Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 23170-23173 375

months for the non-vaccination group. HIV seroprevalence is approximately 9%
among IDUs in these districts.
Results: 91.5% (418 IDUs) of the HBV vaccination group successfully completed the vaccination. Only 1 of the vaccinated group seroconverted for HIV
during follow-up compared to 4 of the non vaccinated group (0.087 vs 1.219
person-years at risk) (Fisher exact = 0.008). Thirty-three HBV seroconversions
occurred in the not-vaccinated group and 14 in the vaccinated group; of whom 11
among the subjects who did not complete the full course of vaccinations, and 3
among the IDUs vaccinated but not responders as regards as antibody titre.
Conclusions: The adherence to the vaccination program can be considered
excellent. The vaccination campaign, along with frequent HIV testing and counseling, appears to have lowered HIV risk behavior. This suggests that ethical
testing of HIV vaccines should be possible with high risk subjects.
23170 From exchanger to non-exchanger: Secondary
acquisition of syringes given out by the Baltimore Needle
Exchange Program
Benjamin Junge1, T. Valente2, M. Safaeian3, M. Brown4, P. Beilenson4,
D. Vlahov5. 1627 N Washington St. Baltimore, Maryland 21205; 2Johns Hopkins
Pub Health/Pop Dynamic Baltimore, MD; 3Johns Hopkins Pub Health Baltimore
MD; 4Baltimore Health Department Baltimore MD; 5Johns Hopkins Pub
Healht/Epidemiology Baltimore MD, USA
Objectives: To examine transfer patterns of syringes distributed by the Baltimore
Needle Exchange Program (NEP) to injection drug users (IDUs) not enrolled in
the NEP.
Methods: A structured interview was administered to active IDUs participating
in an ongoing cohort study (n = 598). Interview topics included: syringe sources;
participation in the Baltimore NEP; transfer of NEP syringes (which are uniquely
marked) from enrolled exchangers to non-exchangers; and resale of NEP syringes on the street-based black market ("street"). Variables were cross-tabulated
by NEP participation using chi-square statistics.
Results: Of 598 respondents, 73% were men, 96% were African-American,
81% were unemployed and 45% were daily injectors; mean age was 34.6. 244
(41%) had exchanged at the NEP during the prior 6 months ("exchangers"), 74
(30%) of whom passed along NEP syringes to someone else (most commonly
to friends or associates, 68%). Of 367 individuals who had never exchanged or
not exchanged during the past six months ("non-exchangers"), 25 (7%) reported
having a friend or lover go to the NEP to get syringes for them. Of the 598 active
injectors, 343 (57%) reported recent syringe purchase on the street; of these 343,
200 (58%) reported buying NEP syringes. The overall proportion of the entire
sample's syringes which originally came from the NEP via street purchase was
23%. The proportion for non-exchangers was 31%.
Conclusions: Findings suggest that NEP syringes made up a substantial
proportion of syringes used by drug injectors who did not visit the exchange
themselves, both through informal channels (e.g., friends) and for a price on the
street.
23171 Effectiveness of HIV prevention programs in the
Collaborative Injection Drug Users Studies (CIDUS)
Edgar R. Monterroso, J. Wu, B. Byers, S. Holmberg. CDC 1600 Clifton Rd NE
MS-E45 Atlanta, GA 30333, USA
Objective: To evaluate the effectiveness of HIV prevention programs targeting
injection drug users (IDUs) in a cohort of street-recruited IDUs in seven US
study sites (Baltimore, New York [1, 2], Connecticut, Chicago, San Jose, and Los
Angeles County).
Methods: Participants were contacted by street recruiters or by using "snowball" techniques, interviewed with a standard questionnaire, and asked to return
for follow-up. HIV serostatus was determined at each visit; participation in prevention programs (needle exchange programs [NEP], drug treatment, reduction
of injection drug use, and sterile needle use) were assessed. A nested study of
high-risk IDUs was conducted.
Results: At baseline, 3771 participants were recruited. Mean age of participants
was 37 years; 36% were female; 39% African American, 33% Hispanic; 49% single. Seroprevalence rate for HIV was 13%. There were 19 seroconverters in 1323
person-years of observation (HIV incidence = 1.5/100 person-years). Injection of
cocaine was the strongest predictor of seroconversion (relative risk [RR], 6.6;
95% confidence interval [Cl], 2.4-18); heavy users (five times per day or more)
had the highest risk (RR, 22; 95% CI, 7-69) of all. Consistent involvement in HIV
prevention strategies was evaluated in a nested study (19 seroconverters/1032
controls); in initial analysis, protective behaviors were bleaching used needles
(RR, 0.2; 95% CI, 0.04-0.6), participating in NEP (RR, 0.4; 95% CI, 0.2-1.0),
and reducing drug injection use (RR, 0.4; 95% CI, 0.1-1.0). Other prevention
strategies may be effective but were not significant in early analysis. Fewer than
17% of the participants reported consistent condom use.
Conclusion: Several HIV prevention strategies for IDUs seem to be partially
effective in this large study, indicating the need for a multifaceted approach to

HIV prevention for IDUs. Safer sex practices also need to be encouraged.

