The monitoring of the spread of drug abuse as an element in the epidemiological surveillance of socially significant infections

The necessity of monitoring the spread of drug addiction in the system of epidemiological surveillance on HIV infection and parenteral virus hepatitides is shown. The results of the epidemiological diagnostics of registered drug addiction are presented. The criteria for the assessment of the epidemiological effectiveness of epidemiological surveillance on drug addiction are determined. As revealed in this study, during the period of 1991-1998 morbidity in drug addiction rose 57-fold in Perm Province, while the number of HIV-infected persons increased 75-fold. Pronounced direct relationship between the number of drug addicts, as well as persons belonging to groups of high risk of developing drug addiction, and the dynamics of morbidity in HIV infection and parenteral virus hepatitides B and C was established.     

The determinants of the spread of HIV among injection drug addicts in Ukraine

The main tendencies in the development of drug addiction in the Ukraine, the dynamics of the spread of HIV among drug addicts introducing drugs intravenously, epidemiological data on HIV, AIDS and drug addiction, as well as prognoses on the development of HIV infection are presented. Since 1995 the number of HIV-infected persons grew 34-fold, the number of cases of HIV infection resulting from the intravenous use drugs rose to 70% simultaneously with the rise (about 34-fold) of the number of persons infected with HIV through sexual contacts (about 13 fold). In 1996-1997 such tendency increased. On the whole, the proportion of drug addicts introducing drugs by intravenous injection was 83% in the Ukraine. By April 1, 1998, official registration covered 18,800 HIV-infected persons, including 270 foreign nationals, as well as 499 AIDS patients, including 487 Ukrainian citizens, among them 28 children. Out of 18,800 HIV-infected persons, 78.3% were drug addicts, most of them young people aged 15-30 years; about 18% were young people under 20 years of age, 80% being males. According to the model the rapid spread of HIV from the group of drug addicts to the heterosexual population, the total number of HIV-infected persons reaching 1,500,000 is expected in the country by 2014.     

Emergency measures to control the spread of diseases caused by the human immunodeficiency virus

Since the middle of 1996 the growth of HIV-infected persons and AIDS morbidity are registered in Russia. In 1997 4,300 new cases of HIV infection were registered, which exceeded 1.6 times the total number of cases for the period of 1987-1996. The highest morbidity rate was observed in the cities of the European part of Russia: Kaliningrad (west), Krasnodar and Rostov-on-Don (south), Nizhny Novgorod and Moscow (center). AIDS patients and HIV-infected persons were registered in 73 out of 89 regions of the country. 90% of HIV-infected persons were drug users in 1997. In 1992-1997 the number of drug addicts increased 3.5 fold and young women in 1987-1997, 6.5 fold. 71 HIV-infected children were registered were born from HIV-infected mothers at present time. The article deals with the main provisions of the federal laws aimed at the prevention of the spread of HIV infection in Russia and characterizes scientific research on AIDS. Evidence is presented that the early detection of HIV-infected persons, as well as rendering timely medical and social assistance to such persons, makes it possible to increase their mean survival time and check the spread of human immunodeficiency virus.     

A strategy for the control of HIV infection and viral hepatitides against the background of the narcotic abuse epidemic

The presence of the epidemic of drug addiction in the Russian Federation is stated: for the recent 10 years the number of drug addicts increased 3.5-fold. The questioning of several thousand drug addicts has revealed that 60% of them have hepatitis B, 80% have hepatitis C, 10% have syphilis. The strategy of controlling HIV infection among drug addicts is proposed. It includes, in the first place, the prevention of the secondary infection from HIV-infected addicts; in the second place, the detection of HIV-infected persons in groups of drug addicts, difficult to establish contacts with; in the third place, the primary prophylaxis within the program "Harm reduction" in the most susceptible groups of drug addicts. The thesis that the prevention of HIV infection must become the prevention of drug addiction by rendering multi-stage assistance to HIV-infected persons, including mainly drug addicts, is substantiated.     

