Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Track D: Social Science: Research, Policy & Action
Mo.D. 1943
REDUCTION OF HIV DRUG-RELATED BEHAVIORS USING A CASE MANAGEMENT
APPROACH: RANDOMIZED, CONTROLLED STUDY
Mejta., Cheryl L. Center For Special Immunology, Chicago
Objective: To determine if a case management approach is effective in reducng drug use
and drug injection behaviors.
Methods: 316 subjects using multiple agents in addition to all being intt avenouv drug users
(IDUs) were prospectively enrolled after repeatedly failing prior rehiabilitation attempts (2
to 5 prior attempts). Most used drugs for > 10 years. Follow up was for three y'ears.The
subjects were selected from IDUs seeking treatment through a central iiltake fac ilityThe following variables were mnonitored on a quarterly basis: treatment status, current drug use,
drug-injection behaviors, and drug-related problems. Standard research instruments were
used including: HIV High Risk Behavior Questionnaire and the Addition Severity Ilndex.
Results: Of the 316, 92% belonged to recognized minority groups; 69% were male;: 79%
were not married; and 57% were unemployed. I160 subjects were randomly assigned to a
case manager whose task was to identify service needs, to link subjects to ppropriate service providers, and to monitor progress in resolution of drug-related behaviors. 156 were
assigned to a control group who were advised to seek treatment on their own in established drug rehabilitation centers. At I 8 month follow up, 27% of the case managed subjects
versus 56% of the control subjects continued to inject drugs (p<.0 I). Case-managed subjects also showed greater reduction in heroin use (F=35.76, p<.0I) and cocaine use
(F= 17. I 3, p<.0 I).
Conclusion: Case management was found to be an effective approach in improving treatment outcomes and in reducing HIV risk behaviors among intravenous drug users.
C-Mejta, 2835 N. Sheffield # 1 04, Chicago, IL 60657, USA Telephone: [phone]
Fax: [phone]
Mo.D. 1944
INCLUSIVE HARM REDUCTION IN THE USA:THEORETICAL OVERVIEW AND
PRACTICAL APPLICATION
Kershnar Sara, Edney Heather. Harm Reduction Coalition, Oakland, CA, USA Santa Cruz
Needle Exchange Project, Santa Cruz, CA, USA
Issues: The presentation will provide a socio-economic, political and cultural overview and
examples of, strategies towards, and tools for the practice of inclusive harm reduction in
the United States. Harm reduction is a set of strategies and tools that reduces the drugrelated harm experienced by individuals and communities. Drug-related harm includes HIV
and other infectious diseases, violence, community disintegration, and death. In the United
States, drug use and harm reduction must be examined within the context of several levels
of violence: direct, structural and cultural. Direct violence is the experience of violent
actions and consequences; structural violence is defined by the institutions and norms that
reinforce damaging conditions and violence surrounding drug use and HIV, and cultural violence is the process by which violence against drug users and others at risk for HIV
becomes invisible anrd/or acceptable. In the United States, harm reduction is practiced nriot
only as a public health strategy but as a political struggle for social justice.
Project: The experiences, services, and advocacy provided by the Harm Reduction Coalition
and Santa Cruz Needle Exchange Project involve the use of harm reduction as both an
intervention and prevention strategy implementing harm reduction into existing program;
creating participant owned harm reduction programs, user self-organization, international
and national harm reduction networking and community organizing.
Results: Increased participant access of services and ownership of projects; decrease in participant shame, harm and alienation; increase in effectiveness of services provided; decrease
in service provider burn-out; the development of support networks for se vice providers,
and the development of a national harm reduction movement
Lessons: Active drug users can and do change their practices, the role of service providers is
evolving from provider to facilitator, and the relationship between service provider s and program
participants is moving from a one-way communication and exchange to a mutual exchange.