23172 The SurvUDI surveillance network: 3 years of HIV
surveillance among IDU recruited at 11 syringe exchange
programmes in Canada
Raymond Parent1, M. Alary2, C. Hankin3, L. Noel4, C. Claessens5. Centre Den
Sante Publique De Quebec 2400 D'Estimauville, Beauport (Quebec); 2Groupe
De Recherche En Epidemiologie Cha Quebec QC; 3Direction Sante Publique
Montreal-Centre Montreal QC; 4Centre De Sante Publique De Quebec Beauport
QC; 5Laboratoire De Sante Publique Du Quebec Ste-Anne De Bellevue QC,
Canada
Background: A dramatic rise in HIV prevalence has occurred among injection
drug users (IDU) in some Canadian cities. In 1994, 11 collaborating programmes
joined together to implement a surveillance network in the province of Quebec as
well as in Ottawa, Ontario. Data are collected on HIV prevalence, HIV incidence,
and associated risk factors.
Methods: We recruit IDU who report injection drug use during the previous 6
months. Consenting IDU provide a saliva sample and answer a short questionnaire. Logistic and Cox regressions were used for multivariate analysis.
Results: By Dec '97, 3153 IDU had completed 4797 questionnaires. 74%
were men with a median age of 31 years (vs 26 for women). Cocaine was the
drug most often injected for 74% (vs heroin for 20%). The majority (94%) were
recruited by urban programmes. Overall HIV prevalence was 14% (95% CI =
11%-17%): 17% in Montreal, 9% in Quebec City, 5% in semi-urban areas and
21% in Ottawa. Overall HIV incidence rate (IR) was 7 per 100 person-years (PY),
[95%CI = 5%-9%] and highest in Ottawa, at 15 per 100 PY (95%CI = 5%-25%).
Multivariate analysis found many risk factors to be associated with higher HIV
prevalence (p-values <0.05): cocaine as the most often injected drug (adjusted
odds ratio (AOR) = 2.7), injecting with borrowed dirty needles mainly obtained
from strangers (AOR = 1.3), older age (AOR = 4.3 for those aged 25-34 years
and 5.1 for those 35 years or more), 6 years or more of injection drug use (AOR
= 1.3), and injecting with strangers (AOR = 1.6). Age (adjusted relative risk [ARR]
= 3.6 for those older than 24), 6 years of injection (ARR = 2.3) and injection
with strangers (ARR = 2.1) were associated with higher HIV incidence (p-values
<0.05). Injecting with dirty borrowed needles (regardless of source) was also
associated with a higher incidence (ARR = 2.4).
Conclusion: Our network was able to detect a recent outbreak in Ottawa
and found HIV incidence to be highest among those who injected with borrowed
dirty needles, whereas HIV prevalence was highest among those who borrowed
those needles mainly from strangers. Ongoing surveillance mechanisms such
as SurvUDI are useful in detecting outbreaks, identifying subgroups where such
outbreaks are likely to occur and discovering links to behaviours.
23173 Attitudes of participants of a van-based syringe
exchange toward pharmacy-based syringe access
Benjamin Junge1, S. Huettner1, E. Riley1, M. Brown2, P. Beilenson2, D. Vlahov1.
SJohn Hopkins, Public Health/Epidemiology, Baltimore; 2Baltimore Health
Department, 627 N. Washington Street, Baltimore, MD, USA
Objective: To examine attitudes of participants of a van-based syringe exchange
program (SEP) toward the prospect of pharmacy-based syringe access.
Methods: Prior to opening a pharmacy-based SEP in Baltimore, participants
of a van-based SEP (n = 206) were interviewed on drug and syringe use, syringe
acquisition factors, attitudes toward/past experiences with pharmacies, and willingness to spend money on syringes. Variables were cross-tabulated by SEP-type
preference (e.g., van vs. pharmacy) using chi-square statistics.
Results: The sample was 67% men, 95% African-American, and 95% unemployed; mean age was 41.5 years. 19% bought syringes at a pharmacy during
the prior six months. "Very important" factors influencing syringe source choice
included: a) desire to relieve withdrawal symptoms (66%); b) time required to
get syringes (54%); and c) familiarity with neighborhood (52%). 37% reported
having been turned down at a pharmacy for syringes; most commonly due to
lack of identification to prove diabetic status (50%). If legal restrictions and ID
requirements were lifted at pharmacies, 92% would have no reservations about
using them to get syringes, and respondents would be willing to pay a mean
price of $.80 (median = $1.00) per syringe. In this scenario, 49% said their first
choice would switch from SEP to pharmacy. Those who would switch from SEP
to pharmacy were more likely to be women (57% v. 38%, p =.045). Compared
to men, these women placed greater importance on knowing the person selling
the syringes (p =.002) and being familiar with the neighborhood (p =.010), and
prefer to get their syringes earlier in the day (p =.003).
Conclusions: Our data suggest that if current restrictions were lifted, pharmacies would be a viable syringe source appealing to a distinct subset of injectors.
That women were disproportionately represented among those who would switch
suggests gender-specific access issues which should be addressed in program
planning and implementation. That the price study participants would be willing
to pay per syringe exceeds typical retail price suggests that pharmacists could
charge enough per syringe to recoup operational costs.