Thursday, July 30, 2009

Does Hep C treatment work for IDUs?

Programs working with IDUs should be providing clients with treatment for Hep C (and possibly vaccination for Hep A and B. There is no Hep C vaccine yet.)

But there is some resistance to this goal from those who question the efficacy of treatment for active drug users. The vast majority of new Hep C cases in the world are among IDUs, so understanding Hep treatment options for IDUs is critically important.

The article below presents data showing that Hep C treatment works for active drug users - important information for our advocacy and implementation, to improve the health of our IDU clients.


Clinical Infectious Diseases 2009;49:561?573

C 2009 by the Infectious Diseases Society of America.

DOI: 10.1086/600304


Hepatitis C Treatment for Injection Drug Users: A Review of the Available Evidence

Margaret Hellard, Rachel Sacks-Davis, and Judy Gold

Centre for Population Health, Burnet Institute, Melbourne, Australia

Globally, 90% of new hepatitis C infections are attributed to injection drug use, but there is a continuing reluctance to treat injection drug users (IDUs). There is evidence that a sizeable proportion of IDUs who begin hepatitis C treatment achieve a sustained virological response (SVR). In chronic hepatitis C treatment trials, the SVR rate among IDUs appears to be comparable to rates among non-IDUs; in trials prescribing pegylated interferon plus ribavirin, the median rate of SVR among IDUs was 54.3% (range, 18.1%-94.1%), compared with 54%?63% in the large treatment trials.
Few trials of acute hepatitis C treatment report on outcomes in IDUs; however, among these trials, the SVR among IDUs was 68.5%, compared with 81.5% among non-IDUs. Additional studies are required to determine the optimal circumstances for treatment (e.g., enrollment in drug treatment, the requirement of a period of abstinence from injection drug use, or the establishment of multidisciplinary treatment programs).

Received 30 October 2008; accepted 18 March 2009; electronically published 9 July 2009.

Reprints or correspondence: A/Prof M. Hellard, Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC 3004, Australia (

Wednesday, July 29, 2009

Behavior change among drug users must consider attitudes towards death

The below article makes the point that successful behavior change among people who are ambivalent towards death can not simply focus on delivering information about how to protect your health.

Summary and link below.


Safe using messages may not be enough to promote behaviour change amongst injecting drug users who are ambivalent or indifferent towards death
Peter G Miller

Go to:

Harm Reduction Journal 2009, 6:18doi:10.1186/1477-7517-6-18

Published: 25 July 2009

Abstract (provisional)

Health promotion strategies ultimately rely on people perceiving the consequences of their behaviour as negative. If someone is indifferent towards death, it would logically follow that health promotion messages such as safe using messages would have little resonance. This study aimed to investigate attitudes towards death in a group of injecting drug users (IDUs) and how such attitudes may impact upon the efficacy/relevance of 'safe using' (health promotion) messages.

Qualitative, semi-structured interviews in Geelong, Australia with 60 regular heroin users recruited primarily from needle and syringe programs.

Over half of the interviewees reported having previously overdosed and 35% reported not engaging in any overdose prevention practices. 13% had never been tested for either HIV or hepatitis C. Just under half reported needle sharing of some description and almost all (97%) reported previously sharing other injecting equipment. Most interviewees reported being indifferent towards death. Common themes included; indifference towards life, death as an occupational hazard of drug use and death as a welcome relief.

Most of the interviewees in this study were indifferent towards heroin-related death. Whilst interviewees were well aware of the possible consequences of their actions, these consequences were not seen as important as achieving their desired state of mind. Safe using messages are an important part of reducing drug-related harm, but people working with IDUs must consider the context in which risk behaviours occur and efforts to reduce said behaviours must include attempts to reduce environmental risk factors at the same time.

Monday, July 27, 2009

New review of the efficacy of Buprenorphine

Please see the link below for a new Cochrane review of the efficacy of Buprenorphine to reduce withdrawl symptoms among drug users.


Buprenorphine is more effective than clonidine or lofexidine, and may have advantages over methadone, for the management of opioid withdrawal.
Dependence on opioid drugs (heroin, methadone) is a major health and social issue in many societies. Managed withdrawal from opioid dependence is an essential first step for drug-free treatment. This review of trials found that the drug buprenorphine is more effective than clonidine or lofexidine in reducing the signs and symptoms of opioid withdrawal, retaining patients in withdrawal treatment, and supporting the completion of treatment. There is no significant difference in the incidence of adverse effects, but patients treated with buprenorphine may be less likely to drop-out due to adverse effects than is the case with clonidine or lofexidine. There is limited evidence comparing buprenorphine with methadone, but it appears that completion of withdrawal may be more likely with buprenorphine and withdrawal symptoms may resolve more quickly with buprenorphine.

Hiring socially skilled workers for your front line work

Please find a link below to a short video by drug expert Mike Ashton suggesting that a socially skilled worker is the most effective on the front lines, and that research indicates it is possible to recruit on that basis.

This video clip comes from a site called Film Exchange on Alcohol and Drugs, a useful resource for your staff working on drug issues.

WHO update on HIV situation among IDUs in Asia

WHO recently published a useful 2 page brochure showing the update on the HIV situation among Asian IDUs, in graphs. Please see the link below to download it.

This could be a helpful advocacy tool, explaining in simple charts / graphs, what the problem is, and how harm reduction can (and has) helped reduce HIV among IDUs already in the region.


Monday, July 13, 2009

Petra Stankard: PSI's new IDU Focal Point in the HIV Dept

Dear IDU Stakeholders

Effective immediately, Petra Stankard is joining the IDU team as your new IDU Focal Point in the HIV Department. Petra spent the last year in the procurement and logistics department at PSI/Washington. In her former role of associate procurement officer, Petra supported operations in Asia, Latin America, Eastern Europe and Washington, D.C. Before joining PSI, Petra worked in Namibia with Africare coordinating HIV care and support interventions in the rural north. She has also supported HIV prevention, care and support interventions in South Africa and Washington, D.C., and previously advocated for increased global HIV funding with Africa Action. Petra is already working hard to get up to speed on PSI's global work with IDUs, so she can help serve your IDU needs with speed and quality!
Welcome, Petra!
Petra replaces Shimon Prohow, who has been your IDU Focal Point for the past year or so (and who is now off to graduate studies). Shimon took on the position with passion and intelligence, and leaves very big shoes to fill.
Thank you, Shimon!