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

378 Abstracts 23184-23188

12th World AIDS Conference

Methods: A survey of IDUs was conducted anonymously on 162 men with a
history of drug use entering two facilities between May to August, 1996. One of
the facilities houses approximately 800 to 900 young men, 16 to 26 years old, and
the other about 1000 male adults. Participants were asked to answer or leave
questions blank, without penalty or consequence to them. The HIV risk behavior
addressed by the questionnaire was the year preceding the survey.
Results: Of the 162 respondents, 156 reported a history of injection drug use,
which comprise the sample for this study. Of 156 IDUs, 95% were Japanese, 5%
were non-Japanese foreigners. The frequency of reported drug injection was: Few
(1-3) times per year 17.9% (95% CI = 12.3%-24.9%); Once/week or Once/month
27.6% (95% Cl = 20.7%-35.3%); Once a day 15.4% (95% Cl = 10.1%-22.0%);
Several times/day or more 39.1% (95% Cl = 31.4%-47.2%). Some 88% (95%
Cl = 81.7%-93.6%) reported sharing needles/syringes in the past 12 months.
Only 61% (95% Cl = 52.9%-69.3%) knew of the HIV risk from sharing needles.
Reasons for sharing included that clean needles/syringes are hard to get (26%),
trusting a water rinse (26%), and too much of a hurry (23%). Unprotected sex
with CSWs was 80%, 40% with MSMs. 40% (95% CI = 31.7%-47.9%) had had
an HIV test, and, surprisingly, 2% (95% Cl = 0.4%-5.8%) reported being HIV
seropositive.
Conclusion: The absence of officially reported HIV in the IDU population is
deceptively reassuring, and may be reporting bias. It also lulls health officials
into a false sense of security. If the HIV risk behavior, i.e., sharing needles and
unprotected sex, is common as shown here, then when HIV does penetrate the
IDU population, the epidemic can spread explosively. Thus, risk behavior, rather
than reported HIV seroprevalence, should become the focus of research in the
earliest phases of an epidemic, such as in Japan.
123184 Epidemiology of drug abuse-related HIV in Russia;
Related research issues
Peter Hartsock1, A.P. Kozlov2. 1National Inst. on Drug Abuse, 5600 Fishers
Lane, Rockville, MD, USA; 2Biomedical Center on AIDS, St Petersburg, Russia
Issue: Rapid rise in wider range of HIV subtypes (A, B, and C) in Russian drug
users as compared with other countries (e.g., primarily subtype B in US) makes
advisable international collaborative epidemiologic and prevention research with
Russia.
Project: Cooperative Russian-US analysis of epidemiologic data describe a
pattern of precipitous increase of HIV in Russia and especially among injection
drug users (IDUs). Between 1987 and 1995, 1062 cases of HIV infection were
diagnosed in Russia; 3 cases were attributed to injecting drug use. In 1996,
1526 new cases were diagnosed; 90% were IDUs. By July 1, 1997, there had
been a total of 4830 HIV cases diagnosed in Russia; more than 90% were IDUs.
Understanding epidemiology of HIV subtypes in Russian IDUs is important for
prevention.
Results: Based on epidemiologic analysis of HIV among Russian IDUs, it is
important to conduct research efforts which link epidemiologic and prevention
needs (1) to better document the epidemiology of HIV in drug using populations
and, using these improved epidemiologic data, (2) to develop effective public
health prevention efforts which reflect both the heterogeneity of HIV subtypes, the
disparate demographic composition of the populations at risk for HIV across Russia, and economic constraints. Important to compare Russian research findings
with those of other countries to improve international prevention efforts.
Lessons Learned: Rapid rise of drug abuse-related HIV subtypes in Russia necessitates increased international cooperative research for better understanding
of epidemiology and prevention issues. Russian-US efforts are already underway.
23185 | Selection bias in needle exchange participation as
observed in two cohorts of injection drug users
Colin Flynn1, M.B. Junge2, E. Riley2, S. Cohn3, P. Beilenson4, D. Vlahov2.
1Maryland AIDS Administration 500 N. Calvert St. Baltimore MD 21201; 2John
Hopkins University Baltimore MD; 3Research Triangle Institute Rockville MD;
Background: To identify characteristics of injection drug users (IDUs) that do
or do not choose to participate in needle exchange programs (NEPs) using 2
cohorts, 1 recruited prior to and 1 recruited during NEP startup.
Methods: The ALIVE study of the natural history of HIV enrolled 2911 IDUs
in Baltimore, Maryland, during 1988-89. Data is collected semiannually on demographics, health history, medical utilization, drug use, and sexual behavior. In
1994 the Baltimore City Health Department began an NEP that provided a legal
source of clean, free needles. Enrollment reopened in ALIVE during the first year
of the NEP (N = 391 recruits), and included direct recruitment of NEP participants.
Results are presented for the 1180 original and 369 new ALIVE recruits with a
visit during the first year of the NEP.
Results: New recruits were younger (mean age 36 vs. 40, p < 0.001), more
likely to be female (33% vs. 22%, p < 0.001), and more likely to enroll in the NEP
(48% vs. 33%, p < 0.001) than the original recruits. Differences in age and gender
remained when stratifying by enrollment in NEP. In both cohorts, self-reported

IDU during the last six months was highly predictive of NEP enrollment. Among
those currently injecting, the rate of NEP participation increased with increasing
frequency of drug injection (for 3+ injections per day, original recruits were twice
as likely and new recruits were three times as likely to enroll as those injecting
less than daily). Other variables such as unemployment, jail time, homelessness,
not living with children, sex with an IDU, cigarette, and alcohol use during the last
six months were also predictive of NEP enrollment.

