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

Tu.C.2498 -Tu.C.2503

Tuesday July 9, 1996

healthy looking person could be infected by HIV" (90% B vs. 76% W). Despite those findings, risky behaviors remained very high.The data suggested a decrease in sexual risk behavior (unprotected sexual activity with an occasional partner - 5 1% B vs. 63% W) but an
increase in sharing works in the last 6 months (58% B vs 30% W) - 62% of the sample
who shared works in B explained the sharing as due to the lack of sterile syringes available
in the moment and place of the drug use. Seroprevalence for HIV remained high - 29% B
vs. 33% W.
Conclusions: In a mutable drug scene, risky behaviors remained high, principally concerning
the sharing of works. Political and legal resistences must be urgently overcome and more
aggressive harm reduction strategies to IDUs should be implemented (like needle exchange
programs), besides current focus on sexual risk behaviors.
Wulmar Bastos Junor, CREDEC - Estrada do Campinho 4700, C.Grande Rio de Janeiro,
Braz Tel: [phone] Fax: [phone] e-mail: ptellesuvhesa.ueq Jbr
Tu.C.2498
HIV- I INFECTION AND RISK FACTORS AMONG INJECTING DRUG USERS (IDU)
ATTENDING A NEEDLE EXCHANGE PROGRAM IN QUEBEC CITY.
Pouln, Celine*, Alary M**, Nol L*, Claessens C***, Lachance C*. *Centre de Sante
pubhlique de Quebec, Qc, Canada; **Groupe de recherche en epidemiologie, Universitd
Laval, Qc, Canada;***Laborastore de sante publique du Quebec, Sainte Anne de Bellevue,
Qc, Canada.
Objective: To assess the impact of the needle exchange program (NEP) of Quebec city on
HIV risk behaviours and to determine HIV prevalence and associated risk factors among
IDU attenders.
Methods: HIV prevalence and associated risk factors will be compared between IDU who
began to attend NEP recently ( < 2 months) and the others, at 3 time points (3 data collection cycles) over 2 years. For each collection, attenders who injected drugs during the
previous 6 months will be asked to arnswer a questionnaire on risk behaviors and to provide an oral fluid sample. An encrypted code based on sex, date of birth, first and last initials will be used to follow participants over two years.Two data collection cycles have now
been completed.
Results: For the second collection. 339 IDUs (247 men and 9I women) accepted to participate. Nearly 65% have been attending the NEP since at least 2 months.The HIV prevalence was II.8% (40/339); CI 95%: 8.6%-15.7%.The prevalence was significantly lower
among IDU who began to attend NEP recently than among the others: 4.2% vs 15.9%, p <
0.0 1.Through univariate analysis, HIV positive IDUs were older and they reported more
often previous emprisonment and a history of hepatitis. In addition, HIV infection was found
to be associated with duration of intravenous drug use, having shared needles with HIV
positive IDU, having sare sex partners and being involved in prostitution or having sexual
partners with these risk factors. Nine of I108 negative subjects seroconverted for an incidence rate of 6.3 per 100 person-years.
Conclusions: Most of these results are similar to those obtained in the first collection and
they are consistent with results previously reported about NEP attenders and non-attenders.The follow-up analyses will help to estimate the incidence rate among this population
and to assess the impact of NEP on HIV behaviours.
C. Poulin, Centre de recherche, Hipital St Sacrement, 1050, Chemin Ste-Foy Qudbec,
Queibec G IS 4L8 Canada.Telephone:[phone] I 8 Fax:(4 I 8) 682-7949
Tu.C.2499
QUALITATIVE ANALYSIS OF INJECTION DRUG USERS (IDUS) FOLLOWING AN
OUTBREAK OF HIV INFECTION IN VANCOUVER
Currie, S, Harvey E, Str athdee, SA, P atric k, D, Ofner: M, Archibald, C, OShaughnessy MV. BC
Centre for- Excellence in HIV/AIDS, BC Ministry of Health, Health Canada, and members of
"The Point" Project team.
Objective: To conduct a qualitatve assessment of risk factors for HIV infection among IDUs
following an outbreak in Vancouver, C anada.
Methods: Prior to launching a case control investigation a qualitative study was conducted.
Eligible cases (N-8) were IDU with a documented HIV seroconversion in '94 or'95 and a
maximum window period of 18 months: controls (N-8) had at least two documented HIV
-ve tests within this s ame period. Eligible IDUts believed to be representative of the souirce
population were identified through clinics, physicians, and street nurses and were verified
through the provincial HIV testing database by record linkage of non-nominal data. Data
were collected thro ugh in-depth interviews which were recorded, transcribed verbatim, and
analysed using Grounded Theory methods where dominant themes emerged.
Results: Three dominant themes emerged with significant sub-themes in each. Consistent
sentiment among pirticipants formed the themes of I. Addiction, 2. Social Determinants,
and 3. Prevention.Within each theme arising from the dialogue, there was an overwhelming
message that needles are readily available however, the need for an immediate fix is
described as more impor tant than the need to ensure cean needles are always used.This
message is contextuAlized in each of the three dominant themes through sub-themes such
as: abuse from the past as well as present, feelings of little control: poor housing, squalor:
ra cism, condom use and the sex trade, and injecting n c groups, few rehabiltation alternatives.
Conclusions: Needles and condoms alone are not sufficient prevention efforts to tackle the
social underpinnings of poverty and addiction. Rhodes model of risk perception is applied
to revisit how individual risk behaviour is approached. Conclusions are illustrated in a scale
where the themes of Addiction and Social Determinants weigh down one side, and
Prevention is on the other side.The scale is unbalanced. If Social Determinants were to be
integrated with Prevention and prevention efforts were to include issues of social concern
stated in the sub themes, the scale may begin to tip the other way so that the risk of HIV
may be at least as important to IDUs as is getting their next fix.
Sue Currie, 6 II - 108 I Burrard St.,Vancouve, B.C.,V6Z I Y6 Tel.: 604-63 I -5535 Fax: [phone]
Tu.C.250 I
INJECTING AND SHARING IV EQUIPMENT IN DIFFERENT CITIES:A POTENTIAL
RISK FOR HIV DISSEMINATION.
Lachance, Nathalie*, Lamothe F*, Bruneau J*, Franco E**,Vincelette J*, Soto J***. *CRC
Andre Viallet, H6pital Saint Luc, Universite de Montreal, **Department of Oncology, McGill

