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  1. Michalopoulos LM, Jiwatram-Negrón T, Choo MK, Kamarulzaman A, El-Bassel N
    BMC Public Health, 2016 06 02;16:464.
    PMID: 27250497 DOI: 10.1186/s12889-016-3125-7
    BACKGROUND: Malaysian fishermen have been identified as a key-affected HIV population with HIV rates 10 times higher than national rates. A number of studies have identified that psychosocial and structural-level stressors increase HIV injection drug risk behaviors. The purpose of this paper is to examine psychosocial and structural-level stressors of injection drug use and HIV injection drug risk behaviors among Malaysian fishermen.

    METHODS: The study employs a cross-sectional design using respondent driven sampling methods. The sample includes 406 fishermen from Pahang state, Malaysia. Using multivariate logistic regressions, we examined the relationship between individual (depression), social (adverse interactions with the police), and structural (poverty-related) stressors and injection drug use and risky injection drug use (e.g.., receptive and non-receptive needle sharing, frontloading and back-loading, or sharing drugs from a common container).

    RESULTS: Participants below the poverty line had significantly lower odds of injection drug use (OR 0.52, 95 % CI: 0.27-0.99, p = 0.047) and risky injection drug use behavior (OR 0.48, 95 % CI: 0.25-0.93, p = 0.030). In addition, participants with an arrest history had higher odds of injection use (OR 19.58, 95 % CI: 9.81-39.10, p 

    Matched MeSH terms: Substance Abuse, Intravenous/psychology
  2. Chou CC, Chronister J, Chou CH, Tan S, Macewicz T
    AIDS Care, 2013;25(12):1551-8.
    PMID: 23713718 DOI: 10.1080/09540121.2013.793267
    This study explored responsibility attribution (RA) of HIV/AIDS infection (i.e., how an individual perceives the cause of their HIV/AIDS infection) and its relationship to coping styles among injection drug users (IDUs) with HIV/AIDS. In addition, this study investigated whether self-esteem, social support, and religiosity mediate the relationship between RA and coping styles of IDUs with HIV/AIDS. Participants were 201 adult IDUs with HIV/AIDS participating in the National Drug Rehabilitation Center in Malaysia. Five measures were used to assess the above constructs. Cluster analysis, analysis of variance, and mediation analyses were conducted. Results of this study indicated that IDUs with HIV/AIDS in Malaysia can be classified into four homogenous attribution groups: external, fatalistic, internal, and indeterminate. Mediator analyses revealed that combination of self-esteem, social support, and religiosity mediate the relationship between RA and coping behaviors. Clinicians working with IDUs with HIV/AIDS need to address the role of RA, self-esteem, religiosity, and social support as these psychosocial constructs are linked to coping with HIV/AIDS. Future researchers should investigate whether enhancing self-esteem, social support, and religiosity can promote active problem-solving coping and reduce the use of avoidance coping behaviors.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology*
  3. Nasarruddin AM, Saifi RA, Othman S, Kamarulzaman A
    AIDS Care, 2017 May;29(5):533-540.
    PMID: 27530678 DOI: 10.1080/09540121.2016.1220485
    HIV status disclosure plays a crucial role in reducing risk behaviors of drug and sexual partners and thereby limiting HIV transmission. As people who inject drugs (PWID) bear a significant HIV burden and disclosure research among PWID is relatively few, we reviewed the literature to highlight what is known about disclosure among HIV-positive PWID. Searches of articles published from 2000 to 2015 yielded 17 studies addressing different aspects of disclosure, and results are presented by major themes. Our results suggest that despite the difficulties, most PWID (64-86%) disclose their HIV-positive status to trusted individuals (family members and intimate sexual partners) and to those who are known to be HIV-positive. Disclosure to non-intimate sexual partners and fellow drug users is relatively lower. Disclosure decision-making is primarily driven by the perceived positive and negative consequences of disclosure. Subsequent risk reduction practices following disclosure are influenced by the feeling of responsibility, as well as partners' willingness to accept risk. Cultural family values, ethnicity, and different localities were several contextual factors that affect patterns of disclosure and risk behaviors of PWID. Areas for future research are recommended.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology*
  4. Culbert GJ, Waluyo A, Iriyanti M, Muchransyah AP, Kamarulzaman A, Altice FL
    Drug Alcohol Depend, 2015 Apr 01;149:71-9.
    PMID: 25659895 DOI: 10.1016/j.drugalcdep.2015.01.018
    BACKGROUND: In Indonesia, incarceration of people who inject drugs (PWID) and access to drugs in prison potentiate within-prison drug injection (WP-DI), a preventable and extremely high-risk behavior that may contribute substantially to HIV transmission in prison and communities to which prisoners are released.

