Crossroads Centre in Antigua, a centre for the treatment of drug and alcohol dependency: the first 100 clients

OBJECTIVE: To describe the demographics, medical histories, drug use patterns, and medical findings in the first 100 clients at a unique, multicultural, not for profit drug and alcohol treatment in Antigua. DESIGN and METHODS: A retrospective review of medical records including laboratory findings in 100 consecutive patients admitted to Crossroads Centre. RESULTS: The age of clients admitted ranged from 22 to 63 years, mean 39.5 years. There were 65 males, 35 female. The population was 19 percent of African descent; 25 percent from the Caribbean (19 Antigua, 2 Barbados, 1 Trinidad, 1 British Virgin Islands, 1 Aruba, 1 Guyana). Non-Caribbean clients were American (80 percent), British (12 percent), Canadian (7 percent), Turkish (1 percent). Polydrug use was seen in 47 percent, with alcohol being the primary drug of choice in 42 percent, heroin 29 percent, cocaine in 22 percent, `pills' in 7 percent, ganja 1 percent. Caribbean clients were less likely to use heroin or `pills'. Prior treatment was seen in 53 percent of clients. A psychiatric diagnosis was known or suspected in 45 percent of clients (depression 28 percent, anxiety 8 percent, ADD 3 percent, chronic pain 3 percent, anorexia, schizophrenia, dyslexia, 1 percent each). Medical conditions included hypertension (8 percent), diabetes (2 percent), ulcers (4 percent), seizures (5 percent). Anaemia was seen in 24 percent, elevated MCV in 52 percent, elevated transaminases in 37 percent, elevated amylase in 3 percent. Hepatitis B was positive in 6 percent (3 with Hep C), VDRL in 1 percent; one client was HIV positive. The 28-days programme was completed by 79 percent of the clients. CONCLUSIONS: Crossroads Centre in Antigua, a not-for-profit drug treatment centre provides care and treatment for Caribbean nationals and international clients suffering from addiction. (Au)

Alcohol, cannabis and cocaine usage in patients with trauma injuries

Sera from 111 patients with trauma injuries, who presented to the Accident and Emergency Unit (A&E), University Hospital of the West Indies, during a 3-month period, were screened for blood alcohol. Urine specimens were analysed for metabolites of cannabis and cocaine. Sixty-two percent (62 percent) of patients were positive for at least one substance and 20 percent for two or more. Positivity rates were as follows: cannabis (46 percent), alcohol (32 percent) with 71 percent of these having blood alcohol levels (BAC) greater than 80 mg per decilitre; cocaine (6 percent). Substance usage was most prevalent in the third decade of life. The patients who yielded a positive result were significantly younger than those who were negative. There was no significant difference in age or substance usage between the victims of interpersonal violence or road traffic accidents. In the group designated "other accidents", patients were significantly older and had a lower incidence of substance usage that the other two groups. Cannabis was the most prevalent substance in all groups. Fifty percent (50 percent) and fifty-five percent (55 percent) of victims of road accidents and interpersonal violence, respectively, were positive for cannabis compared with 43 percent and 27 percent for alcohol, respectively. There was no significant difference in Hospital Stay or Injury Severity Score between substance users and non-users.(AU)

Drug use, sexual behaviour and HIV risk of the homeless in Port-of-Spain, Trinidad

Data were collected from 88 homeless persons in Port-of-Spain, Trinidad to assess HIV risk. 68 percent of the sample were engaging in unprotected sex with multiple partners, 25 percent were exchanging sex for money, and 29.5 percent were regularly smoking crack cocaine. Many had two or more of these behaviours that put them at high risk of HIV infection. Females were significantly more likely to be sex traders, to engage in bisexual behaviour and to have a history of psychiatric illness. The relationship between psychiatric illness and HIV risk behaviours among homeless female persons is explored. Educational interventions are suggested to reduce the public health risks in this population.(AU)

Drug use and syphilis: co-factors for HIV transmission among commercial sex workers in Guyana

