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SIGNpost 00743

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00743 Nepal + Kenya + Nigeria + Abstracts + News 30 April 2014

CONTENTS
1. Nepal | Safe Waste Management Taking Shape at Hospitals
2. Abstract: Medical injection use among adults and adolescents aged 15 to
64 years in kenya: results from a national survey
3. Abstract: Epidemiology and clinical parameters of adult human
immunodeficiency virus/acquired immunodeficiency syndrome at the
initiation of antiretroviral therapy in South eastern Nigeria
4. Abstract: High HIV incidence in a cohort of male injection drug users
in Delhi, India
5. Abstract: Injecting practices in sexual partnerships: hepatitis C
transmission potentials in a ‘risk equivalence’ framework
6. Abstract: Observance of hand washing procedures performed by the
medical personnel after the patient contact. Part I
7. Abstract: Bacterial ecology of hospital workers’ facial hair: a cross-
sectional study
8. Abstract: Disposal of unwanted medications: throw, bury, burn or just
ignore?
9. No Abstract: Hand hygiene compliance and determining factors among
Spanish nursing students
10. News
– Australia: Melbourne women infected with hepatitis C reach $13m
settlement
– Canada: Needle distribution has positive effects: report
Reducing the Risk for HIV, Hepatitis C Among Injection Drug Users
– Kenya: Report: Medical Injections Linked to New HIV Infections in Kenya

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1. Nepal | Safe Waste Management Taking Shape at Hospitals

Crossposted with thanks from Health Care Withour Harm (HCWH)

See also: Nepal | Hospital Implements Safe Medical Waste Disposal
Treatments
www.irinnews.org/report/99601/eco-friendly-medical-waste-disposal-in-nepal
__________________________________________________________________
http://noharm-global.org/issues/global/waste

Nepal | Safe Waste Management Taking Shape at Hospitals

Hospitals and clinics, both private and public, across Nepal are making
great strides to protect the health of the communities they serve through
the adoption of safe health care waste management technologies and
practices. The installation of autoclaves, devices that sterilize waste
with a very hot and high pressure steam, have been a key addition to
several hospital waste management programs. Autoclaves have replaced
incinerators and the toxic byproducts they would generate.

Norvic International Hospital, the first private hospital in Nepal to
become a member of GGHH, installed a new autoclave and started a
segregation system that resulted in the reduction of its total risk waste
from 68% to 32% in just one year.

The National Kidney Center opened its improved non-burn waste treatment
facility. Included in this facility is the first vacuum autoclave for
health care waste management in Nepal.

The Chainpur Sub Health Post in the Chitwan District debuted its new
autoclave. The implementation of safe and environmentally friendly health
care waste management systems will spread to five other small-scale health
care facilities throughout the district throughout 2014.

In addition to autoclaves, hospitals in Nepal are adopting several other
innovative practices and technologies to improve their waste management
programs.

Vermicomposting

Pithuwa Sub Health Post in Chitwan has begun a vermicomposting program, a
method of composting that uses worms to break down material, to process
its food waste

Biogas

Chainpur Sub Health Post in Chitwan has built a biogas plant to dispose of
the placenta generated during birthing at the facility. The kitchen will
use the gas generated during the process to power its cooking appliances.
Norvic International Hospital is currently designing a biogas plant to
manage its biodegradable waste and provide supplemental energy for the
facility

Immunization Waste

Kathmandu Municipal City collaborated with Health Care Without Harm (HCWH)
and Health Care Foundation Nepal (HECAF) to pilot management of
immunization waste such as used syringes and vaccine vials. This program
will serve as a model from which other facilities can learn.
Health Care Foundation Nepal, a GGHH founding member, along with Health
Care Without Harm have collaborated to bring the guidance, expertise and
training necessary to make these programs possible and continue a growing
trend throughout the country for safe, environmentally friendly health
care waste management.
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Medical injection use among adults and adolescents aged 15 to
64 years in kenya: results from a national survey
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24413041

J Acquir Immune Defic Syndr. 2014 May 1;66 Suppl 1:S57-65.

Medical injection use among adults and adolescents aged 15 to 64 years in
kenya: results from a national survey.

Kimani D1, Kamau R, Ssempijja V, Robinson K, Oluoch T, Njeru M, Mwangi J,
Njogu D, Kim AA; KAIS Study Group.

