Exploring risk perception and behaviour of homeless injecting drug users diagnosed with hepatitis C
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Abstract:
Injecting drug users (IDUs) are at the greatest risk of hepatitis C infection by using any item of injecting equipment that has come into contact with contaminated blood. Alongside this, homeless IDUs have been identified as being at increased risk of harm in their illicit drug taking behaviour. This study interviewed 17 hepatitis C positive homeless IDUs about their injecting practices. In-depth interviews explored the impact of a positive hepatitis C diagnosis on their injecting and identified their risk behaviours and perceptions. The interviews were tape-recorded, transcribed and analysed using the framework approach. Homeless IDUs engaged in both high risk and unhygienic injecting practices, such as using drugs outside and in public places, sharing injecting equipment and re-using cleaned needles. Excessive needle reuse whilst in prison was also identified. However, the findings were not universally bleak as a positive diagnosis of hepatitis C did lead to some behaviour change towards safer injecting and some adopted other lifestyle and behaviour changes. It was, however, common for homeless people to devolve responsibility for preventing hepatitis C transmission to their peers, especially when injecting with others. Knowledge regarding possible transmission through injecting paraphernalia appeared to make users more careful to reduce it through these routes. Placing a continuous emphasis on health promotion is therefore important in educating IDUs about the hepatitis C transmission risks associated with injecting drug use. Information regarding safer and hygienic use, including accurate information regarding the most effective methods to clean used equipment, must be re-enforced by people working with homeless injecting drug users.Keywords:
Paraphernalia
Needle sharing
harm reduction
Hepatitis C
SAFER
Hepatitis B
Abstract The study investigates donor sharing and recipient sharing of different types of injecting equipment and the frequency of sharing activities with sexual partners, close friends and casual acquaintances. Structured interviews were conducted with 303 injectors recruited as part of a study of early and episodic opiate use. Subjects were contacted in non-clinical, community settings by a peer recruitment method (Privileged Access Interviews). Spoons and water containers were more frequently shared than needles and syringes. Significant differences were obtained between the frequency of sharing different types of injecting equipment. Many injectors had shared spoons or water containers, but had not shared needles or syringes. Frequency of sharing with others was also associated with intimacy of relationship to the subject. Almost two-thirds of the sample had shared some sort of injecting equipment during the previous year. The sharing of injecting paraphernalia presents a risk of infection with HIV , hepatitis B and hepatitis C. Injectors and drug workers should be more clearly aware of the risks involved in such activities. Harm reduction advice given to drug injectors should target the sharing of injecting paraphernalia. Research into sharing should explicitly include questions about the use of different types of injecting equipment.
Paraphernalia
Needle sharing
harm reduction
Casual
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Injecting drug users (IDUs) are at the greatest risk of hepatitis C infection by using any item of injecting equipment that has come into contact with contaminated blood. Alongside this, homeless IDUs have been identified as being at increased risk of harm in their illicit drug taking behaviour. This study interviewed 17 hepatitis C positive homeless IDUs about their injecting practices. In-depth interviews explored the impact of a positive hepatitis C diagnosis on their injecting and identified their risk behaviours and perceptions. The interviews were tape-recorded, transcribed and analysed using the framework approach. Homeless IDUs engaged in both high risk and unhygienic injecting practices, such as using drugs outside and in public places, sharing injecting equipment and re-using cleaned needles. Excessive needle reuse whilst in prison was also identified. However, the findings were not universally bleak as a positive diagnosis of hepatitis C did lead to some behaviour change towards safer injecting and some adopted other lifestyle and behaviour changes. It was, however, common for homeless people to devolve responsibility for preventing hepatitis C transmission to their peers, especially when injecting with others. Knowledge regarding possible transmission through injecting paraphernalia appeared to make users more careful to reduce it through these routes. Placing a continuous emphasis on health promotion is therefore important in educating IDUs about the hepatitis C transmission risks associated with injecting drug use. Information regarding safer and hygienic use, including accurate information regarding the most effective methods to clean used equipment, must be re-enforced by people working with homeless injecting drug users.
