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

Tu.C.2520 - Tu.C.2526

Tuesday July 9, I 996

Conclusions: IDs in Bar ngkok would appear to be at relatively low risk for acquir ineg HIV
fromr sexual parrtners.There is still considerable likelihood of transmitting HIV to regular
sexu par tners, although there is some evidence for IDUs attempting to protect sexua
partners i tha t IV testing is associated with greater condom use.
S. R aktham, 198/10 Rara 6 Road, Py ttai, Bangkok,Thailard 10400 Telephonre: 66 2 224 -2948 Fax [phone]
Tu.C.2520
COMPARISON OF PROGRESSION AND NONPROGRESSION AMONG INJECTION
DRUG USERS AND HOMOSEXUAL MEN WITH DOCUMENTED DATES OF HIV-I
SEROCONVERSION
Prins iari a. for the f uroperan Se r oconver ter Study Veugeler s, PJ. for the Tricor tinenta
Sero rorverter- Study
Objectives: P corTpreo pr oiession and cr pr ogressior of HIV- I infect on a or prrection
drug users (IDU) anrr1 horoseaurlrrnr (lit with welldocumerited date of eroconversior (SC().
Methods: The study population crompr ised 418 IDU and 122 HM fron cohorts participating in the Europeanr and Tricontinental Seroconverter Study, resp. SC dates were imrputed
for eac subject using a cohort specific estimate of the curmulative seroincidence over calendarc time. In survival analysis, we studied progression fr om SC to AIDS and deth by risk
group. We compared nonprogressionr between both risk groups by evaluating arnnual CD4
declin e (slople0) arnd absolute (.D c ounrt (500cells/Il) 7 yr s followinr SC among AIDSfir-ee subjects.
Results: IDU and IHM were followed for a median of 6.3 and 7.9 yrs.The relative hazard
(RH) for AIDS amongr I iM compared to IDU was 1.53 (95% confidence interval (CI) 1.16 -2.00) before and I.19 (CI 0.86- 1.6) after adjusting for age at SC and year of SC. Fifty IDU
died without AIDS (mrainly due to rnonr-HIV related deaths), compared to 7 HM (crude RH
for I HM 0.10, CI 0.0 0.21 ). Ignoring this pre AIDS mortality the crude RH of death for -HM
compared to IDU was 2.04 (CI 1.45 2.87). After adjusting for age at SC and year of SC inr
multivariate analysis, the RI- became.1 I (CI 0.95- 2.09). Risk of death frorn any cause for
IM c ompared to IDU increased over tirme since SC. Repeating the analysis for subjects
with narrow SC intervals, mern onrly, or those who were enrolled before and just after SC
did not substantially alter the results. Proportions of nonprogressors based on absolute
CD4 count--00 at 7 y s fromr SC we e lower for IDU (I I%) compared to HM (20%). IDU
had tI e highest popcis on when nonr -progressiorn was based on CD4 slope >_0 (I7% for
IDU and 5% for IM). No differences were found in the proportion (~4%) classified as nonprog resso rs by bath criteria, eveni if pre AIDS mortality and loss to follow- up were included.
Conclusions: Ve found little evidernce for notable differences in progression anrid nonpro
gression between I)U and FIt-M, except foi pre AIDS mortality which was much higher
amonrg IDU. Pre-AIDS ri ortality should be considered in clinical and social planning as well
as studies comparing r isk groups.
