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

382 Abstracts 23202-23206

12th World AIDS Conference

23202 Younger female injection drug users report higher risks
for HIV and drug-related harm in San Francisco
Paula J. Lum1, J.R. Guydish1, E. Brown1, R. Allen2. 1UCSF CTR for AIDS
Prevention Studies San Francisco, 74 New Montgomery Street, #600 San
Francisco, California 94105; 2SF AIDS FDN, HIV Prevention Project San
Francisco CA, USA
Objectives: To compare HIV and drug use-related risk behavior between younger
and older female injection drug users (IDUs), who attend needle exchange programs (NEPs) in San Francisco.
Methods: We conducted a cross-sectional, observational study. A random
sample of 150 female IDUs was recruited from all NEP sites in San Francisco.
Women were interviewed using quantitative and qualitative methods. Responses
were stratified by age: women age < 30 (N = 41) and age > 30 (N = 109).
Results: 80% of eligible subjects agreed to participate. Mean ages were 24
and 42 years. Younger women were more likely to be white, to have an IDU parent
(34% vs. 10%; p =.001), to begin injecting at an earlier age (mean = 18 vs. 23; p
=.0003), and to report a drug overdose in the last 12 months (34% vs. 14%; p =.001). They were more likely to own fewer (<30) needles (78% vs. 62%; p <.02)
and to use a needle more than once before exchanging it (85% vs. 60%; p =.003).
Younger women were also more likely to report multiple needle-sharing occasions
and partners (see below). Furthermore, when using with a main injecting partner,
they were more likely to share needles (74% vs. 31%; p =.001) and to inject
second (74% vs. 38%; p =.003). Finally, younger women were less likely to have
taken an HIV test (90% vs. 98%; p <.03), received condoms or vitamins at the
NEP (p <.01), or engaged in conversation with staff at NEP sites (56% vs. 72%;
p <.05).

Needle sharing behavior in last 30 days
Needle-sharing occasions 0
1-5
>5
Needle-sharing partners 0
1

Age < 30
18
12
11
18
13
9

%
44
29
27
45
33
23

Age > 30
80
13
16
80
24
5

%
73
12
15
73
22
5

Conclusions: (1) Younger female injection drug users recruited from needle
exchange programs in San Francisco report higher injection risks for HIV and
other drug-related harm. (2) Needle exchange programs should target expanded
outreach efforts and HIV prevention interventions at younger injection drug-using
women.
23203 Modeling HIV transmission risk in non-intravenous drug
injectors
Robert Heimer1, J.M. Carney', N. Abdala1, J.D. Rich2, B.P. Wilkinson2,
A.E. Fisher3. Yale University School of Medicine 60 College St POB 208034
New Haven Connecticut 06520-8034; 2Mirriam Hospital and Brown University
Province RI; 3Stratogen Health Center Providence RI, USA
Background: While it is well established that intravenous drag injectors are a
great risk for HIV infection, reports of HIV infection among subcutaneous (skin
poppers) and intramuscular (steroid) injectors remain anecdotal. We simulated
and evaluated the risk of HIV transmission attendant upon sharing syringes with
non-intravenous drag injectors.
Methods: Syringes were collected following use for medically indicated subcutaneous or intramuscular injection of individuals known to be infected with HIV-1.
The contents of these syringes were extracted and analyzed for the presence of
antibodies to HIV-1 (by enzyme immunoassay), HIV-1 proviral DNA and human
(/-globin) DNA (by nested polymerase chain reaction; PCR), and HIV-1 viral
RNA (by nested RT-PCR). The sensitivity of each assay was determined to allow
estimation of potentially infectious material within syringes.
Results: No syringes were positive for HIV or f-globin DNA or HIV RNA. A
small number (16 of 260; 6.2%) were positive for antibodies to HIV-1. There was
no significant difference in the percentage of syringes positive for antibodies to
HIV-1 by site of injection. The limits of detection for HIV-1 antibody, for globin DNA,
and for HIV-1 RNA were, respectively, less than 0.001 /il of blood, 32 cells, 1 copy
of HIV-1 DNA, and <80 copies of HIV RNA. Based on these limits, syringes used
for subcutaneous or intramuscular injection may, on occasion contain <0.005 fl1
blood. However, no syringes appear to contain >0.005 Il blood.
Conclusions: Failure to recover either HIV viral RNA or proviral or P-globin
DNA from used syringes suggests that individuals with viral loads <200,000 are
unlikely to create potentially infectious syringes by non-intravenous drag injection.
Syringe sharing among non-intravenous injectors appears to be a low risk, though
not risk-free, practice.
23204 1HIV prevention for adolescent IDUs at a storefront needle
exchange program in Hollywood, CA
Michele D. Kipke1, Renee Edgington2, R.L. Weiker3, M. Albornoz3. 1National
Academy of Sciences IOM, 2101 Constitution Ave. HA 156, Washington DC
20418; 2Harm Reduction Central, Hollywood CA; 3Childrens Hospital Los
Angeles CA, USA
Background: While a growing number of studies have begun to demonstrate the
efficacy of HIV prevention and harm reduction interventions targeted to injection
drug using (IDU) adults, no comparable research has been conducted with youth

