Alya Briceno

Higher risk of incident hepatitis C virus among young women who inject drugs compared with young men in association with sexual relationships: a prospective analysis from the UFO Study cohort

Background Female injection drug users (IDUs) may report differences in injection behaviours that put them at greater risk for hepatitis C virus (HCV). Few studies have examined these in association with HCV incidence. Methods Longitudinal data from a cohort of 417 HCV-uninfected IDU aged 30 or younger were analysed. Cox proportional hazards was used to model female sex as a predictor of new HCV infection. General estimating equation (GEE) analysis was used to model female sex as a predictor of HCV-associated risk behaviour prospectively. Results Women were significantly more likely than men to become infected with HCV during study follow-up (HR 1.4, p<0.05), and were also more likely than men to report high-risk injecting behaviours, especially in the context of sexual and injecting relationships. Sex differences in injecting behaviours appeared to explain the relationship between sex and HCV infection. Conclusions Young women’s riskier injection practices lead to their higher rates of HCV infection. Further study on the impact of intimate partnership on women’s risk behaviour is warranted.

Comparison of Hepatitis C Virus RNA and antibody detection in dried blood spots and plasma specimens.

BACKGROUND Current diagnostic tests for Hepatitis C Virus (HCV) involve phlebotomy and serologic testing for HCV antibodies (anti-HCV) and RNA, which are not always feasible. Dried blood spots (DBS) present a minimally invasive sampling method and are suitable for sample collection, storage and testing. OBJECTIVES To assess the utility of DBS in HCV detection, we evaluated the sensitivity and specificity of DBS for anti-HCV and HCV RNA detection compared to plasma specimens. STUDY DESIGN This cross-sectional validation study was conducted in the context of an existing prospective study of HCV in young injection drug users. Blood samples were collected by venipuncture into serum separator tubes (SST) and via finger stick onto Whatman 903(®) protein-saver cards. Plasma samples and eluates from the DBS were tested for anti-HCV using either a third generation enzyme-linked or chemiluminescent immunoassay (IA), and HCV RNA using discriminatory HCV transcription-mediated amplification assay (dHCV TMA). DBS results were compared to their corresponding plasma sample results. RESULTS 148 participants were tested for anti-HCV and 132 participants were tested for HCV RNA. For anti-HCV, the sensitivity of DBS was 70%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 76% and Kappa was 0.69. For HCV RNA, the sensitivity of DBS was 90%, specificity was 100%, PPV was 100%, NPV was 94% and Kappa was 0.92. CONCLUSIONS DBS are sensitive and very specific in detecting anti-HCV and HCV RNA, demonstrate good correlation with plasma results, and have potential to facilitate diagnosis of HCV infection.

Comparison of Phosphatidylethanol Results to Self-Reported Alcohol Consumption Among Young Injection Drug Users

AIMS To test the value of phosphatidylethanol (PEth) as a biomarker for alcohol consumption among injecting drug users (IDUs). METHODS As part of a longitudinal study of young IDUs, dried blood spots and self-reported alcohol by structured interview were collected at baseline. We compared self-reported alcohol use to detectable PEth (≥8 ng/ml) in the blood spots as well as the relationships between quantitative PEth results and quantity measures of alcohol consumption. RESULTS There were strong associations between PEth and self-reported categorical measures of alcohol consumption (all P < 0.01). There was high specificity for reporting abstaining from alcohol; 94% of those who reported not consuming alcohol in the prior month tested negative for PEth. PEth was well correlated with measures of alcohol use (e.g. with reported number of days drinking in the prior month: Spearman r = 0.70 (P < 0.001)). CONCLUSIONS The positive correlation of PEth with reported alcohol consumption suggests that PEth may be a useful marker in settings where alcohol consumption is difficult to assess, or to corroborate or invalidate self-reported measures of alcohol consumption.

Intimate injection partnerships are at elevated risk of high-risk injecting: a multi-level longitudinal study of HCV-serodiscordant injection partnerships in San Francisco, CA.

Background It is increasingly recognized that the risk for HIV and hepatitis C (HCV) transmission among people who inject drugs (PWID), such as syringe sharing, occurs in the context of relationships between (at least) two people. Evidence suggests that the risk associated with injection behavior varies with injection partner types. Methods We utilized longitudinal dyad-level data from a study of young PWID from San Francisco (2006 to 2013) to investigate the relationship-level factors influencing high-risk injecting within HCV-serodiscordant injection partners (i.e., individuals who injected together ≥5 times in the prior month). Utilizing data from 70 HCV-serodiscordant injection partnerships, we used generalized linear models to examine relationship-level predictors (i.e., partnership composition, partnership closeness, and partnership dynamics) of: (1) receptive syringe sharing (RSS); and (2) receptive cooker use (RCU), as reported by the HCV-negative injection partner. Results As reported by the “at-risk” HCV-negative injection partner, receptive syringe sharing (RSS) and receptive cooker use (RCU) were 19% and 33% at enrollment, and 11% and 12% over all visits (total follow-up time 55 person-years) resulting in 13 new HCV-infections (incidence rate: 23.8/100 person-years). Person-level factors, injection partnership composition, and partnership dynamics were not significantly associated with either RSS or RCU. Instead, intimate injection partnerships (those who lived together and were also in a sexual relationship) were independently associated with a 5-times greater risk of both RSS and a 7-times greater risk of RCU when compared to injecting only partnerships. Conclusion Our findings suggest a positive, and amplified effect of relationship factors on injecting drug risk behaviors among young PWID injection partnerships. The majority of interventions to reduce injection drug use related harms focus on individual-based education to increase drug use knowledge. Our findings support the need to expand harm reduction strategies to relationship-based messaging and interventions.