    AIMS: This mixed method study examined the prevalence, correlates, and social context of WP-DI among HIV-infected male prisoners in Indonesia.

    METHODS: 102 randomly selected HIV-infected male prisoners completed semi-structured voice-recorded interviews about drug use changes after arrest, drug use cues within prison, and impact of WP-DI on HIV and addiction treatment. Logistic regression identified multivariate correlates of WP-DI and thematic analysis of interview transcripts used grounded-theory.

    RESULTS: Over half (56%) of participants reported previous WP-DI. Of those, 93% shared injection equipment in prison, and 78.6% estimated sharing needles with ≥ 10 other prisoners. Multivariate analyses independently correlated WP-DI with being incarcerated for drug offenses (AOR = 3.29, 95%CI = 1.30-8.31, p = 0.011) and daily drug injection before arrest (AOR = 5.23, 95%CI = 1.42-19.25, p = 0.013). Drug availability and proximity to drug users while incarcerated were associated with frequent drug craving and escalating drug use risk behaviors after arrest. Energetic heroin marketing and stigmatizing attitudes toward methadone contribute to WP-DI and impede addiction and HIV treatment.

    CONCLUSIONS: Frequent WP-DI and needle sharing among these HIV-infected Indonesian prison inmates indicate the need for structural interventions that reduce overcrowding, drug supply, and needle sharing, and improve detection and treatment of substance use disorders upon incarceration to minimize WP-DI and associated harm.

