Inconsistent Use of Condoms in Non-Injecting Illicit Drug Users

Non-injecting illicit drug users (NIDU) are a highly vulnerable group for the acquisition of the human immunodeficiency virus (HIV). The majority of these individuals present multiple risk behaviors, such as multiple sexual partners, exchange of sex for money or drugs, and inconsistent use of condoms.¹ In addition, this group consists of individuals with low levels of income and education, which enhances the risk of viral acquisition. Studies have shown high rates of inconsistent use of condoms in NIDU, which increases the risk in this population for the acquisition and transmission of HIV.^2 and 3 In this context, the objectives of this study were to estimate the prevalence of inconsistent condom use in NIDU and to identify the factors associated with unprotected sex with casual partners.

A cross-sectional study was conducted with 323 NIDU hospitalized in two chemical dependency treatment clinics located in the southwest of Goiás, central west region of Brazil. The study included individuals aged 18 years or over who had used non-injection drugs in the month before the admission date (marijuana, intranasal cocaine, crack, intranasal heroin, inhalants, LSD, and ecstasy). Data collection was carried out between September 2014 and June 2015, through face to face interviews, covering sociodemographic characteristics, drug use pattern, and condom use in the previous year.

Inconsistent condom use was defined as irregular use (occasionally or never) by type of sexual intercourse (oral, anal, or vaginal)...² 

The mean age of the participants was 32.4 years (standard deviation: 11.3) and the majority were male (83.0%). Inconsistent use of condoms in oral, vaginal, and anal sex was reported by 72.2% (95% CI: 66.7–76.7%), 83.5% (95% CI: 79.3–87.4%) and 37.5% (95% CI: 32.3–43.1%) of the participants, respectively. A higher prevalence of inconsistent condom use was verified in females (prevalence ratio: 1.40; 95% CI: 1.16–1.69) and in those with a diagnosis of cannabis dependence (prevalence ratio: 1.24; 95% CI: 1.01–1.53).

A high frequency of inconsistent condom use was observed in this study, confirming the vulnerability of NIDU for the acquisition of HIV. In this context, it is necessary to expand health promotion and prevention of sexually transmitted infections in these individuals, with the availability of condoms, encouraging safe sex practices, and health education of this population.

Purchase full article at:   http://goo.gl/SJSgMo

By:   Guimarães RA¹, Rodovalho AG², Fernandes IL³, Lucchese R³, Vera I³.

¹Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, Goiás, Brazil. Electronic address: rafaelalvesg5@gmail.com.

²Secretaria Municipal de Saúde de Catalão, Catalão, Goiás, Brazil.

³Instituto de Biotecnologia, Universidade Federal de Goiás, Catalão, Goiás, Brazil.

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A Systematic Review of the Clinical and Social Epidemiological Research among Sex Workers in Uganda

Background

In response to the high burden of disease among sex workers and their position as a population heavily affected by the HIV epidemic, there has been a growing body of literature investigating the prevalence and risk factors associated with HIV risk among sex workers. To contextualize and summarize the existing research evidence base, a systematic review was conducted to synthesize the epidemiological literature on sex workers in Uganda.

Methods

Database selection and search strategy development followed the Cochrane Collaboration’s standards for conducting systematic review searches. All studies that included sex workers as the primary research participants were included in the review. The search was then geographically restricted to the country of Uganda. Items were identified from 18 databases (grey and peer-review) on March 10–11, 2015.

Results

A total of 484 articles were retrieved from the database search. After removal of duplicates, a total of 353 articles were screened for eligibility and 64 full-text articles were assessed. The final review included 24 studies with quantitative methodology conducted among sex workers in Uganda. 

• The HIV prevalence among female sex workers ranged from 32.4 – 52.0% 
• and between 8.2 – 9.0% had multiple HIV infections. 
• Both multi-drug resistance to antiretroviral therapy (2.6 %) and antibiotics (83.1 %) were observed. 
• Between 33.3 – 55.1 % reported inconsistent condom use in the past month. 
• In the previous 6 months, over 80% of sex workers experienced client-perpetrated violence 
• and 18% experienced intimate partner violence. 
• Over 30% had a history of extreme war-related trauma.

Conclusions

There was limited information on socio-structural factors that affect sex workers’ commercial working environments in Uganda, including the role of policing and criminalization, as well as the prevalence and factors associated with violence. The majority of the existing evidence is based in Kampala, highlighting a need for information on sex work in other regions of Uganda. Additionally, there is limited information on features of the non-commercial components of sex workers’ lives as well as the services needed to reduce risks outside of the sex industry.

Full article at:  http://goo.gl/ucfpAv

By:  Katherine A. Muldoon

School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver V6T 1Z9, BC, Canada

Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa K1H 8L6, ON, Canada

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