A Longitudinal Study of Multiple Drug Use and Overdose Among Young People Who Inject Drugs

OBJECTIVES To determine the association between multiple drug use and nonfatal overdose among young people (younger than 30 years) who inject drugs. METHODS We completed a longitudinal study of 173 injection drug users younger than 30 years living in San Francisco, California, between April 2012 and February 2014. RESULTS The odds of nonfatal overdose increased significantly as heroin and benzodiazepine pill-taking days increased and when alcohol consumption exceeded 10 drinks per day compared with 0 drinks per day. CONCLUSIONS Heroin, benzodiazepine, and alcohol use were independently associated with nonfatal overdose over time among young people who inject drugs. Efforts to address multiple central nervous system depressant use remain an important component of a comprehensive approach to overdose, particularly among young people.

Characteristics and Health Service Utilization in Two Samples of Young Injection Drug Users Recruited Using Direct and Referral Methods in San Francisco, California

Background: Targeted sampling (TS) and respondent-driven sampling (RDS) methods are methods used to recruit ‘hard-to-reach’ populations. We examine similarities and differences in population characteristics and health service utilization, in two independent samples of young adult injection drug users (IDU). Methods: Data from two samples of young adult (18-29 years) IDU sampled using RDS (N=31) and TS (N=97) in San Francisco, California were compared: (1) a cross-sectional study of IDU using RDS as part of the National HIV Behavioral Survey (NHBS) IDU-2 Study conducted by the San Francisco Department of Public Health, from May 2009 to December 2009; and (2) the UFO Study, an ongoing prospective study of young IDU that used TS methods to sample young IDU (<30 years) from May 2010 to December 2010. Results: Compared to the TS sample, the RDS sample was more heterogeneous demographically: a higher proportion of women, and racial/ethnic diversity; a significantly larger proportion of the RDS sample (vs. TS) previously received an HIV test (98.6% vs. 88.5%) whereas the TS sample had a significantly higher prevalence of HCV (58.7% vs. 15.1%). Conclusion: TS and RDS reached a similar cross section of the young adult IDU population in San Francisco; however, some notable differences were observed, especially in HCV infection prevalence. The findings highlight the need for continued efforts to improve sampling strategies aimed high risk IDU, so as to inform both public health surveillance, research and prevention interventions.

A Study of Sexual Relationship Power among Young Women Who Inject Drugs and Their Sexual Partners

ABSTRACT Background: To date, research applying the Sexual Relationship Power Scale (SRPS) has been limited to sexual risk behaviors. Objective: We measured levels of sexual relationship power and examined associations between sexual relationship power and injecting and sexual behaviors that place women at increased risk for blood borne infections. Methods: Using data from a cross-sectional study of young women who inject drugs (WWID) in San Francisco, USA, logistic regression analysis identified independent associations between SRPS and subscale scores (relationship control [RC] and decision making dominance [DMD]) and injecting and sexual behaviors. Results: Of the 68 young WWID, 24 (34%) reported receptive syringe sharing, 38 (56%) reused/shared a cooker to prepare drugs, and 25 (37%) injected someone elses drug residue during the three-months prior to enrollment. Most (60, 88%) reported condomless sex with main sex-partner, 8 (12%) reported transactional sex, and 36 (53%) had two or more recent sex partners. The median SRPS score was 2.98 (IQR: 2.65, 3.18), 3.23 (IQR: 3.23, 3.57) for RC and 2.40 (IQR: 2.20, 2.60) for DMD. No significant associations were detected between SRPS or DMD and injecting or sexual risk behaviors. After adjusting for gender and years injecting, for every one-point increase in RC, women had a 6.70 lower odds of recent condomless sex (95%CI: 0.92, 50.00, p = 0.06), and a 3.90 lower odds of recent transactional sex (95%CI: 1.22, 12.50, p = 0.02). Conclusion: Our study findings suggest that some components of sexual relationship power may play a role in sexual risk, but not in injecting risk.

Homophobias: Lust and Loathing Across Time and Space by David A. B. Murray (Ed)

David A. B. Murray, associate professor at the School of Women’s Studies at York University, edited a book consisting of nine single-authored essays that explore themes of homophobia—the word, its various interpretations in its various contexts. Inspired by his own international travels as a gay man and what he recognized as a binary distinction between gay friendly cities and homophobic places, Murray viewed his observation from his selfproclaimed Euro-American lens. To avoid othering of places and cultures outside of the Euro-American sphere he invited writers from other places or those who wrote about experiences in other places and the complexities alternative sexualities can bring. Murray used an anthropological lens to examine the globalized nature of homosexuality and homophobia and encouraged awareness among his readers when assessing a place’s acceptance and tolerance of sexualities outside of the heterosexual paradigm. He cautioned not to be so liberal when applying our own understanding of homophobia, homosexuality, and sexual identity, as they differ across the world. The chapters are filled with thought-provoking ruminations by nine authors who speak to homophobia, lesbian gay, lesbian, bisexual, transgender (LGBT) hate, gendered politics and masculinity, political economy of sexuality, and LGBT legal representation in the United States and abroad. The authors meticulously rethink, deconstruct, then revise the reader’s collective understanding of the word homophobia by examining its use in and out of its various contexts including in the United States, Jamaica, Indonesia, Barbados, India, and Greece. Religion and racism enter the conversation to help improve this new understanding. The book’s main argument is centered on the premise that, while violence and discrimination that occur along racial and ethnic lines and interrelational violence (predominantly male on female) are examined and solutions for the problems are offered, violence against sexual minorities does not receive the same attention in the media, from law enforcement, or the political arena. This collection of essays represents a concerted effort to change the lack of attention by raising awareness of the forces that drive oppression, marginalization, and the silencing of sexual minorities. The book, Murray explains, “represents an attempt to address the anthropology