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

12th World AIDS Conference

Abstracts 23228-23232 387

Methods: Twenty-five drug use, needle use, and sexual behavior variables
were used to develop the typology using the Ward & Hook and the iterative
K-means cluster analysis procedures over two subsamples of the National AIDS
Demonstration Research Projects (NADR) data (n = 22,929). The IDU types were
further analyzed for their socio-demographic profile using chi-square analysis
and ANOVA with Scheffe's post-hoc test, for nominal and continuos variables
respectively.
Results: A concordant solution of 6 distinct IDU types evolved over the two
clustering techniques, as well as the two data samples. Certain behaviors were
found to be common among all the types including the use of alcohol, marijuana,,
injected use of cocaine, the use of dirty/used needles, the sharing of atleast
cooker/cotton/rinse water, and inconsistent condom use. The types did vary on
the number of drugs they primarily injected, the form of injection equipment
they shared, the type and number of partners they shared with, the number of
partners they had sex with, as well as the different forms of sexual behavior they
indulged with or without condoms. The level of risk for HIV infection varies for the
derived IDU types depending upon their pattern of HIV-risk behaviors practiced.
Examination of the typology by socio-demographic variables revealed that the
IDU types statistically differed in their racial composition, employment status and
major source of income, previous participation in drug-treatment programs, travel
and risk behaviors; no difference was found between types on their baseline AIDS
information score.
Conclusions: Differences between IDU types in their risk-behavior patterns
and their socio-demographic make-up, suggest the need for developing creative
interventions addressing these differences. Similarities between IDU types in
some behaviors including the sharing of injection equipment and the use of dirty
needles, suggest the need for a broader change in policies and laws concerning the availability of new injection equipment and the possession of injection
equipment on one's self.
123228 Drug using behaviors of young and recent initiate
injection drug users in New York City: A unique
opportunity for prevention of HIV
Theresa Diaz1, S. Conover1, V. Edwards1, E. Monterroso2, E. Susser1. 1New
York Academy of Medicine 1216 Fifth Avenue NY 10029; 2Center for Disease
Control and Prevention, USA
Background: Young and recent initiate injection drug users (IDUs) may be likely
to practice risky drug using behaviors. We examined drug using behaviors among
a group of young and recent initiate IDUs in Harlem, NY to determine effective
HIV prevention measures.
Methods: As part of a multi-site cohort study we interviewed street-recruited
IDUs, who were between 18 to 29 years old or had injected drugs for <3 years
(recent), to assess HIV infection risks. We analyzed drug use behaviors and HIV
results from baseline interviews and blood tests.
Results: One hundred IDUs were interviewed from October 1997 to January
1998; mean age was 25 years; 68% were male; 77% were either African American or Latino; and 35% had injected for <3 years. Overall, 7% had tested HIV
positive; none of the recent IDUs tested positive for HIV. Although 86% of all
respondents reported that it was easy to get new needles, 57% had gotten a new
needle once a week or less in the past 6 months. More of the 35 recent IDUs
obtained a new needle once a week or less than the 65 longer term IDUs (65%
vs. 45%, p < 0.05). Most new needles were obtained from a needle exchange
program (38%) or needle dealer (28%). In the past 6 months, 23% of all IDUs
had used a needle after someone else (half the time or greater); women (n = 23)
were more likely to use used needles than were men (n = 77; 37% vs. 20%; p
< 0.05). Sixty eight percent of the 23 IDUs who shared did so because that was
the only needle available. Other risky behaviors practiced (half the time or more)
in the past 6 months among all IDUs included: drawing from the same cooker
(27%), using the same cotton (25%), and using the same rinse water (19%).
Conclusion: In our study, one quarter or more of young or recent initiate IDUs
in Harlem practiced risky drug using behaviors such as sharing needles and
paraphernalia. Interventions targeted to this group could have a dramatic impact
in preventing HIV transmission, particularly because recent IDUs have not yet
contracted HIV infection.
23229 Two-year follow-up of HIV risk behaviors among
participants in the Baltimore Syringe Exchange Program
Elise Riley1, D. Vlahov2, B. Junge2, S. Huettner2, P. Beilenson3. 1627 N.
Washington Street Baltimore, Maryland 21205; 2Johns Hopkins School Pub
Health Baltimore, MD; 3Baltimore Health Department Baltimore, MD, USA
Objective: To compare baseline and 24 month reported HIV risk behavior among
participants of the Baltimore Syringe Exchange Program.
Methods: During the first year of operations, 15% of new enrolles were recruited into an evaluation study and interviewed at six month intervals on current
drug and syringe use behaviors. This analysis is based on participants who
completed baseline and 24 month interviews. Data were analyzed using paired

