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      Exposure to HIV risks among young people who use drugs (YPUD) in three cities in Vietnam: time to develop targeted interventions

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          Abstract

          Introduction

          The aim of this study is to identify the profiles of young people who use drugs (YPUD) and their exposure to HIV risks in the 3 main cities of Vietnam, Haiphong, Hanoi, and Ho Chi Minh City (HCMC), in order to design a community-based intervention to prevent HIV.

          Methods

          A survey using respondent-driven sampling (RDS) was conducted among YPUD aged 16–24. Participants were eligible if they reported drug use, confirmed by a urine test. After obtaining informed consent, they were screened for HIV/HCV and assessed using face-to-face questionnaires and self-report. A cluster analysis was conducted, taking into account risk behaviors and confirmed HIV-positive status.

          Results

          Seven hundred and three YPUD aged 16–24 were recruited between October 2016 and February 2017, 584 of whom were included in the final analysis. Median age was 21 (17.7, 23.0); 79% were male, 18% female, and 2% transgender. Methamphetamines use was reported by 77%, followed by cannabis (51%) and heroin (17%); polydrug use was common; 15% had “ever” injected drugs. HIV prevalence was 7%. Among all participants, 48% reported non-consistent condom use and 1% reported needle/syringe sharing during the previous month. Four distinct profiles of HIV risk behaviors were identified: The high multiple-risk group mixed unsafe drug use with unsafe sexual practices and had higher prevalence of HIV; the second group practiced high-risk sex with non-consistent condom combined with methamphetamine use; the third group was a moderate-risk group with limited unsafe sexual practices; and the fourth was considered at “low-risk” as reportedly, most never had sex and never injected. The highest risk group included more female YPUD, living in HCMC, who used heroin and had unsafe sex with their regular partners. The second high-risk group included most of the MSM and all transgender people and frequently reported mental health disorders.

          Conclusions

          The profiles of YPUD who are at risk of HIV vary according to age, location, and population group. Injecting YPUD are the most exposed to risk and need immediate attention. Sexual exposure to HIV is very common. Mental health is a major concern. Interventions need to be integrated in a differentiated but holistic approach.

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          Most cited references18

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          Self-report among injecting drug users: a review.

          The use of behavioural self-reports of drug users is widespread among studies of illicit drug use. Despite widespread use, concerns about the accuracy of these reports continue to be raised. The current paper critically reviews the literature on the reliability and validity of self-reported drug use, criminality and HIV risk-taking among injecting drug users. The literature shows respectable reliability and validity of self-reported behaviours when compared to biomarkers, criminal records and collateral interviews. It concludes that the self-reports of drug users are sufficiently reliable and valid to provide descriptions of drug use, drug-related problems and the natural history of drug use.
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            Epidemiology of HIV Among Injecting and Non-injecting Drug Users: Current Trends and Implications for Interventions

            Injecting drug use is a major driver of HIV infections in Eastern Europe, the Commonwealth of Independent States, North Africa, the Middle East, and many parts of Asia and North America. We provide a global overview of the epidemiology of HIV infection among drug users and present current drug use trends that may constitute important epidemic drivers. We describe trends in ethnic disparities among injecting drug using (IDU) populations in the United States, and comment upon how these trends may now be changing. We present examples where HIV infection among non-IDUs who use cocaine, crack, and methamphetamine by other routes of administration is similar to that among IDUs, and discuss potential mechanisms of HIV spread in this overlooked population. Finally, we comment upon the potential implications of these observations for HIV interventions among IDU and non-IDU populations, taking into account different strategies that are needed in settings where HIV and/or injecting drug use has been established, or threatens to emerge.
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              Health outcomes associated with methamphetamine use among young people: a systematic review.

              Methamphetamine (MA) use among young people is of significant social, economic and public health concern to affected communities and policy makers. While responses have focused upon various perceived severe harms of MA use, effective public health interventions require a strong scientific evidence base. We conducted a systematic review to identify scientific studies investigating health outcomes associated with MA use among young people aged 10-24 years. The International Classification of Diseases (ICD-10) was used to categorize outcomes and determine the level of evidence for each series of harms. We identified 47 eligible studies for review. Consistent associations were observed between MA use and several mental health outcomes, including depression, suicidal ideation and psychosis. Suicide and overdose appear to be significant sources of morbidity and mortality among young MA users. Evidence for a strong association between MA use and increased risk of human immunodeficiency virus (HIV) and other sexually transmitted infections is equivocal. Finally, we identified only weak evidence of an association between MA use and dental diseases among young people. Available evidence indicates a consistent relationship between MA use and mental health outcomes (e.g. depression, psychosis) and an increased risk of mortality due to suicide and overdose. We found insufficient evidence of an association between MA use and other previously cited harms, including infectious diseases and dental outcomes. As such, future research of higher methodological quality is required to further investigate possible associations. Current interventions should focus attention upon MA-related health outcomes for which sound scientific evidence is available.
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                Author and article information

                Contributors
                laurentnmichel@gmail.com
                linhnguyen@scdi.org.vn
                annguyen2@scdi.org.vn
                pekwaru@gmail.com
                didier.laureillard@yahoo.fr
                n-nagot@chu-montpellier.fr
                olivier.phan@croix-rouge.fr
                oanhkhuat@scdi.org.vn
                Journal
                Harm Reduct J
                Harm Reduct J
                Harm Reduction Journal
                BioMed Central (London )
                1477-7517
                24 February 2020
                24 February 2020
                2020
                : 17
                : 13
                Affiliations
                [1 ]CESP/Inserm 1018, Centre Pierre Nicole, French Red Cross, Paris, France
                [2 ]Supporting Community Development Initiative, 240 Mai Anh Tuan Street, Thanh Cong Ward, Ba Dinh District, Ha Noi, Vietnam
                [3 ]GRID grid.17089.37, School of Public Health, , University of Alberta, ; Edmonton, Canada
                [4 ]GRID grid.411165.6, ISNI 0000 0004 0593 8241, Infectious Diseases Department, , Caremeau University Hospital, ; Nîmes, France
                [5 ]GRID grid.121334.6, ISNI 0000 0001 2097 0141, Pathogenesis and control of chronic infections, Inserm, Etablissement Français du Sang, , University of Montpellier, ; Montpellier, France
                Author information
                http://orcid.org/0000-0002-2000-7838
                Article
                357
                10.1186/s12954-020-00357-4
                7038548
                32093700
                4ce1c0ce-e58b-4e2c-b3b7-ba160e3be2f2
                © The Author(s) 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 September 2019
                : 11 February 2020
                Funding
                Funded by: 5% Initiative, Expertise France
                Award ID: #15SANIN207
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Health & Social care
                young people,methamphetamines,hiv,mental health,sexual risk,drug use
                Health & Social care
                young people, methamphetamines, hiv, mental health, sexual risk, drug use

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