Paraphernalia
Needle sharing
harm reduction
Hepatitis C
SAFER
Hepatitis B
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We report the case of a prisoner for whom tattooing was the likely source of hepatitis C virus (HCV) infection. Many of the tattoos were carried out within prison using equipment that was multiply shared with other prisoners with limited access to means of disinfection. This case supports previous reports that prison is a risk factor for HCV infection and that HCV can be transmitted through tattooing. Use of unsterilised equipment for tattooing within prison must be a high‐risk activity, given the high prevalence of HCV infection among those incarcerated. Harm reduction approaches are required to diminish risk in this environment.
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Hepatitis C
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Abstract
Objective: To assess the role of polymerase chain reaction in defining infectiousness among people infected with hepatitis C virus. Design: Published studies of hepatitis C transmission were examined. Twenty nine studies with identified sources of hepatitis C infection who were tested for presence of hepatitis C RNA by polymerase chain reaction were reviewed, including studies of vertical transmission (n=21), transmission after transplantation (n=3), transfusion of blood components (n=3), and needlestick exposure (n=2). Subjects: All patients identified in studies. Results: A total of 2022 people who had been exposed to sources positive for antibody to hepatitis C were identified. Among 1148 people exposed to sources positive by polymerase chain reaction 148 cases of transmission occurred compared with no definite case among 874 people exposed to negative sources. Rates of transmission from positive sources were 6.2% for perinatal exposure, 6.1% after needlestick exposure, 78% after solid organ or bone marrow transplantation, and 83% after transfusion of blood components. Other factors influencing risk of vertical transmission were coinfection with HIV and level of hepatitis C viraemia. Conclusions: Negative results by polymerase chain reaction indicate an extremely low probability of transmission of hepatitis C from a person with antibody to hepatitis C.Key messages
Between 20% and 50% of people infected with hepatitis C virus do not progress to chronic infection Polymerase chain reaction can detect ongoing hepatitis C viraemia and thus the presence of chronic infection The risk of transmission from people who are positive for hepatitis C antibody but have negative results by polymerase chain reaction is extremely low The rate of transmission from people who are positive for hepatitis C antibody and have positive results by polymerase chain reaction varies from 6% for mother to child transmission and occupational exposure to about 80% after transplantation or transfusion of blood components Polymerase chain reaction should be used to define infectiousness among people who are positive for antibodies to hepatitis CHepatitis B
Hepatitis C
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Injection drug use is a major risk factor for HIV and hepatitis infections. Whereas programs to prevent new infections have focused on HIV, they have generally neglected hepatitis B and C. This study was designed to examine the interrelationships among HIV and hepatitis knowledge, risky drug preparation and injection practices, and participation in syringe exchange programs (SEPs).Surveys of injection drug users (IDUs) collected data on socio-demographics, medical history, drug use and injection practices, and HIV- and hepatitis-related knowledge.Inner-city US neighborhoods in Chicago, IL, Hartford, CT and Oakland, CA.The study population was a convenience sample of 493 IDUs recruited using street outreach and snowball sampling strategies.HIV and hepatitis knowledge, injection-related risks for virus transmission, associations between the two, and with SEP use.HIV knowledge was significantly higher than hepatitis knowledge among SEP customers and non-customers alike. Elevated hepatitis knowledge was associated with a history of substance abuse treatment, hepatitis infection, hepatitis B vaccination and injection practices that reduced contact with contaminated blood or water but not with SEP use. SEP customers were consistently less likely to engage in risk behaviors, with the notable exception of safely staunching blood postinjection.Increased hepatitis awareness among IDUs is necessary for reducing hepatitis transmissions. Although SEPs continue to effectively disseminate HIV prevention messages-as evidenced by lowered risk behaviors among their customers-they must do more to prevent hepatitis transmissions.
Hepatitis C
Hepatitis B
Snowball sampling
Outreach
harm reduction
Needle sharing
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Hepatitis C
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The main objective of the study was to calculate and report the prevalence of probable risk factors involved in the transmission of pathogenic agents among type B and C acute viral hepatitis cases confirmed in Bucharest (1998-2000). The standardized values of the risks detected in the 45-180 days preceding the onset of illness suggest that in both types of acute viral hepatitis considered in our study transmission associated to the individuals' behaviour (19.0%-hepatitis B and 20.1%-hepatitis C) seems more frequent than "iatrogenic" transmission; in case of hepatitis B, sexual contacts with more than one partner coming first (15.7%), whilst in case of hepatitis C the use of i.v. drugs (heroine) was most frequently incriminated (12.4%). The study reviews the present knowledge of the risk factors involved in the transmission of the disease and approaches prevention strategies.