1*Center for Global Health, Centers for Disease Control and Prevention,
Nairobi, Kenya; †National AIDS and Sexually Transmitted Infection (STI)
Programme, Ministry of Health, Nairobi, Kenya; and ‡National Public Health
Laboratory Services, Ministry of Health, Nairobi, Kenya.

BACKGROUND: Unsafe medical injections remain a potential route of HIV
transmission in Kenya. We used data from a national survey in Kenya to
study the magnitude of medical injection use, medication preference, and
disposal of medical waste in the community.

METHODS: The Kenya AIDS Indicator Survey 2012 was a nationally
representative population-based survey. Among participants aged 15-64
years, data were collected regarding medical injections received in the
year preceding the interview; blood samples were collected from
participants for HIV testing.

RESULTS: Of the 13,673 participants who answered questions on medical
injections, 35.9% [95% confidence interval (CI): 34.5 to 37.3] reported
receiving =1 injection in the past 12 months and 51.2% (95% CI: 49.7 to
52.8) preferred receiving an injection over a pill. Among those who
received an injection from a health care provider, 95.9% (95% CI: 95.2 to
96.7) observed him/her open a new injection pack, and 7.4% (95% CI: 6.4 to
8.4) had seen a used syringe or needle near their home or community in the
past 12 months. Men who had received =1 injection in the past 12 months
(adjusted odds ratio, 3.2; 95% CI: 1.2 to 8.9) and women who had received
an injection in the past 12 months, not for family planning purposes
(adjusted odds ratio, 2.6; 95% CI: 1.2 to 5.5), were significantly more
likely to be HIV infected compared with those who had not received medical
injection in the past 12 months.

CONCLUSIONS: Injection preference may contribute to high rates of
injections in Kenya. Exposure to unsafe medical waste in the community
poses risks for injury and infection. We recommend that community- and
facility-based injection safety strategies be integrated in disease
prevention programs.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Epidemiology and clinical parameters of adult human
immunodeficiency virus/acquired immunodeficiency syndrome at the
initiation of antiretroviral therapy in South eastern Nigeria
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24761241

Ann Med Health Sci Res. 2014 Mar;4(2):217-21.

Epidemiology and clinical parameters of adult human immunodeficiency
virus/acquired immunodeficiency syndrome at the initiation of
antiretroviral therapy in South eastern Nigeria.

Eleje G1, Ele P2, Okocha E3, Iloduba U4.

1Department of Obstetrics and Gynecology, Nnamdi Azikiwe University
Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria.
2Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, PMB
5025, Nnewi, Anambra State, Nigeria.
3Department of Hematology, Nnamdi Azikiwe University Teaching Hospital,
PMB 5025, Nnewi, Anambra State, Nigeria.
4Department of Pediatrics, Nnamdi Azikiwe University Teaching Hospital,
PMB 5025, Nnewi, Anambra State, Nigeria.

BACKGROUND: Human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS) has continued to ravage the teeming populations in
Nigeria, with disastrous consequences. Despite many studies and progress
on HIV/AIDS in Africa, the data on the status of the patients at the
commencement of therapy is lacking.

AIM: The aim of this study is to determine the demographic, clinical and
some laboratory features of adult HIV/AIDS patients, seen at the
commencement of antiretroviral therapy (ART) in Nnamdi Azikiwe University
Teaching Hospital, Nnewi, south-east Nigeria between July 2002 and October
2004.

SUBJECTS AND METHODS: The study was a cross-sectional, descriptive study.
Adult patients living with HIV/AIDS were studied using an interview
administered questionnaire. Data was analyzed using Epi Info 2008 version
3.5.1.

RESULTS: A total of 400 respondents participated in this study. The mean
age was 36.8 (8.8) years. Almost 60% patients were married and the HIV
concordance rate was 53.3% (136/255). Nearly 30% of the families had at
least one child positive for HIV.

*** The most common associated risky behavior was injection administered
in patent medicine stores 74.5%(302/400) and the most common clinical
symptom was respiratory.

Of the 400 patients recruited in this study, 19 (4.8%) were lost to
follow-up on the 6 months’ visit, giving a follow-up rate of 95.2%
(381/400). There was statistically significant difference in the mean body
weight (P = 0.02), mean total white blood cell count (P < 0.001) and mean
CD4(+) count (P < 0.001) at presentation and after 6 months of ART
therapy.

