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

376 Abstracts 23174-23178

12th World AIDS Conference

23174 Structural and functional characteristics of Syringe
Exchange Programs in Southern European Countries
(PESESUD)
Anna Rodes1, K. Perez1, M. Alberny1, S. Cagliero2, A. Sabatini3, J. Casabona1.
SCeescat Hospita Univ. Germans Trias I, Pujol Ctra. Canyet, S/N, 08916
Badalona, Spain; 2Medecins du Monde, Paris, France; 3Consiglio Nazionale
Delle Ricerche, Milan, Italy
Background: France, Italy and Spain are some of the countries with the highest
HIV incidence among intravenous drug users. During the last decade syringe
exchange programs (SEPs) have been developed as a harm reduction strategy.
PESESUD is an European Commission funded project which aims to describe
structural and functional characteristics of syringe exchange programs in these
countries.
Methods: Two studies have been carried out: a) a mail survey to all the SEPs
identified in France, Italy and Spain that were operating in 1996; b) a qualitative
study of four SEPs in each country.
Results: Of 262 SEPs contacted, information from 220 SEPs with 562 distribution points was obtained. Sixty eight percent of Spanish SEPs were staffed fixed
site, while 65% of Italian SEPs were machines. In France 39% of the SEPs were
staffed fixed site, in addition to 32% that were mixed model which include mobile
units, fixed site and machines. As a whole, more than half the programmes (54%)
established an exchange model of one for one (1/1), that is to say, a new syringe
for each used syringe (65% in Spain, 20% in France and 75% in Italy). Six percent
of the SEPs made the user pay for the first syringe while 21% requested payment
if a used syringe was not returned. In Spain these proportions were 6% and 12%
respectively, in France 3% in both cases and in Italy 8% and 52% respectively. In
addition to sterile equipment 11% of the SEPs provided some kind of health care
on-site, 13% provided specialised care for drug addiction and 39% psycho-social
care.
Conclusions: Important variability was observed between and within countries in functional and structural characteristics of syringe exchange programs in
France, Italy and Spain, this leads to the need to evaluate the conditions in which
SEPs can be more effective.
23175 1 Continued spread of HCV among needle exchange
attenders with low HIV prevalence and incidence
Margaret Mac Donald1, A. Wodak2, J. Kaldor1. 'National Centre in HIV
Epidemilogy and Clinical Research Level 2/376 Victoria Street, D'Arlinghurst,
NSW 2010; 2St. Vincent's Hospital Alcohol and Drug Services, Sydney, NSW,
Australia
Objectives: To measure the prevalence and incidence of HIV infection among
IDU surveyed at needle exchanges (NSEP) over three consecutive years and to
compare predictors of HIV and HCV infection.
Design: Repeated cross sectional survey
Methods: Over a one week period in March 1995, June 1996 and October
1997, all clients attending 21, 20 and 23 NSEP throughout Australia were asked
to complete a brief, self-administered questionnaire and provide a finger prick
blood sample. Respondents in more than one survey were matched by a coded
identifier and incidence has been estimated for 1995 and 1996 participants.
Results: Completed questionnaires with blood samples suitable for testing
were provided by 979 (41%) 1451 (54%) and 1708 (55%) IDU in 1995, 1996
and 1997 respectively. HIV prevalence (2%) was significantly higher among men
who described themselves as homosexual compared to men who described
themselves as heterosexual (>20% vs < 1%, p < 0.001) in all surveys. Of 101
respondents who tested negative for HIV infection in 1995 and were retested
in 1996, one (1%) male who reported his sexual orientation as homosexual,
seroconverted to HIV during the 18 month period. Of 23 respondents who tested
negative for HCV in 1995 and were retested in 1996, 61% seroconverted to HCV
[95%CI: 39,80]. Predictors of HCV infection included longer duration of injecting,
heroin injection compared to 'speed', more frequent injecting, and shared injecting
equipment in the past month. Syringe use after anothererson in ther prs past month
remained unchanged (29% in 1995 and 26% in 1996).
Conclusion: HIV prevalence and incidence remains low in IDU except among
men who describe themselves as homosexual. In sharp contrast, the prevalence
and incidence of HCV is high even among IDU new to injecting. Even though
new HIV infections in male homosexual IDUs were probably acquired through
sexual transmission rather than blood contact, the high rate of newly acquired
HCV infections suggests that blood contact between IDU continues to occur.
23176 HIV prevalence and risk behaviors among new initiates
into injection drug use over 40 years old
Mariangela Carneiro1, C. Fuller2, M. Doherty2, D. Vlahov2. WJohns Hopkins
School of Hygiene & Public Health, Baltimore, Maryland; 2Johns Hopkins
University, Baltimore, Maryland, US
Objectives: To identify older adult initiates into injection drug use (IDUs) recruited

into the ALIVE Study (AIDS Link to Intravenous Experiences Study) for a cohort
study of the natural history of HIV infection, and to compare patterns of HIV-related
risk behaviors among initiates by age group.
Methods: This cross-sectional study includes volunteers enrolled using extensive community recruitment techniques in 1988 and 1989 in Baltimore, MD.
This analysis included 722 participants representing 24.7% of the total population
enrolled in the ALIVE study, all of whom reported their first injection within six

