Robyn Dwyer

Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study.

Abstract Objectives: To estimate the incidence of HIV and hepatitis C virus and risk factors for seroconversion among a cohort of injecting drug users. Design: Retrospective cohort study. Setting: Primary healthcare facility in central Sydney. Subjects: Injecting drug users tested for HIV-1 antibody (n=1179) and antibodies to hepatitis C virus (n=1078) from February 1992 to October 1995. Main outcome measures: Incidence of HIV-1 and hepatitis C virus among seronegative subjects who injected drugs and underwent repeat testing. Demographic and behavioural risk factors for hepatitis seroconversion. Results: Incidence of HIV-1 among 426 initially seronegative injecting drug users was 0.17/100 person years (two seroconversions) compared with an incidence of hepatitis C virus of 20.9/100 person years (31 seroconversions) among 152 injecting drug users initially negative for hepatitis C virus. Incidence of hepatitis C virus among injecting drug users aged less than 20 years was 75.6/100 person years. Independent risk factors for hepatitis C virus seroconversion were age less than 20 years and a history of imprisonment. Conclusions: In a setting where prevention measures have contributed to the maintenance of low prevalence and incidence of HIV-1, transmission of hepatitis C virus continues at extremely high levels, particularly among young injecting drug users. Key messages The prevalence and incidence of hepatitis C virus is high, while the prevalence and incidence of HIV remains low among injecting drug users Young age and history of imprisonment are risk factors for acquisition of hepatitis C virus infection HIV prevention strategies have been relatively ineffective in preventing hepatitis C virus infection in this population The role of imprisonment in the acquisition of hepatitis C infection should be further investigated

A very low response rate in an on-line survey of medical practitioners

Objective: To report on the response rate achieved in a survey of medical practitioners and discuss the reasons for it.

Injecting-related injury and disease among clients of a supervised injecting facility.

BACKGROUND The process of drug injection may give rise to vascular and soft tissue injuries and infections. The social and physical environments in which drugs are injected play a significant role in these and other morbidities. Supervised injecting facilities (SIFs) seek to address such issues associated with public injecting drug use. AIMS Estimate lifetime prevalence of injecting-related problems, injury and disease and explore the socio-demographic and behavioral characteristics associated with the more serious complications. DESIGN, SETTING, PARTICIPANTS Self-report data from 9552 injecting drug users (IDUs) registering to use the Sydney Medically Supervised Injecting Centre (MSIC). FINDINGS Lifetime history of either injecting-related problems (IRP) or injecting-related injury and disease (IRID) was reported by 29% of the 9552 IDUs; 26% (n=2469) reported ever experiencing IRP and 10% (n=972) reported IRID. Prevalence of IRP included difficulties finding a vein (18%), prominent scarring or bruising (14%) and swelling of hands or feet (7%). Prevalence of IRID included abscesses or skin infection (6%), thrombosis (4%), septicaemia (2%) and endocarditis (1%). Females, those who mainly injected drugs other than heroin, and those who reported a history of drug treatment, drug overdose, and/or sex work, were more likely to report lifetime IRID. Frequency and duration of injecting, recent public injecting, and sharing of needles and/or syringes were also independently associated with IRID. CONCLUSIONS IRPs and IRIDs were common. Findings support the imperative for education and prevention activities to reduce the severity and burden of these preventable injecting outcomes. Through provision of hygienic environments and advice on venous access, safer injecting techniques and wound care, SIFs have the potential to address a number of risk factors for IRID.

Doing things together? Analysis of health education materials to inform hepatitis C prevention among couples

Considerable effort has been expended in developing health education materials and programmes aimed at reducing transmission of hepatitis C virus (HCV) among people who inject drugs. Health education is considered more likely to be effective when it is targeted to defined segments of the population and when people actively identify with the messages presented. In this context, it is important to understand the health messages on offer in these materials. This article conducts a discourse analysis of an extensive corpus of Australian heath education literature on HCV to explore the kinds of messages these materials attempt to present. It questions the unexamined assumptions they include and it considers how effectively these materials address the social context of HCV transmission. It focuses on issues of individual and group conduct: in particular, because HCV transmission occurs commonly between sexual partners, on the place of couples who inject together in prevention education. The article concludes by arguing that these materials pay insufficient attention to couples, relying almost without exception, and despite a longstanding critique recommending new approaches, on the individual as the core unit of agency in HCV transmission and in turn prevention.

Making addictions in standardised screening and diagnostic tools

ABSTRACT What counts as a drug problem? What exactly is addiction? What can be done to address it? Researchers work in a wide range of disciplines to answer these questions, often relying upon information collected via screening and diagnostic tools. Typically developed within epidemiological research, these tools establish and stabilise key criteria for identifying problematic substance use and addiction, and these criteria are then deployed to measure the extent and scale of the problems within populations. In this article, we analyse these tools to identify the logics and assumptions at work within them. Recognising that epidemiology constitutes, as much as it measures, the diseases it tracks, this article examines how addiction screening and diagnostic tools go about making the phenomena they purport to track. Our analysis suggests that through processes of reduction, expression, quantification, normalisation and populationisation, addiction screening and diagnostic tools work to establish, standardise and reify addiction as an independent, pre-existing affliction located in individuals. In so doing, they erase the complexities and subjective interpretations of individual experiences. In conclusion, we consider the material effects of defining addiction in certain ways, measuring it in certain communities and contexts, and through certain methods, and designing responses based on these strategies.

