Harm reduction should address the specific needs of couples who inject drugs

nam/aidsmap, 21 March 2017

The sharing of drug injecting equipment most often occurs between sexual partners, but the ways in which couples manage risks and care for each other have been largely ignored by harm reduction services, say Australian researchers.

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Prisons need better drug treatment programs to control infectious diseases

The Conversation, July 15, 2016 10.56am AEST

Worldwide, around 30 million people enter and leave prison each year. Of these people, around 4.5 million have hepatitis C, almost 1 million have HIV and 1.5 million have hepatitis B infections.

In many countries, prisons are underfunded and overcrowded, and injecting drug use is common. Those who enter prison uninfected are at risk of becoming infected, as few countries provide the range of prevention programs required to halt transmission inside.

Once detained, prisoners are often denied access to life-saving treatment for these infections.

  • Read more here
  • Read HIV, prisoners, and human rights from The Lancet here

 

Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes

Clin Infect Dis. 2016 Jun 25. pii: ciw416. [Epub ahead of print]

Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis

BACKGROUND:

Human immunodeficiency virus (HIV)-infected people who inject drugs (PWID) frequently encounter barriers accessing and remaining on antiretroviral therapy (ART). Some studies have suggested that opioid substitution therapy (OST) could facilitate PWID’s engagement with HIV services. We conducted a systematic review and meta-analysis to evaluate the impact of concurrent OST use on ART-related outcomes among HIV-infected PWID.

METHODS:

We searched Medline, PsycInfo, Embase, Global Health, Cochrane, Web of Science, and Social Policy and Practice databases for studies between 1996 to November 2014 documenting the impact of OST, compared to no OST, on ART outcomes. Outcomes considered were coverage and recruitment onto ART, adherence, viral suppression, attrition from ART, and mortality. Meta-analyses were conducted using random-effects modeling, and heterogeneity assessed using Cochran Q test and I2 statistic.

RESULTS:

We identified 4685 articles, and 32 studies conducted in North America, Europe, Indonesia, and China were included. OST was associated with a 69% increase in recruitment onto ART (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.32-2.15), a 54% increase in ART coverage (odds ratio [OR], 1.54; 95% CI, 1.17-2.03), a 2-fold increase in adherence (OR, 2.14; 95% CI, 1.41-3.26), and a 23% decrease in the odds of attrition (OR, 0.77; 95% CI, .63-.95). OST was associated with a 45% increase in odds of viral suppression (OR, 1.45; 95% CI, 1.21-1.73), but there was limited evidence from 6 studies for OST decreasing mortality for PWID on ART (HR, 0.91; 95% CI, .65-1.25).

CONCLUSIONS:

These findings support the use of OST, and its integration with HIV services, to improve the HIV treatment and care continuum among HIV-infected PWID.

Access full text (free access) here

To tackle hepatitis C, we need to close the justice gap

Croakey, Dec 22, 2015

Health Minister Sussan Ley’s announcement of PBS listing for new treatments for hepatitis C has been welcomed by Hepatitis NSW as “brilliant news”. Given the high rates of hepatitis C among people in prisons, it is significant that the Government has agreed to fund these medicines for prisoners.

However, tackling hepatitis C will also require public health interventions such as the introduction of needle and syringe programs into correctional centres, and concerted efforts to reduce the over-representation of Aboriginal and Torres Strait Islander people in prisons, according to Heather McCormack from Hepatitis NSW.

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The health of Australia’s prisoners 2015

AIHW, released: 27 Nov 2015

The health of Australia’s prisoners 2015 is the fourth report produced by the Australian Institute of Health and Welfare on the health and wellbeing of prisoners. The report explores the conditions and diseases experienced by prisoners; compares, where possible, the health of prisoners to the general Australian community and provides valuable insight into the use of prison health services.

New to the 2015 report are data on the disabilities or long-term health conditions of prisoners entering the prison system (prison entrants), self-assessed mental and physical health status of prisoners and data on smoke-free prisons

Of special note:

Chapter 6 (Communicable diseases) includes:

  • Sexually transmissible infections
  • Bloodborne viruses
  • Surveillance
  • Medication for Hepatitis C

Chapter 12 (Illicit drug use and needle sharing) includes:

  • Drug use prior to prison
  • Drug use in prison
  • Needle sharing
  • Opioid substitution treatment (OST)
  • Tattooing and body piercing

Chapter 14 (Injuries, assaults and unprotected sex) includes:

  • Head injury
  • Accidents or injuries
  • Assault and sexual assault
  • Unprotected sex

See full table of contents & download report (PDF) or read summary here

How patterns of injecting drug use evolve in a cohort of PWID

Australian Institute of Criminology, June 2015

This study examines some of the ways in which injecting drug use evolves over time in a cohort of People Who Inject Drugs. It shows shifts in the settings in which cohort members reported buying and using their drugs. These shifts have important implications for the harms experienced by PWID, and the wider community.

Read more here