title: Lifetime ATS use and increased HIV risk among not-in-treatment opiate injectors in Malaysia.
abstract: BACKGROUND
  Malaysia has been experiencing significant drug abuse problems since the 1970s, and drug abuse is the major driver of HIV transmission in Malaysia. We investigated risk factors for HIV associated with use of amphetamine type stimulants (ATS) among not-in-treatment opiate injectors in Malaysia.
  
  
  METHODS
  Between October of 2006 and May of 2008, we conducted a series of surveys in three major urban areas of Malaysia. A total of 732 opiate IDUs (679 males and 53 females) were enrolled in the three surveys. The survey instruments consisted of a structured interview on demographic characteristics, drug use history (including year of first use, and past month history of use of illicit drugs; lifetime and past month history of IDU or needle or equipment sharing), and HIV status.
  
  
  RESULTS
  There were 194/704 (27.6%) HIV positive participants in the sample. Two factors were significantly associated with HIV infection in this sample: lifetime history of ATS use (OR [95%CI]: 2.3 [1.5-3.6]) and lifetime history of sharing of injection equipment (OR [95% CI]: 4.2 [1.8-9.8]). Both HIV-positive and HIV-negative participants reported high levels of current needle/equipment sharing practices: 82% vs. 75%, respectively.
  
  
  CONCLUSIONS
  ATS use spread rapidly in the study sample after 1997 and is associated with an increased risk of HIV infection in this population already at high risk because of opiate IDU. Out-of-treatment IDUs in Malaysia engage in high risk behaviors regardless of their HIV status. Increased education and public health prevention measures are needed to reduce HIV transmission risks in this population.
authors.affiliation: Yale University School of Medicine, New Haven, CT 06519, USA. marek.chawarski@yale.edu
authors.forename: Marek C
authors.initials: MC
authors.lastname: Chawarski
authors.forename: Balasingam
authors.initials: B
authors.lastname: Vicknasingam
authors.forename: Mahmud
authors.initials: M
authors.lastname: Mazlan
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schottenfeld
mesh_terms: D000328:Adult; D000662:Amphetamines / Q000008:administration & dosage; D000697:Central Nervous System Stimulants / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D013287:Illicit Drugs; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D012306:Risk; D012307:Risk Factors; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology* / Q000821:virology
chemical_list: D000662:Amphetamines; D000697:Central Nervous System Stimulants; D013287:Illicit Drugs