Harm reduction approach in Egypt: the insight of injecting drug users (original) (raw)
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Advances in Public Health, 2014
Background. Rapidly growing youth population with changing sexual trend in Egypt raised HIV potential. The aim of this study is to assess knowledge, attitude, and practice regarding unsafe sexual behavior among Egyptian drug abusers.Methods. This cross-sectional study was conducted in 2008 in the Freedom Drugs and HIV Program on 410 drug abusers in Egypt. Included respondents were subanalyzed by gender, age, education, and intravenous drug usage.Results. KAP average scores on safe sexual behavior were low compared to the maximum possible denoting low awareness and action of drug addicts towards avoidance of infection. Respondents with higher education had significantly better knowledge about safe sexual behavior. Significant positive correlation was shown between age and knowledge of safe sexual behavior. Older age groups were predicted to know more about safe sex, while gender; educational level and intravenous drug usage were not. Similarly, females and intravenous drug users were...
PLoS Medicine, 2014
Background: It is perceived that little is known about the epidemiology of HIV infection among people who inject drugs (PWID) in the Middle East and North Africa (MENA). The primary objective of this study was to assess the status of the HIV epidemic among PWID in MENA by describing HIV prevalence and incidence. Secondary objectives were to describe the risk behavior environment and the HIV epidemic potential among PWID, and to estimate the prevalence of injecting drug use in MENA.
2014
Despite the fact that HIV epidemic is mainly driven by injection drug use in Iran, partners of People Who Inject Drugs (PWID) have been seriously neglected in terms of effective preventive interventions. Currently, sexual partners of PWID might have access to some harm reduction services at Voluntary Counselling and Testing (VCT) centers; however, their needs have not been effectively targeted and met. Unfortunately, the current programs implemented by the Ministry of Health have overlooked the importance of this population in the course of the HIV epidemic throughout the country. In this policy brief, we are trying to draw the health policy-makers’ attention to this overlooked population and while reviewing the advantages and disadvantages of some of the readily available options on the table, come up with a recommended action to tackle this problem. Our recommended action that seems to have had promising results elsewhere in Asia would try to implement preventive interventions targeting this particular population through peer prevention programs.
Interventions to reduce the sexual risk behaviour of injecting drug users
International Journal of Drug Policy, 2005
Reducing the risk of sexual HIV transmission by injecting drug users (IDUs) is important for controlling the HIV epidemic among all drug users and for controlling the larger epidemic. Over the past few years, several qualitative and meta-analyses reviews have been published. Most of these reviews involved numerous studies conducted in resource-rich countries, while a few covered the smaller number of studies undertaken in resource-constrained countries. In order to make greater strides in controlling the HIV epidemic, we assessed the generalisability of the results of the major studies and reviews for use in developing programmes in resource-constrained countries. We also discuss the implications for global research efforts and public health practice. The reviews show that IDUs in both resource-rich and resource-constrained countries have changed their sexual risk behaviours, reflecting rational and altruistic responses to a major health threat. Findings show that IDUs changed their sexual risk behaviour to avoid becoming infected with HIV and to avoid transmitting HIV to their sexual partners. Although the risk-reduction effect is moderate, it is important to implement programmes to reduce the sexual risk behaviour of IDUs in all countries. Providing evidence-based interventions is ethically responsible compared to providing no interventions. As interventions are implemented in different settings, it is important to bear in mind that stigmatisation of HIV/AIDS, or drug or condom use may limit an intervention's effectiveness. There is a need for research on adapting interventions to different cultural or national settings, and to develop and evaluate new interventions that may produce greater reductions in sexual risk behaviours.
Factors Associated With an Explosive HIV Epidemic Among Injecting Drug Users in Sargodha, Pakistan
Background: During a routine surveillance round, an extremely high prevalence of 51.3% was found among injecting drug users (IDUs) in Sargodha, a small town in Pakistan. This sharp increase of HIV among this group warranted an urgent need to explore the factors leading toward this explosion of HIV infection among IDUs at this very location to direct the policy makers in designing preventive activities, especially in the context of HIV prevention. Methods: In 2007, 400 current IDUs were recruited through multistage cluster sampling based on mapping studies. Participants provided dried blood spot samples for HIV testing and completed a questionnaire on demographic characteristics and sexual/drug injecting behaviors. Logistic regression was used to examine the independent association of multiple variables with HIV infection. Results: Of the 400 IDUs tested, 205 (51.3%) were HIV positive confirmed through enzyme-linked immunosorbent assay and Western blot. In multivariate analysis, geographical location of IDUs [adjusted odds ratio (aOR) 2.4 for IDUs located in the northern zone vs southern zone, 95% confidence interval (CI) 1.5 to 3.7], injected in groups (aOR 1.8, 95% CI 1.1 to 3.1), and sharing injecting paraphernalia with other IDUs (aOR 1.5, 95% CI 1.0 to 2.4) were strong correlates of HIV infection. Conclusions: Effective outreach programs need to be developed to provide a comprehensive package of HIV prevention services to IDUs not reached by existing services, entry into drug abuse treatment and medical care needs to be facilitated, and essential legal and social services need to be provided with community participation.
