The prevalence of sexually transmitted diseases (STD) among female drug abusers was determined by screening 130 new inmates of a rehabilitation centre. The majority of the subjects (77.7%) were self-confessed sex workers. A high prevalence of syphilis (50.8%), hepatitis B (52.2%), moniliasis (23.8%) and trichomoniasis (19.2%) were noted. Gonorrhoea vaginitis was seen in 8.5%, which was low compared to previous studies. Six subjects were seropositive for human immunodeficiency virus (HIV), with 5 of them admitting to needle sharing and working as prostitutes. More than half of them harboured 2 or more STD. A rich reservoir of STD was seen among the drug abusers. With more evidence now available concerning the ease of HIV transmission associated with ulcerative STD, a stage could be set for greater heterosexual HIV transmission. As part of the rehabilitation process, female drug abusers need a thorough screening for STD followed by aggressive treatment regimens.
Hepatitis C infection is a global public health problem. This study was designed to identify the risk factors associated with hepatitis C infection among adult patients in Kedah state, Malaysia. A matched, hospital-based, case-control study was conducted at a tertiary hospital. Cases were adult (aged ≥ 18 years) patients with positive serology test results for hepatitis C virus antibody and detectable hepatitis C virus RNA from January 2015 to December 2018, and controls were age-, sex- and ethnicity-matched patients who were not infected with hepatitis C virus. Self-administered questionnaires were used to collect data on demographic characteristics and previous exposure to selected risk factors among the study participants. Associations between hepatitis C and demographic and risk factors were assessed using univariable and multivariable logistic regression analyses. A total of 255 case-control patient pairs were enrolled. The multivariable analysis indicated that having a history of blood or blood product transfusion before 1992 (adjusted odds ratio [AOR] = 6.99, 95% confidence interval [CI]: 3.73-13.81), injection drug use (AOR = 6.60, 95% CI: 3.66-12.43), imprisonment (AOR = 4.58, 95% CI: 1.62-16.40), tattooing (AOR = 3.73, 95% CI: 1.37-12.00), having more than one sexual partner (AOR = 2.06, 95% CI: 1.16-3.69), piercing (AOR = 1.71, 95% CI: 1.04-2.80), and having only secondary education (AOR = 1.92, 95% CI: 1.06-3.57) were independently associated with hepatitis C. No associations were found between health care occupation, needle-prick injury, surgical procedures, haemodialysis, acupuncture, cupping, or contact sports and hepatitis C infection. These findings demonstrate that hepatitis C risk is multifactorial. Having a history of blood or blood product transfusion before 1992, injection drug use, imprisonment, tattooing, having more than one sexual partner, piercing, and having only secondary education were associated with increased odds of hepatitis C.
We review evidence for effectiveness, cost-effectiveness, and coverage of antiretroviral therapy (ART) for injecting drug users (IDUs) infected with HIV, with particular attention to low-income and middle-income countries. In these countries, nearly half (47%) of all IDUs infected with HIV are in five nations--China, Vietnam, Russia, Ukraine, and Malaysia. In all five countries, IDU access to ART is disproportionately low, and systemic and structural obstacles restrict treatment access. IDUs are 67% of cumulative HIV cases in these countries, but only 25% of those receiving ART. Integration of ART with opioid substitution and tuberculosis treatment, increased peer engagement in treatment delivery, and reform of harmful policies--including police use of drug-user registries, detention of drug users in centres offering no evidence-based treatment, and imprisonment for possession of drugs for personal use--are needed to improve ART coverage of IDUs.