University ***Sante publique, Laval. Quebec, Canada.

Objectives: To report HIV seroprevalence, risk behaviours, and to correlate those with patterns of mobility among injection drug users (IDUs) from Montreal who reported having
shared drug equipment in another city
Methods: Recent injectors were recruited fiom 1988 to 1995 in the Saint Luc cohort in
Montr6al. Information on demographics, drug use, medical history sexual practices were
collected at entry and HIV status assessed at each visit. Participants were also asked to
report whether they have shared injection equipment outside Montreal since 1978 and to
list those cities. Differences between mobile and non-mobile IDUs were examined.
Results: Of 1598 participants at entry in the Saint-Luc cohort, 315 (19.7%) reported having
shared drug equipment in a city other than Montrdal.The three cities most visited by
mobile IDUs (MIDUs) were VancouverToronto and Quebec city. Differences were found
between french and english speaking MIDUs: french MIDUs tending to stay ore in
Quebec, while english MIDUs shared more in cities from other parts of Canada and USA
(p<0.000 I).
MIDUs were significantly older and have been using drugs longer began injection at a
younger age, are more often unemployed but reported higher revenues than other IDUs
(all p<0.02). MIDUs have been more often in prison (76.5% vs 65.4%) and have shared
more often in jail (I16.6% vs 8.8%); they report more sexual partners in the past 6 months
and had more sexually transmitted diseases (56.5% vs 47.5%) (all p< 0.0 1).They tend to
present higher risk injection profiles: they go more often in shooting galleries (21.9% vs
16.6%, p-=0.03), are less in treatment (44.1% vs 56%), share more (83.5% vs 73%) and share
more often with an occasional partner (60% vs 40%) or an HIV + person (I 5.6% vs 9.4%)
(all p<0.02). HIV seroprevalence at entry was not different among MIDUs and non MIDUs
(10.2% vs 10.8%). HIV seroincidence was similar in both groups. Hepatitis B markers were
higher in MIDUs (57% vs 47.7%, p<0.00 I).
Conclusion: An important number of IDUs in Montreal reported sharing in other cites, a
potential risk for dissemination of HIV and other blood borne pathogens. MIDUs tend to
report higher risk behaviours profiles, although HIV prevalence and incidence are not higher
in this group. Mobility seems to be influenced by cultural identity and language of origin.
Nathalie Lachance, Hopital Saint-Luc, 1058 Saint-Denis Montreal PQ. Canada H2X 3J4 Tel.
(5 14) 28 I -2 I 00, Fax (5 I 4) 28 1-2443, email: [email protected]
Tu.C.2502
RISK FACTORS FOR HIV SEROCONVERSION AMONG INJECTION DRUG USERS IN
THE SAINT-LUC COHORT, MONTREAL 1988-1995.
Lamothe, Francois *, Bruneau J*, Franco E**, Lachance N*', Desy M***,Vincelette J*, Soto
J****. *CRC Andre Viallet, Hopital Saint-Luc, Universite de Montreal, **Department of
Oncology McGill University ***Unite depidemiologie et de biostatistique. Institut ArmandFrappier, ****Santf publique, Laval. Quebec, Canada.
Objectives: To evaluate HIV seroconversion in a cohort of injection drug users (IDUs) and
to determine factors associated with seroconversion.
Methods: Recent injectors were recruited in a cohort directly from the street via a wordof-mouth system, and through treatment centers when admitted. Information on demographics, drug use, medical history, sexual practices were collected at entry and HIV status
