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

12th World AIDS Conference

Abstracts 23238-23242 389

original estimate by 250%. Many IDUs have stopped injection, over 50% access
mobile site healthcare services.
(1) Public officials are strategic partners in establishment of needle exchange
programs; (2) Needle exchagne programs must offer auxiliary health services; (3)
trust gained by needle exchange workers leads to increased rehabilitation, and:
(4) former drug users often pioneer successful needle exchagne.
23238 Classification of drug users' skin lesions using
photographs: A method for corroborating HIV risk
Henry Cagle, D.G. Fisher, A.R. Kastner, A.M. Fenaughty, R. Thurmond. IVDU
Project University of Alaska, 3211 Providence Drive Anchorage, AK 99508, USA
Issue: Among drug users, a major correlate of increased HIV risk may be the
presence of skin lesions resulting from injection drug use. When targeting drug
users for HIV risk reduction, distinguishing injection drug use lesions (i.e., needle
tracks) from lesions attributable to disease or other factors, may be an important
part of determining the most appropriate intervention. Yet, because standardized
identification methods do not exist, prevention workers may fail to correctly discern
needle tracks. The objective of this study is to develop a classification system for
drug users' skin lesions to serve as a tool for identifying needle tracks.
Method: In a National Institute on Drug Abuse-funded study of drug users in
Anchorage, Alaska, participants (N = 282) consented to have photos taken of skin
lesions purported to be needle tracks. Professionally trained staff used a Nikon
N6006 camera with a 105mm micro lens. A practicing dermatologist viewed each
photo and determined a classification based upon how consistent the lesion was
with injection drug use; photos were grouped using a pile sorting method.
Results: Six classifications were developed (ranked from most to least consistent). 1. Recent and Old (23%): lesions that appear recent (e.g., inflammation,
infection, or nonhealed puncture wounds) paired with evidence (e.g., scars, old
granulomas, atrophy, or pigment changes) at multiple locations. 2. Recent (25%):
lesions that appear new (e.g., scabs, punctures, acute or subacute inflammation,
thrombosis with wounds, abscesses, or granulomas). 3. Old (40%): includes
scars, atrophy, hyper- or hypo-pigmentation, pigmented granulomas, or noninflamed thrombosis. 4. Conflictive (1%): lesion characteristics are indiscernible.
5. Unsure (1%): photos too close or insufficient evidence. 6. Inconsistent (10%)
lesions not injection sites or insufficient evidence.
Conclusions: Study findings suggest that the development and utilization of a
classification system for discerning needle tracks may be a helpful way for HIV
prevention workers to determine the most appropriate intervention for injection
drug users and their sex partners. These findings may also have implications for
researchers targeting injection drug users for recruitment into vaccine trials and
other research. Research is ongoing to evaluate interrater reliability of this system
and determine potential validity measures.
123239 HIV-risk behaviour and prevention for injecting drug
users: Are women more at risk?
Dominique Hausser, D. Kuebler. IREC/Swiss Federal Institute of Technology,
P.O. Box 555, Lausanne, Switzerland
Objectives: Recent research has identified female injecting drug users as a population which is particularly at risk for HIV-infections. The aim of this presentation
is to assess HIV-risk behaviour of female injecting users of heroin and/or cocaine
in Switzerland, using a sample in which respondents have been recruited outside
treatment settings and helping services.
Methods: In the context of the first Swiss Hidden Population Study, 917 users
of heroin and/or cocaine have been recruited outside treatment contexts. 242
(26%) of the respondents have been injecting in the six months prior to interview.
52 of them (22%) are female.
Results: The women in our sample are younger than the men and they are
more likely to have a drug using partner. Self-reported HIV prevalence is not
significantly higher for women than for men. Women report more injections with
unsterile injection material (33%) than men (17%). Women are significantly less
using needle exchange schemes (46%) than men (72%). But women do not go
significantly more to chemist's shops for clean injection material. Condom use
with occasional sexual partners is the same for men and for women.
Conclusion: Women are more likely to share needles, mostly in the context
of a sexual relationship. The argument of protection against HIV is therefore
unlikely to produce effect on this behaviour. Nevertheless, there are plenty of
other good reasons not to share injection equipment. These should be continually
emphasised by prevention efforts.
| 23240 Finding young injectors in a conservative, suburban
environment
Lisa Carver', G.W. Harper2. 1633 Alma Avenue #12, Oakland, California 94610;
2De Paul University, Chicago, IL, USA
Issue: Initial data collection in a study of truant, homeless youth in a suburban,

Northern California community yielded little contact with young injectors although
it was suspected that there were many in the area.
Project: This study targeted truant, homeless youth ages 13-20 using an
anonymous survey. Due to the extreme secrecy surrounding injection drug use, it
was necessary to tap into multiple social networks of youth engaging in increasing
levels of risk behavior. The process of reaching young injectors took over one
year.

