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Background: In Nepal, prevalence of Hepatitis C (HCV) among injecting drug users (IDUs) has been measured at 50% and knowledge of the virus is low. Rehabilitation and harm reduction attendees constitute populations to whom health care providers can deliver services. As such, characterizing their drug use and risk profiles is important for developing targeted service delivery. We measured drug use and risk patterns of IDUs participating in residential rehabilitation as well as those contacted through needle exchanges to identify correlates of drug use frequency, risky injection practices as well as HCV testing, knowledge and perceived risk., Methods: We collected cross-sectional data from one-on-one structured interviews of IDUs contacted through needle-exchange outreach workers (n=202) and those attending rehabilitation centres (behaviour immediately prior to joining rehabilitation) (n=167)., Results: Roughly half of participants reported injecting at least 30 times in the past 30 days and individuals with previous residential rehabilitation experience reported frequent injection far more than those without it. About one in fourteen respondents reported past week risky injection practices. Participants were over three times as likely to report risky injection if they consumed alcohol daily (17.2%) than if they did not (5.0%) (p=0.002). Those who reported injecting daily reported risky injection practices (11.9%) significantly more than non-daily injectors (1.8%) (p<0.001). Respondents reported high HCV infection rates, low perceived risk, testing history and knowledge. HCV knowledge was not associated with differences in risky injecting., Conclusion: Treatment centres should highlight the link between heavy drinking, frequent injection and risky injecting practices. The link between rehabilitation attendance and frequent injection may suggest IDUs with more severe use patterns are more likely to attend rehabilitation. Rehabilitation centres and needle exchanges should provide testing and education for HCV. Education alone may not be sufficient to initiate change since knowledge did not predict lower risk., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Human Immunodeficiency Virus (HIV) infection has been frequently associated with chronic inflammation as well as depression. C-reactive protein (CRP) is positively associated with depression in people without HIV infection. We tested the hypothesis of an independent relationship between CRP and depression in a cohort of HIV-positive people., Methods: A cross-sectional survey was conducted among 316 HIV-positive people (181 men and 135 women) aged 18-60years residing in the Kathmandu Valley, Nepal. The latex agglutination turbidimetric method was used to measure serum CRP concentrations and the Beck Depression Inventory (BDI)-I method was used to measure depression, with a cut off of ⩾20 indicating likely depression. The relationship between CRP concentrations and depression symptoms was assessed using both multiple linear regression analysis and multiple logistic regression analysis, with adjustment for potential socio-demographic, cardiovascular, life-style, and HIV-related clinical and treatment confounding factors., Results: Twenty-six percent participants (men: 23%; women: 29%) met criteria for depression. In multiple regression analysis, the authors observed a linear relation between serum CRP concentrations and BDI score (beta for 1 unit change in ln(CRP)=1.13, p=0.001) in HIV-positive participants. In a logistic regression analysis, participants with serum CRP levels>3mg/L had a 2.3-fold higher odds of depression symptoms compared to those with serum CRP level⩽3mg/L (p=0.005). In analyses stratified by sex, associations were stronger in men than in women. For example, CRP>3mg/L was associated with a 3.6-fold higher odds of depression in men (p=0.002), while in women the odds ratio was 1.7 (p=0.33)., Conclusion: We found a linear relationship between serum CRP concentrations and depression symptoms score in HIV-positive people, and evidence that risk of depression is elevated among HIV-positive men with a high level of inflammation (CRP>3mg/L). Further prospective study to confirm the role of inflammation in depression among HIV-positive people is warranted., (Copyright © 2014 Elsevier Inc. All rights reserved.)

In many resource-poor countries, home-based care for young children is crucial. Yet little has been known about the negative impacts of sibling caretaking on mental health conditions of adolescent student caretakers. This study explored associations between sibling caretaking, school performance, and depression among 1943 students randomly selected from 11 junior high and high schools in Cambodia. The Asian Adolescent Depression Scale was used to measure depressive symptoms. In bivariate analyses, we used χ(2) test or Fisher's exact test for categorical variables and t-test or one-way analysis of variance for continuous variables. Multiple linear regression models were then constructed. Of total, 60.1% of our participants took care of their younger sibling(s) regularly during the past one year. The number of siblings under their care ranged from one to nine, and the time they spent for sibling care ranged from one to 10h per day. After adjustment, increased levels of depressive symptoms remained significantly associated among boys with sibling caretaking (p<0.001), as well as poor school performance (p=0.001) and perceived likelihood of dropping out of school in the near future (p=0.002). Among girls, increased levels of depressive symptoms retained their significant association with sibling caretaking (p<0.001); also poor school performance (p<0.001). Sibling care responsibility might have negative impact on school performance and the mental health condition of adolescent caretakers., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: HIV prevalence is high and risky injection practices occur frequently among injecting drug users (IDUs) in Nepal. We explored the correlates of sharing injection equipment (having injected with a needle or syringe previously used by another) among male IDUs in Kathmandu, Nepal., Methods: From August to September 2007, we anonymously interviewed 296 male IDUs in Kathmandu, Nepal, using a structured questionnaire. We performed bivariate and multivariable logistic regression analysis and identified variables associated with sharing injection equipment., Results: Over half (n=152) of the participants reported injecting drugs with a needle or syringe previously used by another in the past year. Of these, 70% reported engaging in sharing injection equipment with multiple persons. The unavailability of new needles and drinking alcohol were independently associated with sharing injection equipment among the study participants., Conclusions: IDUs who drank alcohol or who could not obtain new needles when needed were more likely to share injection equipment. Our results suggest that reducing alcohol use and increasing the availability of new needles and syringes might improve safer injection practices among male IDUs in Kathmandu, Nepal., (Copyright © 2010 Elsevier B.V. All rights reserved.)

We assessed the impact of an HIV/AIDS programme for Nepalese migrants to India that involved writing letters. The programme created opportunities for sending HIV/AIDS-related messages to the migrants in India, and encouraging them practicing safer sex. Initially, they received the messages only from the programme, but later from their colleagues, spouses or other family members. They discussed the messages in groups, disseminated them, and sought more knowledge in their destinations. These findings indicated that using letters could be an effective way to reach inaccessible migrants at their destinations, and help them to improve their HIV/AIDS-related knowledge, and safer sex practices.