Heroin-gel capsule cocktails and groin injecting practices among ethnic Vietnamese in Melbourne, Australia

BACKGROUND Evidence of harms associated with temazepam gel capsule injecting among injecting drug users in Australia led to its withdrawal from manufacture in Australia. Subsequently, diphenhydramine gel capsule injecting was identified among a subset of ethnic Vietnamese injecting drug users. METHODS Observational fieldwork around an active street-based illicit drug marketplace together with targeted purposive sampling enabled 66 ethnic Vietnamese injecting drug users to be recruited for in-depth interview. RESULTS Data revealed that the injection of gel capsules increases exposure to non-viral infections. Analysis of participant interviews show how participants have established their own ways of reducing these harms including thinning the drug solution by jacking regularly during injection. Controversially, femoral vein administration of diphenhydramine-heroin cocktails was also seen as a harm reduction strategy by participants. DISCUSSION Health education campaigns to address the potentially negative consequences of gel capsule groin injection will not be successful unless health workers and policy makers work with drug users and incorporate local understandings and meanings of risk in health promotion activities.

The economic burden to the public health system of treating non-viral injecting-related injury and disease in Australia (a cost of illness analysis)

Objective: We estimated the cost to the public health system of treating Injecting‐Related Injuries and Diseases (IRIDs) in the three most populous states in Australia in the 12 months over 2005/06.

Benefits and barriers to expanding the availability of take-home naloxone in Australia: A qualitative interview study with service providers

Abstract Aims: To investigate the perspectives and experiences of service providers regarding provision of take-home naloxone to people who use opioids in Victoria, Australia. Methods: Content analysis of qualitative semi-structured interviews with 15 service providers who are either involved with take-home naloxone programs or whose work brings them in contact with people who use opioids. Findings: Statements about take-home naloxone were universally positive. Both direct and indirect benefits of take-home naloxone were described. Alongside potential reductions in opioid overdose-related harms, service providers highlighted the empowering effects of providing people who use opioids with take-home naloxone. No significant risks were described. Service providers supported the expansion of naloxone availability, but also identified several intertwined barriers to doing so. Key among these were costs, current regulations and scheduling, availability of prescribers and stigma related to illicit and injecting drug use. Conclusions: Expanding the availability of naloxone is a key component of strategies to reduce harms associated with opioid overdose. Our article provides Australian evidence of the successful operational implementation of peer-to-peer THN delivery within a range of drug primary health services and needle syringe programs. Further research is required to better understand the implications of and impediments to scale-up of this potentially life-saving public health intervention.

Addicting Via Hashtags: How Is Twitter Making Addiction?

Persons, substances, bodies, consumption: an ever widening process of “addicting” is underway in Western societies. In this article, we turn our attention to the production of addiction on the microblogging social media platform, Twitter, as an important emerging site in which the addicting of contemporary societies is also occurring. Our analysis explores two questions. First, we investigate the ways in which addiction is enacted via Twitter. How is addiction being made on Twitter? Second, we ask how the technology of Twitter itself is shaping meaning: how do the technological “affordances” of Twitter help constitute the kinds of addiction being materialized? While we find a multiplicity of meanings in the 140-character messages, we also find a pattern: a tendency toward extremes—addiction riven between pain and pleasure. In addition, we find significant areas of commonality between approaches and notable silences around alternatives to common understandings of addiction. We argue that the constraints on communication imposed by Twitter technology afford a “shorthand” of addiction that is both revealing and productive. Illuminated is the importance of addiction as a piece of cultural shorthand that draws on and simultaneously reproduces simplistic, reductive addiction objects. In concluding, we consider what these realities of addiction being enacted through Twitter can tell us about contemporary conditions of possibility for drug use in society and for individual subjectivities and experiences.

An overview of take-home naloxone programs in Australia: Take-home naloxone programs in Australia

INTRODUCTION AND AIMS Take-home naloxone (THN) programs commenced in Australia in 2012 in the Australian Capital Territory and programs now operate in five Australian jurisdictions. The purpose of this paper is to record the progress of THN programs in Australia, to provide a resource for others wanting to start THN projects, and provide a tool for policy makers and others considering expansion of THN programs in this country and elsewhere. DESIGN AND METHODS Key stakeholders with principal responsibility for identified THN programs operating in Australia provided descriptions of program development, implementation and characteristics. Short summaries of known THN programs from each jurisdiction are provided along with a table detailing program characteristics and outcomes. RESULTS Data collected across current Australian THN programs suggest that to date over 2500 Australians at risk of overdose have been trained and provided naloxone. Evaluation data from four programs recorded 146 overdose reversals involving naloxone that was given by THN participants. DISCUSSION AND CONCLUSIONS Peer drug user groups currently play a central role in the development, delivery and scale-up of THN in Australia. Health professionals who work with people who use illicit opioids are increasingly taking part as alcohol and other drug-related health agencies have recognised the opportunity for THN provision through interactions with their clients. Australia has made rapid progress in removing regulatory barriers to naloxone since the initiation of the first THN program in 2012. However, logistical and economic barriers remain and further work is needed to expand access to this life-saving medication.