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(2008)Journal ArticleObjectives: It has been previously argued that the methodology employed by the Composite International Diagnostic Interview version 2.1 to assess the substance induced and general medical condition exclusion criteria are inadequate. As a result prevalence estimates generated from epidemiological studies using this interview may be underestimated. The purpose of the current study was to examine the substance induced and general medical condition exclusion criteria in the Australian National Survey for Mental Health and Well-being and determine the impact they have on prevalence estimates of the common mental disorders. Method: Data from the 1997 Australian National Survey of Mental Health and Wellbeing were analyzed. Frequencies were generated as an indication of how many respondents believed their psychiatric symptoms were always due to a substance or general medical condition. New DSM-IV prevalence estimates were calculated ignoring the application of the substance induced and general medical condition exclusion criteria and compared to standard DSM-IV prevalence estimates. Results: The effect of the substance induced and general medical condition exclusion criteria on final prevalence rates were minimal with around a 0.1% increase when the exclusions were ignored. This equates to a relative difference ranging from no difference for Generalized Anxiety Disorder to an increase of 12% of the base prevalence estimate for Agoraphobia. Conclusions: In surveys that use the Composite International Diagnostic Interview version 2.1 the substance induced and general medical condition exclusion criteria have a minor impact on determining final case definition in the majority of mental disorders.
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(2003)ReportThis project, funded by NHMRC and NSW Health, aimed to investigate and report on a number of aspects of initiation and transition to injecting drug use among young people. The report focuses on issues of: • transition to injecting – what drugs were used prior to injection, what was participants’ contact with injectors; • the initiation episode – describing the factors about the occasion (what drugs were used, where injecting equipment was accessed), as well as characteristics of the initiator and their social networks; • the effect of drug most frequently used – between current stimulant and opioid injectors; • age at initiation – differences between early and late initiators; • hepatitis C status – self-reporting of positive hepatitis C serostatus; • risk practice for blood borne viruses – variables of risk, demography, and social networks are examined in determining those more likely to self-report risk practices such as sharing, borrowing or re-using injection equipment; • transitions out of injecting – we examine patterns of drug use and efforts of participants to reduce or stop drug use.
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(2003)ReportThis project, funded by NHMRC and NSW Health, aimed to investigate and report on a number of aspects of initiation and transition to injecting drug use among young people. The report focuses on issues of transition to injecting, the initiation episode, the effect of drug most frequently used, age at initiation, hepatitis C status, risk practice for blood borne viruses, and transitions out of injecting.
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(2009)Journal ArticleBackground: HIV prevalence data suggest that men who have sex with men (MSM) in low-income and middle-income countries (LMIC) are at increased risk of HIV The aim of this article is to present global estimates on key HIV prevention needs and responses among MSM in LMIC. Methods: Data on HIV testing, HIV prevention coverage, HIV knowledge and condom use among MSM were derived from UNGASS country progress reports submitted in 2008. Eligible country estimates were used to calculate global and regional estimates, weighted for the size of MSM populations. Results: Of 147 LMIC, 45% reported at least 1 indicator that reflects the HIV prevention needs and responses in MSM. Global weighted estimates indicate that on average 31 % of MSM in LMIC were tested for HIV; 33% were reached by HIV prevention programs; 44% had correct HIV knowledge; and 54% used condoms the last time they had anal sex with a man. Conclusions: The 2008 UNGASS country reports represent the largest harmonized data set to date of HIV prevention needs and responses among MSM in LMIC. Although reporting is incomplete and does not always conform to requirements, findings confirm that, in many LMIC, HIV prevention responses in MSM need substantial strengthening.
