIV incidence. Reduction of sharing frequency in HIV-positive IDU has no significant influence on HIV incidence at HIV testing rates of 10 and 50% per year, if infectivity is highest during primary infection. CONCLUSIONS: A stabilization of HIV prevalence does not exclude the possibility of a future rise. Predictions about the future course of an epidemic are inherently uncertain. The effect of prevention programmes on HIV prevalence only becomes visible on a long time-scale. Social networks of IDU play an important role in transmission dynamics and success of prevention.     

Readmissions to drug abuse treatment and HIV risk behavior

The objectives of the study were (a) to investigate the characteristics of drug abuse treatment clients who return to treatment and (b) among those with readmissions, to describe changes over time in risk behavior for human immunodeficiency virus (HIV) infection and to identify factors associated with behavior change. Data were derived from a multisite HIV surveillance program in a single community; the program used a unique identifier to link HIV test results and behavioral information from multiple contacts. During a 30-month period, 1994 clients were admitted to three satellite facilities of a single treatment agency: detoxification, long-term residential, and outpatient. Of these clients, 574 (29%) had one or more readmissions to the same or a different facility during the 24 months following the index admission. Drug injectors, those tested for HIV, and those living in the community were more likely to be readmitted to treatment. There was little overall change in HIV risk behavior between the index admission and the readmission furthest in time from the index admission. Clients whose index visit was at the residential facility were more likely to reduce their injection risk behavior than those admitted to the other facilities. Clients readmitted to either the residential or the outpatient facility were more likely to have reduced their injection risk behavior than those readmitted to detoxification. Treatment facility was not associated with sexual risk behavior change. Men were more likely than women to reduce their high-risk sexual behaviors. The results underscore the need for treatment programs to make HIV testing readily available to their clients and to make special efforts to assist female clients to reduce their HIV risk.     

Concordance of PCR and antibody results from HIV testing of injecting drug users

Standard HIV-1 testing relies on the enzyme immunoassay (EIA) for detecting antibodies specific to HIV-1. This technique may misclassify persons as HIV-1-negative in instances where testing follows infection but precedes development of antibody to HIV-1. To evaluate the occurrence of HIV infection in the absence of positive antibody, polymerase chain reaction (PCR) for viral DNA in the blood has been applied. Research comparing these two testing techniques has generally focused on populations of homosexual and bisexual men. This study compares PCR and antibody testing of 337 injecting drug users recruited from street settings in San Francisco. Of 286 HIV-1 antibody-negative samples, 3 (1.0%) were PCR-positive. Of 49 HIV-1 antibody-positive samples, 1 (2.0%) was PCR-negative. Two samples were antibody-indeterminate and PCR-negative. This yielded an overall concordance of 331/335 (98.8%), excluding the indeterminate results. These results suggest that current antibody methodology is adequate. However, misclassification among recently infected individuals may occur, which is of concern in high-incidence groups.     

HIV/AIDS and drug abuse: epidemiology and prevention

In the United States, the AIDS epidemic is a dynamic process with increasing rates of AIDS reported among women, minority populations, heterosexual men, and users of drugs by routes other than injection. The 1993 CDC AIDS definition change has created some difficulties in interpreting trends in the United States. Drug use continues to represent a significant problem among HIV-infected persons. Several strategies have been advanced to decrease transmission of HIV among drug users, their sexual partners and children. However, more effective and comprehensive prevention and treatment strategies are needed.     

High rates of drug use, but low rates of HIV risk behaviours among injecting drug users during incarceration in Dutch prisons

AIMS: To determine levels of injecting drug use and sexual risk behaviours in injecting drug users during and immediately following imprisonment in The Netherlands. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey of drug injectors attending methadone clinics, a sexually transmitted disease clinic and a central research site in Amsterdam. The mean age of the 188 participants was 35 years, 78% were male and 34% had HIV antibodies. MEASUREMENTS: Self-reported drug use and sexual behaviours during the last period of imprisonment in Dutch prisons within the previous 3 years and injecting drug use in the week following release from prison. FINDINGS: A period of imprisonment in the preceding 3 years was reported by 188 (41%) of 463 interviewed drug injectors. The mean duration of last imprisonment was 3.6 months. Any use of cannabis, heroin or cocaine during imprisonment was reported by 55%, 37% and 20%, respectively. Five injectors (3%) admitted to having injected in prison, but no sharing of needles and syringes was reported. Vaginal or anal sex was reported by two (1%) of the men and none of the women. Relapse to drug injecting during the week following release from prison was reported by 78/186 (42%) participants, in most cases (34%) at the very first day of release. Drug use behaviours during imprisonment were similar for those who were designated current injectors at the time of imprisonment and those who were not, but injecting in the first week following release from prison was far higher among 'current' injectors (63%) than among those who were not (11%). CONCLUSIONS: Contrary to findings from other countries, low levels of HIV risk behaviours occur among imprisoned drug injectors in The Netherlands. Intra-prison HIV preventive measures should be considered taking into account the nationally, regionally or locally varying conditions within the existing prisons.     

