Migration and transmission of blood-borne infections among injection drug users: Understanding the epidemiologic bridge

Rachlis, Beth; Brouwer, Kimberly C.; Mills, Edward J.; Hayes, Michael; Kerr, Thomas; Hogg, Robert S.

doi:10.1016/j.drugalcdep.2007.03.014

Cited by 77 publications

(86 citation statements)

References 97 publications

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“…One aspect may be that drug-related services in Switzerland do not tend to be culture-specific, so as not to specifically arrange services for certain migrant subgroups, which may have the effect of increasing the likelihood of cultural misperception and overlook social variables. Previous studies elsewhere showed that migrants without legal documentation might avoid seeking medical advice or entering treatment services because of fear of expulsion from the country [27,79]. Furthermore, some authors reported a more serious progression of opioid dependence in an immigrant population (leading to the acquisition of multiple infections) and interpreted this finding as part of a multifaceted acculturation problem [80].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have shown that immigration is often associated with increased substance use because of social difficulties and stressors [27] and that while patterns of substance use begin to resemble that of the native population over time [28], immigrants are initially more likely to engage in riskier injection behaviors and to share syringes [29,30]. Women with an immigration background and co-occurring substance use disorders are estimated to have an elevated risk of contracting HIV, either by injecting drugs, having sex with an injecting drug user, or through other high-risk sexual behaviors and absence of condom use [31,32].…”

Section: Introductionmentioning

confidence: 99%

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Ethnic- and gender-specific differences in the prevalence of HIV among patients in opioid maintenance treatment—a case register analysis

Liebrenz

Stohler²,

Nordt³

2014

Harm Reduction Journal

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BackgroundWe have sought to identify ethnic- and gender-specific differences in HIV prevalence among heroin users receiving opioid maintenance treatment in the canton of Zurich, Switzerland.MethodsWe used a generalized linear model (GEE) to analyze data from the anonymized case register for all opioid maintenance treatments in the canton of Zurich. Patients who received either methadone or buprenorphine between 1991 and 2012 (n = 11,422) were evaluated for gender (male vs. female), ethnic background (Swiss vs. non-Swiss), and lifetime method of drug use (ever injector vs. non-injector). We addressed missing data by multiple imputation.ResultsThe overall prevalence of HIV among patients declined substantially from 33.7% in 1991 to 10.6% in 2012 in the complete dataset. In the imputed datasets, the respective prevalence dropped from 32.8% in 1991 to 9.7% in 2012. Non-injectors had a four to five times lower risk ratio (RR) compared to the reference group, ‘Swiss males who ever injected’. In addition, we found a significantly higher risk ratio of HIV prevalence among females who had ever injected; this was true both for the complete dataset and the imputed dataset (Swiss RR 1.18 CI 95% 1.04–1.34, non-Swiss RR 1.58 CI 95% 1.18–2.12).ConclusionIn this population, gender, ethnic background, and lifetime method of drug use influenced the risk of being HIV positive. Different access to treatment and different characteristics of risk exposure among certain subgroups might explain these findings. In particular, the higher risk for women who inject drugs—especially for those with an immigrant background—warrants additional research. Further exploration should identify what factors deter women from using available HIV-prevention measures and whether and how these measures can be better adapted to high-risk groups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ethnic- and gender-specific differences in the prevalence of HIV among patients in opioid maintenance treatment—a case register analysis

Liebrenz

Stohler²,

Nordt³

2014

Harm Reduction Journal

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“…Nevertheless, this group of injectors is younger and their living conditions are poorer, both factors that can increase their vulnerability to those infections [29] .…”

Section: Discussionmentioning

confidence: 99%

“…The number of IDUs from Eastern Europe and Africa has increased considerably in Catalonia in recent years [11] . This group may be more vulnerable to STIs because of factors such as marginalization, irregular immigration status, the lack of a family support network, and ignorance of the social services and health care system [12] .…”

Section: Introductionmentioning

confidence: 99%

Sexually Transmitted Infections and Sexual Practices among Injecting Drug Users in Harm Reduction Centers in Catalonia

Folch

Casabona

Brugal³

et al. 2011

Eur Addict Res

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Background: The objectives of the study were to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae and sexual risk practices, and to identify factors associated with infection by C. trachomatis/N. gonorrhoeae. Methods: Injecting drug users were interviewed at harm reduction centers and biological samples were collected to estimate the prevalence of C. trachomatis and N. gonorrhoeae. Results: The prevalence of C. trachomatis was 2.3%, and this was higher among immigrants (3.6%); the prevalence of N. gonorrhoeae was 0.7% (no differences between Spanish-born and immigrants). Respondents aged ≤25 years had a higher risk of sexually transmitted infections (STIs) (OR 3.39), as did women (OR 3.08). Also associated with having an STI were not having registered employment (OR 4.70), injecting drugs daily (OR 4.21), and having unprotected sex with a stable partner (OR 3.37). Conclusion: Although the prevalence of STIs observed is low, scant condom use makes it necessary for prevention programs to include messages related to sexual risk practices, especially among young people and women.

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“…This is a simplification since most societies with a serious drug problem have substantial use of more than one substance, and/or have to deal with mobile drug users that may affect the course and costs of an epidemic in places other than their origin (see, e.g., Roxburgh et al, 2004;Rachlis et al, 2007). So, besides discussing an important question on optimal control, we introduce here for the first time an optimal control model that considers two interacting populations of drug users.…”

Section: The Drug Control Modelmentioning

confidence: 99%

Optimal control of interacting systems with DNSS property: The case of illicit drug use

Zeiler

Caulkins

Tragler

2011

Journal of Economic Behavior & Organization

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a b s t r a c tIn this paper we generalize a one-dimensional optimal control problem with DNSS property to a two-dimensional optimal control problem. This is done by taking the direct product of the model with itself, i.e. we combine two similar system dynamics under a joint objective functional that is separable in both states and controls. This framework can be applied to the construction of various optimal control problems, such as optimal marketing of related products, optimal growth of separate but interacting economies, or optimal control of two related capital stocks.We study such a system for a particular case drawn from the domain of drug control. The main result of this paper is that in this domain even a modest amount of interaction can sometimes make a very big difference. Hence, drawing conclusions by simplifying the real world into two independent, one-dimensional models may be problematic.Methodologically the combination of two systems with DNSS property leads to a fascinating series of situations with multiple optimal steady states and associated threshold behavior. These instances reflect some important recent developments in optimal dynamic control theory.

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Migration and transmission of blood-borne infections among injection drug users: Understanding the epidemiologic bridge

Cited by 77 publications

References 97 publications

Ethnic- and gender-specific differences in the prevalence of HIV among patients in opioid maintenance treatment—a case register analysis

Ethnic- and gender-specific differences in the prevalence of HIV among patients in opioid maintenance treatment—a case register analysis

Sexually Transmitted Infections and Sexual Practices among Injecting Drug Users in Harm Reduction Centers in Catalonia

Optimal control of interacting systems with DNSS property: The case of illicit drug use

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