CONCLUSION: HIV/AIDS patients present late and body weight, CD4(+) count
and total white blood cell count seemed to recover quickly on commencement
of ART. The prevalence of concordance among couples and mother to child
transmission rates tended to be high. Administration of injectable at
patent medicine stores and multiple sexual partners are the most
significant risk factors.

KEYWORDS: CD4 counts, Clinical patterns, Epidemiology, Respiratory

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991943/

Free Full Text Article http://dx.doi.org/10.4103%2F2141-9248.129045
__________________________________________________________________
________________________________*_________________________________

4. Abstract: High HIV incidence in a cohort of male injection drug users
in Delhi, India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24768060

Drug Alcohol Depend. 2014 Mar 30. pii: S0376-8716(14)00797-2.

High HIV incidence in a cohort of male injection drug users in Delhi,
India.

Sarna A1, Saraswati LR2, Sebastian M2, Sharma V2, Madan I3, Lewis D3,
Pulerwitz J4, Thior I5, Tun W6.

1Population Council, Zone 5A, India Habitat Center, Lodhi Road, New Delhi
110003, India. Electronic address: asarna@popcouncil.org.
2Population Council, Zone 5A, India Habitat Center, Lodhi Road, New Delhi
110003, India.
3Sahara Center for Residential Care and Rehabilitation, B-9/11 Chandan
Singh Market, IGNOU Road, Siadulajab, New Delhi 110030, India.
4ARISE Project, PATH, 1800K Street NW, 8th Floor, Washington, DC 20006,
USA; Population Council, 4301 Connecticut Ave NW, Suite 280, Washington,
DC 20008, USA.
5ARISE Project, PATH, 1800K Street NW, 8th Floor, Washington, DC 20006,
USA.
6Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC
20008, USA.

BACKGROUND: India has an estimated 177,000 injection drug users (IDU) with
a national HIV prevalence of 7.14%. Reliable estimates of HIV incidence
are not available for this population.

METHODS: We report HIV incidence in a cohort of male, HIV-negative IDUs
recruited through peer-referral, targeted outreach and as walk-in clients
in Delhi from May to October, 2011. Fourth-generation Antigen-Antibody
tests were used to diagnose new infections and results were confirmed
using Western blot tests. HIV incidence based on HIV seroconversion was
calculated as number of events/person-years. Cox regression was used to
identify significant (p<0.05) seroconversion predictors.

RESULTS: A total of 2790 male HIV-negative IDUs were recruited at
baseline; 67.4% (n=1880) returned for their first follow-up visit and 96%
(n=1806) underwent HIV testing. Participants were followed for a median of
9.7 months.

A total of 112 new HIV infections occurred over a cumulative 1398.5
person-years of follow-up resulting in an incidence rate of 8.01 new
infections/100 person-years (95% CI: 6.65-9.64); 74% of these participants
reported risky injection practices in the past month.

In multivariate analysis, moderate-high risk injection behaviors (Adjusted
Hazard Ratio [AHR] 2.59; 95% CI 1.45-4.62) were associated with a higher
risk of new infections.

CONCLUSIONS: Male IDUs in Delhi continue to practice unsafe injection
practices leading to high sero-incidence despite the availability of HIV
prevention services offered through targeted intervention programs.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:
Cohort study, HIV-incidence, India, Injection drug user, Sexual behavior,
Unsafe injection practices
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Injecting practices in sexual partnerships: hepatitis C
transmission potentials in a ‘risk equivalence’ framework
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23664125

Drug Alcohol Depend. 2013 Oct 1;132(3):617-23.

Injecting practices in sexual partnerships: hepatitis C transmission
potentials in a ‘risk equivalence’ framework.

Harris M1, Rhodes T.

1London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place,
London WC1H9SH, UK. Electronic address: magdalena.harris@lshtm.ac.uk.

BACKGROUND: Evidence indicates minimal hepatitis C (HCV) sexual
transmission risk among HIV negative heterosexual partners. Limited HCV
literacy has been demonstrated among people who inject drugs, yet there is
a dearth of research exploring perceptions of HCV heterosexual
transmission risk among this high risk population.

