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

Monday, July 8, 1996

Mo.D.354 - Mo.D.364

Lessons Learned: A wider scope of soldiers and policemen havt' I:,i r ie odc. However,
many more are still uninformed and some do not believe the e ris-,tc, i. AI[)S.
Mpoudi Ngole Eitel (M.D.) Service de Lutte contre le Sida B.P I55 Y iad Ic:reroun
Mo.D.354
HIV EXPOSURE RISK IN MILITARY POPULATIONS:AN UNCHARTED
PREVENTION FRONTIER
Temoshok, Lydia R.', Kingma, SJ.** *Uniformed Services Universit> a,! iHalth Sciences,
Bethesda, MD.;**UNAIDS, Geneva, Switzerland
Objective: To apply the results of the first large-scale survey of I- IL,u u,ae rsuk -relevant
factors in a military population (the US Army) to the developrmet! i:r, itted HIV behavioural prevention strategies for world-wide military populations.
Methods: An anonymous self-administered survey of HIV exposure,kreievarrt factors was
completed by 18,031 soldiers in a stratified, probability sample of ai 'a Arrn installations
world-wide.
Results: Data fi-om this representative survey of the ethnically a;d eographically diverse
men and women in the US Army indicate that soldiers, in general, hIve greatly increased
vulnerability to HIV infection, compared to general civilian populis it tie JS, the UK,
and France, in which recent national surveys have been conducted. Ris, lactor s include high
rates of sexual partner change, elevated rates of STD, relatively low r ates of condom use
with prostitutes and other "casual" partners, and significant mixingr bet reer groups having
high and low-risk behaviour patterns, as well as higher and lower fIV pi e alence. Findings
were used by GPA/WHO and UNAIDS to develop an HIV/AIDS inforrtion booklet for
police and armed forces personnel worldwide, as well as for the training of rni'dical officers
who carry out UN peacekeeping missions.
Conclusions: Even militaries which are not considered "high-riskl" popaitions, may represent potential venues for epidemic spread if they have high prevalene of HIV exposure risk
factors, and if certain conditions are met. Examples of "situational chIrges" which have triggered HIV epidemics in some parts of the world include civil conflict aind large scale military conscription and/or deployment to an area with high HIV preIvalence.Tsrgetted HIV
behavioural surveillance and prevention programmes, which are typicli rl not priorities in
military populations, are urgently needed on this largely uncharted I yr i aertion frontier
Lydia R.Temnoshok, Ph.D., ch. de I'Avanchet 20, I 2 I 6 Cointrin, Geneve. 'Switzerlanrd.
Tel/FAX: [phone]
Mo.D.361
EVALUATION OF THE BALTIMORE NEEDLE EXCHANGE PROGRAM:
PRELIMINARY RESULTS
Vlahov D, lunge, Benjamin, Beilenson P, Brookrneyer RS, Cohn S.'arreriniai. The Johns
Hopkins School of Public Health; *Baltirarore City Health Departrent.
Objective: To evaluate the first year of the Needle Exchange Progran r (NEP) for injection
drug users (IDUs).
Methods: All participants between 8/12/94 and 8/i 1/95 who under'ient enrollment interviews on sociodemographic and drug use practices. A systematic snaple was interviewed at
initial, two week and six month follow-up visits about needle acquisition, use and disposal
practices during the 2 weeks before each interview. Data were analyzed us paired Ttests.