Conclusions: This study showed that persons enrolling in NEP were high
frequency drug users with high levels of other risk factors. The NEP successfully
enrolled the population most in need of its services, however, it then becomes
difficult to identify an appropriate comparison group for evaluation of program
effect. Caution must be used in selecting populations for evaluating NEPs and in
interpreting the results.
S23186 Home-made drugs as an active factor of HIV
transmission in Russia
Vasily Bolekhan, E.I. Zmushko. Lebedeva Str. 6 Saint-Petersburg 194044, AIDS
Department, Medico-Military Academy, Russia
The most available and wide-spread narcotics in Russia are home-made drug
compounds that contain along with the main drug substance a great amount
of toxic components. These narcotics include opium preparations obtained by
means of primitive technique from the poppy straw. Clinical analysis of these
preparations shows that opium alkaloids account for only 37% of the obtained
substance while the other 63% are presented by toxic products. In order to neutralize these toxins, the clandestine drug manufacturers utilize different chemical
agents. Sometimes, in the absence of such agent they use human blood that
possesses a good absorption property. The profitableness of it's usage is obvious,
as far as every 1 ml of acetic anhydride bought illegally costs 1$. At the same
time human blood is much cheaper as it may be either an own one or taken from
the nearest neighborhood. Purification of the drug obtained from one glass of
poppy straw requires the usage of several drops or 4-5 ml of fresh blood. Since
drug addicts are predominantly pushers as well, the risk of contamination of the
drug via infected blood is rather high. The chance to got infection even after a
single injection of this drug tends to be maximal.
Apart from the well-known factors such as the lack of individual containers, syringes and needles, contaminated drug presents an active and the most significant
factor of parenteral HIV-infection transmission epidemiology.
123187 1New sharing partners encounter places among needle
exchange attenders
Francois Lamothe1, J. Bruneau2, E. Franco2, N. Lachance', J. Vincelette'.
SChum Saint - Luc 1058 Saint - Denis, Montreal QC; 2McGill University, Montreal
QC, Canada
Background: Because higher rates of HIV seroconversions have been documented among injection drug users (IDUs) attending needle exchange programs
in Montreal, (Bruneau J et al, Am J Epidemiol 146: 994-1002), the possibility
that NEP facilitate encounters with new sharing partners among attenders was
explored.
Methods: From February 1996 to June 1997, interviews were conducted
among IDUs recruited and followed in an open prospective cohort, probing for
NEP frequentation, provision and use of syringes and new sharing partners
encounter places.
Results: Of the 446 IDUs reporting having attended NEP at least once in the
past 3 to 6 months 116 (26%) were positive for HIV. 71% of all subjects reported
having attended NEP in the last month for their own needs, and secondary
distribution was frequent: 21% obtaining syringes from another attender and 27%
for somebody else. More than 5 visits at NEP in the past month were reported by
19% of IDUs. The mean number of syringes obtained in the past month was 50
(range 1-1600) for self needs, 29 (1-360) from another attender and 44 (1-800)
for somebody else with no difference according to HIV status. Of all subjects,
248 (56%) reported having a new sharing partner in the past 3 to 6 months. Most
frequent encounter places for these new partners were: the street (18.5%), the
immediate neighbourhood (17.7%), home (13.3%), while NEP only accounted for
3.6% and pharmacies for 2.4%. Encounter places differed for HIV positive and
HIV negative subjects: street (40.5% vs 14.7%), immediate neighbourhood (5.4%
vs 19.9%), other sites (54. 1% vs 65.4%) (p < 0.001).
Conclusion: NEP are attended by high risk active IDUs and secondary distribution of clean syringes is widely practiced. The street is the major encounter
place for new sharing partners and these results suggest that NEP do not play a
role as an encounter site for new sharing partners.
[23188 Assessing and responding to HIV infection associated
with injecting drug use
Martin Donoghoe1, A. Ball1, C. Fitch2, S. Rana', T. Rhodes2, G. Stimpson2,
G. Weller'. ' WHO, Geneva, Switzerland; 2The Centre for Research on Drugs,
London, UK
Issue: The shared use of injection equipment has a critical role in HIV epidemics
in many countries and regions of the world.
Project: The WHO Programme on Substance Abuse Drug Injecting Project
Phase II assesses HIV/AIDS and other health risks associated with injecting
drug use, in order to prevent and reduce HIV transmission and other adverse

health consequences of injecting drug use, through specific interventions and the
strengthening of local, national and regional assessment and response capacity,
particularly in developing countries and countries in transition. The project aims
to develop instruments and methods for an ongoing process of assessment and
response development.
Results: WHO, and its international and country collaborators, are developing
and testing innovative quantitative and qualitative research, assessment and