Results: Youth workers from the target population assisted in recruiting 677
youth, 130 (19.5%) of whom reported ever injecting drugs. Injectors were mostly
male (60%) and more likely to be white (p <.003). Compared to non-injectors,
injectors experienced higher rates of school suspension (50.8% vs. 20.5%, p <.033) and being kicked out of their home (63.1% vs. 29.9%, p <.001). Many lived
with older injectors. Injectors also reported higher rates of other drug use: cocaine
(63% vs. 18.5%, p <.001), ecstasy (47.7% vs. 18.3%, p <.001), heroin (54.6%
vs. 2.8%, p <.001) and speed (55.6% vs. 17.7%, p <.001) and sexual activity
including vaginal sex (91.3% vs. 84.1%, p <.008), anal sex (35.4% vs. 15.3%, p
<.001), and trading sex for money, drugs or shelter (26.2% vs. 10.1%, p <.001).
Police harassment has resulted in fear of syringe exchange and medical care.
Lessons Learned: The stigma concealing high numbers of young injectors in
this suburban area challenges traditional methods. Interventions must address
the underground population and be on multiple levels. Strategies must include
input from the affected community and assessment of networks. Additionally,
policy should be created to assure confidential, non-judgemental services.
23241 1 Physical characteristics of syringes turned in at the
Baltimore Needle Exchange Program
Beth Masters, Benjamin Junge, H. Farzadegan, D. Vlahov. 'Johns Hopkins
University 615 N Wolfe St (6614) Baltimore MD USA 21205, USA
Objectives: To examine physical characteristics of syringes turned in at the
Baltimore Needle Exchange Program (NEP) with respect to traits which might put
injectors at risk for skin abscesses and blood-borne pathogens.
Methods: Syringes returned in one day to the NEP were collected (n = 2,697)
and tagged with ID number of participant who returned the syringes and date/site
of return. A subset of participants turning in syringes had previously undergone
voluntary HIV testing. Each syringe was examined independently by two observers using a standardized scale (agreement = 74%), with respect to: residual
blood, dust, dirt, functionality of syringe, presence of needle and needle cap,
and whether the syringe originated from the NEP. Variables were cross-tabulated
by syringe status (NEP vs. non-NEP), transfer status and HIV status, using
chi-square statistics.
Results: The 2,697 syringes examined were collectively turned in by 97 individuals who were; 71% male, 91% African-American, 27% antibody-positive and
had a mean age of 41 years. Of the syringes 10% contained visible blood, 52%
had visible dust, 54% still had the needle intact, and 70% had a needle cap.
Compared to syringes from non-NEP sources, program syringes were more likely
to have visible blood (13% v. 9% p = < 0.003), the needle still intact (56% v. 52%
p = < 0.050) and a needle cap (73% v. 69% p = < 0.005). Syringes turned in
by individuals other than the original recipient were less likely to have the needle
intact (49% v. 71% p = < 0.0001) and the needle cap (68% v. 82% p = < 0.002)
compared to non-transferred syringes. HIV positive individuals were more likely
to turn in syringes with the needle still intact (79.1% v. 55.9% p = < 0.0001) and
the needle cap (82.4% v. 65.2%).
Conclusions: In this sample, risk of transmission of blood-borne infections
exists from program and non-program needles. Behaviors traditionally associated
with transmission from used needles include recapping and breaking off needles.
However, in the context of NEP where drug injectors must transport used needles,
recapping and breaking of needles continues to be practiced.
23242 1 Sexual behavior of persons addicted to narcotics
Zbigniew Izdebski, Agnieszka Walendzik. Pedagogical University Social
Pedagogy Institute Plac Slowiariski 25 65-625, Zielona Gora, Poland
Design: Research
Methods: Research made in the years 1996-1998 among persons addicted to
narcotics; authors: Zbigniew Izdebski and Agnieszka Walendzik
Results: In Poland, a new phenomenon in the surveyed population of the
addicted persons is the fact of benefiting of sexual service among drug-addicted
persons. It concerns exclusively men - over 30% of the surveyed persons admitted to have used such service. The data breaks a convention which used to be
attributed to the drug-addicted persons.
Part of the respondents revealed the fact of their prostitution in order to obtain
a drug or money for a drug for themselves and/or for their partner. The data is not
surprising as some of the drug users earn this very way for money for drugs if
they cannot get the money elsewhere. This concerns mainly women, though not
only; some of the surveyed men had had some prostitution experience.
Approximately 8% of the surveyed men and 40% of the women had experienced
sexual violence.
Within the period of addiction, approximately 10% of the respondents always
used a condom during sexual intercourse. However, 40% of them had never used
condoms. This is an alarming phenomenon since drug users are strongly exposed to the risk of HIV infection due to the use of non-sterile injection equipment,
which is specific in Poland. That is because we have here a characteristic way of
common drug use, i.e. with one needle and syringe, from a common vessel. It is
to strengthen the feeling of solidarity and membership to a drug users group.