HIV and hepatitis C prevalence, and related risk behaviours among people who inject drugs in three cities in Croatia: Findings from respondent-driven sampling surveys

Background

There are limited data on HIV and hepatitis C virus (HCV) epidemiology among people who inject drugs (PWID) in Croatia. This study aims to provide data on HIV and HCV prevalence and sexual and injecting risk behaviours among PWID in Zagreb, Split, and Rijeka.

Methods

Using respondent-driven sampling (RDS) we recruited from November 2014 to February 2015 a total of 176 PWID in Zagreb, 255 in Rijeka and 399 in Split. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire.

Results

• The proportion of female PWID ranged from 19.5% in Zagreb to 26.0% in Split. 
• In the month before the survey, 2.5% of PWID in Split, 5.6% in Rijeka and 8.0% in Zagreb reported sharing non-sterile needles and syringes. 
• Many PWID injected opioid substitution therapy (OST) in the month before the survey (57.0% in Zagreb and 57.5% in Split and Rijeka, respectively). 
• Among PWID who had a casual sexual partner in the past 12 months (ranging from 39.2% in Split to 44.4% in Rijeka) condom use was low. 
• Although HIV prevalence was low (0.2% in Rijeka and Zagreb, 0.3% in Split), 
• HCV antibody prevalence was considerable (29.1% in Zagreb, 31.5% in Rijeka, 38.3% in Split). 
• HIV and HCV testing coverage in the past 12 months was insufficient (6.8% and 7.0% in Split; 13.2% and 13.5% in Zagreb; 20.2% and 21.5% in Rijeka, respectively).

Conclusion

We found a low-level HIV epidemic and a sizable HCV epidemic among PWID in Zagreb, Split and Rijeka. Presence of high-risk injecting and sexual behaviours together with inadequate HIV and HCV testing coverage call for development of a comprehensive approach to harm reduction and introduction of needle and syringe exchange programmes in prisons, as well as strengthening sexual health interventions.

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By:  Senad Handanagic, Ivana Bozicevic, Marta Civljak, Zoran Dominkovic, Sandra Sevic, Jelena Barbaric, Tatjana Nemeth Blazic, Oktavija Dakovic Rode, Josip Begovac

WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia

Correspondence

Corresponding author. Tel.: +385 1 4590 147; fax: +385 1 4684 212. 

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Erectile Dysfunction, Boredom, and Hypersexuality among Coupled Men from Two European Countries

INTRODUCTION:

Much of the research on the association between erectile dysfunction (ED) and possible clinical relevant hypersexuality up to now has been only descriptive in nature.

AIM:

The present study aimed to explore the relationships among hypersexuality, ED, and sexual boredom in a sample of coupled community men.

METHODS:

An Internet-based survey was conducted in two European countries. The sample included 911 Croatian and 210 German coupled men. The survey comprised the Hypersexual Disorder Screening Inventory, the International Index of Erectile Function and the Sexual Boredom Scale. Poisson regression analysis was used to examine how ED, solitary sexual activities and sexual boredom were associated with hypersexuality.

RESULTS:

Among Croatian and German men, hypersexuality was significantly correlated with proneness to sexual boredom and more problems with erectile function.

CONCLUSIONS:

In some men, hypersexual behavior may serve as a coping mechanism for sexual fantasy poverty-associated boredom. In addition, ED within an intimate relationship can accompany this simultaneously. Klein V, Jurin T, Briken P, and Štulhofer A. Erectile dysfunction, boredom, and hypersexuality among goupled men from two European countries.

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By:  Klein V1, Jurin T2,3, Briken P1, Štulhofer A2.

• 1Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
• 2Sexology Unit, Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia.
• 3Unit for Health and Clinical Psychology, Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia. 

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HIV Risks & HIV Prevention among Female Sex Workers in Two Largest Urban Settings in Croatia, 2008-2014

Harm reduction-based HIV prevention has been in place among female sex workers (FSWs) in Croatia for more than a decade. However, little is known about how well the existing programs meet the needs of FSWs in an environment where sex work remains criminalized and highly stigmatized. 