t-tests and chi-square statistics.
Results: Of 1,765 participants who registered within the first six months, 319
(18%) enrolled into the evaluation, and 74 (23% of 319) returned for 24 monthinterviews. The sample was 75% male, 89% African-American, 92% unemployed,
32% HIV seropositive, and mean age was 40 years. From baseline to 24 months,
mean daily injection frequency decreased from 5.6 to 4.1 (p < 0.01) and injections
per syringe decreased from 11 to 3 (p < 0.01). Giving away used syringes de
creased from 15% to 8% (p < 0.01); drug-, cooker-, or cotton-sharing decreased
from 36% to 25% (p < 0.01); and injection with another person's used needles did
not change significantly. The percentage of participants enrolled in drug treatment
rose from 7% to 24% (p = 0.016).
Conclusions: Although a modest number of persons remained in the evaluation for 2 years, this is one of the longest follow up periods of syringe exchange
participants to date. These findings are consistent with previous reports of behavioral risk reduction among syringe exchangers, and suggest long-term efficacy of
syringe exchange as an HIV prevention measure.
1 232301 Harm reduction programmes for injectable drug users in
Porto Alegre - An experience report
Domiciano Siqueira. Joao Pessoa 325, 90040-000 - Porto Alegre, Brazil
Issues: Porto ALegre is the third capital city in Brazil in number of notified AIDS
cases. 31% of these cases are due to the use of injectable drugs. Abstinence as a
way of preventing AIDS is a slow method while AIDS spreads quickly among this
population. For this reason, the harm reduction needle exchange approach has
been chosen as a way of directly intervening in the sharing of equipements for
the use of injectable drugs, for this behaviour accounts for the highest exposure
to risk.
Project: The intervention method chosen was to contact IDUs in places with
high rates of drug dealingand use. Reducers go to the slums and deprived neighborhoods and find inhabitants (spontaneous agents) who are willing to participate
in the project distributing and collecting needles in the times with the highest use
rate, often times when the reducerr is not present.
Results: Data show that as needle distribution increases, needle exchange
increases, thus decreasing the difference between one and the other, The average time to implement the project in an area is around 3 months, and within this
period 50% of the needles distributed are return.
Lesson Learned: From the date obtained in our work we can say that the
return rates of the needles and the average time to enter into the IDUs network
is related to the fact that we have spontaneous agents in the field 24 hours a day
and to the profile of our reducers in relation to drug use, which makes contact
easier.
S23231 HIV-1 and HTLV infection in northeast Brazil: Differences
for male and female intravenous drug users
In6s Dourado1, T. Andrade2, B. Galvao-Castro3. 1Health Collective
Institute/UFBA, R. Padre Feijo-29-4o-Andar-Canela, Salvador-Bahia; 2Study
Center for Drug Abuse/UFBA; 3LASP/CPqGM/Fio Cruz, Salvador BA, Brazil
Objectives: To investigate sex-specific risk factors for human retroviruses infection among intravenous drug users, we conducted a study in the Historical District
of Salvador, Brazil, from 1994-1996.
Design: Cross-sectional.
Methods: 216 asymptomatic IVDUs was selected using snowball contact technique. Risk factor data were obtained from interviews conducted at the Drug
Abuse Center. Blood samples were collected for serological assays. Sera were
screened for HIV-1/2 and HTLV-I and II antibodies by ELISA and confirmed by
Western blot.
Results: The prevalence of HIV-1, HTLV-I and HTLV-II was 44.1%, 22.0% and
11.3% for males and 74.4%, 46.2% and 10.3% for females respectively. Using
univariate analysis, the variables which were significantly associated with HIV-1 infection among males included duration of IVDU, reutilization of needles/syringes,
HTLV-1 and HTLV-II infection and history of syphilis. Among women, only duration
of IVDU was associated with HIV-1 infection. Variables which were significantly
associated with HTLV-I infection among males involved needle sharing practices,
duration of IVDU, HIV-1 seropositivity and syphilis. Most of these risk factors were
associated with HTLV-I infection among women, except needle sharing practices
and HIV-1 seropositivity. Using logistic regression technique, HTLV-I infection and
history of syphilis was significantly associated with HIV-1 infection among males
but no variable reached a statistically significant association among females. On
the other hand, duration of injecting drug use was significantly associated with
HTLV-I infection among females.
Conclusions: We found high seroprevalence of HIV-1 and HTLV-I among
IVDUs in Salvador, Brazil. The prevalence of HTLV-I was higher than HTLV-II
among males and females. The small sample size specially for females may
have limited ability to ascertain differences in HIV-1 and HTLV-I seroprevalence
according to gender.
| 23232 1 HIV-risk and prevention needs for young and
recent-onset drug users outside treatment settings
Daniel Kuebler, Dominique Hausser, D. HAUSSER. IREC/Swiss Federal
Institute of Technology, rPO. Box 555, Lausanne, Switzerland
Objectives: Recent research has identified young and recent-onset users of co
caine and/or heroin as a population which is particularly at risk for HIV-infections.
The aim of this presentation is to assess HIV-risk behaviour of recent-onset and
young users of heroin and/or cocaine in Switzerland who are not in contact with
treatment agencies and discuss eventual needs for specific intervention.
Methods: In the context of the first Swiss Hidden Population Study, 917 users
of heroin and/or cocaine have been recruited outside treatment contexts. 145
(15%) of the respondents can be considered as recent-onset and young users.