Viral Hepatitis
Sexual transmission
Hepatitis B
Hepatitis C
Acute hepatitis B
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Objectives To estimate the prevalence of direct and indirect syringe sharing among intravenous drug users (IDUs) attending a harm reduction center in Catalonia (Spain) and to identify factors associated with risk behaviors. Methods A cross-sectional study was conducted between 2008 and 2009 in harm reduction centers. Behavioral data were collected using anonymous questionnaires administered by trained interviewers. Results Of the 748 respondents, 31.5% had shared syringes at least once in the previous 6 months and 55.2% reported sharing injection paraphernalia (spoons, water, filters). A higher risk of syringe sharing was found among IDUs who injected daily (OR=1.5), injected cocaine (OR=1.6), had less than half their supply of syringes from a free source (OR=2.5), had an IDU sexual partner (OR=1.8) or who reported indirect sharing (OR=4.1). A higher risk of indirect sharing was found in respondents who had an illegal source of income (OR=1.5), injected daily (OR=1, 5), injected cocaine (OR=1.4), reported sharing syringes (OR=3.9), or who reported a previous overdose (OR=1.5). Conclusions Despite the widespread use of harm reduction programs in Catalonia, a significant proportion of IDUs continue to practise injection-related risk behaviors. Further reductions in risk behaviors could be achieved by improving access to all sterile injecting equipment, especially among cocaine injectors and IDUs who inject frequently, and by including IDU sexual partners within the current network of harm reduction centers.
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Needle sharing
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Objective
To find the level of awareness about hepatitis B and hepatitis C transmission through sexual contact among those suffering from these conditions.
Study design
Cross sectional survey.
Place & Duration of study
Fatima Hospital, Baqai Medical University and Osmania Hospital Karachi, From January 2017 to March 2017.
Methodology
Patients suffering either from hepatitis B and hepatitis C or both, between eighteen to fifteen years were interviewed through questionnaire at the outpatient department.
Results
Among ninety-five patients, only thirty-seven patients were aware of sexual transmission of viruses. Twenty-two out of thirty-seven have been using latex condom to protect their mates from getting infected. Fifteen infected patients with HCV or HBV gave history that their mates were already suffering from the same viral illness.
Conclusions
Most of the study participants were unaware of the fact that hepatitis viruses can be transmitted through sexual contact. Moreover, females were more aware as compared to males regarding sexual transmission of hepatitis B and hepatitis C.
Key words
Hepatitis B, Hepatitis C, Sexual activity.
Sexual transmission
Sexual contact
Hepatitis B
Outpatient clinic
Hepatitis C
Viral Hepatitis
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Background: Sharing of injecting paraphernalia is known to contribute to hepatitis C virus (HCV) transmission amongst people who inject drugs.Objectives: In this paper, we identify the variables correlated with paraphernalia sharing among male drug injectors in Kermanshah city, western Iran.Methods: We enrolled 606 male drug injectors using snowball sampling in a cross-sectional study. Serological testing for HCV, HIV and HBV infections were performed after the completion of a bio-behavioral questionnaire. To identify variables associated with paraphernalia sharing, logistic regression analysis was completed.Results: The respondents were aged 18–65 years (mean±SD age of 36.7 ± 8.5). Approximately half of those surveyed (55.3% 335 individuals) reported sharing of injecting paraphernalia in the month prior to interview. Serological testing showed 54.8% (CI 50.8–58.7%), 6.4% (4.4–8.3%) and 2.9% (1.6–4.3%) positive result for HCV antibody, HIV antibody and HBs-Antigen, respectively. Being unemployed P < .001, single P < .001, having a history of drug overdose P < .001, having a previous positive HCV test P < .001, less than weekly attendance to needle/syringe programs P < .001and alcohol consumption P < .001 were all significant in the final model.Conclusions: With over half the participants reporting injecting paraphernalia sharing, providing more accessible harm reduction programs together with HCV testing and treatment programs may help to reduce the transmission of HCV among networks of drug injectors in Kermanshah city.
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Needle sharing
harm reduction
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