Adrian Renton

Situational factors influencing drug injecting, risk reduction and syringe exchange in Togliatti City, Russian Federation: a qualitative study of micro risk environment

We undertook a qualitative study to explore the micro-environment of drug injecting, risk reduction and syringe exchange practices among injecting drug users (IDUs) in Togliatti City, Russia. Semi-structured qualitative interviews (n=57) were undertaken with current IDUs in May 2001. Findings highlight a recent transition away from hanka (a home-produced liquid opiate derived from opium poppy) towards the injection of heroin powder, and a drug use culture in which injecting predominates. Findings emphasise that risk reduction practices may be influenced less by availability of injecting equipment than by an interplay of situational and micro-environmental factors. Principal among these is a reported fear of police detainment or arrest among IDUs which encourages a reluctance to carry needles and syringes, and which in turn, is associated with needle and syringe sharing at the point of drug sale. We note the role of policing practices in influencing risk reduction and the potential role of policing agencies in supporting HIV prevention initiatives among IDUs.

Epidemics of syphilis in the Russian Federation: trends, origins, and priorities for control

After continuous decline throughout the 1980s, surveillance-defined estimates of the incidence of syphilis in Russia have shown a rapid and substantial increase during the 1990s. The reasons for this epidemic are unclear, but must be sought among changes both in sexual behaviour and in the patterns of provision, use, and effectiveness of diagnostic, treatment, and contact tracing services. High incidence of sexually transmitted disease causes correspondingly high levels of morbidity and suffering as well as significant health-care and other economic costs. Our current understanding suggests that the transmissibility of HIV is increased by infection with sexually transmitted disease. The syphilis epidemic together with changes in sexual behaviour, increased travel and migration, and rapid increases in injecting drug use may create the conditions for an epidemic of sexually acquired HIV infection in Russia that substantially outstrips those encountered in most Western European countries.

Measles vaccination as a risk factor for inflammatory bowel disease.

Measles virus may persist in intestinal tissue, particularly that affected by Crohns disease, and early exposure to measles may be a risk factor for the development of Crohns disease. Crohns disease and ulcerative colitis occur in the same families and may share a common aetiology. In view of the rising incidence of inflammatory bowel disease (Crohns disease and ulcerative colitis), we examined the impact of measles vaccination upon these conditions. Prevalences of Crohns disease, ulcerative colitis, coeliac disease, and peptic ulceration were determined in 3545 people who had received live measles vaccine in 1964 as part of a measles vaccine trial. A longitudinal birth cohort of 11,407 subjects was one unvaccinated comparison cohort, and 2541 partners of those vaccinated was another. Compared with the birth cohort, the relative risk of developing Crohns disease in the vaccinated group was 3.01 (95% CI 1.45-6.23) and of developing ulcerative colitis was 2.53 (1.15-5.58). There was no significant difference between these two groups in coeliac disease prevalence. Increased prevalence of inflammatory bowel disease, but not coeliac disease or peptic ulceration, was found in the vaccinated cohort compared with their partners. These findings suggest that measles virus may play a part in the development not only of Crohns disease but also of ulcerative colitis.

Crime, fear of crime, environment, and mental health and wellbeing: Mapping review of theories and causal pathways

This paper presents the findings from a review of the theoretical and empirical literature on the links between crime and fear of crime, the social and built environment, and health and wellbeing. A pragmatic approach was employed, with iterative stages of searching and synthesis. This produced a holistic causal framework of pathways to guide future research. The framework emphasises that crime and fear of crime may have substantial impacts on wellbeing, but the pathways are often highly indirect, mediated by environmental factors, difficult to disentangle and not always in the expected direction. The built environment, for example, may affect health via its impacts on health behaviours; via its effects on crime and fear of crime; or via the social environment. The framework also helps to identify unexpected factors which may affect intervention success, such as the risk of adverse effects from crime prevention interventions as a result of raising awareness of crime.

Explosive spread and high prevalence of Hiv infection among injecting drug users in Togliatti City, Russia

ObjectiveTo establish the prevalence of antibodies to HIV (anti-HIV) and associated risk factors among injecting drug users (IDU) in Togliatti City, Samara Oblast, Russian Federation. DesignAn unlinked anonymous cross-sectional community recruited survey with oral fluid sample collection. MethodsBetween September and October 2001, 426 IDU were recruited by trained fieldworkers. Participants completed an interviewer administered questionnaire, and oral fluid samples were tested for anti-HIV. Univariate and multivariate analyses compared potential risk factors for anti-HIV. ResultsAnti-HIV prevalence was 56% (234/418). Three-quarters of anti-HIV-positive IDU (74%) were unaware of their positive status. In an adjusted model, the odds of HIV infection were higher among IDU who had ever injected home-produced drugs, who reported injecting with used needles and syringes in the past 4 weeks, and who were living in one particular district of the city (Komsomolksii). ConclusionThe high prevalence of HIV, and a recent increase in HIV detected through routine screening tests since 2000, suggests that an explosive epidemic has occurred among IDU in Togliatti City. In the face of currently inadequate HIV prevention coverage among IDU, this has urgent implications for maximizing the distribution of sterile injecting equipment as well as for enhancing sexual risk reduction. Recognizing that it is likely that similar explosive epidemics are taking place in other Russian cities, we recommend community-wide HIV prevention coverage supported by city and state policies oriented to harm reduction.

Methods to recruit hard-to-reach groups: comparing two chain referral sampling methods of recruiting injecting drug users across nine studies in Russia and Estonia.

