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

388 Abstracts 23233-23237

12th World AIDS Conference

95 of them (65%) has never been in contact with treatment agencies and can
therefore be considered as a "hidden population".
Results: Self-reported HIV prevalence is lower in the group of the "hidden"
recent-onset users (1%) in comparison to the general sample (7%). Of those
"hidden" recent-onset users who have already injected, 21% say they already
injected with unsterile injection material. And 5% of those who are actually using
drugs by injection said they did so in the 6 months prior to interview. Condom
use with occasional sexual partners is similar to the general population. "Hidden"
recent-onset users who inject, do not report specific difficulties of obtaining sterile
needles and syringes. They get their syringes mainly from chemist's shops and
not from needle exchanges schemes.
Conclusion: Recent-onset and young drug users in Switzerland are not at a
significantly higher risk for HIV infection than other drug users. Accessibility of
clean injection material is to be kept high.
23233 High rate of HIV infection in homeless young injectors:
Sex poses greatest risk
Judith Hahn1, Kimberly Shafer2, A.R. Moss3. 1995 Potrero Ave. Ward 95 Room
513 SanFrancisco California 94110; 2UCSF Center for AIDS Prevention Studies
San Francisco CA; 3University of California San Francisco CA, USA
Objectives: Heroin and amphetamine injection are spreading among young
people in the US. We examined HIV infection in homeless injection drug users
(YIDUs).
Methods: In 1990-94, we studied HIV infection in homeless persons in San
Francisco in serial cross sectional studies. We report HIV prevalence and univariate and multivariate risk factors among homeless injectors aged <30 (YIDUs),
compared to older injectors.
Results: Median age was 26 vs 39 in the two groups, median years injecting
were 6 and 17. The prevalence of HIV infection in YIDUs was 15% (n = 126) vs
14% in those > = 30 (n = 843). YIDUs were more likely to be white rather than
African American or other nonwhite (62% vs 43%, p =.001). They were more
likely to be living on the streets (36% vs 13%, p = 0.001), to be currently injecting
(37% vs 25%, p = 0.006), and to inject amphetamines (54% vs 41%, p = 0.05).
Male young injectors were more likely to have sex with men (39% vs 27%, p =
0.01), to have 2 or more sexual partners in the prior year (26% vs 12%, p <
0.001), and to have sold sex for money (24% vs 10%, p < 0.001). YIDUs were
also more likely to have had sex with another injector in the prior year (47% vs
37%, p = 0.03). Equal proportions had used needle exchange, recently shared
needles, recently used crack, and used alcohol frequently. A stepwise logistic
regression model showed that among young injectors, current sexual activity but
not current drug use was associated with HIV infection.
Independent predictors of HIV among homeless injectors <30, identified by stepwise regression.
Variable Adjusted OR 95% Cl p-value
# of same sex partners
2-4 vs 0-1 8.6 2.1-34.9 <0.01
< = 5 vs 0-1 10.5 2.6-42.3 <0.01
Sex with injector(s) 4.3 1.1-17.5 0.04
Conclusions: Young injectors, with shorter injection histories but more high-risk drug use and sexual behaviors, had the same rate of HIV infection as
older injectors. Unsafe sex may be the greatest source of risk among young
injectors.
23234 Is a voluntary confidential HIV test associated with
reduced HIV risk factors amongst uninfected injecting
drug users?
Vivian David Hope1, P.A. Rogers2, T.L. Lamagni3, J.V. Parry4, O.N. Gill3. 1PHLS
AIDS and Centre, Communicable Disease Surveillance Centre 61 Colindale
Avenue, London NW9 5EQ; 2PHLS Statistics Unit, London; 3PHLS AIDS & STD
Centre, CDSC, London; 4Central Public Health Laboratory, London, UK
Background: Past HIV risk behaviour may increase the uptake of voluntary confidential (VC) HIV testing, whilst current risk behaviours may be modified following
a VC test. A large sample of HIV negative injecting drug users (IDUs) recruited in
an ongoing survey provided an opportunity to examine these issues.
Methods: Questionnaires and saliva samples were collected from current and
former IDUs attending specialist agencies throughout England and Wales as
part of the Unlinked Anonymous HIV Prevalence Monitoring Programme. Saliva
samples were tested anonymously for anti-HIV and the questionnaire collected
self-reports of VC testing for HIV, risk behaviours and demographic characteristics. The data were analysed using logistic regression, separately by gender, with
past VC HIV testing as the outcome variable.
Results: During 1995-96, 6300 completed survey kits were returned; of these
62 (1%) tested positive for anti-HIV. Of the 5847 anti-HIV negative IDUs who
provided information on past VC HIV testing 52% had had a test. Of the 1595

recruited in 1996 who reported having a VC test 75% had their last test during
the previous 3 years. Having had a VC test was associated with increased risk
factors in the past, such as longer time injecting and ever receiving used needles/syringes, in men but this was less clear for women. Current risk behaviour
was examined by looking at injecting in the previous 4 weeks (31% had not),
sharing needles/syringes among current injectors (18% had), number of sexual
partners in last year (31% had 2 or more), and condom use (16% always used).