M. Pr ins, Municipal Health Service, Nieuwe Achtergracht 100, 1018 W [ Amsterdam,
Netherlarnds Felephonre: 31 -0 5555 569 Fax: 3I 20 5555 533 email: [email protected]
Tu.C.2522
SURVIVAL OF HUMAN IMMUNODEFICIENCY VIRUS (TYPE-I) IN INJECTION
SYRINGES
Stephens P Clay*, Heirner R', Jariwala Freeman B, Negioanu D, Griffith B.
[*Epidemiology and PubicH I-ealth, laboratory Medicine/Virology Reference LaboratoryVA Hospital,Yale Urriversity School of Medicine and 'Yale College, New Haven, C f:
' Lifecodes, Stanford, C; USA]
Objectives: (I) To develop and deploy a whole blood quantitative rmicroculture assay
(WBQMA) able to utilize the small volumes of blood remaining in injection syringes after
use. (2) To determine the duration of survival of HIV I in injection syringes. (3) To determine the viral oad In syrin ges over the survival period. (4) To discern policy implications of
the findings.
Methods: A whole blood quantitative microculture for HIV I was developed and standardized to currernt PBMC quantitative culture techniques. Multiple syringes were loaded with
blood infected by two wild type strains of HIVI and stored in simulatior of street use in
accordance with ethnographic studies. Contents were removed at Day 0 throug Day 28
and were cocultured with unir-ected PBP1Cs for a maxiirrumr of 2 ldays. Testing for p24 AG
in the superratart, using Abbott kits, was conducted for viral load calculation. Statistical
analysis includ ed Chi Square, Median Iest, ad the Boferror ni Method for Multiple
Comparisons.
Results:Viable HIV I was cultured from syrinrges stored for as long as 28 days. 50% of Strain
VS00 I- and 99% of VS002 loaded syrriges were positive for viable virus; the over all syringe
positivity rate was 75% SThe two strains differed from one another by number of syringes
positive per, tire of storage and by storage time specific viral loads (p<0.05 and p<0.01
respectively). I cdscon Days 0, 1, 3, 7, 21, 218 differed (p<-0.05) from Day I.
Conclusions (I)1he WB)MA is cpable of qluanrtifving viral load fr or small inputs. (2) A
28-day survival tirre exceeds curirnt stirates. (3) load appears to be suftcient to effect
transmisson. (4)I i s survival tire povides scientiic basis for aeedle exchan.ge and sup
poet the ue of harir redutior t,-h-us d he rernval f-rom ci rculation of used
syringe and injection equiprent
P Clay Stephens 701 Elm Street Hew Haven, c- 065r II USA Phone [phone] Fax
[phone] Em i: PSTEPfHENclbiomed.rned.yale.edu
Tu.C.2523
NEEDLE EXCHANGE USE AMONG A COHORT OF DRUG USERS
Scoe bao EACe ' lii tol Dli, Crocr-eciteh Mt-I Mortefare ed Cnter Abert Einstei n
Lo li-ge If Medic ire, B-onix, 1 los Yrk, LISA.
Objective: To prospecticely study inection belaiors acaong IDU who did and did not uti
lize ib oal ire-idle- echarnge ir ti~e Birn-, NewYork Cic.
Methods: Startirnp in 198', I~ attenrdirap a methadone crnternacce prograa were
err o led iS a prospectiv - tu y of t V r e'lted is a auior s Sin ce I 989, w he n cnedle
ec ancge opened e r tte meti ado-e proram- data were collected regardin the number
and percert of reedles obtannd at tihe needle e-ciange. By end of 1993, 12.6% had died