Demographic implications of socioeconomic transition among the tribal populations of Manipur, India

The demographic implications of socioeconomic transition are studied among the three subsistence categories of the Gangte, a little known tribe from northeast India. Reproductive histories of 444 ever-married women and other data on the 343 households from which these women were drawn were collected from 11 villages representing the 3 transitional groups. A trend of increasing household income and literacy of couples was observed from shifting cultivators to settled agriculturists to the town-dwelling Gangte. The effect of socioeconomic transition is also seen in the constriction at the base of the age-sex pyramid of the town dwellers compared with the other subsistence categories, suggesting a relatively lower proportion of children in the 0-5-year-old age group. Although exogamy is practiced among all the subsistence categories, a considerably higher percentage of admixture with non-Gangte is observed among the town dwellers compared with the others. Overall infant and child mortality among the Gangte is low. However, variation exists among the three subsistence groups in the sense that a considerable reduction is seen from the traditional shifting cultivators to the urbanized town dwellers, reflecting better socioeconomic conditions and greater awareness and accessibility of the town dwellers to public health amenities. No consistent or perceptible trend is evident in mean number of live births. The genetic implications of this demographic transition are reflected in Crow's indexes of selection.     

Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study

OBJECTIVES: To estimate the incidence of HIV and hepatitis C virus and risk factors for seroconversion among a cohort of injecting drug users. DESIGN: Retrospective cohort study. SETTING: Primary healthcare facility in central Sydney. SUBJECTS: Injecting drug users tested for HIV-1 antibody (n=1179) and antibodies to hepatitis C virus (n=1078) from February 1992 to October 1995. MAIN OUTCOME MEASURES: Incidence of HIV-1 and hepatitis C virus among seronegative subjects who injected drugs and underwent repeat testing. Demographic and behavioural risk factors for hepatitis seroconversion. RESULTS: Incidence of HIV-1 among 426 initially seronegative injecting drug users was 0.17/100 person years (two seroconversions) compared with an incidence of hepatitis C virus of 20.9/100 person years (31 seroconversions) among 152 injecting drug users initially negative for hepatitis C virus. Incidence of hepatitis C virus among injecting drug users aged less than 20 years was 75.6/100 person years. Independent risk factors for hepatitis C virus seroconversion were age less than 20 years and a history of imprisonment. CONCLUSIONS: In a setting where prevention measures have contributed to the maintenance of low prevalence and incidence of HIV-1, transmission of hepatitis C virus continues at extremely high levels, particularly among young injecting drug users.     

A case of paragonimiasis in a civet cat with a new Paragonimus sub species in Manipur, India

Primary multiple malignant neoplasms and multifocal neoplasms are a very complex problem and therefore have been a topic of many articles. The mechanism of origin, frequency of occurrence, co-existence of neoplasms in functionally similar organs (uterus, mammary gland), heredity, a possibility of diagnostic and therapy are the most interesting aspects. Frequency of multiple primary malignant neoplasms occurrence is about 2-8% and still increases. Pathogenesis of multifocal and multiple neoplasms has rarely been a subject of articles. A simultaneous exposure of a tissue to damaging factors and special tissue sensitivity are the main reasons for neoplasms origin in this group. The authors present a rare case of parotid gland multiple neoplasm: fibrosarcoma and squamous cell carcinoma, as well as discuss the diagnostics, therapy, and prognosis of multiple neoplasms.     

Meta-analysis of HIV risk-reduction interventions within drug abuse treatment programs.