Evidence suggests rapid diffusion of injecting drug use and associated outbreaks of HIV among injecting drug users (IDUs) in the Russian Federation and Eastern Europe. There remains a need for research among non-treatment and community-recruited samples of IDUs to better estimate the dynamics of HIV transmission and to improve treatment and health services access. We compare two sampling methodologies “respondent-driven sampling” (RDS) and chain referral sampling using “indigenous field workers” (IFS) to investigate the relative effectiveness of RDS to reach more marginal and hard-to-reach groups and perhaps to include those with the riskiest behaviour around HIV transmission. We evaluate the relative efficiency of RDS to recruit a lower cost sample in comparison to IFS. We also provide a theoretical comparison of the two approaches. We draw upon nine community-recruited surveys of IDUs undertaken in the Russian Federation and Estonia between 2001 and 2005 that used either IFS or RDS. Sampling effects on the demographic composition and injecting risk behaviours of the samples generated are compared using multivariate analysis. Our findings suggest that RDS does not appear to recruit more marginalised sections of the IDU community nor those engaging in riskier injecting behaviours in comparison with IFS. RDS appears to have practical advantages over IFS in the implementation of fieldwork in terms of greater recruitment efficiency and safety of field workers, but at a greater cost. Further research is needed to assess how the practicalities of implementing RDS in the field compromises the requirements mandated by the theoretical guidelines of RDS for adjusting the sample estimates to obtain estimates of the wider IDU population.

Syphilis and other sexually transmitted infections in the Russian Federation

The countries of the former Soviet Union are currently experiencing major epidemics of sexually transmitted infections (STIs). By 1997 rates of syphilis notification in the Russian Federation had risen to 277 per 100,000 total population, a 43-fold increase over 1989 levels, with rises proportionally larger among young women. Epidemics of gonorrhoea occurred earlier in Russia with official notification rates rising from 105 per 100,000 in 1987 to 232 per 100,000 in 1993; and exceeded one per 100 among both young men and young women in that year. The true incidence of gonorrhoea is certainly much higher. These STI epidemics cause direct suffering and may be important in significantly enhancing the transmission of human immunodeficiency virus (HIV), in the context of liberalization of sexual behaviour, and epidemics of injecting drug use and related HIV transmission. This paper reviews recent epidemiological trends in syphilis and other STIs in Russia against the background of existing mechanisms for the control of these infections.

The association of Mycoplasma hominis, Ureaplasma Urealyticum and Mycoplasma genitalium with bacterial vaginosis : observations on heterosexual women and their male partners

Summary: The prevalence of 3 mycoplasmas (Mycoplasma hominis , Ureaplasma urealyticum and Mycoplasma genitalium) was determined in a cohort of women with or without bacterial vaginosis (BV) and in their respective male partners. Heterosexual women with or without BV and their male partners were recruited and genital sampling for these microorganisms was performed. Seventeen women with BV and 21 women with normal flora, and their respective male partners, were recruited. M. hominis was present in 9 (53%) of 17 women with BV compared with none of 21 women without BV (P =0.0001). Of the 17 male partners of women with BV, 8 (47%) had M. hominis compared to 5 (24%) of 21 male partners of women without BV (not significant [n/s]). U. urealyticum was detected in 11 (65%) of 17 women with BV in comparison with 10 (48%) of 21 women without BV (n/s). U. urealyticum was present in 4 (24%) of 17 male partners of women with BV compared to 6 (29%) of 21 male partners of women without BV (n/s). M. genitalium was not detected in any of 15 women with BV and in only 2 (12%) of 17 women without BV (n/s). M. genitalium was present in 4 (25%) male partners of 16 women with BV in comparison with 3 (16%) male partners of 19 women without BV (n/s). Thus, M. hominis was the only mycoplasma detected significantly more often in women with, rather than in those without, BV. None of the mycoplasmas was found significantly more often in male partners of women with, rather than those without, BV. Overall, M. genitalium behaved somewhat similar to Chlamydia trachomatis . It was the least commonly occurring mycoplasma, a reflection perhaps of the relatively low incidence of partner change in this study population.

Opa‐typing: a high‐resolution tool for studying the epidemiology of gonorrhoea

A single gonococcus possesses a family of 11 distinct and highly variable opa genes. The extensive variation and rapid evolution of the opa gene repertoire has been exploited to provide a high‐resolution typing method for studies of the short‐term transmission of gonorrhoea. The 11 opa genes are amplified with a single pair of primers by the polymerase chain reaction, digested with frequently‐cutting restriction enzymes, and the fragments are fractionated on polyacrylamide to provide an opa‐type. The method appeared to be highly discriminatory as the opa‐types of gonococci, isolated world‐wide over the last 30 years, were all different. Opa‐typing discriminated between isolates of the same auxotype/serovar class. Similarly, there were 41 opa‐types among 43 consecutive isolates from a sexually transmitted disease (STD) clinic. The two pairs of isolates from this clinic that gave the same opa‐types were identical by other criteria and may have been from unsuspected sexual contacts. With one minor exception, identical opa‐types were obtained from gonococci recovered from known sexual contacts. These results suggest that variation in the family of 11 opa genes evolves so rapidly that the opa‐types of gonococci are distinguishable, unless the isolates are from sexual contacts or a short chain of disease transmission. The identification of gonococci with identical opa‐types is therefore believed to be a good indicator that the individuals from which they were recovered were sexual partners, or part of a short chain of disease transmission.

Rapid assessment, injecting drug use, and public health

We argue that the public-health potential of rapidassessment has yet to be fully realised. We begin bysummarising the key methodological principlesunderpinning rapid assessment. We then draw on recentexamples of the rapid spread of HIV-1 infectionassociated with injecting drug use (IDU) in the newlyindependent states of Eastern Europe to emphasise thatrapidity, methodological pluralism, and an orientationtowards multisectoral intervention are critical features ofeffective public-health assessment and response. Weconclude by proposing that whereas rapid assessmentremains largely peripheral to mainstream public-healthapproaches, it should be given a central role as a generic