    Matched MeSH terms: Substance Abuse, Intravenous/psychology*
  5. Polonsky M, Rozanova J, Azbel L, Bachireddy C, Izenberg J, Kiriazova T, et al.
    AIDS Behav, 2016 12;20(12):2950-2960.
    PMID: 27011378
    In this study, we use data from a survey conducted in Ukraine among 196 HIV-infected people who inject drugs, to explore attitudes toward drug addiction and methadone maintenance therapy (MMT), and intentions to change drug use during incarceration and after release from prison. Two groups were recruited: Group 1 (n = 99) was currently incarcerated and Group 2 (n = 97) had been recently released from prison. This paper's key finding is that MMT treatment and addiction recovery were predominantly viewed as mutually exclusive processes. Group comparisons showed that participants in Group 1 (pre-release) exhibited higher optimism about changing their drug use, were less likely to endorse methadone, and reported higher intention to recover from their addiction. Group 2 participants (post-release), however, reported higher rates of HIV stigma. Structural equation modeling revealed that in both groups, optimism about recovery and awareness of addiction mediated the effect of drug addiction severity on intentions to recover from their addiction.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology*
  6. Amadora-Nolasco F, Alburo RE, Aguilar EJ, Trevathan WR
    Drug Alcohol Rev, 2002 Jun;21(2):137-43.
    PMID: 12188992
    Injecting drug users (IDU) represent a small fraction of the HIV and AIDS cases in the Philippines. To determine if these people are engaging in behaviors that put them at risk for HIV, interviews were conducted with 360 male IDUs in Cebu City, Philippines, from 1997 to 1999, as part of a national surveillance system. The interviews assessed knowledge about HIV transmission, sources of information about HIV/AIDS, perceived risks of contracting HIV, needle-sharing practices, condom use, self-reported signs and symptoms of STDs and number of sex partners. Although most of the men were able to recognize behaviors accurately that put them at risk for HIV, more than two-thirds claimed that they shared needles and almost two-thirds of those who were sexually active claimed that they never used condoms. Intervention strategies must be developed for this population if the nation is to avoid the dramatic increase in HIV infection among IDUs that has been witnessed in neighboring Southeast Asian nations such as Malaysia and Vietnam.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology
  7. Wai BH, Singh S, Varma SL
    Addiction, 1996 Mar;91(3):435-8.
    PMID: 8867206
    One hundred and seventy-one drug-dependent females in a drug rehabilitation centre were studied to estimate the prevalence of HIV infection among them. Twenty-four (14%) were positive on the Western Blot test. The presence of HIV infection was significantly correlated with syphilis (p < 0.03) and age (p < 0.001); 83% of those who were HIV positive were intravenous drug users. The need for harm reduction programmes to prevent spread of HIV infection among injecting drug users is stressed.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology
  8. Jin H, Earnshaw VA, Wickersham JA, Kamarulzaman A, Desai MM, John J, et al.
    AIDS Care, 2014;26(10):1223-8.
    PMID: 24625279 DOI: 10.1080/09540121.2014.894616
    Stigma perpetuated by health-care providers has been found to be a barrier to care for vulnerable populations, including HIV-infected, people who inject drugs (PWIDs), and men who have sex with men (MSM) in multiple clinical contexts and remains unexamined among professional health-care students in Malaysia. This cross-sectional, anonymous, and Internet-based survey assessed the attitudes of medical and dental students toward HIV-infected, PWID, and MSM patients. Survey invitation was emailed to 3191 students at 8 professional schools; 1296 (40.6%) responded and scored their attitudes toward these patient groups using a feeling thermometer, indicating their attitudes on a sliding scale from 0 (most negative) to 100 (most positive). Compared to general patients (mean = 76.50), the mean scores for HIV-infected (mean = 54.04; p < 0.001), PWID (mean = 37.50; p < 0.001), and MSM (mean = 32.13; p < 0.001) patients were significantly lower and significantly different between each group comparison. Within group differences, most notably religion, ethnicity, and personally knowing someone from these populations were associated with significant differences in attitudes. No differences were noted between pre-clinical and clinical year of training. Health-care students represent the next generation of clinicians who will be responsible for future HIV prevention and treatment efforts. Our findings suggest alarmingly negative attitudes toward these patients, especially MSM, necessitating prompt and effective interventions designed to ameliorate the negative attitudes of health-care students toward vulnerable populations, specifically HIV-infected, PWID, and MSM patients in Malaysia.
    Site site: online surveys at seven universities: University of Malaya, National University of Malaysia, International Islamic University Malaysia, Universiti Malaysia Sarawak, Penang International Dental College, Universiti Teknologi MARA Malaysia, and Universiti Sains Malaysia.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology*
  9. Bazazi AR, Vijay A, Crawford FW, Heimer R, Kamarulzaman A, Altice FL
    AIDS Care, 2018 Jan;30(1):59-64.
    PMID: 28803503 DOI: 10.1080/09540121.2017.1363852
    HIV testing services are the gateway into HIV treatment and are critical for monitoring the epidemic. HIV testing is recommended at least annually in high-risk populations, including people who inject drugs (PWID). In Malaysia, the HIV epidemic is concentrated among PWID, but their adherence to testing recommendations and the proportion of HIV-positive PWID who are aware of their status remain unknown. We recruited 460 PWID in Greater Kuala Lumpur using respondent-driven sampling and conducted HIV testing. We examined past testing behaviors, estimating testing frequency, correlates of testing in the past 12 months, and the proportion of those living with HIV who were aware of their status. Results showed that most PWID living with HIV (90.4%, 95% CI: 83.6%-95.9%) were aware of their status. Among those never previously diagnosed with HIV, few had accessed HIV testing in the past 12 months (14.3%, 95% CI: 11.1%-18.0%). Prison (57.0%) and compulsory drug detention centers (36.1%) were the primary locations where PWID reported ever being HIV tested, and the main correlate of recent testing in regression was recent criminal justice involvement. Although awareness of HIV status may be high among PWID living with HIV in Kuala Lumpur, testing occurs primarily in prisons and compulsory drug detention centers, where it is involuntary and linkage to care is limited. A shift in HIV testing policy is needed to align health and human rights objectives, replacing mandatory testing with voluntary testing in settings where individuals can be rapidly linked to HIV care.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology
  10. Iakunchykova O, Meteliuk A, Zelenev A, Mazhnaya A, Tracy M, Altice FL
    Int J Drug Policy, 2018 Jul;57:11-17.
    PMID: 29655101 DOI: 10.1016/j.drugpo.2018.03.022
    BACKGROUND: Among the estimated 340,000 people who inject drugs (PWID) in Ukraine, HCV prevalence is approximately 70%. As HCV treatment availability increases, an assessment of the HCV treatment cascade is needed to guide HCV prevention and treatment strategies.