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(2009)Journal ArticleObjectives: The 2001 Declaration of Commitment from the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) set the prevention of HIV infection among injecting drug users (IDUs) as an important priority in the global fight against HIV/AIDS. This article examines data gathered to monitor the fulfillment of this commitment in low-income and middle-income countries (LMICs) where resources to develop an effective response to HIV are limited and where injecting drug use is reported to occur in 99 (of 147) countries, home to 75% of the estimated 15.9 million global IDU population. Methods: Data relating to injecting drug use submitted by LMICs to the Joint United Nations Programme on HIV/AIDS (UNAIDS) in the 2008 reporting round for monitoring the Declaration of Commitment on HIV/AIDS were reviewed. The quality of the data reported was assessed and country data were aggregated and compared to determine progress in HIV prevention efforts. For each indicator, the mean value weighted for the size of each country's IDU population was determined; regional estimates were also made. Results: Reporting was inconsistent between countries. Forty percent of LMIC (40/99), where injecting occurs, reported data for 1 or more of the 5 indicators pertinent to HIV prevention among IDUs. Many of the data reported were excluded from this analysis because the indicators used by countries were not consistent with those defined by UNAIDS Monitoring and Evaluation Reference Group and could not be compared. Data from 32 of 99 countries met our inclusion criteria. These 32 countries account for approximately two-thirds (68%) of the total estimated IDU population in all LMICs. The IDU population weighted means are as follows: 36% of IDUs tested for HIV in the last year; 26% of IDUs reached with HIV prevention programs in the last year; 45% of IDUs with correct HIV prevention knowledge; 37% of IDUs used a condom at last sexual intercourse; and 63% of IDUs used a clean syringe at last injection. Marked variance was observed in the data reported between different regions. Conclusions: Data from the 2008 United Nations General Assembly Special Session reporting round provide a baseline against which future progress might be measured. The data indicate a wide variation in HIV service coverage for IDUs and a wide divergence in HIV knowledge and risk behaviors among IDUs in different countries. Countries should be encouraged and assisted in monitoring and reporting on HIV prevention for IDUs.
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(2007)ReportIn 2004, the Beckley Foundation reported on the legal changes that took place in Portugal in 2001 (Allen, Trace & Klein 2004). This report aims to provide an updated overview of the effects of these changes, using data from the evaluations that have been carried out and from new interviews with key stakeholders in Portugal. We reviewed the available evaluative reports (Moreira, Trigueiros & Antunes 2007; Tavares, Graça, Martins & Asensio 2005; Trigo de Roza 2007) and also carried out 11 interviews with key stakeholders in October 2007. These included representatives of the Institute for Drugs and Drug Addiction (the government body in charge of researching and responding to drug addiction and use), non-governmental organisations, political parties and national and international drug researchers1. This report provides information for an international audience on the current trends and the perceptions of key stakeholders regarding the major impacts, successes, and challenges in adopting decriminalization.
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(2008)ThesisSuicide attempts and opioid dependence are important clinical issues, as both are associated with a high degree of psychiatric morbidity and elevated risk of mortality. Research has identified a number of risk factors for suicide attempts among the general population, and to a lesser extent, among heroin users. Due to a lack of case-control studies, however, it is still not known to what extent opioid dependence per se is a risk factor for suicide attempts. This thesis comprised the first study to directly examine whether opioid dependence is a unique risk factor of suicide attempts. This thesis examined suicide attempts, associated risk factors, and related comorbidity among an opioid-dependent case group and a non-opioid-dependent control group. A structured interview was used to collect data from 726 opioid-dependent cases and 399 non-opioid-dependent controls. This thesis identified a number of important findings. Firstly, although opioid-dependent individuals were more likely to report lifetime suicide attempts compared to controls, the risk factors were largely the same for both groups. It appeared that opioid-dependent individuals were characterised by a higher likelihood of the same risk factors for suicide attempts, rather than having different risks. Cases appeared to be at increased risk of suicide attempts because of increased levels of multiple risk factors. Secondly, borderline personality disorder (BPD) and impulsivity were identified as important risk markers for suicidal behaviour, especially among opioid-dependent individuals. The study concluded that the treatment of BPD should be prioritised among this group. Third, self-mutilation was identified as a clinically significant problem in its own right, however, when combined with a history of attempted suicide, the psychological dysfunction observed was found to be very high. Fourth, non-fatal opioid overdose and suicide attempts were found to be distinct behaviours. The risk factors for each were completely different. While drug-related risks were associated with non-fatal overdose, the risk markers for suicide attempts were related to the presence of psychological disorders. This thesis has highlighted important areas of concern for clinical interventions as well as for future research to explore. Considering this is the first study of its kind, future research should focus on its replication.