Sara Kershnar, phone: [phone]/fax: [phone] Berkeley, CA 91703, USA
Mo.D. 1945
HEALTH GROUPS IN DIFFERENT DRUG TREATMENT MODALITIES: FACTORS
AFFECTING ATTENDANCE
Nessel, Jerry T. Addiction Research & Treatment Corp., New York, Ul.S.A. American Institute
of Life-Threatening Illness & Loss, New York, U.S.A. Mercy College, New York, U.S.A.
Objective: To analyze factors affecting Health Group attendance, by diu ns addicts, in different
treatment modalities.
Methods: I. Attendance was carefully monitored, over the last 7 yeas, at 8 dray, treatment
Health Groups, 6 of which are still functioning.The 8 Health Groups rie: 2 in a residential
drug-free program that also has some short-term methadone treatment, 3 in methadone
maintenance programs, I in an alcoholism treatment program for drug addicts, and 2 in
drug-free out-patient programs, that also have acupuncture services.
2. A number of factors that could be affecting attendance were considered.
Results: I. By the end of January 1996, in just the first 6 Health Groups menioni'd above,
there were documented:
29,188 individual participations
1,823 patients in attendance
946 Health Group meetings
2,1 I 2 hours of Health Groups
2. Some factors affecting attendance were: supplies such as coffee, donuts and meIls, content such as a large video selection and newspaper articles, carfare, travel distance, HIV status, gender: length of group and an active role in selecting the subje-t matte and order of
the group, by the patients, as well as the physical accommodations and the attitude of support of staff in informing patients or rewarding attendance.
Discussion & Conclusions: The large numbers in attendance, ir almost llI treatmen t modalities, shows the value of Health Groups, in a variety of situations.Three major actors in
attendance were: A large selectioi of activities (videos, topics, printed msater iaI), coffee and

donuts and an active, voluntary role of patients in the group.
JerryThomas Nessel, M.D., PO. Box 266,Triborough Station, New York, New York, 10035
U.S.A. Tel: (2 I12)568-7472 Fax: (2 I12)864-0267

Mo.D.1943 - Mo.D.1949
Mo.D. 1946
INCLUSIVE HARM REDUCTION IN THE USA:THEORETICAL OVERVIEW & PRACTICAL APPLICATION
Edney Heather,* Kershnar, Sara.* */* Santa Cruz Needle Exchange Project, Santa Cruz, CA
S*USA Harm Reduction Coalition, Oakland, CA, USA
Issues: The presentation will provide a socio-economic, political and cultural overview and
examples of, strategies towards, and tools for the practice of inclusive harm reduction in
the United States. Harm reduction is a set of strategies and tools that reduces the drugrelated harm experienced by individuals and communities. Drug-related harm includes HIV
and other infectious diseases, violence, community disintegration, and death. In the United
States, drug use and harm reduction must be examined within the context of several levels
of violence: direct, structural and cultural. Direct violence is the experience of violent
actions and consequences; structural violence is defined by the institutions and norms that
reinforce damaging conditions and violence surrounding drug use and HIV, and cultural violinice is the process by which violence against drug users and others at risk for HIV
becomes invisible and/or acceptable. In the United States, harm reduction is practiced not
only as a public health strategy but as a political struggle for social justice.
Project: The e~.eriences, services, and advocacy provided by the Harm Reduction Coalition
and Santa Cruz f'jeedle Exchange Project involve the use of harm reduction as both an
intervention inrd i)'evention strategy implementing harm reduction into existing program;
creating participasnt-owned harmn reduction programs, user self-organization, international
and national harmn reduction networking and community organizing.
Results: Increased participant access of services and ownership of projects; decrease in participant shame, harm and alienation; increase in effectiveness of services provided; decrease
in service provider burn out; the development of support networks for service providers,
and the development of a national harm reduction movement
Lessons: Active drug users can and do change their practices, the role of service providers
is evolving forom pr ovider to facilitator, and the relationship between service providers and
program participants is moving firom a one-way communication and exchange to a mutual
exchange.