In a community cohort (the ALIVE Study) demographics and HIV seroconversion rates
were compared between participants who used vs. did not use the NIResults: During the first year, 2965 IDUs enrolled in the NEP of.shori 87% were AfricanAmerican, 72% were male, 56% had < 12 years of education, 92% were unemployed and
90% injected 1/day; the median age was 38 years old.Within the AL.LE cohort, NEP
users were mnore likely to inject >_1/day, otherwise IDUs not enrolled ir INEP were statistically simrnilar Of the 2965, 55% returned at least once to exchange, and / were high volumre exchangers (> 50/visit); among high volume exchangers injection frequency and needles exchanged were similar. In the interviewed subset, there was a significant decrease (p <.05) of injections on the street, frequency of injection, needle sharing, use of galleries, and
discarding needles on the street in the 2 weeks prior and subseqrrent to enrollment.These
changes were sustained at the six month visit. Conclusion: This NEP has recruited a large
number of IDUs and preliminary data suggest that the NEP attracts hirh isk IDUs, and that
a reduction in HIV risk drug use is observed.
Benjamin Junge, Johns Hopkins SHPH, 627 N.Washington Street, B ll tnore, MD 21205, USA
Phone: [phone] Fax: [phone]
Mo.D.362
AIDS PREVENTION PROGRAMME INCLUDING NEEDLE DISTRIBUTION FOR
FEMALE PRISONERS:THE HINDELBANK PILOT PROJECT
Zeegers Paget, D, Benasconi, S.,* Wasserfallen Fraiois,* Rihs idel. I'-I.,*,elles, ].,**
Burki, B.,'** Baechtold, A.***' Federal Office of Public Health;;'Pschiati c Jniversity
Clinic of Bern; ***M.D., prolect manager D**-**Department of Polce rn:I military affairs of
the canton of Bern
Issue: ue to laigh prevalen es of HIV ard hepatitis in prisons, thee s rieed for prevention pirogsrinmes far prisoner s wh fconinue to sljeet dirugs ir )- o
Project: Coipieher re AItS and drugs n nevento pi ograir n r n r.sdle dirbu-o
rion in the finsale pison of I Iisebbnik.Tfhe pirogiranne aimed +is I innvei st~ ar ting or
re entering drug consumptson; 2) decreasing risks linked to dru ci, irptios; nd 3) preventing new and re infection with HIV and hepatitis.larget group: I 0 feie prisoners (of
which a third indicated having used heroin or cocaine before enter ). At tIhe same time,
eduraton ad trasirnin progs amine fo i the pison per sounel mee 5e t Irs. hs tryr ansiae
included irformintrue rneelrrgs, rosinsoiling usa a weekly basis, a toledton is rt!is', infor malion iraster sriineedlie excharge nmahines, stireetwor k (Isiked wirh s 5 'ti s's Itl' excfsange
machines), and informing the media on a regular and open basis
Results: The 14irdelbank< pilot prolect was evaluated extermally.] h evah, ri demonstrat
ed positive results.The most important being: a) the health status,:,f 5 io r's improved
(e.g., no new abscesses linked to intravenous drug use); b) no new us 5s oif Ifection with
HIV or hepatitis; c) an iportant decrease in needle sharing; d) no u es,' i druigs consumption; e) needles were not used as weapons. The evaluation al ' 5, c l i that there
was no change in sexual risk taking: and thsat the personnel remain divided,, tIe issue of
needle distislution in prison, even though the programme on the wol 'was well received.

