Syringe exchange programs in Brazil: preliminary assessment of 45 programs.
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The present study aims to evaluate the current operation of Brazilian syringe exchange programs (SEP). After consulting national and regional networks of people working in projects/programs aiming to reduce drug-related harm, we identified 134 potential participant programs. Unfortunately, only 45 SEPs answered a survey, even after repeated attempts. The survey addressed: coverage, funding, procurement of basic supplies, managerial capacity, and the local political environment. Findings were triangulated with in-depth interviews with key informants. The main findings included: satisfactory adherence to the initiatives and adequate documentation, but deficiencies in terms of coverage and monitoring, and uneven procurement of resources. Program personnel work mostly on a provisional basis, despite the efforts of local coordinators. Most programs are funded by the National STDs/AIDS Program. A comprehensive agenda aiming to improve current operations should include: concerted efforts to improve local and regional databanks, incentives/sanctions toward full accountability of initiatives carried by the programs, and a genuine culture of monitoring and evaluation. (+info)
A capture-recapture technique to estimate the size of the injecting drug user population attending syringe exchange programs: AjUDE-Brasil II Project.
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This paper presents the results of a study with a two-occasion capture-recapture design. The data are part of the AjUDE-Brasil II Project, carried out in 2000-2001. Estimation of the size of the IDU population attending a syringe-exchange program (SEP) in Sao Jose do Rio Preto, Salvador, and Porto Alegre, Brazil, was performed using Chao's model. Capture probabilities were also estimated. For Porto Alegre a comparison of the results from the AjUDE-Brasil I and AjUDE-Brasil II Projects was performed. Results are also presented for error rates secondary to the choice of matching criteria. (+info)
Characteristics of male and female injecting drug users of the AjUDE-Brasil II Project.
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The object of this study is to compare female and male injection drug users (IDUs) in terms of sociodemographic profile and aspects of their initiation to the use of injection drugs. It was a cross-sectional and multicentric study realized in 2000-2001 in six Brazilian syringe-exchange programs. 146 women and 709 men were interviewed, with average ages of 29.5 and 28.3 years, respectively. Both began injection drug use at similar ages, 18.6 and 19.3, for women and men, respectively, although women report more frequently than men that they were initiated by a sexual partner to acquiring drugs and syringes, and to the act of injection. Compared to men, women report significantly more regular sexual partners (83% versus 72%); fewer casual partners (39% versus 58%), more use of injection drugs with their partners, as well as more "exchange" of sex for drugs. Among HIV-seropositive individuals, women show less education, had more chance of their sexual partners participating in their initiation to injection drugs, and report sexual partners that used injection drugs more frequently. Female IDUs exhibit aspects of behavior indicating greater vulnerability to HIV infection than do males. (+info)
Injecting drug users who are (un)aware of their HIV serostatus: findings from the multi-center study AjUDE-Brasil II.
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This study aimed to characterize the profiles of injecting drug users (IDUs) who were unaware of their HIV serostatus, given the importance of this information for prevention strategies, especially in this vulnerable population, key to the HIV/AIDS dynamic. As part of a cross-sectional multi-city survey, IDUs were interviewed and HIV-tested by the ELISA technique. IDUs were categorized according to knowledge of their own HIV status as either aware or unaware. Means, averages, and proportions were compared between the groups using bi- and multivariate analyses. Of 857 IDUs interviewed, 34.2% were unaware of their HIV serostatus. Those who were unaware were more likely: to have been recruited at sites where the HIV prevalence rate was considered medium (> 10 to 50%; odds ratio = 8.0) or high (> 50%; 4.0); to be illiterate (OR = 4.54); to have no prior HIV test (OR = 2.22); to be male (OR = 1.81); and to have been enrolled more recently in syringe-exchange programs (OR = 1.69). HIV prevention programs should target both individuals at risk and HIV-positive individuals. Programs to expand access to HIV testing are pivotal and should be tailored to specific contexts and populations. (+info)
AIDS incidence and mortality in injecting drug users: the AjUDE-Brasil II Project.
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This paper presents AIDS incidence and mortality among injecting drug users (IDUs) reached by the AjUDE-Brasil II Project. From a cross-sectional survey, 478 IDUs were interviewed in three Brazilian cities: Porto Alegre, Sao Jose do Rio Preto, and Itajai. The cohort was followed up in the Brazilian surveillance database for AIDS and mortality during 2000 and 2001. AIDS incidence was 1.1 cases per 100 person-years, and the mortality rate was 2.8 deaths per 100 person-years. AIDS cases only occurred in IDUs who reported ever having shared injecting equipment. Female gender (RR = 5.30), homelessness (RR = 6.16), and report of previous sexual relations with same-sex partners (RR = 6.21) were associated with AIDS. Deaths occurred only among males. Homelessness (RR = 3.00), lack of income (RR = 2.65), HIV seropositive status (RR = 4.52), and no history of incarceration (RR = 3.71) were also associated with death. These findings support evidence that gender and socioeconomic conditions are both determinants of morbidity and mortality in Brazilian IDUs. (+info)
HCV and HIV infection and co-infection: injecting drug use and sexual behavior, AjUDE-Brasil I Project.
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This study aimed to characterize sexual and drug-use behaviors in injecting drug users (IDUs) in relation to single hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection and HCV/HIV co-infection. The sample consisted of 272 IDUs enrolled in the AjUDE-Brasil I Project, a cross-sectional multi-center study conducted in five Brazilian cities in 1998. Data were collected with a structured questionnaire using self-reported risk behavior, and HCV and HIV serological status used ELISA on filter paper. IDUs were clustered in four distinct groups: HCV/HIV seronegative; HCV mono-infected; HIV mono-infected; and HCV/HIV co-infected. Active sharing of injecting equipment was associated with HCV infection (p = 0.001). Sexual behavior variables, especially male same-sex sexual relations, were consistently associated with HIV infection. HCV/HIV co-infection was associated with both sexual and drug use variables. It was possible to distinguish different behavioral indicators for HCV and HIV infection and co-infection in this population. (+info)
Advocacy and coverage of needle exchange programs: results of a comparative study of harm reduction programs in Brazil, Bangladesh, Belarus, Ukraine, Russian Federation, and China.
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To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on "high coverage sites", adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services) should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage. (+info)
Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime.
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North America's first medically supervised safer injecting facility (SIF) recently opened in Vancouver, Canada. One of the concerns prior to the SIF's opening was that the facility might lead to a migration of drug activity and an increase in drug-related crime. Therefore, we examined crime rates in the neighborhood where the SIF is located in the year before versus the year after the SIF opened. No increases were seen with respect to drug trafficking (124 vs. 116) or assaults/robbery (174 vs. 180), although a decline in vehicle break-ins/vehicle theft was observed (302 vs. 227). The SIF was not associated with increased drug trafficking or crimes commonly linked to drug use. (+info)