Multi-variable analysis shows that VC testing was generally not associated with
current risk behaviours, although those sharing needles/syringes were less likely
to be tested. Men who currently injected were more likely to have been tested
than those who did not.
Conclusions: A half of anti-HIV negative IDUs attending drug agencies have
had a voluntary confidential (VC) HIV test. Having had a VC HIV test was associated with increased risk taking in the past but was not associated with diminished
current risk behaviour. Further promotion of testing may contribute little to preventing HIV transmission. These observations, however, could be biased as former
injectors, who may have ceased injecting due to a VC test, will not necessarily be
in contact with drug services.
232351 HIV serostatus and STD risks in the collaborative
injection drug users studies (CIDUS)
Edgar R. Monterroso1, S. Holmberg2, J. Wu2, J. von Bargen2. 11600 Clifton Rd
NE MS-E45 Atlanta, GA; 2CDC Atlanta GA, USA
Objectives: To determine risks for STD transmission among high-risk, streetrecruited injection drug users (IDUs) at seven US study sites (Baltimore, New
York [2], Connecticut, Chicago, San Jose, and Los Angeles County).
Methods: Participants were recruited by street recruiters using "snowball"
techniques, interviewed with a standard questionnaire, and asked to return for
follow-up. HIV serostatus was determined at each visit and, at three sites, by
syphilis serostatus rapid plasma reagin (RPR).
Results: At baseline, 3,771 participants were recruited. Mean age participants
was of 37 years; 36% were female; 39% African American, 33% Hispanic, 25%
white; 49% single. Seroprevalence rate for HIV was 13% and, for three sites,
syphilis was 16%. Participants who tested HIV-positive were more likely to have
had sex with an HIV-positive person (odds ratio [OR], 5.4; 95% confidence interval
[CI], 4.1-7.1); to have had an STD (OR, 2.0; 95% CI, 1.5-2.7); to have current
genital/anus ulcer or discharge (OR, 2.0, 95% CI 1.3-2.4); to have ever having
received drugs or money for sex (OR, 1.3, 95% CI 1.0-1.7); or, to be gay/bisexual
males (OR, 2.1, 95% CI 1.5-3.0).
Conclusion: IDUs who may share needles should also be considered at risk
for sexual acquisition and transmission of HIV. STD control measures, such as
treatment and condom usage, should be encouraged by all programs for IDUs.
Conversely, STD programs should not forget other risk behaviors and should
encourage IDUs in safe injection practices.
23236 | Reducing risk behaviors among injecting drug users in
the Rhode Island Needle Exchange Program
Kai-Lih Liu1, P.G.L. Loberti1, L.F.M. Minuto1, B.E.L. Lindberg2,
M.R.R. Reyes-Slopes'. ' Rhode Island Department of Health, Providence; 2Data
of Rhode Island, Providence, USA
Objectives: To evaluate the short-term harm-reduction effects of a needle exchange program on the risk behaviors of injecting drug users.
Methods: The RHode Island ENCORE (Education, Needle Exchange, Counseling, Outreach, and Referral) program has been administered by the Rhode
Island Department of Health since April 1995. Two-stage client interviews were
conducted at the time of enrollment and at least one month after enrollment.
Results: The demographic distribution of 123 clients who have completed
two-stage interviews was similiar to the entire enrollment of 602 clients. After
being enrolled in the program at least thirty days, the proportion of clients who
disposed used needles int the trash, toilet and ground dropped from 70.5% to
16.4%. The proportion of clients who reported sharing behaviors in the past thirty
days decreased from 52.6% to 30.2% after enrollment (Chi-square = 15.1, p <.001) After comparing the pre and post interview results, the means of pre-post
differences in the frequencies of sharing works, shooting drugs, reusing works,
and cooker sharing in the past thirty days were -5.45 (S.E.: 6.34), -0.93 (S.E.:
7.05), -12.0 (S.E.: 2.45), and -1.91 (S.E.: 5.84) times, respectively. However,
only the mean of pre-post difference in reusing works was statistically significant
(paired t-test = -4.9, p <.0001).
Conclusion: The short-term harm-reduction effects were a decrease in unsafe needle disposals, sharing behavior, and frequency of reusing works among
active needle exchange clients. Further follow-up on client behaviors, drug treatment referrals, and case management is needed to evaluate the long-term harm
reduction in injecting drug users.
23237 1Life points: Creating a needle exchange program for HIV
H.G. Simpson. Community Health Awareness Group, 3028 E. Grand Blvd.
Detroit, MI, USA
Objective: To create a needle exchange program in a metropolitan area with an
estimated 30,000 injection drug users.
Project: One of ten areas of highest drug use in the entire world, Detroit established a city-sanctioned needle exchange program funded by private sources

and with the full cooperation of the City of Detroit and its department of health.
Included are strategies for changing public policy, creating a one-for-one needle
exchange, policies of street distribution and use of the harm reduction model. Of
special significance to North and South where injection drug use accounts for up
to 50% of all new infections.
Results: Harm reduction strategy has improved the quality of life for injection
drug users. Within 12 months, the number of needles exchanged exceeded the