Lessons learned: A comprehensive AIDS prevention programme, including needle distribulion for prisoners who continue to inject drugs, is feasible. Accompanying measures, including the information and training of personnel, should also be taken.
Francois Wasserfallen, Federal Office of Public Health, Hess-Strasse 27E, Postfach, 3097
Bern-Liebefeld, Switzerland Telephone:* -31 -323 87 29 Fax:* -31 323 87 89
Mo.D.363
SOCIAL DETERMINANTS PREDICT NEEDLE SHARING BEHAVIOUR AMONG
INJECTION DRUG USERS IN VANCOUVER.
Strathdee Steffanie A, Patrick DM, Archibald C, Ofner M, Craib KJPR Cornelisse PGA, Eades
G, Schechter MT,, Rekart M., O'Shaughnessy MV. BC Centre for Excellence in HIV/AIDS
and University of British Columbia,Vancouver; BC Centre for Disease Control; Laboratory
Centre for Disease Control, HIV/AIDS Epidemiology Unit, Health Canada.
Objective: To identify determinants of needle sharing behaviour in Vancouver where a
recent outbreak of HIV infection occurred among injection drug users (IDUs) despite longstanding needle exchange and outreach services.
Methods: A total of 28 I IDUs participated in a case control study of risk factors for HIV
infection. IIV+ subjects had a documented seroconversion in 1994 -1995 (N=89) and
HIV-'ve subjects had two documented negative tests within the same period (N= 92).
Face to-fiace interviews focused on the period between the two HIV tests (inter-test interval), and included questions on drug use, needle sharing, source of needles, sexual behaviours, migration, housing, incarceration, and depression (7 item CES-D). Subjects were also
asked whether they had "ever been forced to have sex" before age 12, between 12-17 yrs
or > I18 yrs. Univariate and multivariate logistic regression models were used to identify
determinants of borrowing used needles within the inter-test interval.
Results: 105 males and 49 females reported borrowing needles. Borrowers were more likely to: live maried and common law (65% vs 5 I%, p=0.03), inject >4 X/day, (p<0.001), inject
> I drug (p<0.001), have sex with the same sex (1I7% vs 6%, p=0.007), report having been
forced to have sex (67% vs 46%, p<0.00 I), have a CES-D score above the upper quartile
(32% vs 88%, p=0.009), and test HIV+ at the end of the interval (38% vs 24%, p=0.008).
Females were more likely than males to report forced sex (75% vs 27%, p<0.001I), but
males were mnore likely to report forced sex < 12 yrs (p=0.08). At least 59% of these subjects experienced forced sex befor xOe first injecting drugs. In the finsal multivariate model, after
adjusting for HIV serostatus [AOR--2.2, (95% CI: I.2-4)], factors remaining independently
associated with borrowing were: being male [AOR=3. I, (Cl: 1.5-6.6)], living common
law/married [AOR=2.4, (CI: 1.3 -4.7)], injecting >4X/day [AOR=3.4, (CI: I1.9-6. I)], injecting
> I drug [AOR4. I, (CI: 2.2-7.8)], ever being forced to have sex [AOR--2.9, (CI: I.5-5.7)], a
higher CES-D score [AOR-2.3, (CI: I.2-4.7)] and having sex with the same sex (AOR=2.6,
Cl: 1.03 6.8). Access or barriers of clean needle use were not independently associated with
borrowing used needles. Results were similar after stratifying by gender.
Conclusions: Fac tors suggestive of underlying psychological distress, rather than access to
clean needles, were strongly associated with needle sharing, as indicated by a higher frequency of sexual abuse and depression among borrowers. Early identification of these factors should be a component of HIV prevention programs aimed at IDUs. Improved social
support and coping skills could reduce the frequency of needle-sharing behaviours.
Dr. Steffanie A. Strathdee, BC Centre for Excellence in HIV/AIDS, 6 I I-108 I Burrard Street,
St. Paul's HospitalVancouver, BC,V6Z I Y6. tel [phone], fax [phone],
email steff(@hivnet.ubc.ca
Mo.D.364
LIMITATIONS ON THE SALE AND POSSESSION OF SYRINGES;
RESULTS OF A NATIONAL SURVEY OF LAWS AND REGULATIONS
Lazzarini, Zita,* Gostin, L.O.,# Flaherty, K.M.,# Jones,TS.** *Harvard School of Public
Health, Boston, MA; #Georgetown-Johns Hopkins Program in Law and Public Health,
Washington, DC; **Centers for Disease Control and Prevention (CDC), Atlanta, GA
Background: Legal provisions in many United States (U.S.) jurisdictions criminalize sale, possession, distribution or manufacture of hypodermic syringes and needles (drug paraphernalia
laws); require a physician's prescription for legal sale (syringe prescription.laws); or restrict
sales by regulation.
Objectives: I.o collect and review legal barriers limiting injecting drug users' (IDUs')
access to syringes. 2. to recommend changes in syringe-related laws and regulations which
integrate the public health, law enforcement and community perspectives into public policy.
Methods: We surveyed and analyzed U.S. federal and state laws and regulations, and
selected local ordinances limiting access to syringes; reviewed the social and legislative history of such provisions; and examined characteristics and legal status of syringe exchange
programs (SEPs).
Results: Our analysis revealed more extensive legal barriers to access to syringes than have
been reported elsewhere. Forty-nine states and territories have drug paraphernalia laws.
Nine have syringe prescription laws.Thirty-one have regulations that limit sale of syringes in
some way. Access to syringes is also limited at the local level through city or county ordininces. Although the number of SEPs operating in the U.S. is increasing rapidly, the legal statss of tEPs rea ins tenuous, only 9 states have specifically authorized syringe exchanges by
statsute or ae hiw and SEPs me legal in 2 others where state law does not criminaluze posse smuts. sae oron dustsribution of syringes. Only 6 states and the District of Columabia exempt
SEPs fiom their drug paraphernalia laws and 3 exempt SEPs from syringe prescription laws.
Conclusions: Existing laws and regulations in many U.S. juisdictions pose substantial barriers to public health efforts to decrease HIV transmission among IDUs. Four recommendatruons I) Legamlize syringe exchange programs 2) Allow use of federal funds for SEPs; 3)
Ropeaml syr rae prescription laws anad egmslatiOtis to allow sale of syringes in pharmacies 4)
Refsrm di ui painaphenealia laws to exclude syringes frow definition of paraphernalia.
Zita Lazzarini, ftrvard School of Public Health, Dept. Health Policy and Management,
67/ Huntington Ave. Boston, MA U.S.02 I 15, Phone/Fax: (4 I 3) 533-7550

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