Objective To examine the relation between plasma HIV-1

Aims Despite proven benefits of antiretroviral therapy (ART), many HIV-infected injection drug users (IDU) do not access treatment even in settings with free health care. We examined whether methadone maintenance therapy (MMT) increased initiation and adherence to ART among an IDU population with free health care. Design We prospectively examined a cohort of opioid-using antiretroviral-naïve HIV-infected IDU and investigated factors associated with initiation of antiretroviral therapy as well as subsequent adherence. Factors independently associated with time to first initiation of antiretroviral therapy were modelled using Cox proportional hazards regression. Findings Between May 1996 and April 2008, 231 antiretroviral-naïve HIV-infected opioid using IDU were enrolled, among whom 152 (65.8%) initiated ART, for an incidence density of 30.5 (95% confidence interval [CI]: 25.9–35.6) per 100 person-years. After adjustment for time-updated clinical characteristics and other potential confounders, use of MMT was independently associated with more rapid uptake of antiretroviral therapy (relative hazard = 1.62 [95% CI: 1.15–2.28]; p = 0.006). Those prescribed methadone also had higher rates of ART adherence after first antiretroviral initiation (odds ratio = 1.49 [95% CI: 1.07–2.08]; p = 0.019). Conclusion These results demonstrate that MMT contributes to more rapid initiation and subsequent adherence to ART among opioid-using HIV-infected IDU. Addressing international barriers to the use and availability of methadone may dramatically increase uptake of HIV treatment among this population.

Although research has examined the impacts of childhood maltreatment among various marginalized populations, few studies have explored the relationship between child abuse and subsequent involvement in sex work among drug using street-involved youth. In the present study, the relationships between the level of childhood maltreatment and involvement in sex work were examined using the Childhood Trauma Questionnaire (CTQ) as part of an extensive interview protocol in an ongoing prospective cohort study of street-involved youth in Vancouver Canada. Between September 2005 and June 2006, 361 youth were recruited using extensive outreach methods and snowball sampling. The prevalence rates for abuse in the sample were 73% for physical abuse; 32.4% for sexual abuse; 86.8% for emotional abuse; 84.5% for physical neglect; and 93% for emotional neglect. Univariate and logistic regression analyses demonstrated that not only was sexual abuse independently associated with sex work, but emotional abuse was as well. These findings have implications for early intervention efforts aimed at vulnerable, high risk youth populations as well as intervention strategies for active sex trade workers.

Objectives-We assessed the effects of syringe exchange program (SEP) policy on rates of HIV risk behavior and HIV incidence among injection drug users.Methods-Using a multivariate generalized estimating equation and Cox regression methods, we examined syringe borrowing, syringe lending, and HIV incidence among a prospective cohort of 1228 injection drug users in Vancouver, British Columbia.Results-We observed substantial declines in rates of syringe borrowing (from 20.1% in 1998 to 9.2% in 2003) and syringe lending (from 19.1% in 1998 to 6.8% in 2003) following SEP policy change. These declines coincided with a statistically significant increase in the proportion of participants accessing sterile syringes from nontraditional SEP sources (P<.001). In multivariate analyses, the period following the change in SEP policy was independently associated with a greater than 40% reduction in syringe borrowing (adjusted odds ratio [AOR]=0.57; 95% confidence interval [CI]=0.49, 0.65) and lending (AOR=0.52; 95% CI=0.45, 0.60), as well as declining HIV incidence (adjusted hazard ratio=0.13; 95% CI=0.06, 0.31).Conclusions-Widespread syringe distribution appears to be a more effective SEP policy than do more restrictive SEP policies that limit syringe access. Efforts should be made to ensure that SEP policies and program design serve to maximize rather than hinder syringe access.Cities throughout the world are increasingly experiencing HIV epidemics among injection drug users (IDU) as a result of sharing contaminated injecting equipment. 1 In response, various initiatives such as syringe exchange programs (SEPs) have been established. 2 Despite the growing implementation of SEPs, IDU-driven HIV epidemics have persisted in some settings. 3 This has been true of Vancouver, British Columbia, Canada, which experienced Correspondence should be sent to Thomas Kerr, PhD, Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver BC V6Z 1Y6, Canada (uhri@cfenet.ubc.ca). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.. Contributors T. Kerr and E. Wood designed the study. R. Zhang, K. Li, and T. Kerr conducted the statistical analyses. T. Kerr and E. Wood drafted the article and incorporated all suggestions. W. Small, J. Montaner, and C. Buchner made significant contributions to the conception and design of the analyses, interpretation of the data, and drafting of the article. T. Kerr is guarantor of this study. All authors approved the version to be published. Human Participant ProtectionThe Vancouver Injection Drug Users Study, from which the data for this report were derived, is approved by the University of British Columbia's research ethics board. one of North America's highest HIV rates although the city has been home to one of the continent's largest SEPs. 4 Preliminary reports have suggested that many local IDU have historically experienced difficulty accessing sterile syringes as a result of policy and programmatic factors such as ...