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

668 Abstracts 33390-33394

12th World AIDS Conference

sexual activities before the age of 14 (HR = 3.3, 95% Cl 1.5-7.4) and having had
a regular or occasional homosexual partner (HR = 2.4, 95% Cl 1.0-5.7).
Conclusion: The incidence of drug initiation injection is high among Montreal
street youth. These preliminary analyses allow us to identify a profile of future
young injectors. Further analyses combined with other types of research such as
qualitative methods that include participant observation are necessary to better
understand this phenomenon.
411* /33390 Implementing a harm reduction program (HRP) in
the complex environment of Rio de Janeiro City
P.R. Telles1 2, C.M. Sampaio1, W. Bastos, Jr1. 1Nepad/UERJ - RJ;
2PEB-COPPE-FAPERJ - RJ, Brazil
Issue: The Brazilian Ministry of Health launched in 1996 a HRP in Rio, together
with other important cities in the Country critically affected by the AIDS problem
among Injecting Drug Users (IDUs). Among the problems faced by all Projects are
the legal constrains regarding needle exchange and the widespread prejudiced
image of IDUs. Rio though seemed to meet additional problems due to its specific
social environment. To face these drawbacks, a series of unique strategies had
to be implemented.
Project: The project initiated its activities relying on a fixed place (close to a
drug treatment center) and a mobile unit. Among the activities offered by the HRP
are: counseling, distribution of informative folders and preventive materials, needle exchange, HIV testing and referral to other clinical or drug treatment places. A
short voluntary anonymous questionnaire about drug habits and other behavioral
aspects is proposed for each client attending the HRP. At the beginning of the
project we faced a great difficulty to reach IDUs, Rio de Janeiro's social environment, unlike any other place in the country, keep IDUs extremely segregated,
organized in small networks and with low interconnection. They are specially
persecuted by the police, unwanted even by other non-injecting drug users and
not tolerated by drug dealers (drug trade is power full and very organized in
Rio). The inclusion of ex-IDUS and IDUs as outreach workers; an intensive work
with the community (and community leaders) principally at the slums where most
of the drug trade occurs; enrollment of religious, governmental and non gov.
organizations; field work with sex-workers (high percentage of drug use); focus
groups with ex-drug users; easy access to testing, treatment and free medication;
are among the activities used to reach and engage in the program this hidden
population.
Results: From May 1997 until January 25, 1998, the project reached a
growing number of IDUs, among them 182 filled the questionnaire. The HRP
distributed/exchanged 6,721 informative folders, 7,456 condoms, 3,329 needles/syringes and 285 kits (above material plus bleach and distilled water). Many
non-injecting drug users and more than 200 sex workers, considered as potential
bridges to IDUs, were also contacted.
Lessons Learned: Specific activities developed at the HRP in Rio de Janeiro,
despite its difficulties, are potentially successful to the extent that a growing number of IDUs is being reached and we are dealing with an extremely segregated
population.
577* / 33391 The effects of two years of harm reduction in Rome
Marina Davoli, Annette Verster, Teresa Spadea, Fabio Patruno,
Fulvia Pascualini, Carlo Alberto Perucci, Massimo Arca. Department of
Epidemiology, Lazio Region Health Authority, via Santa Costanza, Rome, Italy
Background: A pilot harm reduction programme was conducted in Rome,
1995-1996. The aim was to contact drug users currently not in treatment and offer
them a range of services including street outreach, needle exchange schemes,
methadone maintenance, first aid intervention (overdose) and drop-in centers for
day and night care.
Methods: Descriptive analysis of the activities of the different components
of the programme and dynamic mathematical modelling to estimate the effects
of the programme on HIV incidence. Cost-benefit of the programme has been
estimated.
Results: In the two-year period (August 1994-July 1996) the three outreach
units had over 128,000 contacts with more than 5,000 drug users of whom 1,900
never treated before. About 200,000 syringes and 60,000 condoms were distributed and 526 were referred to the methadone unit. The emergency unit and
the street outreach teams intervened in 519 events of overdose. It was estimated
that the programme would have prevented at least 134 new HIV infections by 31
December 1996, of which 34% would have been among the general population.
In case the programme would continue for another 8 years, a total of 1,073
infections would have been prevented, of which 50% among non-drug users.
The cost for every prevented infection has been calculated at circa US$ 30,000,
20,000 if the programme was to be continued for another 8 years. The calculated
costs include all the activities of the programme even though not directly related
to HIV prevention (i.e. overdose interventions).
Conclusions: The cost of the programme, i.e. the costs of prevented HIV
infections, are considerably lower than the cost of managing an HIV infection,

given that in Italy an AIDS patient cost is estimated to be around US$ 25,000
per year. This benefit becomes larger if the programme proceeded. Moreover the
programme succeeded in contacting and referring to treatment a large number of
drug users.