This study aims to assess changes in FSWs' vulnerability to HIV infection in the 2008-2014 period. Using convenience samples of FSWs in Croatia's two largest urban settings, behavioral data were collected in 2007-2008 and 2014. 

Outreach workers interviewed 154 FSWs in the first wave of the survey and 158 in the second. 

• The period under observation was characterized by a stable prevalence of most HIV-relevant risk behaviors and experiences. 
• Significant changes in client-based victimization and HIV knowledge were observed only among FSWs in the capital city. 

Substantial and mostly sustained levels of sexual and nonsexual victimization call for more research into the limits of the current behavior-based harm reduction approach to HIV prevention in the country.

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By:   Štulhofer A1, Landripet I, Božić J, Božičević I.

• 1a Department of Sociology, Faculty of Humanities and Social Sciences , University of Zagreb , Zagreb , Croatia. 

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Is High Sexual Desire a Facet of Male Hypersexuality? Results from an Online Study

Despite of a growing number of studies, hypersexuality remains controversial and empirically elusive. Using a group comparison approach, this study revisited the claim that hypersexuality cannot be reliably distinguished from high sexual desire. 

An online survey, advertised as focusing on pornography use and sexual health was carried out in 2014 among 1,998 Croatian men aged 18-60 years (M_age = 34.7, SD = 9.83). Membership in the hypersexuality group (HYP; n = 57) was determined using the Hypersexual Disorder Screening Inventory and the Hypersexual Behavior Consequences Scale. The highest values on two indicators of sexual desire/interest set membership in the HSD group (HSD; n = 70). The overlap between the groups was negligible (n = 4). 

Compared to the rest of the sample, men in the HYP group had significantly higher odds of being single, not exclusively heterosexual, religious, depressed, prone to sexual boredom, experiencing substance abuse consequences, holding negative attitudes toward pornography use, and evaluating one's sexual morality more negatively. In contrast, the HSD group differed from controls only in reporting more positive attitudes toward pornography use. 

The study findings point to a distinct phenomenology of HSD and HYP in men. Clinical implications of the findings are briefly discussed.

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By:  Štulhofer A1, Jurin T1, Briken P2.

• 1 Department of Sociology , Faculty of Humanities and Social Sciences, University of Zagreb , Zagreb , Croatia.
• 2 Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf , Hamburg , Germany.

 

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Therapeutic Drug Monitoring and the Conservative Management of Chronic Tuberculous Empyema: Case Report and Review of the Literature

Below:  Panel a: A posterior-anterior (PA) chest radiograph dated November, 2010 showing a large loculated pleural effusion on the right side. Earlier radiographs (now purged) were reported to show a similar abnormality. Panelb: A PA chest radiograph dated January, 2012 showing an air-fluid level in the previously described loculated effusion. It is consistent with the interval development of a bronchpleural fistula. Panel c: A computed tomographic image dated June, 2012 showing right sided volume loss and a peripherally calcified loculated right hydropneumothorax. Panel d: A PA chest radiograph dated May, 2015 showing the previously described chronic loculated effusion to be reduced in size. An air-fluid level is no longer visible

An 84 year old male immigrant to Canada from Croatia was diagnosed with a CTE after he developed a BPF. The diagnosis was made 62 years after what was, in retrospect, an episode of tuberculous pleurisy. He was treated with computed tomography-guided catheter drainage and TDM-guided high-end dosed anti-TB drugs (serum and pleural fluid drug concentrations) over a 10 month period. Sustained closure of the BPF and mycobacteriologic cure of the CTE was achieved. Drug concentrations in the present case and all other reported cases are summarized and interpreted.

When serum concentrations of the anti-TB drugs isoniazid, pyrazinamide and ethambutol at the high end of the normal range are achieved, pleural fluid concentrations at the low end of the normal range may be anticipated in CTE. Though highly protein bound drugs such as rifampin and moxifloxacin appear to penetrate CTEs less well, their free concentrations in the pleural space may be proportionately higher on account of lower protein concentrations. Interventional radiology and TDM increase the chances that conservative management of CTE will be successful.

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