assessed at each visit. Entry factors were correlated with HIV seroconversion, using unr variate and multivariate analysis, by a Cox proportional hazards model.
Results: Between September 1988 and January 1995, 974 seronegative subjects were
enrolled in the cohort. Mean follow up time was I15.4 months, 89 seroconverted for an
incidence rate of 5. I per 100 person-years (Confidence Intervals at 95% (C195%): 4. I-6.2).
Factors associated with subsequent seroconversion in the univari ate nalysis were being a
man, no fixed address, being out of treatment, number of sexual partners, previous emprinsonment, suicide attempt and having HIV+ acquaintances. Other associatedc factors were
related to drug use: cocaine as drug of choice, number of injections, number of sharing
partners, shooting galleries, sharing with an HIV+ person and needle exchange program
attendance. In the Cox proportional hazards model, six factors were independantly associated with seroconversion: cocaine as the drug of choice (Hazard Ratio (HR) 2.9 (C195%:
1.5-5.4)), sharing with an HIV+ person (HR 2.0 (C195%: I. I-3.7)), >30 injections in the last
month (HR 2.2 (C195%: 1.3-3.5)), being out of treatment (HR 1.7 (C95%. I -2.7))j, no fixed
address (HR 1.8 (C195%.1.0-3.2)) and needle exchange program attendance (HR 1.6
(0195%:1.0-2.6)).
Conclusion: Seroconversion has remained high and stable among IDUs in Montreal over
the past 7 years. Cocaine and injection behaviours are strongly associated with HIV sero
conversion, in spite of knowledge of risks and availability of sterile equipment.
Francois Lamothe, H6pital Saint-Luc, 1058 Saint-Denis Montreal (Que.) H2X 3J4 Telephone:
(514) 28 1-2100 Fax: [phone] email: [email protected]
Tu.C.2503
RISK FACTORS FOR NEEDLE SHARING IN WOMEN WHO INJECT DRUGS
Leonard Lynne E,* Baskerville B,** Hotz S.* *University of Ottawa, Ottawa. ON Canada;
**Ottawa Civic Hospital. Ottawa, ON Canada.
Objectives: To determine the factors associated with needle sharing and to report on other
HIV risk related behaviours of women who inject drugs.
Methods: Women injection drug users (IDUs), (N-78), were interviewed on demographic
and HIV risk related injection and sexual behaviour variables. Anonymous saliva or blood
spot samples were obtained to determine HIV prevalence. SPSS CHAID (Chi-Squared
Automatic Interaction Detection Algorithm) was used to iteratively segment the data into
mutually exclusive subgroups of women IDUs for variables predicting needle sharing.
Results: Fifty seven per cent of the women were aged 25 or over were single and were living with a sex partner; 73. 1% were on welfare and 97.4% reported incomes below
$20,000; 65.4% had been in jail. HIV risk- related sexual practices: 56.0% reported never
using condoms with their regular opposite sex partner, 8 1.0% reported that these partners
injected drugs; 22.2% reported never using condoms with casual partners, 33.3% reported
injection drug use in these partners: 35.4% rated their sex practices as "completely safe" for
avoiding transmission of, or becoming infected with, HIV HIV risk-related inection practices:
31.7% were injecting with used needles, 70.6% obtained these needles from their regular
sex partner; 32.9% reported injecting with new needles about half the time. Of women
planning to stop sharing, 63.6% reported that their primary need was access to clean needes or being able to purchase their own. CHAID analysis revealed that use of the needle

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