The epidemiological characteristics of HIV infection in Turkmenistan

In the presence of the low spread of HIV infection a sharp increase in sexually transmitted diseases is noted. Nevertheless, taking into account a rise in STD, the reality of the potential risk of the spread of HIV is emphasized. Thus, in 1996 morbidity is syphilis was found to grow 7.2 times in comparison with 1992, amounting to 37.5 cases per 100,000 of the population; morbidity in gonorrhea amounted to 32.4 cases per 100,000 of the population with the proportion coming to medical institutions not exceeding 30%. A high proportion of hepatitis B virus carriers was also established (from 15% to 30% of healthy persons), while morbidity in virus hepatitides rose twofold for the period of 1994-1995. During recent years the service for the prophylaxis of AIDS was noted to considerably decrease measures on mass screening. At the same time the article attracts attention to the necessity of increasing the work on the dissemination of information and education on HIV/AIDS drug among addicts, prostitutes and homosexuals. The Draft National Program of the Prophylaxis of HIV infection and STD for 1998-2002 has been worked out. Great importance of methodological and financial assistance rendered since 1994 by international organizations, including WHO, UNFPA, etc., have been emphasized.     

The epidemic of human immunodeficiency virus-caused infection among users of psychotropic preparations in Russia

The development of the epidemic of HIV infection among the intravenous injecting users of psychotropic substances in Russia in 1994-1999 is described on the basis of the data provided by territorial centers for the prevention and control of AIDS. In addition, the results of the screening in individual groups of the population of Russia for antibodies to HIV, carried out at the period of 1994 to the first half of 1999, are presented. In 1999 a considerable rise in the number of newly detected cases of HIV infection, mainly among persons injecting psychotropic drugs intravenously for non-medical purposes, was noted. The conclusion was made that the spread of HIV among drug addicts led to its passage to other groups of the population, mainly by heterosexual transmission.     

Development of HIV infection epidemic among intravenous drug users in the Sverdlovsky region

The Sverdlovsky region takes the fourth place among the 89 subjects of the Russian Federation by the number of registered cases of HIV infection. Drug addiction has reached an excessive scale in this region: according to the data of express evaluation carried out by the Regional Narcological Hospital and the Regional AIDS Center, not less than 7-8% of persons aged 15-30 years constantly use injection drugs. The large-scale epidemic of injection drug addiction has led to the rapid spread of HIV among addicts. The first penetration of HIV into this population took place in 1996 and, starting from the year 2000, rapid, development of the epidemic began, taking the character of an avalanche. The peak of new cases of HIV infection fell on 2001 (9,230 cases were registered). The concentrated stage of the epidemic development is observed in the region at present, the prevalence of HIV infection among drug addicts being 13.8%. Children born from HIV-infected drug addicted mothers now represent a new risk group due to great difficulties in the prophylaxis of the vertical virus transmission.     

An analysis of the situation with injection narcotic usage in the city of Voronezh during the development of the HIV infection epidemic in Russia

The medico-demographic situation in Voronezh, characterized by a decrease in the birth rate, a rise in the mortality rate, the prevalence of pensioners (38%) in the structure of the population, is presented. The negative influence of the deterioration of socio-economic conditions on the social health of the population, especially on the situation with drug addiction, is pointed out. The extent of the misuse of narcotic and toxic substances among adolescents essentially increased. The rapid assessment of the situation with the intravenous use of drugs in Voronezh was carried out, following the WHO methodology. The conclusion was made concerning the necessity of complex sociological monitoring with a view to obtaining more reliable data on the number of drug addicts. The calculation of the supposed number of users in Voronezh among persons aged 15-30 years, made by three modules of assessment, revealed this number reached 61,374 persons, i.e. every fifth or sixth young person used some narcotic substances. The necessity of taking drastic measures on the primary prophylaxis of HIV infection among injecting drug users by creating conditions for the realization of the programs "Harm Reduction" and "Equal Helps Equal" which proved to be effective in other regions of the Russian Federation.     

HIV infection in the penitentiaries of Ukraine

In connection with a sharp increase of the number of HIV-infected persons in the Ukraine the natural growth of the number of such persons in penitentiary institutions was registered, starting from 1995 (455 persons in 1995, 2,937 persons in 1996, 2,779 persons in 1997 and 173 persons during 5 months of 1998). 83% of HIV infection persons were drug addicts introducing drugs intravenously. In 1997 the strategy of decreasing the risk of infection in penitentiary institutions was worked out in collaboration with UNAIDS experts: repressive and isolation measures were replaced with measures aimed at the "decrease of harm". Special attention is given to circumstances aggravating the epidemic situation in HIV infection, and particularly at the sharp growth of morbidity in tuberculosis and syphilis (10.6 and 10.3 times respectively in 1997 in comparison with 1993). In addition, in 1997 the number of person having drug addiction was noted to increase 2.3 times in comparison with 1993. The necessity of taking constant information and educational measures aimed at decreasing the risk of the spread of HIV infection is emphasized.     