A meta-analysis was conducted on studies using a treatment-comparison group design to evaluate HIV/AIDS risk-reduction interventions for clients enrolled in drug abuse treatment programs. Overall, the interventions studied were found to have a reliable positive (weighted) effect size (d?=?0.31), and this was unlikely to be due to publication bias. Effect sizes for specific categories of outcome variables were 0.31 for knowledge, attitudes, and beliefs; 0.26 for sexual behavior; 0.62 for risk-reduction skills; and 0.04 for injection practices. A number of potential moderators were examined. Effect sizes were negatively correlated with the presence of predominantly ethnic minority samples and positively correlated with the number of intervention techniques used, the intensity of the intervention, intervention delivery at a later stage of drug treatment or within methadone treatment, and the presence of a number of specific intervention techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Declining seroprevalence in a very large HIV epidemic: injecting drug users in New York City, 1991 to 1996

OBJECTIVES: This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City. METHODS: We analyzed temporal trends in HIV seroprevalence from 1991 through 1996 in 5 studies of injecting drug users recruited from a detoxification program, a methadone maintenance program, research storefronts in the Lower East Side and Harlem areas, and a citywide network of sexually transmitted disease clinics. A total of 11,334 serum samples were tested. RESULTS: From 1991 through 1996, HIV seroprevalence declined substantially among subjects in all 5 studies: from 53% to 36% in the detoxification program, from 45% to 29% in the methadone program, from 44% to 22% at the Lower East Side storefront, from 48% to 21% at the Harlem storefront, and from 30% to 21% in the sexually transmitted disease clinics (all P < .002 by chi 2 tests for trend). CONCLUSIONS: The reductions in HIV seroprevalence seen among injecting drug users in New York City from 1991 through 1996 indicate a new phase in this large HIV epidemic. Potential explanatory factors include the loss of HIV-seropositive individuals through disability and death and lower rates of risk behavior leading to low HIV incidence.     

Patterns of sexual and injecting risk behaviours in French intravenous drug users not reporting HIV and hepatitis C virus seropositivities

AIMS: To characterize and identify determinants of risk behaviour patterns of intravenous drug users (IDUs) independently of changes due to knowledge of HIV or hepatitis C Virus (HCV) seropositivity. DESIGN: A cross-sectional survey using a structured questionnaire concerning sexual, injecting and HIV and HCV antibody testing practices. SETTING: IDUs were interviewed in the Paris region at 10 treatment or psychosocial centres. PARTICIPANTS: Six hundred and twelve consecutive sexually active IDUs over 18 years able to answer the questionnaire. MEASUREMENTS: Five hundred and ninety-five IDUs completed the questionnaire. The risk-behaviour patterns of the 328 IDUs not reporting HIV or HCV seropositivity were analysed by phi correlation. Risk factors for each risk behaviour were determined by regression logistic models yielding odds ratios (OR) and their 95% confidence intervals (95% CI). FINDINGS: Several risk behaviour patterns were suggested: (1) lending, borrowing; (2) not or inconsistently testing HIV and HCV serology and not or inconsistently using condoms; (3) having multiple partners and prostitution; and (4) not using clean equipment. Alcohol abuse was independently and specifically associated with lending (OR = 3.8; 95% CI: 2.1-7.0) and borrowing (OR = 3.3; 95% CI: 1.8-6.1); homelessness with injecting risk behaviours and with prostitution (OR = 2.7; 95% CI: 1.2-6.1); low educational level and having children with not or inconsistently using condom and serology testing; and cocaine use with not or inconsistently using condoms (OR = 0.4; 95% CI: 0.3-0.7) and serology testing and not using clean equipment (OR = 0.4; 95% CI: 0.2-0.8). Having multiple partners and prostitution had no common risk factors. CONCLUSIONS: Identifying specific risk factors could help to target drug harm reduction programmes for each risk behaviour pattern among IDUs not reporting HIV and HCV seropositivity.     

HIV sex and drug risk behavior and behavior change in a national sample of injection drug and crack cocaine using women

This paper describes HIV sex and drug risk behavior and behavior change of injection drug and crack cocaine using women enrolled in a national multi-site Cooperative Agreement program. Baseline data on the 1,403 women who were randomly assigned to a two session intervention that was standardized across sites indicate that sex and drug risk behavior for becoming infected with HIV was considerable. Six-month post intervention follow-up data for the same sample of women show that significant reductions in sex and drug risk behavior were observed for the entire sample of women for the risk variables under study. Significant reductions were also demonstrated for various sub-groups of women enrolled in the study on most of the sex and drug risk variables. Given these findings, it appears that the standard intervention was effective in assisting drug using women reduce their behaviors that put them at risk of becoming infected with HIV. Further research in needed on the development and evaluation of HIV interventions that target specific risk behaviors and various HIV risk behavior profiles of women.