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

Track C: Epidemiology and Public Health
Conclusions: The nature and scope of drug abuse varies by region;r, abt-use patterns follow
trafficking routes; and, heroin is the drug most abused. Misinformation regardin HIV/AIDS
was common.
Dr BaThaung,Yangon Drug Dependence Treatment Unit Deparatrent of eIrllthYangon,
Myanmar
Tu.C.2548
PREVALENCE AND RISK FACTORS FOR HIV INFECTION AMONG DRUG USERS IN
ROTTERDAM,THE NETHERLANDS
Wiessing, Lucas G*,Toet J**, Houweling H*, Koedijk PM**,Van den Akkc R, Sprenger
MJW*. *National Institute of Public Health and Environmental Protection (RIVMi), Bilthoven,
**Municipal Health Services, Rotterdam, the Netherlands
Objectives: To determine the prevalence and risk factors of HIV infectiii nrronrg injecting
(IDUs) and non-injecting drug users in Rotterdam.
Methods: Between 6 September and 18 December 1994 a saliva sarmplr and questionnaire
on risk behaviour were collected from 701 drug users (494 IDU) in Rott-,rlin.
Participants were recruited through methadone care (67%) and on thec street (33%).
Participation was on a voluntary basis and anonymous. Independent risk factor, were
assessed in multivariate logistic regression analysis.A capture-recapture.ass sinint of population size was done using the proportion reporting recent methadone treatrrmenrt and the
number of treated drug users in the Rotterdam methadone treatment registration.,
Results: Of 492 tested IDUs 57 were seropositive (prevalence 12%, 95% conidence interval [Cl] 9-14%), among the 207 non-IDUs three infections were found (i.5%, 95%Cl 0- 4%).
Independent risk factors for a positive test result among IDUs were a younger age (<25 yrs
OR=5.17 [I.27-21], 25-34 OR- 1.89 [1.01-3.57], >34 OR= I), country of birth
(Netherlands OR= I,Turkey Morocco, Surinam, Dutch Antilles ORP=0.1) [0.02 0.94], other
foreign OR- I1.54 [0.72-3.32]), imprisonment (never OR= I, once OR- 1.96 [0.6 I -6.28], > I
time OR=3.40 [1.36 8.52]) anrid a longer injecting history (0-2 yrs OR-=2.17 [0.65-7.27], 3 -10 OR1 I, > 10 OR-=3.05 [1.39-6.7I]).The number of drug users iin Rotterdam is estimated
at a minimum of 3500 on a yearly basis, of which 2500 IDUs and 200 to 300 infected.
Conclusions: The prevalence of HIV infections in Rotterdam is estimated at 12% among
intravenous drug users and 1.5% among non-intravenous drug user,, correspocnding with
about 200 to 300 HIV infected drug users. Risk factors for HIV infection amorng IDUs are
younger age, imprisonment and a longer injecting career IDUs bcr n i l-rke-7 Morocco,
Surinam or the Dutch Antilles are infected less often.
L.G. Wiessing, RIVM, PO. Box 1,3720 BA Bilthoven, the Netherlands. To eephor, +31-30--
2743398 Fax: [phone] email: [email protected]
Tu.C.2549
LOW LEVELS OF HIV RISK BEHAVIOUR AMONG INJECTING DRUG USERS
DURING AND FOLLOWING IMPRISONMENT IN THE NETHERLANDS
van Haastrecht, f-arry.A., van den Hoek, J.A.R., Coutinho, R.A. M (arlal I Ii- lth Service,
department of Public Health and Environment, Amsterdam, the st-iher lands
Objective: To determine levels of sexual and injectring d rug use -r ik b haiour of injecting
drug users (IDUs) during and immediately followin mprisonment ii iiv-e Nether lands. In
the Netherlands a "one roan per cell" penitentiary system applies.
Methods: Within the (non-prison) setting of a cohort study on HIfV rid/\ID among IDUs
in Amsterdam, participants were interviewed about their sexual rid injeng i;( tug use
behaviours during their last period of imprisonment in the previous years arid about
injecting drug use in the week following release from prison.
Results: Between April 1994 and January 1996 467 IDUs were intervi.ewe'd (67% male,
mean age 35 years, 35% HIV antibody positive). A period of imp!-ionanir-rt inr the previous 3
years was reported by 191 (4 I%) IDUs; 78% of 191I being male, mean a ge 35, 34% HIV
positive. Mean duration of last period of imprisonment was 3.6 rcnt r. Any rise of heroine,
cocaine, and cannabis (all illegal) during imprisonment was reported by 36%, 20%, and 55%
respectively; 84% received methadone treatment at least part of the time. Only 5 iDUs
(3%) reported to have injected in prison: in 4 cases only once and in I case t times. No
needles/syringes were used that had already been used by someone else.Vagirral/anal sex
was reported by 2 (1%) of the men and none of the women. Relapse to drug injecting during the week following release from prison was reported by 77 (4 i%) IDUs, in 82% of
these cases at the very first day of release. Most (62%) took their first shot alone, while all
except I (99%) reported having used a new needle/syringe for their ir r st ihot. t)nly a single
person reported a first shot with a needle/syringe that had already been used by someone
else.
Conclusions: Contrary to findings from other countries, low levels of HIV risk behaviours
occur among imprisoned IDUs in the Netherlands. Although noniniecting use of cocaine
and heroine in prison is quite common, drug injecting is rare, presinably because of a lack
of available needles and syringes. We therefore conclude that there appears to be no
ground for increasing the asailability of clean injection material in Dutch prsons.
H.J.A. van Haistrecht, Municiprl feilthr Service, Nieuwe Achterr act I tt. it)I8 VT
Amsterdam, NetherfandsTele-phone: [phone] tax: 3 1-20 555553 inn',
Haastrechta sara tl
Tu.C.2550
TRENDS IN AIDS CASES ASSOCIATED WITH INJECTING DRUG USE IN THE
UNITED STATES, 1985-1995
Nakashima Altyn K, Fleming PL, Ward JW. Centers for Disease Cotrol and Iirvention,
Atlatnta, CA. USA
Objective: To describe the recent trends in AIDS associated with i- ect diug use.
Methods: We reviewed AIDs cases reported to CDC through Spta; c -i i
Cumulative AIDS cases were analyzed by age, risk group, race/ett a: te a, I e, g-r phic
region.Trends in cases among adolescents/adults for 1985-1994 were r.lyzed after adjusting for reporting delay redistribution of persons reported without ask, and changes in the
AIDS case definition.We calculated 1994 incidence rates (per 100, l po tion) using

