The role of nongovernmental organizations in the response to the AIDS epidemic

The main trends in the activities of the Public Movement "Faith, Hope, Love", organized by an initiative group of specialists in public health, law, public order maintenance, as well as volunteers, in June 1996 are presented. The main aspects of the activities of this non-governmental organization are the prevention of AIDS and sexually transmitted diseases (STD) among vulnerable groups of the population (female sex workers, injecting drug users, street children, representatives of sexual minorities); educational activities on the problems of the prevention of drug addiction and AIDS/STD among adolescents and young people; rendering psychological assistance to the vulnerable groups of the population; practical assistance to street children. Approaches and methods used in the work on AIDS/STD prevention among vulnerable groups of the population are as follows: active involvement of the representatives of vulnerable groups in preventive work, the creation of the possibility of contacts with specialists for representatives of vulnerable groups by opening confidence rooms, mutual assistance centers, provision with individual preventive remedies, active involvement of representatives of government structures in the realization of the projects carried out by the Movement, etc.     

Adult consequences of late adolescent alcohol consumption: a systematic review of cohort studies

Background

Although important to public policy, there have been no rigorous evidence syntheses of the long-term consequences of late adolescent drinking.

Methods and Findings

This systematic review summarises evidence from general population cohort studies of drinking between 15–19 years old and any subsequent outcomes aged 20 or greater, with at least 3 years of follow-up study. Fifty-four studies were included, of which 35 were assessed to be vulnerable to bias and/or confounding. The principal findings are: (1) There is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is also associated with alcohol problems including dependence; (2) Although a number of studies suggest links to adult physical and mental health and social consequences, existing evidence is of insufficient quality to warrant causal inferences at this stage.

Conclusions

There is an urgent need for high quality long-term prospective cohort studies in order to better understand the public health burden that is consequent on late adolescent drinking, both in relation to adult drinking and more broadly. Reducing drinking during late adolescence is likely to be important for preventing long-term adverse consequences as well as protecting against more immediate harms. Please see later in the article for the Editors'' Summary     

A “Krokodil” emerges from the murky waters of addiction. Abuse trends of an old drug

“Krokodil” is the street name for the semi-synthetic opioid derivative desomorphine. Although an old drug, it re-staged on “drug arena” during the last decade causing detrimental effects to its users. Despite the fact that Russia and other former Soviet Republics were the initial plagued countries, “krokodil” arrived in Europe and United States lately, as a substitute of the relative expensive, and in many cases unavailable, heroin. It can be easily manufactured in home-environment from codeine and causes significant health problems, even deaths worldwide. The aim of this review is to summarize the current knowledge about this drug, concerning its chemistry, synthesis, pharmacology and toxicology. Published or reported “krokodil” related cases, fatalities or intoxications, as well as self reports from drug users are reviewed. The existing analytical methodologies for the determination of desomorphine in biological samples as well as its legal status are also presented.     

A Qualitative Study of Alcohol,Health and Identities among UK Adults in Later Life

Increasing alcohol consumption among older individuals is a public health concern. Lay understandings of health risks and stigma around alcohol problems may explain why public health messages have not reduced rates of heavy drinking in this sector. A qualitative study aimed to elucidate older people''s reasoning about drinking in later life and how this interacted with health concerns, in order to inform future, targeted, prevention in this group. In 2010 a diverse sample of older adults in North East England (ages 50–95) participated in interviews (n = 24, 12 male, 12 female) and three focus groups (participants n = 27, 6 male, 21 female). Data were analysed using grounded theory and discursive psychology methods. When talking about alcohol use older people oriented strongly towards opposed identities of normal or problematic drinker, defined by propriety rather than health considerations. Each of these identities could be applied in older people''s accounts of either moderate or heavy drinking. Older adults portrayed drinking less alcohol as an appropriate response if one experienced impaired health. However continued heavy drinking was also presented as normal behaviour for someone experiencing relative wellbeing in later life, or if ill health was construed as unrelated to alcohol consumption. Older people displayed scepticism about health advice on alcohol when avoiding stigmatised identity as a drinker. Drinking patterns did not appear to be strongly defined by gender, although some gendered expectations of drinking were described. Identities offer a useful theoretical concept to explain the rises in heavy drinking among older populations, and can inform preventive approaches to tackle this. Interventions should engage and foster positive identities to sustain healthier drinking and encourage at the community level the identification of heavy drinking as neither healthy nor synonymous with dependence. Future research should test and assess such approaches.     