METHODS: We conducted a qualitative life history study with people who had
been injecting drugs for over six years, to explore the social practices
and conditions of long-term HCV avoidance. Participants were recruited
through London drug services and drug user networks. The sample comprised
10 women and 27 men (n=37), of whom 22 were HCV antibody negative.
Participants were aged from 23 to 57 years and had been injecting for 6 to
33 years. Twenty participants were in long term heterosexual partnerships.

FINDINGS: The majority of participants in relationships reported
‘discriminate’ needle and syringe sharing with their primary sexual
partner. Significantly, and in tension with biomedical evidence,
participants commonly rationalised syringe sharing with sexual partners in
terms of ‘risk equivalence’ with sexual practices in regard to HCV
transmission. Participants’ uncertain knowledge regarding HCV
transmission, coupled with unprotected sexual practices perceived as being
normative were found to foster ‘risk equivalence’ beliefs and associated
HCV transmission potential.

CONCLUSION: HCV prevention messages that ‘add on’ safe sex information can
do more harm than good, perpetuating risk equivalence beliefs and an
associated dismissal of safe injecting recommendations among those already
practicing unprotected sex.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS: Harm reduction, Hepatitis C, Injecting drug use, Risk, Sexual
transmission
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Observance of hand washing procedures performed by the
medical personnel after the patient contact. Part I
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23715929

Int J Occup Med Environ Health. 2013 Apr;26(2):257-64.

Observance of hand washing procedures performed by the medical personnel
after the patient contact. Part II.

Garus-Pakowska A1, Sobala W, Szatko F.

1Department of Hygiene and Health Promotion, Chair of Hygiene and
Epidemiology, Medical University of Lodz, Lódz, Poland. anna.garus-
pakowska@umed.lodz.pl

OBJECTIVES: The Centers for Disease Control and Prevention (CDC) as well
as the World Health Organization (WHO) state that adequate hand hygiene
maintained by medical personnel is an indispensable prerequisite for
controlling nosocomial infections. The recommendations of CDC and WHO
emphasize the obligation to wash hands after each contact with a patient,
after the exposure to a potentially infectious material or upon the
contact with objects surrounding the patient.

MATERIALS AND METHODS: The study was performed by quasi-observation among
the group of 188 medical staff members (nurses and physicians) working in
three selected hospitals of the Lódz Province. The procedure of hand
washing/disinfection performed directly after the patient contact
according to the recommendations of CDC and WHO was observed. The results
were subject to statistical analysis (p < 0.05).

RESULTS: During 1544 h of observations, 4101 activities requiring hand
washing were recorded. The medical personnel followed the hand hygiene
procedures after the patient contact in 26.4% of the situations that
require hygiene according to the guidelines. The level of observance of
the hand washing procedures depended significantly on the type of
performed activity, profession, degree of workload, index of activity, and
time of duty hours. The mean time of hand washing after patient contact
was 9.2 s for physicians and 6.7 s for nurses.

CONCLUSION: Both the level of observance of hygienic procedures after the
contact with patients as well as the time of hand washing are
insufficient. There is an urgent need to work out educational programs on
maintaining proper hand hygiene for medical personnel.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Bacterial ecology of hospital workers’ facial hair: a cross-
sectional study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24746610

J Hosp Infect. 2014 Mar 26. pii: S0195-6701(14)00090-5.

Bacterial ecology of hospital workers’ facial hair: a cross-sectional
study.

Wakeam E1, Hernandez RA2, Rivera Morales D3, Finlayson SR4, Klompas M5,
Zinner MJ3.

1Center for Surgery and Public Health, Department of Surgery, Brigham and
Women’s Hospital, Boston, MA, USA. Electronic address:
ewakeam@partners.org.
2Center for Surgery and Public Health, Department of Surgery, Brigham and
Women’s Hospital, Boston, MA, USA; Department of Surgery, Dartmouth-
Hitchcock Medical Center, Lebanon, NH, USA.
3Center for Surgery and Public Health, Department of Surgery, Brigham and
Women’s Hospital, Boston, MA, USA.
4Center for Surgery and Public Health, Department of Surgery, Brigham and
Women’s Hospital, Boston, MA, USA; Department of Surgery, University of
Utah School of Medicine, Salt Lake City, UT, USA.
5Division of Infectious Disease, Department of Medicine, Brigham and
Women’s Hospital, Boston, MA, USA.