1992 U.S. census.
Results: Of 496,263 AIDS cases reported through September 199. 17: ),1 I.I (.7%) were
related to injecting drug users (IDUs). Of these, I 24,064 (69.8%) w--e 1etirosexual
IDUs, 2,064 (1 8.0%) in men who had sex with men (MSM) and in ected drus, 1 7,952

Tu.C.2548 -Tu.C.2553
( 0. I %) in helerosexual sex partners of IDUs, and 3,661 (2.0%) in children whose mothers
were either IDUs or sex partners of IDUs.The proportion of persons with IDU-related
AIDS increased fromn 29.0% in 1985 to 40.3% in 1993 arnd has remained level. Dunring
1985 1994, atreo its i IDU-related AIDS increased steadily among adult male and female
heterosexuals arid declined among MSMs after 1992 (Figure).Trends continued to increase
in the northeastern and southern regions but levelled off in other regions after 1992.Trends
among black persons increased steadily; between 1993 and 1994, cases increased 7.6% in
this group.Trends arnong whites and Hispanics have changed little since 1992. In 1994, the
rate of IDU related AIDS was nearly 14-fold higher among blacks than among whites. Rates
were higher among blacks than among other race/ethnic groups in all regions of the country.
Conclusions: iDU -related AIDS has become increasingly focused in heterosexuals and
minorities, par ticularly blacks. Although reporting biases must be considered, there appears
to be no indication of levelling of trends in these groups. Reducing IDU-related AIDS will
requirel eultirally sensitive prevention strategies tailored to the needs of minorities
Allyn Nakashira. CDC, 1600 Clifton Road, MS E -7,Atlanta, GA 30333, (404)639 -2010,
fax:[phone]
Tu.C.255 I
USE OF A MEDICAL EXAMINER DATABASE TO ESTIMATE HIV SEROPREVALENCE
IN THE INJECTION DRUG USING POPULATION OF LOS ANGELES COUNTY
H3ufuny n W, Simon, P2, Suarez, N, Padilla,T, Sathyavagiswaran. L3. Mute. J3,Wohl, AR',
Denning. P'. Keridt PRI.I Dept. of Health Services, I A. CA; 2CDC, Atlanta, GA; 3Medical
Examiner 's Office, LA. CA
Background: HIV seroprevalence among injection-drug users (IDUs) in drug treatment set
tin gs in Los Angeaes County (LAC) has remained stable at 2 3%. However, few data are
available on the general IDU population in the County. the majority of whom are not in
treatment.
Methods: F itra June 1994 through June 1995, 829 decedents >13 years of age with physical signs or a story of IDU were investigated by the LAC Medical Examiner's (ME) Office
f)emogra phic and cause of death information were recorded on each decedent and a
blood specinn cobtained for HIV antibody and toxicologic testing.
Results: (he study group consisted of 666 (80.3%) men and 163 (19.7%) women; 345
(4.6%) were white, 208 (25.1 %) were black, and 258 (31. I%) were Latino. Of the 805
(97. I%) decedents for whom blood specimens were available, 4 I (5.1%) tested HIV positae. HIV seroprevalence did not vary by gender (5. I% in both men and women) but was
Ier in blac ( i 36%; OR- 1.8:95% Cl 0.8-3.7) and lower in Latinos (2.4%; OR-0.5: 95%
Cl 0.2- 1.2) than in whi tes (5. I%). Seropr evalence was highest in the 25-29 year old age
gi oup (9. 7%), followed by the 30 34 year old age group (8 6%) None of the 40 decedents
-25 yers old were seropositive. Of the S62 (69.8%) decedents for whom one or nore