Enhanced communication and coordination in the public health surveillance component of the Cincinnati Drinking Water Contamination Warning System

Effective communication and coordination are critical when investigating a possible drinking water contamination incident. A contamination warning system is designed to detect water contamination by initiating a coordinated, effective response to mitigate significant public health and economic consequences. This article describes historical communication barriers during water contamination incidents and discusses how these barriers were overcome through the public health surveillance component of the Cincinnati Drinking Water Contamination Warning System, referred to as the "Cincinnati Pilot." By enhancing partnerships in the public health surveillance component of the Cincinnati Pilot, information silos that existed in each organization were replaced with interagency information depots that facilitated effective decision making.     

Epidemic human immunodeficiency virus (HIV) infection among intravenous drug users (IVDU)

Human immunodeficiency virus (HIV) infection is epidemic among intravenous drug users (IVDU), particularly in the northeastern United States. IVDU are playing a critical role in the spread of HIV by infecting their heterosexual partners and children, as well as their needle-sharing partners. The epidemiology of HIV infection among IVDU is reviewed here, including a compilation of seroprevalence data. Relevant determinants of the future spread of HIV among IVDU are discussed, including the major risk factors for HIV seropositivity, the modes of HIV transmission, and aspects of the natural history of HIV infection in IVDU. The public health policy implications of these issues include the need for education of adolescents and the general public about the risks of drug injection and heterosexual intercourse with IVDU, as well as motivation of IVDU to stop injecting, never share injection paraphernalia, or, at least, clean needles effectively.     

The realization of the concept of Harm Reduction in Russia

By the present moment cases of HIV infection among injecting narcotic users (INU) have been registered in more than 100 countries. To prevent HIV infection, the program "Harm Reduction" has been developed in Britain; the program states that the prevention of HIV infection must be considered more important than the prevention of the use of narcotic drugs, as this infection is a growing danger for both drug users and public health in general. Breaking drug dependence must not be the only aim of services working with drug addicts, because this will exclude persons decisively disposed to the mode of life including the prolonged use of drugs from the sphere of their activity. Active INU having no contacts with organizations which must give them treatment and assistance find themselves in dangerous situations more often than INU maintaining contacts with such organizations. Penetration into such hidden group and its education must be the primary task. Propaganda plays a decisive role in this process, as the only way to penetrate into such group is to develop work in its territory, so that drug addicts, supplied with the necessary means could change their behavior in the desired direction. In the Russian Federation work on the project "Harm Reduction" has been carried out in 50 regions. This work has contributed to conducting teaching seminars, working out teaching programs, as well as to augmenting the interest among specialists of different professions to the problem of decreasing the spread of HIV infection. The importance of information distributed by the narcological service and the probability that very responsible persons take correct decisions on the basis of their understanding the situation have increased. The rating of public organization has risen.     

Drug use among youths

The levels of drug use among youths under 14 have remained extremely low for the past few years, as well as in most European countries. Yet, patterns of early drug use are often related to high-risk behaviours that require specific public policy strategies. Over the last years, the Government has set the target of reducing levels of drug use among specific groups such as young people: an awareness-raising media campaign has been launched and a specific outpatients clinics setting has been implemented for cannabis users in particular. This paper examines the relationship between health service providers and criminal justice authorities underlying the effectiveness of the current system. It underlines the need for an early screening and early interventions so as to avoid the shift from simple use to misuse or dependence.     