It is unknown whether healthcare workers’ facial hair harbours nosocomial
pathogens. We compared facial bacterial colonization rates among 408 male
healthcare workers with and without facial hair.

Workers with facial hair were less likely to be colonized with
Staphylococcus aureus (41.2% vs 52.6%, P = 0.02) and meticillin-resistant
coagulase-negative staphylococci (2.0% vs 7.0%, P = 0.01).

Colonization rates with Gram-negative organisms were low for all
healthcare workers, and Gram-negative colonization rates did not differ by
facial hair type.

Overall, colonization is similar in male healthcare workers with and
without facial hair; however, certain bacterial species were more
prevalent in workers without facial hair.

Copyright © 2014 The Healthcare Infection Society. Published by Elsevier
Ltd. All rights reserved.

KEYWORDS: Bacterial ecology, Facial hair, Healthcare workers, Hospital-
acquired infection
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Disposal of unwanted medications: throw, bury, burn or just
ignore?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23419056

Int J Pharm Pract. 2013 Apr;21(2):131-4.

Disposal of unwanted medications: throw, bury, burn or just ignore?

Koshy S.

Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University,
Kuwait. samuelk24@yahoo.com

OBJECTIVES: The aim of this article is to highlight the relevance of
proper disposal of unwanted medications.

KEY FINDINGS: Proper disposal of unwanted medications is a global issue.
The consequences of improper disposal are a major concern, as it has
negative consequences on both human health and the environment.
Pharmacists are in a key position to ensure proper disposal and reduce the
generation of unwanted medications.

CONCLUSION: There is urgent need for awareness on a global scale, among
the public and healthcare professionals, of the importance of proper
disposal of unwanted medications. Research is required to assess
pharmacists’ attitudes and methods used for disposal from pharmacies.

© 2012 The Author. IJPP © 2012 Royal Pharmaceutical Society.
__________________________________________________________________
________________________________*_________________________________

9. No Abstract: Hand hygiene compliance and determining factors among
Spanish nursing students
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23523231

Am J Infect Control. 2013 Oct;41(10):943-4.

Hand hygiene compliance and determining factors among Spanish nursing
students.

Hernández-García I1, Cardoso A.
Author information

1Department of Preventive Medicine, Faculty of Medicine, University of
Salamanca, Salamanca, Spain, and Department of Preventive Medicine,
University Hospital of Salamanca, Salamanca, Spain. Electronic address:
ignaciohernandez79@yahoo.es.
__________________________________________________________________
________________________________*_________________________________

10. News

– Australia: Melbourne women infected with hepatitis C reach $13m
settlement
– Canada: Needle distribution has positive effects: report
Reducing the Risk for HIV, Hepatitis C Among Injection Drug Users
– Kenya: Report: Medical Injections Linked to New HIV Infections in Kenya
Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://tinyurl.com/qz43lec

Australia: Melbourne women infected with hepatitis C reach $13m settlement
Lawyers for group of 50 women infected by drug-addicted anaesthetist say
they have reached proposed settlement

Australian Associated Press, theguardian.com, (28.04.14)

A group of women infected with hepatitis C at a Melbourne medical clinic
has reached a $13.75m proposed settlement of a class action against the
facility.

More than 50 women brought the action against Croydon Day Surgery and the
Australian Health Practitioner Regulation Authority after they were
infected by drug-addicted anaesthetist James Latham Peters.

Lawyers for the group told the Victorian supreme court on Monday the
parties have reached a proposed settlement.

The settlement, which still requires the court’s approval, involves a
total payout of $13.75m.

A woman infected at a Melbourne medical clinic said she had since suffered
ongoing mental health issues and a family breakdown. The woman, who cannot
be named, said the settlement would allow her the stability she needed to
rebuild her family. “(It means) the end of torment and heartache,” she
said. “It’s done and it’s over and we can move on with our lives.”

Slater and Gordon principal lawyer Julie Clayton praised the bravery and
patience of the women in dealing with a major public health incident. “It
has been a nightmare for our clients. Their faith in the medical
system has been seriously tested,” she said. “An out-of-court settlement
will allow them to focus on the future.”