    METHODS: Opioid dependent PWID were interviewed and tested for HIV and HCV in five Ukrainian cities from January 2014 to March 2015. Logistic regression was used to examine the independent correlates of two cascade steps: a) anti-HCV positive status awareness; b) chronic HCV confirmation; and of c) annual HCV testing for PWID.

    RESULTS: Among 1613 PWID, 1002 (62.1%) had anti-HCV positive test result, of which 568 (56.7%) were aware of it before the study and 346 (34.5%) reported previous confirmatory testing for chronic HCV. Independent correlates of being aware they had anti-HCV positivity included: current [AOR: 3.08; 95%CI: 2.16-4.40] or prior [AOR: 1.85; 95%CI: 1.27-2.68] opioid agonistic treatment (OAT) experience, relative to no prior OAT, living in Lviv [AOR: 0.50; 95%CI: 0.31-0.81] or Odesa [AOR: 2.73; 95%CI: 1.51-4.93] relative to Kyiv and being aware of having HIV [AOR: 4.10; 95%CI: 2.99-5.62]. Independent correlates of confirming HCV infection among those who were aware of their anti-HCV positive status included: current OAT [AOR: 2.00; 95%CI: 1.24-3.23], relative to prior OAT, the middle income category [AOR: 1.74, 95%CI: 1.15-2.63], relative to the lowest, and receiving ART [AOR: 4.54; 95%CI: 2.85-7.23]. Among 1613 PWID, 918 (56.9%) were either HCV negative or not aware of their HCV positive status, of which 198 (21.6%) reported recent anti-HCV test (during last 12 month). Recent anti-HCV test in this group was associated with current [AOR: 7.17; 95%CI: 4.63-11.13] or prior [AOR: 2.24; 95%CI: 1.32-3.81] OAT experience, relative to no prior OAT.

    CONCLUSION: Encouraging PWID to participate in OAT may be an effective strategy to diagnose and link PWID who are HCV positive to care. Among HIV negative participants, regular HCV testing may be ensured by participation in OAT. More studies are needed to assess HCV treatment utilization among PWID in Ukraine and OAT as a possible way to retain them in treatment.

    Matched MeSH terms: Substance Abuse, Intravenous/psychology*
  11. Vicknasingam B, Narayanan S, Navaratnam V
    AIDS Care, 2009 Aug;21(8):984-91.
    PMID: 20024754 DOI: 10.1080/09540120802657530
    Despite the growing HIV threat among injecting drug users (IDUs) in Malaysia, there is a dearth of information on their HIV risk behaviour. This study focused on identifying specific risk behaviours that distinguished HIV positive IDUs from those who were not. For the first time, data on IDUs not in treatment were obtained through a cross-sectional survey of 526 subjects recruited from five selected cities across peninsular Malaysia. A structured questionnaire and face-to-face interviews were utilised to collect detailed information on their drug use practices and sexual behaviours. On-site serological testing determined their HIV and hepatitis C status. The findings indicated that ethnic Malays, who are also Muslims, form the majority of IDUs not in treatment. Bivariate analysis identified six risk factors associated with HIV seropositivity: being 44 years or younger; not holding a regular job; initiating drug use at age 23 or younger; being a morphine user; sharing injecting equipment and having multiple-sex partners. However, only the last two remained significant in multivariate analysis. That sharing contaminated injecting equipment is a significant risk factor strongly justifies the widening of the pilot needle and syringe exchange programme initiated hesitantly in late 2005 as a reaction to the worsening HIV/AIDS situation. Condom use, though not independently significant, remains important because consistent and wider use could neutralise the second risk factor--having multiple-sex partners. The finding that injecting drug use is increasingly occurring in groups underscores the need for outreach programmes that emphasise safe injecting practices in group settings. In addition, counsellors should endeavour to convince drug users to enter treatment since being in treatment appears to reduce risk behaviours. Finally, conservative Muslim unease about harm reduction must be assuaged quickly since Malay Muslims form the majority of IDUs not in treatment.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology
  12. Loeliger KB, Marcus R, Wickersham JA, Pillai V, Kamarulzaman A, Altice FL
    Addict Behav, 2016 Feb;53:31-9.
    PMID: 26436520 DOI: 10.1016/j.addbeh.2015.09.013
    Substance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology
  13. Zelenev A, Long E, Bazazi AR, Kamarulzaman A, Altice FL
    Int J Drug Policy, 2016 11;37:98-106.
    PMID: 27639995 DOI: 10.1016/j.drugpo.2016.08.008
    BACKGROUND: HIV is primarily concentrated among people who inject drugs (PWID) in Malaysia, where currently HIV prevention and treatment coverage is inadequate. To improve the targeting of interventions, we examined HIV clustering and the role that social networks and geographical distance play in influencing HIV transmission among PWID.