A cross-sectional survey was conducted among 124 street-and brothel-based female commercial sex workers (CSWs) in Georgetown in January and February 1997 to determine the seroprevalence of human immunodeficiency virus (HIV) infection and describe the sexual practices and drug use patterns. Their median age was 30 years (range 17 to 52 years). 119 (88 percent) reported regular alcohol consumption while looking for clients, 27 (22 percent) said they smoked cocaine and 51 (42 percent) reported use of marijuana. Street-based CSWs were significantly more likely to report marijuana use (p = 0.033). 72 percent reported that they never used condoms with regular sex partners and 35 percent reported that they never used condoms with clients. Brothel-based women were significantly more likely to report consistent condom use with their clients (p = 0.05). 46 percent (54/118) tested HIV positive and 28 percent (33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95 percent CI = 2.7-21.97; p < 0.01) and a history of having received treatment for syphilis (OR = 2.93; 95 percent CI = 1.12-7.8). Weak associations were also found between HIV infection and a history of cocaine use (OR = 2.57; 95 percent CI = 0.95-7.11; p = 0.039); having more than four clients per night (OR = 5.14; 95 percent CI = 1.65-16.74; p = 0.04; and a history of receiving treatment for salpingitis (OR = 2.31; 95 percent CI = 0.93-5.75; p = 0.0035). No statistically significant association was found between HIV infection and marijuana use nor any sociodemographic variables (age, place of work, and duration of sex work). There is an urgent need for a community based behavioural intervention programme targetting this high risk population (AU)

Use of illicit drugs among high-school students in Jamaica

Reported are the results of a survey to assess the prevalence of illicit drug use among high school students in Jamaica. A total of 2417 high-school students in 26 schools were covered: 1063 boys and 1354 girls of whom 1317 were grade-10 students (mean age 15.7 years) and 1100 were grade-11 students (mean age 16.8 years). Of the students, 1072 and 1354 were from rural and urban schools, respectively, while 1126 and 1291 were children of parents who were professionals and nonprofessionals, respectively. The following drugs were used by the students: marijuana (10.2 percent), cocaine (2.2 percent), heroin (1.5 percent) and opium (1.2 percent). Illicit drug use among males, urban students and children of professionals was higher than that among females, rural students and children of nonprofessionals, respectively.(Au)

Factors associated with violence against women who attend counselling centres in Kingston and St. Andrew, Jamaica

One of the problems of modern society is the extent to which violence has become a part of everyday life. Daily reports in the news media suggest that the problem is increasing and while previous research findings suggest a number of factors, which contribute to the problem, there is no indication that mitigation measures are actually helping. In fact reported incidents of violence continue to increase both in Jamaica and the world in general. Violence against women has also become a major problem all over the world. Reports indicate that incidents of violence against women range from 22 percent in some countries to a high of 59 percent in others, (Heise, 1994). Measures to address the problem in Jamaica has resulted in the establishment of a Crisis Centre, which seeks to help abused persons, primarily women. This study was carried out at the Crisis Centre and the Family Court located in Kingston in 1998. A total of 87 abused persons who sought help at these facilities within the study period were interviewed. The abuse took many forms and required various degrees of medical and emotional attention. Of weapons used the gun and stick featured prominently. Several reasons were given for the abuse experienced by respondents, however jealousy resulting in quarrels over a third party was the most common reason given for the onset of abuse (81 percent). When asked why they remained in the abusive situation respondents indicated children as the main cause 80.5 percent of the time. Medical attention was received from private medical practitioners 43 percent of the time, while 72.4 percent of respondents expressed a willingness to testify against their abusers in court. The use of alcohol, tobacco, marijuana and cocaine was prevalent, suggesting some link between substance abuse and the violence carried out against female partners. Most respondents indicated that friends and family members were the main sources of support. Very little practical assistance was obtained from the church, an institution of which almost all respondents were members. Respondents cited counselling as the main reason for attending counselling centres. In light of the findings recommendation could include mandatory counselling for males abuse who women and public education programmes to sensitize the society on the consequences of violence against women.(Au)