Clayton said there were about six women who had been infected who had not
yet joined the class action.

The formal application to settle the action will be heard in the next
fortnight.

The trial for a separate lawsuit, involving a woman who refused to join
the class action, has been adjourned until Wednesday.

Peters was jailed in 2013 for 14 years, with a non-parole period of 10
years, after pleading guilty to 55 counts of negligently causing serious
injury.

Peters injected the women with the same needles he used to give himself
doses of the opiate Fentanyl while working as an anaesthetist at the
abortion clinic in 2008 and 2009.

In jailing Peters, Justice Terry Forrest said he caused vulnerable women
to suffer needlessly.

“The physical damage caused by your conduct and the associated emotional
harm cannot adequately be described by me in words,” he said.

“You breached the great trust that every patient places in his or her
treating doctor.”
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/qh2t879

Canada: Needle distribution has positive effects: report

By Mark Rendell, The Telegram, Labrador Canada (26.04.14)

Injection drug use on the rise across the province

An independent assessment of the province’s main needle distribution
service found it had a positive impact on drug user health and likely
saved the health-care system money.

The report found that SWAP, a program that seeks to reduce HIV and
Hepatitis transmission by supplying clean needles to drug users, allowed
clients to access supplies from non-judgmental staff, helped addicts
connect with treatment and helped spread understanding about drug use.

The assessment was conducted by the consulting firm Goss Gilroy Inc. and
released on Friday.

It doesn’t specify exactly how effective the program, which is part of the
AIDS Committee of Newfoundland and Labrador (ACNL), has been at halting
the spread of infectious disease.

But it notes, “Through SWAP’s contribution to reducing rates of infection
and illness it was felt there have been cost savings to the health
system.”

The evaluation and needs assessment was conducted following a dramatic
increase in people using the program over the last decade.

Between 2005 and 2012 the number of needles annually distributed by SWAP
increased 60-fold, from 5,600 to 330,000.

There seems to be an increase in injection drug use across the province,
the report notes; though, “the clandestine nature of the activity makes it
more difficult to quantify the exact numbers engaged in injection drug
use.”

However the increase in SWAP’s needle distribution can be attributed to
their opening “satellite sites” outside of St. John’s, their use of
delivery vans, and the 2012 airing of the documentary “The Needle and the
Damage Done” which, the report says, raised awareness about the program.

Marie Ryan, the report’s lead author, said the rising number of SWAP
needles doesn’t necessarily mean that more needles are left lying around.

But she did note that the ratio of needles given out to those collected
was around 60 per cent last year, and had dropped as low as about 50 per
cent in 2012.

It’s one of the key areas, along with record keeping and partnership
building, which, according to the report, SWAP needs to improve.

The ACNL has contacted municipalities across the province about the
report’s findings, and to a person, says Ryan, the mayors have
acknowledged the truth and importance of the report.

In particular they’ve accepted the crucial point that injection drug use
is not limited to St. John’s. Municipalities of all sizes are affected,
with areas like Conception Bay North and Labrador growing concerns.

Nor is injection drug use limited to a certain type of person.

The consultants surveyed 55 injection drug users and found a diverse group
of people. The male/female spilt was 60 per cent to 40 per cent. The ages
ranged from 18 to 61, though more than half were between the ages of 24
and 33.

They had obtained varying levels of education — some had no more than
elementary school education and some had post-graduate degrees.

Perhaps most importantly for SWAP, around 30 per cent of respondents said
they shared needles with others.

It’s this kind of behavior SWAP is trying to reduce by ensuring access to
clean needles, something especially important as around 40 per cent of
respondents said they have Hepatitis A, B or C and eight per cent said
they have HIV.

Ryan and Gerard Yetman, executive director of the ACNL, will be presenting
the report’s findings at the annual Canadian Conference on HIV/AIDS
Research that will be held in St. John’s next week.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/p74n3jh

Infectious Disease Special Edition (24.04.14)

ISSUE: APRIL 2014

Reducing the Risk for HIV, Hepatitis C Among Injection Drug Users

Coordinated education and counseling services can successfully control at-
risk behaviors such as needle-sharing among injection drug users and
thereby curb the spread of HIV and hepatitis C among this high-risk
population, a new study has confirmed.