Heat and acid tolerance of Clostridium novyi Type A spores and their survival prior to preparation of heroin for injection

Clostridium novyi Type A was implicated as a cause of an outbreak of serious illness and deaths among drug users in the United Kingdom who injected heroin intramuscularly. A contaminated batch of heroin was believed to be the source of infection. To test the ability of the outbreak strain to survive certain processes associated with heroin use, it was tested for its ability to survive a range of temperature and pH and the process used in preparation of "street" heroin for injection. C. novyi spores survived temperatures of up to 100 degrees C in aqueous solution for 5 min and survived pH 2.0 at ambient temperatures for a similar time. However, a combination of low pH and raised temperatures reduced survival times. An experiment reconstructing the "street" preparation of heroin demonstrated that any C. novyi spores present would survive this process and thus be capable of initiating infection under the right conditions.     

Drinking and Driving

Alcohol misuse generates many health and social problems at a cost that society is increasingly unwilling to sustain. One of the most tragic consequences of alcohol misuse is the result of drinking and driving. Each week, impaired drivers kill 40 Canadian men, women and children and injure 1250 others. The Canadian Medical Association (CMA), in its campaign against drinking and driving, has recommended that a condition of obtaining or renewing a driver''s licence include the individual''s written consent to allow the taking of blood samples by qualified medical personnel when deemed necessary by law enforcement agencies. CMA has recommended to the provinces that the legal age for the purchase and public possession of alcohol be raised to 21. CMA also supports the ban of all alcohol advertising in the electronic media and emphasizes that since alcohol is a drug, all containers should be visibly labelled “Misuse of this Product can be Injurious to Health”. CMA continues to support and encourage the federal and provincial governments in their battle to prevent alcohol-related deaths and injuries through education, control of advertising, use of breathalyzer devices, mandatory blood alcohol testing and legislation enacting stiffer penalties for drinking and driving.     

Needle exchange programs: an economic evaluation of a local experience

OBJECTIVE: To determine whether providing a needle exchange program to prevent HIV transmission among injection drug users would cost less than the health care consequences of not having such a program. DESIGN: Incidence outcome model to estimate the number of cases of HIV infection that this program would prevent over 5 years, assuming that the HIV incidence rate would be 2% with the program and 4% without it, and that an estimated 275 injection drug users would use the service over this time. SETTING: Hamilton, Ont. OUTCOME MEASURES: Estimated number of cases of HIV infection expected to be prevented with and without the program over 5 years; estimated lifetime health care costs of treating an AIDS patient. The indirect costs of AIDS to society (e.g., lost productivity and informal caregiving) were not included. Projected costs were adjusted (discounted) to reflect their present value. In a sensitivity analysis, 3 parameters were varied: the estimate of the HIV transmission rate if no needle exchange program were provided, the number of injection drug users participating in the program, and the discount rate. RESULTS: With very conservative estimates, it was predicted that the Hamilton needle exchange program will prevent 24 cases of HIV infection over 5 years, thereby providing cost savings of $1.3 million after the program costs are taken into account. This translates into a ratio of cost savings to costs of 4:1. The sensitivity analysis confirmed that these findings are robust. CONCLUSION: Needle exchange programs are an efficient use of financial resources.     

Injection drug use and HIV/AIDS transmission in China

After nearly three decades of being virtually drug free, use of heroin and other illicit drugs has re-emerged in China as a major public health problem. One result is that drug abuse, particularly heroin injection, has come to play a predominant role in fueling China's AIDS epidemic. The first outbreak of HIV among China's IDUs was reported in the border area of Yunnan province between China and Myanmar where drug trafficking is heavy. Since then drug-related HIV has spread to all 31 provinces, autonomous regions and municipalities. This paper provides an overview to HIV/AIDS transmission through injection drug use in China. It begins with a brief history of the illicit drug trade in China, followed by a discussion of the emergence of drug related AIDS, and a profile of drug users and their sexual partners who have contracted the virus or who are vulnerable to infection. It ends by summarizing three national strategies being used by China to address both drug use and AIDS as major health threats.     

Pattern of Drug Use and Depressive Symptoms among Amphetamine Type Stimulants Users in Beijing and Guangdong Province,China

Background

In recent years, amphetamine-type stimulants (ATS) have increased dramatically in East-south Asia, especially in China. Most ATS users suffered from psychosis comorbidity, and depression is the main syndrome in ATS users.