I leather Edney, 138 Younger Way Santa Cruz, CA, 95060, USA. phone: [phone]
fax: [phone]
Mo.D. 1947
PRESENCE OR ANTI-HIV ANTIBODIES IN USED SYRINGES LEFT OUT IN PUBLIC
PLACES, BEACHES OR COLLECTED THROUGH EXCHANGE PROGRAMMES.
Chamaret S. Squinazi F. Courtois Y Montagnier L.Laboratoire de Reference sur la Virologie
du SIDA. Institut Pasteur Paris ** Laboratoire d'Hygiene de laVille de Paris
Objective: To determine the prevalence of collected in situ used syringes left in public
piaces, beaches or exchanged by drug users in 1995.
Methods: All these collected syringes were shipped in containers to our Center at the
Pasteur institute for detection of HIV-specific antibodies.The I 13 syringes picked up in public places and the 20 ones collected from beaches were very often covered with sand and
dirt.The 54 syringes obtained from needle exchange programmes were in good condition,
the needles being protected. Each syringe was rinsed with 100 microlitres of PBS buffer
containing 0. i of SDS (Sodium Dodecyl Sulfate). This buffer was used to lyse the coagulated blood remaininmg in the syringe and/or the needle and to solubilise proteins present
inside the syringes. Antibodies to HIV I were sought in rinsing solution by Western Blot
(New Lay Blo I, Diagnostics Pasteur).The final dilution was 1/100. Some samples were also
analysed by Western Blot from another company containing a human IgG control on the
strip (Bioptim, Diagnostics Biotechnology).The seropositivity was established by the presence of antibodies against products of env gene (gp I 60, gp I 20) and reactivity at least with
one g y gene product (WHO Criteria).
Results: According to these criteria, 6 (I 2%) samples were positive for the syringes collected in public plances, 2 (10%) for the syringes collected in beaches and 27 (54%) for the
exchanged syringes.
Lessons learned: The low proportion of HIV positive syringes collected in public places and
their poor condition would suggest that risk of infection following accidental injury with this
material is low. The seropositivity of exchanged syringes corresponds to current estimates
of HIV prevalence in french IV drug users.
S. (lf aret, Institut Pasteur 28 rue du Dr Roux, 75015 Paris, France Tel: [phone]
Fax: 0 45 e8 89 16
Mo.D. 1949
INTERVENTION AMONG MULTI RACIAL INJECTING DRUG USERS FROM
DIFFERENT CULTURAL AND ECONOMICAL BACKGROUND.
Nar ara _Pal-npan. Project Manage: IKHLAS Centre.
Objective: to roinote hsarm reduction methods and safe behavior among IVDUs from a
nulti culural back ound through care, support and empowerment.
Method: IKHLAS is a drop in centre providing basic necessities and needs (medical treatmennt, ood, showe facilities) of clients while imparting knowledge and materials for safe
iniectin in a non judgmental, trusting & friendly manner while taking into account the cultural driffer eni i ind the need to build their self esteem. Providing care and support for
HIV+ cient. Working with families and making referrals to health and service organizations.
To empower users by creating a "home-like" safe space where their voices are heard and
they are treated with respect and importance.Workers taking the roles of fi-lends and coniantes rather then service providers. Street outreach to hard to reach clients for HIV
awareness and arm reduction methods. Facilitating access to social systems which are usually dent ed i.e, medical treatment, occupation.
Results: By creating a promising/hopeful situation there is a clear evidence in behavioral
cIane. Dr users: i) are successfully stabilized in their consumption, ii) have switched fre
i Iectin' to smoking dnugs, iii) are prepared to go through rehabilitation.
Conclusion Prevention among IDUs must be non judgnental, client centered, sensitive to
basic needs, am to build relationships which are empowering and increase self esteem.

Narsnrana ir ppan, IKHLAS Center PO.Box I1I 859, 50760 Kuala Lumpur: Malaysia.
Te!: 603.44 41699 -ix: 603.44 15699

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