who are IDUs. We conducted a multi-method study of HIV prevention and harm
reduction interventions targeted to youth ages 24 and younger to evaluate the
impact of Harm Reduction Central's (HRC) innovative needle exchange program
(NEP).
Methods: The multi-method evaluation included documentation of program
utilization by each youth participant (N = 889), and a cross-sectional survey
with a sample of participants (N = 97). Descriptive statistics were computed
for all variables in the structured survey instrument. Chi-square analyses were
performed to determine which independent variables to include in the multivariate
model. Logistic regression analyses were performed and odds ratios and 95%
confidence intervals were computed.
Results: This evaluation provided information about the relationship between
NEP utilization and injection-related HIV risk behavior of young IDUs enrolled in
the largest youth NEP in North America. Of those youth who had ever injected,
29% had shared needles in the last 30 days. Respondents who used the needle
exchange five or more times in the past six months (OR = 0.3) were less likely to
have shared needles in the past 30 days. Those youth who exchanged needles
for themselves (OR = 18.9), and who had used the needle exchange five or more
times in the past 6 months (OR = 13.1) were more likely to score high on our
access to safe needles index. Youth received a point on the index for: obtaining
their needles through the NEP, having their own needles, considering it "easy" to
get new ones, and using a needle one time only.
Conclusions: Youth and young adults ages 12-24 years make up a substantial
portion of HRC's participants. Youth who were consistent users of HRC's services
were able to access and use clean needles more readily than those youth who
used HRC less frequently. They were also less likely to have shared needles in
the last 30 days.
23205 1Psychosocial antecedents of sexual risk reduction by
drug-injecting men and women
Douglas Longshore. UCLA Drug Abuse Research Center, 1100 Glendon Ave
#763, Los Angeles, CA, USA
Objective: To identify and compare psychosocial antecedents of sexual risk
reduction among drug-using men and women.
Design: Multivariate analysis of prospective dataset.
Methods: The sample was composed of 155 female and 134 male heterosexual adult injection drug users interviewed at baseline and one year later.
The AIDS risk reduction model, which depicts behavior change as a three-stage
process, guided selection of psychosocial factors to be tested and served as the
conceptual framework for analysis. The outcome measure was change in the
frequency of unprotected sex during the year after baseline. Psychosocial factors
tested as predictors of sexual risk reduction were: perceived risk of HIV infection,
AIDS knowledge, AIDS fear, AIDS education received, peer norms regarding
sexual risk reduction, self-efficacy for sexual risk reduction, response efficacy for
sexual risk reduction, and intention to use condoms.
Results: For both women and men, stronger intention to use condoms predicted subsequent reductions in unprotected sex. For women, but not men, higher
perceived self-efficacy also led to reductions in unprotected sex.
Conclusions: Explicit commitment to risk reduction is the most crucial psychosocial antecedent to sexual behavior change among drug-injecting men,
whereas commitment to risk reduction and perceived control over sexual risktaking are the two most crucial pathways to sexual behavior change among
drug-injecting women.
|23206 Risky injection practices, injection partner mixing and
sero-prevalence and seroincidence: Post-intervention
risk behavior changes
Richard Needle1, J. Normand1, J. Sonnefeld2, W. Scarbrough3, T. Gordon3.
Research Consrotium, NIDA Cooperative Agreement Program; 'NIDA/NIH,
Room 9A-42, 5600 Fishers Lane Rockville, MD 20857; 2R.O. W Sciences, Inc.,
Rockville, MD; 3CSR, Incorporated, Washington, DC;, USA
Objective: To assess post-intervention changes in risk behaviors among injection drug users (IDUs) following exposure to a community-based HIV prevention
intervention.
Design: Multi-site prospective quasi-experimental intervention field study.
Methods: 15,966 out-of-treatment IDUs were recruited in 23 US metropolitan
areas between 01/92-10/97 with a baseline seroprevalence 10%. Risk behaviors were assessed at baseline and 6-month followup. HIV seroconverters were
matched with controls. In addition to traditional measures of injection frequency
and multiperson reuse of syringes, risk was reconceptualized and operationalized to reflect historical changes in rates of reuse and the proportion of injection
episodes in which reuse occurs.
Results: Baseline data indicated that injection frequency, reuse, risky injection
practices and injection partner mixing are associated with HIV seroprevalence.
Significant post-intervention reductions were observed on all of these risk variables. The case-control incidence study reveals that only risky injection and
injection partner mixing were associated with HIV seroconversion. Post-interven
tion change data on these latter sensitive risk indicators will be presented in detail
and their viability as meaningful indicator discussed.
Conclusion: With the changing dynamics of the drug abuse and HIV epidemics
occurring (fewer reporting multiperson reuse of syringes), in part because of the
effectiveness of community-based interventions, risk has to be reconceptualized
and the interventions tailored to help IDUs decrease their risk of HIV infection.