Methodology

A cross-sectional study of depressive symptoms and associated factors among ATS users was conducted in compulsory and voluntary drug detoxification and rehabilitation centers of Beijing and Guangdong Province from March, 2010 to August, 2010. Total 402 eligible participants were recruited and investigated by trained interviewers using a structured questionnaire, the depression was measured by the short 13-item Beck Depression Inventory (BDI-13). Multiple logistic regression was used to determine the impact of associated risk factors of depressive symptoms (%≥8).

Principle Finding

The mean score of BDI-13 is 8.11, and 169 participants (42.04%) have depressive symptoms, including 106 (26.37%) with moderate and 63 (15.67%) with severe depressive symptoms. Higher dose of ATS use, history of ATS relapse were associated with moderate and severe depressive symptoms, the adjusted odds ratios (OR) was 2.62, (95% CI: 1.45–4.74) and 2.01 (95% CI: 1.18–3.42) respectively. The cessation of 12 months or more had less risk of depressive symptoms than the current users, the OR was 0.46 (95% CI: 0.24–0.91), and the ATS users reporting nicotine dependence and alcohol drinking had significantly more risk of depressive symptoms for 3.11 (1.83–5.28) and 2.22 (1.35–3.65) times than those without these behaviors.

Conclusions

Depressive symptoms co-occurred frequently among ATS users in China. The efforts that facilitate drug users’ attempts to stop using ATS use and relapse, quit cigarette smoking and stop alcohol drinking during the ATS treatment and management process should be supported as they may contribute to improving the mental health among this population.     

Evaluation of sampling and screening techniques for tiered monitoring of toxic cyanobacteria in lakes

Exposure to cyanotoxins can pose serious human health consequences both through drinking water and recreational use of a contaminated waterway. We adapted a tiered framework proposed by the World Health Organization (WHO) for monitoring cyanobacteria populations and assessing public health risks and implemented the program in Lake Champlain. This study focused on evaluating the sampling protocols employed in this adapted monitoring program over two field seasons (2003 and 2004). Using a paired sampling design, we evaluated whether 63-μm Wisconsin net samples adequately represented whole-water conditions and whether chlorophyll a concentration could serve as a useful predictor of cyanobacteria density and microcystin concentration. We also evaluated the spatial and temporal dynamics of blooms and their implications for monitoring. Our results suggest that using threshold values of either potentially toxic cyanobacteria density counted using a rapid screening protocol or chlorophyll a concentration serve as initial indicators of potentially high levels of cyanotoxin; however, the utility of chlorophyll a is system-dependent. Whole-water samples provide more accurate estimates of population density and higher microcystin concentrations than net samples, offering a more cautionary approach to assessing risk to recreational lake users. Shoreline samples generally showed higher cyanotoxin concentrations than offshore, but restricting sampling to the shoreline may miss early warnings of bloom development.     

The Epidemiology of Alcohol Use and Alcohol Use Disorders among Young People in Northern Tanzania

IntroductionAlcohol use is a global public health problem, including as a risk factor for HIV infection, but few data are available on the epidemiology of alcohol use and alcohol use disorders (AUD) among young people in sub-Saharan Africa.MethodsWe conducted a cross-sectional survey among 4 groups of young people aged 15–24 years old (secondary school students, college/university students, employees of local industries and casual labourers) in two regions (Kilimanjaro and Mwanza) of northern Tanzania. Using a multistage stratified random sampling strategy, we collected information on demographics, alcohol use, and behavioural factors. We screened severity of alcohol use using the Alcohol Use Disorder Identification Test (AUDIT) and estimated the quantity and frequency of alcohol consumption using the timeline-follow-back-calendar (TLFB) method.ResultsA total of 1954 young people were surveyed. The prevalence of reported alcohol use was higher among males (47–70% ever users and 20–45% current users) than females (24–54% ever users and 12–47% current users). Prevalence of use was substantially higher in Kilimanjaro than Mwanza region. In both regions, participants reported high exposure to alcohol advertisements, and wide alcohol availability. College students reported the highest prevalence of current alcohol use (45% among males; 26% among females) and of heavy episodic drinking (71% among males; 27% among females) followed by casual labourers. Males were more likely to have AUD (an AUDIT score ≥8) than females, with 11–28% of males screening positive for AUD. Alcohol use was associated with male gender, being in a relationship, greater disposable income, non-Muslim religion and a higher number of sexual partners.ConclusionsAlcohol use is a significant problem among young people in northern Tanzania. There is an urgent need to develop, pilot and deliver interventions to help young people delay initiation and reduce levels of harmful drinking, particularly among college students and casual labourers.     

