Objective

To examine HIV risk behavior and HIV infection among new injectors in Tallinn, Estonia.

Design and methods

Data from two cross-sectional surveys of injecting drug users (IDUs) recruited from a syringe exchange program (N = 162, Study 1) or using respondent driven sampling (N = 350, Study 2). Behavioral surveys were administered; serum samples were collected for HIV testing. Subjects were categorized into new injectors (injecting ≤ 3 years) and long-term injectors (injecting > 3 years).

Results

Twenty-eight of 161 (17%, Study 1) and 73/350 (21%, Study 2) of the study subjects were new injectors. HIV infection was substantial among the newer injectors: HIV prevalence was 50% (Study 1) and 34% (Study 2), and estimated HIV incidence 31/100 PY and 21/100 PY, respectively. In Study 2, new injectors were more likely to be female and ethnic Estonian and less likely to be injecting daily compared with long-term injectors. No significant difference was found among two groups on sharing injecting equipment or reported number of sexual partners.

Conclusions

A continuing HIV epidemic among new injectors is of critical public health concern. Interventions to prevent initiation into injecting drug use and scaling up HIV prevention programs for IDUs in Estonia are of utmost importance.

Objective

We examined patterns in medications use for secondary prevention of cerebrovascular disease in older British men from 1999-2005, and investigated socio-demographic and disease-related influences on medication use.

Methods

Prevalences of antiplatelet drugs, blood pressure lowering drugs and statins use were examined in men, aged 65-87years in 2005, with a doctor diagnosis of stroke or transient ischaemic attack (TIA) from a population-based cohort based in one general practice in each of 24 British towns.

Results

In 1999, most men with cerebrovascular disease received antiplatelet drugs (67%). However, few received blood pressure lowering drugs (50%) and statins (13%). By 2005 the use of all drug types had increased; each were now received by at least half of patients. However, only one-third of patients received all three medication types and combined blood pressure treatment was limited. Older age, a diagnosis of TIA rather than stroke, and absence of co-existing CHD were associated with lower rates of use of specific medication categories.

Conclusions

Despite improvements in secondary prevention medication use, there is scope for achieving the full potential of these medications, particularly by increasing combination blood pressure treatment and statin use, and ensuring that older patients receive the benefits of prevention.

Background

Deficiencies in implementation of secondary prevention of coronary heart disease (CHD) have been identified. We explored the extent of medication use for secondary prevention of CHD since the introduction of the National Service Framework (NSF) for CHD and the influence of patient age, social class, region and time since diagnosis in older British men.

Methods

Prospective study in 24 British towns using patient information on medication use in 1998-2000 and 2003. Subjects were men with medically recorded diagnosis of myocardial infarction or angina, aged 62-85 years in 2003. Prevalence of medication use (aspirin, statins, ACE inhibitors and beta-blockers) in 1998-2000 and 2003 was ascertained.

Results

Prevalence of use of all drugs increased in 2003 and was markedly higher in patients with a history of myocardial infarction than angina. Older age was related to lower prevalence of drug use, particularly statins. In 2000, older subjects (74-85 years) were 60% (95% CI 41%, 72%) less likely to receive statins compared with younger subjects (62-73 years); this pattern changed very little between 2000 and 2003. Although social class appeared to have little relation to drug use, the prevalence of use of all medications decreased with increasing time since diagnosis.

Conclusions

Although the uptake of medications for secondary prevention in CHD patients increased since the NSF in 2000, marked age inequalities in statin use were present both in 1998-2000 and 2003. Further action is needed to reduce these inequalities, since older patients are at particularly high risk of recurrent and fatal CHD.