Drug Addiction - Pushers Generated from the Addicts

This work develops a model for the spread of drug addiction in a closed population of size N. The spread of addiction is considered as an epidemic process where the addicts mix homogeneously within the population. There is an additional group (or pushers) with whom the susceptibles interact, but who are generated from the addicts. State probabilities and moments are obtained for this stochastic process. An extension to a generalized model is also made.     

Molecular epidemiology of HIV-infection in drug addicts of Southern Ural

The analysis of HIV-1 variants circulating among drug addicts in 16 settlements of the Sverdlov, Chelyabinsk and Orenburg regions (72, 90 and 42 patients respectively) was carried out. As shown by the serological analysis, the spread of HIV-1 variant IDU-A among the drug addicts in this area continued in this area and could be detected in 99.5% of the samples (203 out of 204 samples). These data were confirmed by the results of the analysis of 35 samples by the Heteroduplex Mobility Assay for genes env and gag. The analysis of nucleotide sequences of gene env revealed that HIV-1 variants in the Southern Urals, where the greatest outbreak of HIV infection in Russia had been registered, were genetically related to viruses of subtype A, detected earlier in this group of risk in other regions of Russia, as well as in Ukraine, Belarus and other East European countries.     

The results of conducting a rapid assessment of the situation in relation to intravenous narcotic abuse in the city of Rostov-on-Don

The main aspects of the spread and intravenous use of drugs in the city, contributing to the transmission of HIV infection among users of intravenous drugs (UID) have been studied. Anonymous questionnaires were distributed among 61 UID; of these, 50 were males (82%) and 11 were females (18%), mainly at the age of 19-35 years. In addition, sociological study was carried out among 582 persons; 61% of them were under 18 years of age, 18% were aged 19-25 years, 13% were aged 26-35 years. The drug users regarded their individual risk of getting HIV infection as insignificant in 23% of cases, slight in 21% of cases, high in 15% of cases, and 15% believed they were at no risk. As shown by the results of the sociological study, 91% of the respondents believed that the problem of drug addiction was topical in the city. The analysis of data obtained from physicians treating drug addicts and from the Head Office of Public Health made it possible to calculate that the number of UID in the city was about 9,000-10,000 persons. Taking into account the results of the rapid evaluation of the situation, the development of the draft program of "diminishing the harm" of the intravenous use of drugs is now in progress.     

The epidemic situation in relation to HIV infection in Ukraine (1987-1997)

The analysis of the dynamics of the epidemic process for 10 years made it possible to find out the presence of two separate epidemic waves of HIV infection. The first wave (1987-1994) was manifested as the slow type of the development of the epidemic, characterized mainly by sexual transmission. During this period 398 persons with HIV infection were detected, 24 persons were found to have AIDS; of these, 13 persons died. The second epidemic wave began in 1995 and was due to the spread of HIV among users of drugs introduced by injection. By the end of 1995 the number of HIV carriers was 34 times greater than that of 1994, reaching 1490 persons. In 1996-1997 this figure increased 8 times (annually). The number of AIDS patients rose to 420 persons. The most unfavorable regions with respect to HIV infection and AIDS morbidity were determined. The western regions of the Ukraine were noted to be in a more favorable situation in this respect with infection indices being lower more than 30 times. Up to 80% of all infected persons were found to be addicts introducing drugs intravenously. Growing morbidity in sexually transmitted disease, particularly in syphilis, contributed to the deterioration of the epidemiological situation. The conclusion was made on the necessity of introducing new prophylactic programs and expanding current ones. The signs of stabilization in Odessa and Nikolayev were observed; in these cities pilot programs aimed at the strategy of the "decrease of harm" have been introduced (in collaboration with UNAIDS) since 1996.     

HIV infection in Russia and Commonwealth of Independent States: current situation and prospective

The dynamics of the spread of HIV infection in Russia and the CIS countries is presented. The relationship between the spread of HIV infection and an increase in the number of injection drug users is substantiated. The factors inhibiting the spread of the epidemic of HIV/AIDS in Russia and the CIS countries are analyzed with due regard to the world experience. Attention is paid to the development of the epidemic situation in HIV infection due to, similarly to Russia and to more than 100 countries of the world, drug addiction. The effectiveness of the activity of the Russian health service organs in controlling this epidemic is emphasized. The prospects of prophylactic measures for controlling HIV infection in Russia and the CIS countries are determined.     