    METHODS: Data were derived from a respondent-driven survey sample (RDS) collected during 2010 of 460 PWID in greater Kuala Lumpur. Analysis focused on socio-demographic, clinical, behavioural, and network information. Spatial probit models were developed based on a distinction between the influence of peers (individuals nominated through a recruitment network) and neighbours (residing a close distance to the individual). The models were expanded to account for the potential influence of the network formation.

    RESULTS: Recruitment patterns of HIV-infected PWID clustered both spatially and across the recruitment networks. In addition, HIV-infected PWID were more likely to have peers and neighbours who inject with clean needles were HIV-infected and lived nearby (<5km), more likely to have been previously incarcerated, less likely to use clean needles (26.8% vs 53.0% of the reported injections, p<0.01), and have fewer recent injection partners (2.4 vs 5.4, p<0.01). The association between the HIV status of peers and neighbours remained significantly correlated even after controlling for unobserved variation related to network formation and sero-sorting.

    CONCLUSION: The relationship between HIV status across networks and space in Kuala Lumpur underscores the importance of these factors for surveillance and prevention strategies, and this needs to be more closely integrated. RDS can be applied to identify injection network structures, and this provides an important mechanism for improving public health surveillance, accessing high-risk populations, and implementing risk-reduction interventions to slow HIV transmission.

    Matched MeSH terms: Substance Abuse, Intravenous/psychology
  14. Vijay A, Bazazi AR, Yee I, Kamarulzaman A, Altice FL
    J Subst Abuse Treat, 2015 Jul;54:29-36.
    PMID: 25841703 DOI: 10.1016/j.jsat.2015.01.014
    Little is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology*
  15. Kamarulzaman A, Altice FL
    Curr. Opin. Infect. Dis., 2015 Feb;28(1):10-6.
    PMID: 25490106 DOI: 10.1097/QCO.0000000000000125
    HIV management in people who use drugs (PWUD) is typically complex and challenging due to the presence of multiple medical and psychiatric comorbidities as well as social, physical, economic and legal factors that often disrupt the HIV continuum of care. In this review, we describe the individual, health systems and societal barriers to HIV treatment access and care retention for PWUD. In addition, the clinical management of HIV-infected PWUD is often complicated by the presence of multiple infectious and noninfectious comorbidities.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology
  16. Bachireddy C, Bazazi AR, Kavasery R, Govindasamy S, Kamarulzaman A, Altice FL
    Drug Alcohol Depend, 2011 Jul 1;116(1-3):151-7.
    PMID: 21232882 DOI: 10.1016/j.drugalcdep.2010.12.001
    Pre-incarceration HIV transmission behaviors and current attitudes toward opioid substitution therapy (OST) among HIV-infected male prisoners in Malaysia have important implications for secondary HIV prevention efforts.
    Matched MeSH terms: Substance Abuse, Intravenous/psychology
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