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The Injection of Amphetamine Type Stimulants and Associations With The global epidemiology of methamphetamine injection: A review of the evidence on use and associations with HIV and other harm Louisa Degenhardt, Bradley Mathers, Mauro Guarinieri, Samiran Panda, Benjamin Phillips, Steffanie Strathdee, Mark Tyndall, Lucas Wiessing, Alex Wodak on behalf of the Reference Group to the United Nations on HIV and injecting drug use National Drug and Alcohol Research Centre UNIVERSITY OF NEW SOUTH WALES Sydney, Australia ISBN 978 0 7334 2589 9 © NDARC 2007 This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. All other rights are reserved. Requests and enquiries concerning reproduction and rights should be addressed to the Information Manager, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. ii Acknowledgements This report is a product of, and was reviewed by, the Reference Group to the United Nations on HIV and injecting drug use. The Reference Group includes: • Tasnim Azim • Mauro Guarinieri • Matthew Hickman • Adeeba Kamarulzaman • Kasia Malinowska-Sempruch • Fabio Mesquita • Azarakhsh Mokri • Olanrewaju Olusola Onigbogi • Fred Owiti • Samiran Panda • Steffanie A Strathdee • Fayzal Sulliman • Abdalla Toufik • Jallal Toufiq • Mark Tyndall • Lucas Wiessing (See http://www.idurefgroup.unsw.edu.au//idurgweb.nsf/page/Reference%20Group) This report was also reviewed by the Secretariat to the Reference Group: The Secretariat includes: • Louisa Degenhardt • Kate Dolan • Bradley Mathers • Richard Mattick • Benjamin Phillips • Alex Wodak (See http://www.idurefgroup.unsw.edu.au//IDURGWeb.nsf/page/Secretariat) iii iv Thanks to those who assisted with the compilation of the literature: • Gabrielle Campbell, NDARC, University of NSW • Eva Congreve, NDARC, University of NSW • Laura Kemmis, NDARC, University of NSW • Benjamin Phillips, NDARC, University of NSW • Steven Riddell, NDARC, University of NSW • Amanda Roxburgh, NDARC, University of NSW • Natasha Sindicich, NDARC, University of NSW Thanks to those who assisted with compilation of data, or who commented on the report: • Nicolas Clark, WHO, Geneva, Switzerland • Jeremy Douglas, UNODC Regional Centre for East Asia and the Pacific, Bangkok, Thailand • Matthew Dunn, NDARC, University of NSW, Sydney, Australia • Danica Klempova, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal • Jane Maxwell, Addiction Research Institute, The University of Texas at Austin, Austin, United States • Rebecca McKetin, NDARC, University of NSW, Sydney, Australia • Vladimir Poznyak, WHO, Geneva, Switzerland • Amanda Roxburgh, NDARC, University of NSW, Sydney, Australia • James Shearer, NDARC, University of NSW, Sydney, Australia • Jessica Singleton, NDARC, University of NSW, Sydney, Australia • Annette Verster, WHO, Geneva, Switzerland • Paul Williams, UNODC, Vienna, Austria v vi Table of contents Acknowledgements ...............................................................................................................iii List of Tables ......................................................................................................................... xi Foreword............................................................................................................................. xiii Abbreviations ..................................................................................................................... xvii Executive summary ............................................................................................................. xix Epidemiology of use and associations with HIV............................................................... xix Other harms associated with meth/amphetamine use ....................................................... xx The importance of form and route of administration........................................................ xxi Possible responses.......................................................................................................... xxii Supply reduction......................................................................................................... xxii Precursor control ..................................................................................................... xxii Laws related to drug possession or supply ............................................................... xxii Demand reduction ...................................................................................................... xxii Treatment of meth/amphetamine dependence ......................................................... xxii Community education ............................................................................................ xxiii Harm reduction.......................................................................................................... xxiii Injecting related harm reduction............................................................................. xxiii Sexual risk reduction .............................................................................................. xxiv Interventions to address HIV among meth/amphetamine IDU .................................... xxiv HIV treatment.......................................................................................................... xxv Future research.............................................................................................................. xxvi Conclusions ................................................................................................................. xxvii 1. Introduction ....................................................................................................................1 1.1. What are amphetamine type stimulants?.................................................................1 1.2. Routes of administration .........................................................................................3 1.3. Meth/amphetamine dependence.............................................................................4 1.3.1. Risk factors .....................................................................................................5 2. Harms associated with meth/amphetamine injection and use..........................................7 2.1. Association with HIV..............................................................................................7 2.2. Injection risk behaviours.........................................................................................8 2.3. Sexual risk behaviours ..........................................................................................10 2.3.1. Characteristics of meth/amphetamine users...................................................11 2.3.2. Direct effects of meth/amphetamine..............................................................13 2.3.3. HIV risk perception.......................................................................................13 2.4. Meth/amphetamine use among HIV positive persons............................................15 2.4.1. Reasons for meth/amphetamine use..............................................................15 2.4.2. Impact upon viral replication........................................................................16 2.4.3. Synergy of neurotoxic effects ........................................................................16 2.4.4. Interactions with HIV treatment ....................................................................17 2.4.4.1. Meth/amphetamine’s effects......................................................................17 2.4.4.2. Impact upon treatment adherence.............................................................17 2.5. Viral hepatitis .......................................................................................................18 2.6. Other injection-related injuries and diseases.........................................................19 2.7. Acute negative side effects of meth/amphetamine use...........................................19 2.8. Mental health problems........................................................................................19 2.8.1. Psychosis ......................................................................................................19 2.8.2. Other mental health problems ......................................................................20 2.9. Mortality...............................................................................................................21 vii viii 3. Global meth/amphetamine markets...............................................................................23 3.1. Production areas...................................................................................................23 3.2. Types produced....................................................................................................24 3.3. Use.......................................................................................................................24 4. The epidemiology of meth/amphetamine use, injection, and association with HIV........27 4.1. Eastern Europe and Central Asia ...........................................................................28 4.2. East and South-East Asia .......................................................................................32 4.3. South Asia ............................................................................................................36
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