Tobacco habit: historical, cultural, neurobiological, and genetic features of people's relationship with an addictive drug

This article reviews the cultural history of man's relationship with tobacco and the steps in the discovery of tobacco addiction. Nicotine dependence (ND) or nicotine addiction (NA), among other forms of drug addiction, continues to be a significant public health problem in the world, as it is associated with major severe diseases such as cardiovascular disease and cancer. Evidence for a genetic influence on smoking behavior and ND has prompted a search for susceptibility genes. Proof has recently accumulated that single nucleotide polymorphisms (SNPs) in the genetic region encoding the nicotinic acetylcholine receptor (nAChR) subunits α5, α3, and β4 are associated with smoking and ND. In this review, we consider tobacco as the archetype of substance addiction and describe the evolution of the tobacco habit from elite users to lower socioeconomic abusers (by mass marketing and specific targeting of vulnerable groups by the tobacco industry) to exemplify detrimental behavior with major threats to public health. Finally, we discuss the reasons for the difficulty of quitting addictions/habits and highlight possible solutions.     

Psychosocial factors associated with smoking and drinking among Japanese early adolescent boys and girls: Cross-sectional study

Background  

Smoking and drinking alcohol among early adolescents are serious public health concerns, but few studies have been conducted in Japan to assess their prevalence and etiology. A regional survey was conducted in eight schools in two Japanese school districts to identify psychosocial factors associated with smoking and drinking behaviors for boys and girls.     

The acceptance of a strategy for decreasing the risk of contracting an HIV infection among drug abusers

The narcotization level of the country is sufficiently high. According to some expert evaluations, the number of drug users varies between 2-4 million persons. Of these, about 100,000 are registered in narcotics service of the Ministry of Health of the Russian Federation and about 250,000 are registered in the system of the Ministry of Internal Affairs of the Russian Federation. The main annual increase in drug users is given by unemployed young people and students (more than 15% of them are minors). An important task standing at present before the specialists of the service responsible for the prophylaxis of HIV infection is the steady spread of information among executive and legislative authorities, as well as the preparation of public opinion, on the necessity for the state to choose and accept the optimum variant of the strategy for the prophylaxis of HIV infection among drug users.     

Alcohol,tobacco and cannabis use among Nova Scotia adolescents: implications for prevention and harm reduction

OBJECTIVE: To characterize adolescent drug use in terms of a risk continuum and to explore the rationale for harm reduction as a potential approach for school-based drug prevention. DESIGN: Self-reported surveys, in 1991 and 1996, of adolescent students concerning their use of drugs, especially alcohol, tobacco and cannabis, and the harmful consequences of such use. SETTING: Nova Scotia. PARTICIPANTS: A total of 3452 (in 1991) and 3790 (in 1996) junior and high school students in randomly selected classes in the public school system. OUTCOME MEASURES: Prevalence of drug use and patterns of multiple drug use and of alcohol- and drug-related problems; independent risk factors for multiple drug use. The risk continuum for the response to alcohol problems was used as a policy framework. RESULTS: The prevalence of cigarette smoking and the use of hallucinogens and stimulants was markedly higher in 1996 than in 1991. Over one-fifth (21.9%) of the students reported multiple drug use of alcohol and tobacco and cannabis in the 12 months before the 1996 survey. The 3 main subgroups--nonusers, users of alcohol only and users of multiple drugs--had distinct patterns of use, numbers of problems and risk factors. In all, 27.1% of the students had experienced at least 1 alcohol-related problem and 6% had experienced at least 1 drug-related problem in the 12 months before the 1996 survey. CONCLUSION: There is a need for integrated school- and community-based drug prevention programs, with goals, strategies and outcome measures capturing the full spectrum of patterns of use and levels of risk among subgroups of the adolescent student population.