flicit drugs were detected in the toxicologic screen, 24 (4.3%) were seropostive. Arong
the 6S (8 I I) patisons who were homeless at the time of death, 4 (6.2%) were seroposi
rive.
Conclusions: Although deceased IDUs investigated by the ME rnay not be representative of
tIre gena a Ift population, ME data prosde a convenient source for obtaining what are
ikely to be upper estimates elof HIV seroprevalence in this group. he findings suggest that
IV sce, >prn-eai'nce in the general LAC IDU populatior may be as much as 2-3 timnes r'sigh
er thiarn- rns' t Ire subgroup of IDUs who are receiving drug treatment services.
Pete! R aer,t 600 5. Commonwea th Ave, Suite 1920, Los Angeles, CA 90005 Telephone:
(2 31 35 1 8 96, Fax: [phone], email: prel(wonder.emr.cdc.gov
Tu.C.2552
A COMPARISON OF HIV RISK BEHAVIOR INVOLVEMENT AMONG
NEEDLE-SHARING INJECTION DRUG USERS WHO USE AND THOSE WHO DO
NOT USE SHOOTING GALLERIES
Klein I ugh, Cark D, Hoffman J, Boyd F. Koba Associates, Inc.
Objective:_To exarmine whether injection drug users (IDUs) who use shootinrg galleres aind
injection drug users who do not differ in terms of their frequencies of using various types
of drugs, lh.,eir irvolvement in injection-related risk behaviors, and/or their involvement in
sexual risk ct vtr es.
Methods:_f ac. 'to-face baseline interviews are followed by a randomly assigned "standard
or "enhanced" intervention, then six months later by follow-up interviews. Sample is 2,109
out of treatment injection drug users, aged 18 or older, who knowingly used a previously
used needle at least once during the previous 30 days (70.3% male; 33.0% African
Amer ican, 32.3% Caucasian, 28.3% Latino:; mean age = 37.4; 77.6% with a high school education or less;: 10.0% homreless)
Results:_On almost all of the sexual risk behavior measures under study shooting gallery
user-s and anonusers did not differ fom one another Compared to IDUs who did not use
shooting galle as, those who reported using a shooting gallery at least once in the pr evious
-, tt: - rat an nate 27)9 rrnore often (jp <.00S), cased cnrace 34./S mere c tern (ta <.00OS). used spe -dbnlf 69.4% a-r 0o0ten (p a-.0001). injaected drug- S4.3a- ire tines (p <-., I r, ani Irtee proeiualy-used cookers, cottons, and/or rise water" 42.2- neo trnaea:a - 004). Comined, all of these and other unmentioned factors led shooting gallery
users to have HIV seroprevwfence rates twice as high as those of drug injectors who did
-sari a-s Ianolrr-argaloerea (1 3.9a-aversus 6.8a-a,jp <.001I).
Conclusion:.ID s-lao esa shoot valleres engage an a variety of drug- and injectionr
-ated rowrsthIInanahaat place thema at iecsp eiy high risk for contracting HIV.These individuIr n cn at I argoet group no atuh a n r -- a - -r r, une h-IV eutreach arid ratervaentcor
pa I sho dfocus particula attnt an
tuh K. n, Pobn Associates, Inc Sut- 200, j 56 I5th St. W -V Washington, 3.C 20005. tel:
(202) 7,,-7/ Inx: [phone] email: hughkdicats.con

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Tu.C.2553
DRUG SHARING: IMPLICATIONS FOR HIV PREVENTION
Koceter Stephen, Anderson K. Hoffer L. Urban Links, University of (
Med ir 1e. rentn, Colorado
Objective: T dentify strategies for t rdcing the risk of HIV transrmi
pare "hared dran s.

or ado School of
an w hen IDUs pre