Published in the April issue of the journal AIDS Education and Prevention
(2014;26:144-157), the study assessed the efficacy of the “Staying Safe
Intervention,” which was developed by researchers at New York University’s
(NYU) Center for Drug Use and HIV Research, in New York City. The
program’s content was based on the findings of an earlier study that
observed the behaviors of injection drug users and the stigmas associated
with these behaviors. Participants in this earlier study injected drugs
for as long as 15 years without contracting HIV or hepatitis C, due in
part to self-imposed safeguards. These safeguards served as the
underpinnings of the strategies at the core of the Staying Safe
Intervention.

For the new study, injection-drug users were enrolled in the 5-session
Staying Safe education program, which included material on safe injection
strategies, the risks for HIV and hepatitis C associated with injection
drug use, and approaches for managing these risks. In all, 68 injection
drug users participated in the intervention, and 87% attended at least 1
group session; 46% of study participants attended all 5.

According to the study authors, participants reported increases in
planning skills to avoid injection-related risks (P<0.001), increases in
self-efficacy in avoiding sharing injection equipment (P=0.005), and
increases in stigma management strategies (P=0.002). At 3-month follow-up,
patients reported that their average weekly injections and daily drug
expenses declined (P<0.001), and that their mean daily drug expenditure
dropped from $77 before the Staying Safe Intervention to $47 after.
Additionally, there were reductions in overall sharing of syringe and
nonsyringe injection equipment, cotton filters, water, and water
containers when diluting drugs (P<0.001 for all) among study participants.

“Given the substantial reductions observed among Staying Safe participants
in key injection-related behaviors associated with HCV transmission, the
Staying Safe Intervention may have the potential to contribute to
sufficient additional risk reduction to help address the seemingly
intractable rates of HCV transmission among people who inject drugs,” the
study’s principal investigator, Pedro Mateu-Gelabert, PhD, said in a
statement on the study released by NYU. “The goal is to implement the
Staying Safe approach with this new generation of young injectors, so they
do not get infected with HIV or HCV.”
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http://tinyurl.com/m9y2x7p

Kenya: Report: Medical Injections Linked to New HIV Infections in Kenya

Standard Digital, Nairobi Kenya (21.04.14)

Standard Digital News reported that according to the Kenya AIDS Indicator
Survey, a large number of Kenyans have acquired HIV infections from
contaminated medical injections. The report states that many of these
injections were self-administered or administered at health facilities or
from traditional healers. The report estimates that 2.2 percent of new HIV
infections in 2008 resulted from unsafe injections at health facilities.
Since then, more people, including HIV-positive patients, have continued
to receive various injections at these facilities, leading to increased
infection management issues for Kenya’s medical system.

The Government of Kenya and US agencies initiated the study, led by CDC’s
Dr. Daniel Kimani, which took place from October 2012 to February 2013.
The study attributed the problem to several factors including Kenyans’
preference for injections rather than pills; poor disposal of used medical
waste; a large number of HIV-positive individuals receiving injections;
and possible reuse of needles by medical workers and traditional healers.
A total of 13,720 individuals ages 15–64 completed the survey. One of 15
respondents indicated they had seen a used needle or syringe in their
community or near their home within the previous year. Study researchers
noted that some of these needles could have been HIV-contaminated.

The study confirmed a high HIV prevalence among persons who had received
injections from traditional practitioners. The report also noted that
women received 70 percent of the medical injections. Contraceptive
injections accounted for 40 percent of this number. Because of the noted
preference for injections over oral medication, the researchers
recommended the reproductive health program include injection safety
procedures in its health services.

The full report, “Medical Injection Use Among Adults and Adolescents Aged
15 to 64 Years in Kenya: Results From a National Survey,” was published in
the Journal of Acquired Immune Deficiency Syndromes (2014; doi:
10.1097/QAI.0000000000000106).
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* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

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get SIGNpost archives at: http://signpostonline.info/archives-by-year

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The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail: sign@who.int
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The 2010 annual Safe Injection Global Network meeting to aid collaboration
and synergy among SIGN network participants worldwide was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
http://www.who.int/entity/injection_safety/toolbox/sign2010_meeting.pdf

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

Translation tools are available at: http://www.google.com/language_tools
or http://www.freetranslation.com
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