International Journal of Drug Policy, 2008
Background: HIV Surveillance data from IDUs is suggestive of an escalating epidemic in major cities of Pakistan. The relatively widespread presence and interlinking of IDU and high-risk sexual networks, combined with low levels of HIV knowledge and prevention methods, indicate that there is potential for a rapid spread of HIV to other high-risk groups and its further expansion to general population through bridging groups. Methods: We reviewed Second Generation Surveillance data which provides mapping, biological and behavioural information from IDUs in eight major cities across Pakistan. Geographic mapping provided information about the location and size of the population, which was followed by a behavioural survey, conducted with a representative sample of 2432 IDUs. In addition, blood samples were also obtained which were tested for HIV. Results: Despite availability of syringe and needle exchange programmes in larger cities, drug users continued to reuse syringes (78.1%), injected in groups (73.3%) where extensive sharing of needle and injecting paraphernalia took place (50%). 12.6% of the respondents reported to having sexual relationships with female sex workers and 14.7% had sex with males in the past 6 months. 65% never used condoms. In addition 5.3% reported exchange of sex for money and drugs. Fairly low levels of coverage were reported from most of the cities. Conclusion: Despite an existing nationwide harm reduction programme, increasing rates of HIV infection among IDUs underscore the need to identify gaps in the existing prevention strategy. Data available on coverage shows that effective harm reduction activities are unable to reach a substantial number of IDUs to actually avert or delay the emerging IDUs epidemic. There is an urgent need to expand coverage, and to integrate harm reduction in the mainstream of public health.
Journal of the International AIDS Society
Introduction: Emerging HIV epidemics have been documented among people who inject drugs (PWID) in the Middle East and North Africa (MENA). This study estimates the HIV incidence among PWID due to sharing needles/syringes in MENA. It also delineates injecting drug use role as a driver of the epidemic in the population, and estimates impact of interventions. Methods: A mathematical model of HIV transmission among PWID was applied in seven MENA countries with sufficient and recent epidemiological data and HIV prevalence ≥1% among PWID. Estimations of incident and/or prevalent infections among PWID, ex-PWID and sexual partners of infected current and ex-PWID were conducted. Results: The estimated HIV incidence rate for 2017 among PWID ranged between 0.7% per person-year (ppy) in Tunisia and 7.8% ppy in Pakistan, with Libya being an outlier (24.8% ppy). The estimated number of annual new infections was lowest in Tunisia (n = 79) and Morocco (n = 99), and highest in Iran and Pakistan (approximately n = 6700 each). In addition, 20 to 2208 and 5 to 837 new annual infections were estimated across the different countries among sexual partners of PWID and ex-PWID respectively. Since epidemic emergence, the number of total ever acquired incident infections across countries was 706 to 90,015 among PWID, 99 to 18,244 among sexual partners of PWID, and 16 to 4360 among sexual partners of ex-PWID. The estimated number of prevalent infections across countries was 341 to 23,279 among PWID, 119 to 16,540 among ex-PWID, 67 to 10,752 among sexual partners of PWID, and 12 to 2863 among sexual partners of ex-PWID. Increasing antiretroviral therapy (ART) coverage to the global target of 81%factoring in ART adherence and current coveragewould avert about half of new infections among PWID and their sexual partners. Combining ART with harm reduction could avert over 90% and 70% of new infections among PWID and their sexual partners respectively. Conclusions: There is considerable HIV incidence among PWID in MENA. Of all new infections ultimately due to injecting drug use, about 75% are among PWID and the rest among sexual partners. Of all prevalent infections ultimately attributed to injecting drug use as epidemic driver, about half are among PWID, 30% among ex-PWID and 20% among sexual partners of PWID and ex-PWID. These findings call for scale-up of services for PWID, including harm reduction as well as testing and treatment services.