years prior to the baseline interview. Participants were divided in two groups,
younger than 35 years of age and 35 years of age or older based upon the overall
median age of participants enrolled in the ALIVE study. Forty years was used as
a cut-off point to categorize older mature versus younger IDUs.
Result: Of the 722 injection drug users who had initiated injection within the
prior six years, 124 (17.2%) were over 35 years old of whom 53 were 40 years and
older. Rates of HIV were lower among those over 40 years (13.2%) than those
who were 35-39 years (22.5%) or under 35 years old (20.9%). The behavioral
characteristics of those aged 35-39 were similar to those under 35 years old but
those over 40 years old were more likely to inject with their own works (52.7% vs
29.7%, p = 0.021).
Conclusion: This study shows that a non-trivial proportion of injection drug
users initiate injection drug use over the age of 35-40 years old, an age when
some researchers suggest that the typical user matures out of drug use. Also
shows that safer needle hygiene practices early after initiation tend to be safer in
older compared to younger initiates.
123177 Heterogeneity of risk: Variability in social and risk
networks of drug users
Richard Rothenberg1, R. Trotter2, J. Baldwin2, C. Sterk3, C. Maxwell3, A. Pach4.
1Emory University, 69 Butler Street, S.E., Atlanta, Georgia 30303; 2Northern
Arizona University Flagstag, AZ; 3Emory University School of Medicine, Atlanta,
AZ; 4National Opinion Research Center, Washington, DC, USA
Objectives: To determine the network structure in populations that differ in their
degree of risk-taking, ethnic makeup, and HIV prevalence, and to assess the
influence of that structure on HIV transmission.
Design: A comparison of two methods (random walk and chain link) of network ascertainment in communities at two sites (Flagstaff AZ and Atlanta GA) (a
total of 12 networks), with prospective followup of participants for a total of four
evaluations over approximately two years.
Methods: Data from the first round of interviewers were used to compare demographic characteristics of participants, drug use and sexual practices, features
of network structure, and mixing matrices using standard analytic tools (SAS,
UCINET) and network visualization (KRACKPLOT). Critical ratios of differences
of proportions were used where appropriate.
Results: These populations exhibited heterogeneity with regard to virtually
all factors considered. Compared to Flagstaff, the networks in Atlanta had a
substantially higher prevalence of homelessness (40.4% vs. 10.6%) and prostitution (10.2% vs. 0.4%), and of underemployment and undereducation. Heroin
and cocaine were injected more frequently in Atlanta than in Flagstaff, but the
reverse was true for amphetamines. On the other hand, prophylaxis (condoms
and cleaning works) was practiced more frequently by participants in Atlanta. The
mixing matrix in Atlanta exhibited almost exclusive homophily (95.6% for African
Americans), a contrast with that among the four major ethnic groups in Flagstaff
(African American, 77.9%; Hispanic 47.3%; Indian, 68.6%; White, 76.8%). Within
the Atlanta communities, the density of network microstructures was variable, but
in general low, in keeping with the general absence of seroconversion, despite
an HIV prevalence of 15%.
Conclusions: Preliminary evidence from a long term study of drug users
suggests diversity in network structure and mixing patterns. Such diversity may
influence the development of epidemic HIV spread, despite continuing risky
behavior.
410*/23178 A simple method for process evaluation of needleand syringe-exchange programs: Results of pilot
testing in Poland, 1997
Philip Alcabes1, M. Beniowski2, M. Zygadlo3, E. Bozek2, G. Widowski3,
J.P.C. Grund4. 1New York Univ School of Medicine, 341 E. 25th St. 2nd Floor
New York, NY; 41HRD, Open Society Institute, New York, NY, USA; 2Katowice
Centre for AIDS Diagn. & Therapy, Chorzow; 3Monar-Krakow, Krakow, Poland
Background: The utility of needle- and syringe-exchange programs (NSEPs)
in preventing the spread of HIV can be difficult to demonstrate rigorously. We
developed a simple and easily implemented method for determination of the total
number of syringes in circulation and syringe circulation times, indicators needed
for evaluating NSEP success. We carried out pilot studies of this method at two
NSEPs in Poland, one a multisite program in a Silesian conurbation with a severe
HIV epidemic and the other a street-based NSEP operating near Krakow's main
drug market.
Methods: Based on traditional "capture-recapture" techniques, our approach
consisted of the programmed distribution and enumerated collection of 5- and
10-cc syringes that are labeled but otherwise indistinguishable from syringes
typically distributed by an NSEP.
Results: In Upper Silesia, 870 labeled syringes were distributed at 4 of 12
NSEP sites serving the region's injectors. We found low between-site interactions
and a median turnover time of 2 weeks, but separate fast- and slow-turning-over
populations of syringes were evident. An estimated 4800 (95% confidence interval

4000 to 5800) syringes were estimated to be in circulation in the region's main city,
showing that the NSEP accounts for over half of circulating syringes. In Krak6w,
706 labeled syringes were distributed in two waves to both accurately estimate
turnover times and enumerate circulating syringes. Based on returns of 394 of
these plus 1343 unmarked syringes, estimated halflife was 7-8 d and a total of
2480 (95% Cl 2160-2800) syringes were estimated to be in use, indicating that
the NSEP provides over 60% of local syringes. In both cases, NSEP-originating