aIId 23.7% aer!c 1, Ptfollwup.

Results: Of 904 IDUs,shI 'njected between 1985 -1993, 21.9% used the needle exchange.
Male gender (ORa. -.57), HIV seropositivity (ORad1 I.39) and younger age (ORadj/10 yrs
of age I1.66).. re idependantly associated with needle exchange use.The percent injecting
declined each year, pr eyeding the needle exchange opening and concurrent with its opera
tion (fronc 646% m ini! 3 to 43.6% in 1993).The proportion of active injectors using the
needle exchr-Rne incresed 'rom 38/398 (9.6%) in 1989 to 140/251 (55.8%) in 1993.
Among the 329 IDU who injected in I1988, the year before the exchange opened, 53/I 24
(42.7%)(p<.00I) who went on to use the needle exchange and 168/205 (81.9%)(p<.001)
non-users stopped or decreased injecting by 1993. Needle exchange users reported less
needle sharing than non-users (p<.05 in 1993). HIV infected and uninfected IDUs were
equally likely to decrease or stop injecting.
Conclusions: Methadone treated IDUs with access to a needle exchange decreased injec
tion and needle sharing.This pattern of harm reduction, which began years before the needle exchange opened, occurred in those who did and did not utilize the needle exchange.
Needle exchange, as a strategy to decrease injection-related harm, should not be viewed as
discordant with methadone treatment.
Ellie E. Schoenbaum, MD, Montefiore Med. Ctr., AIDS Research III E. 210th Street, Bronx,
NewYork 10467, USA Phone:[phone] FAX:[phone]
Email:[email protected]
Tu.C.2524
UPDATED INSTRUCTIONS ON NEEDLE CLEANING:A MESSAGE NOT RECEIVED
BY INJECTION DRUG USERS
Schilling, Robert F*, Fernando, D**, EI-Bassel, N*. *Columbia University **Association for
Drug Abuse Prevention and Treatment, NewYork City
Objective: Since 1986, IDUs have been instructed to clean their equipment with undiluted
bleach, if they shared. However, several epidemiological studies failed to find any protective
effect for such methods, and laboratory tests later indicated that undiluted bleach should be
in contact with HIV for at least 30 seconds. CDC, NIDA, and the Center for Substance
Abuse Treatment revised recommendations for bleach disinfection instruction to include 30
second exposure.Yet little attention has been focussed on whether street IDUs have
learned of the 30 second exposure recommendation.
Methods: In the course of a multi-year, multi-site HIV risk reduction study funded by the
CDC, we selected 374 IDUs using systematic random sampling methods, carned out in
defined street corners in four neighborhoods in the South Bronx.
Results: In this sample, 344 had injected drugs in the past six months, of whorem 315 (92%)
had heard about bleach disinfection. Only 66 (1I9%) had heard about the need for 30 second exposure to undiluted bleach.
Conclusion: Inadequate bleaching procedures are apparently normative in the South Bronx.
Many IDUs may be following the "bleach, bleach; water, water" method, erroneously believ
ing that they are properly disinfecting their paraphernalia. Effective bleach distribution
requires IDUs to receive and follow complex messages about proper use of bleach. Bleach
kits cost about $0.50 and are bulky for outreach workers and IDUs to carry. In contrast, a
new syringe does not require a n IDU to learn new protocols, costs pennies, and s eas ly
distributed and carried. With the increasing acceptance of needle exchange and distribubton
in communities once opposed to such activities, it is time to reexamine the utility of bleach
distribution as an HIV prevention strategy
Robert F. Schilling, Columbia University School of Social Work 622 W I 13th Street, New
Yo-k, NY 10025, USA Telephone: [phone] Fax: [phone] email:[email protected]
Tu.C.2525
DRUG SHARING AS A HIV RISK BEHAVIOR AMONG INJECTING DRUG USERS IN
NEWYORK CITY
Fernando, Daniel*, Schilling, R.F**, EI-Bassel, Ne* *. *Association for Drug Abuse Prevention
and Treatment, New York City **"Columbia University
Objective: Researchers and outreach organizations have emphasized "needle shaning but
until recently have paid little attention to pervasive drug-sharing practices, which also place
IDUs at high risk for HIV infection. HIV may be transmitted via drug sharing, even when all
participants have their own needles.We sought to gain an understanding of the phenomenon of drug sharing via structured interviews with IDUs in street settings in the South
Bronx.
Methods: In the course of a CDC-funded HIV prevention study we selected 386 IDUs
using systematic random sampling methods carried out in defined street corners in four
neighborhoods in the south Bronx.
Results: In this sample, 338 respondents had injected drugs in the past six months, of
whorn I 69 (50%) had ever shared drugs, including 79 and 46 who had shared in the past 7
and 8-30 days respectively Of those who shared ever, 26 (15%) had divided the drug (usually heroin) before cooking, and 139 (82%) shared the drug after it was prepared in a comnaon cooker.
Conclusion: Drug sharing may be a more prevalent HIV risk behavior than the sequential
use of needles. Unless drug-sharing is addressed, even expansive needle distribution
schemes will fail to achieve intended reductions in the spread of HIV.
Daniel Fernando, ADAPT-South Bronx (Substance Abuse/HIV Prevention Center) 552
Southern Boulevard, Bronx NY 10455 USA Telephone: [phone] I Fax: 7 I 8-665-0492
Tu.C.2526
PREDICTORS OF INJECTING IN PUBLIC SETTINGS AMONG NYC INJECTION
DRUG USERS
Sotheran, to L*, Friedman SR*, Clatts MC*, Des Jarlas DC**. Natiocal Development and
Research Institutes, Inc, New York, NY LISA, ** Beth hsrael Medical Center and NDRI, New
York, NY LISA
Objectives: To examine predictors of injection in public settings (including 'shooting gallertes," abandoned buildings, streets, parks, toilets in public places), some 01 which have been
inmplicated in risky inection behavior and attendant risks for DIV transmussion.
Methods: 3.029 IDUs recruited in 1990-93 in streets and a detoxuication ward as part of
the New York component of the WHO Multi-City study were asked structured questions
about their most recent injection: analysis was restricted to 1,541 I (5 I%) who part apated

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