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.     

Spread of hepatitis virus as a threat to national security

Information on viral hepatitis A, B and C morbidity in Russia is presented. A distinct trend to decreased viral hepatitis B and C morbidity in 2001-2002 in comparison with the 1990-ies is noted. Nevertheless, there is still unfavorable prognosis regarding high hepatitis B morbidity among the population of reproductive age, as well as among adolescents, which increases the risk for children at an early age. In addition, a new specific feature of hepatitis A spread is observed: morbidity in this infection is shifted to older age groups. The role of vaccinal prophylaxis in the decrease of hepatitis A and B morbidity, virus safety of blood and its components, the quality of the diagnostics of chronic hepatitis, especially hepatitis C, are discussed. The complex of measures for the prophylaxis of viral hepatitis is proposed.     

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization and infection in intravenous and inhalational opiate drug abusers

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in hospital-acquired and community-acquired infections. We hypothesized that drug abuse is a risk factor for community-acquired MRSA (CA-MRSA) infection, and we employed a rapid multiplex PCR technique for MRSA identification. The study was conducted on MRSA isolates from 60 opiate addicts (intravenous and inhalational drug users) to detect the rate and location of MRSA colonization and infection among them in comparison to 60 non-addict patients and 15 healthy volunteer controls. The proportion of addicts with MRSA colonization (and/or infection) was significantly higher than non-addict patients with MRSA colonization. MRSA colonization was associated with infection in 58% of MRSA-colonized addicts. The MRSA nasal carriage in the addicts was significantly higher than MRSA carriage elsewhere, whether in the addicts group or in the non-addict patients group. Moreover, the nasopharyngeal carriage rate of MRSA among addicts was significantly higher than among the non-addict patients. Increasing the duration of addiction resulted in a significant increase in CA-MRSA colonization in opiate addicts. Both inhalational and intravenous drug use led to significant MRSA colonization in the addict population. In conclusion, this study demonstrated how drug abusers, a high-risk group for infections with MRSA, could be a source or a reservoir of CA-MRSA infection in the non-addict population.     

Deaths of drug addicts in the United Kingdom 1967-81.

A search of the Home Office index of notified drug addicts identified 1499 deaths during 1967-81, of which 226 (15%) were of therapeutic addicts--that is, patients who had become addicted during medical treatment with a notifiable drug--and 1273 (85%) were of non-therapeutic addicts. The crude mortality fell from 23.5/1000/year for the period 1968-70 to 18.4/1000/year for 1978-80. Altogether 416 addicts aged under 50 at notification died after 1972, which was 16 times the number of deaths expected in a population with a similar age and sex composition. A more detailed examination of the cohorts of addicts notified each year showed little variation between them in the first two years of follow up. Nineteen addicts (1.6%) had died by 31 December of the year of their notification and 39 (3.3%) one year later. These figures may be an indication of the clinical course of addiction. Most deaths of non-therapeutic addicts in which a drug was implicated (939 cases (74%] were due to medically prescribed drugs--barbiturates at first and later opiates such as dipipanone hydrochloride and dextromoramide. Heroin was implicated in only 65 (7%) of these deaths. The Home Office index is a valuable source for identifying drugs of abuse and serious problems of addiction. The fact that prescribed drugs are causing the death of so many addicts demands a response from the medical profession.     

A genetic analysis of variants of the human immunodeficiency virus type 1 (HIV-1) circulating among drug abusers in Moscow and Moscow Province

The genetic analysis of the variants of human immunodeficiency virus of type 1 (HIV-1), circulating among drug addicts in Moscow and Moscow Province, has been carried out. The serological analysis of 122 blood specimens taken from HIV-infected drug addicts, residing in Moscow and 22 settlements of the Moscow region, has shown that in this region HIV-1 variant of subtype A spreads among drug addicts. These data have been confirmed by the results of the analysis of 44 specimens, made with the use of the method of the heteroduplex mobility assay for gene env. As revealed in this study, HIV-1 variants spreading at present among drug addicts in Moscow and the Moscow region are genetically related to viruses of subtype A, detected earlier in this group of risk in other regions of Russia, the Ukraine, Belarus and other countries of Eastern Europe.     

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.