I33392 What is the current state of syringe exchange in the UK?
A national survey
Jim Parsons, P. Turnbull. The Centre for Research on Drugs and Health
Behaviour 200 Seagrave Road London SW6 1RQ, England
Objectives: To survey the current extent and nature of syringe exchange (SE)
service provision for injecting drug users in the UK.
Design: National survey of 420 syringe exchange providers in the UK.
Methods: Questionnaires were distributed to local co-ordinators of pharmacy
SE schemes (n = 145) and those responsible for managing SE provided by
specialist drug services (n = 275). Survey findings were compared with those
from the last comprehensive survey of UK SE services conducted in 1991.
Results: 111 (77%) pharmacy syringe exchange co-ordinators and 171 (62%)
specialist drug services returned completed questionnaires. The projected total
number of syringe exchange outlets is 2334. This compares with an estimated
200 outlets in 1991. They distributed a range of HIV prevention materials and
an estimated 27,184,836 syringes in 1997. This compares with an estimated
4,000,000 syringes distributed in 1991. In 1997 an estimated 1,248,096 visits
were made and an estimated 47,000 injecting drug users received syringes,
directly or through others, from SE services. This gives approximately 535 annual
visits per SE outlet, 578 syringes received annually by each IDU, and 22 syringes
distributed per visit.
Conclusions: Findings show a marked increase in syringes distributed between 1991 and 1997. This highlights the continued importance of SE in averting
epidemics of HIV among UK IDUs. Given that IDU population estimates have
remained fairly constant (52,000 to 78,000) findings suggest that, at lower IDU
population estimates, current levels of syringe distribution appear to be adequate.
At higher population estimates, current levels of syringe distribution remain inadequate.
33393 Harm reduction needle kits: A HIV prevention project for
injecting drug users
Peter Halbheer. AIDS-Hilfe Schweiz, Postfach CH-8031 Zirich, Switzerland
Issues: Multiple use of injection equipment is the most important cause of HIV
transmission among injecting drug users. For appropriate HIV-prevention, a good
availability of injection material of high quality is required.
Project: The two objectives were: 1. Manufacturers of needle kits produce kits
that prevent HIV infections and reduce other health risks and that injecting drug
users widely accept. 2. Lack of availability of sterile injection material is no longer
a reason for HIV infections.
To reach objective 1, inputs of drug and HIV /AIDS experts, drug users, street
workers and pharmacists were used to create a catalogue of standards for the
composition and the ingredients of harm reduction NEEDle kits.
To reach objective 2, a net of vending machines was to complete existing
offers. To initiate communal activities, a documentation containing offer for support, distribution channels, political arguments, above standards and a survey on
products was announced by a folder to communities, drug advice centres and
others.
Results: Objective 1: Although the main product meets most standards, no
contract could be signed to ensure quality improvement. Objective 2: Only in
few cantons a satisfying net of vending machines could be established. Political
opposition, lack of courage and fear of drugs and aids prevented many new offers
although the objective corresponds with the federal aids and drug policies.
Lessons Learned: In federal structures, organisations and persons responsible for the prevention of HIV have to engage: a) in the development of the drug
policies towards better living conditions of drug users. b) in the implementation
of the objectives of aids and drugs policies on all levels, especially the cantonal
level.
33394 1Changing patterns in injection practices and other drug
use before and after the start of NEP among adolescent
and young adults who recently initiated injection drug
use in the Risk Evaluation and Community Health Study
(REACH II)
David Vlahov, Crystal Fuller, A. Arria, D. Ompad. The REACH II Team; Johns
Hopkins University, 615 N. Wolfe St., Baltimore, MD, USA
Background: To examine the drug use behaviors surrounding initiation of an
injecting career before and after the opening of six needle exchange program
(NEP) sites in Baltimore, Maryland among adolescent and young adult IDU's.
Methods: Adolescent and young adult IDUs (15-30 years of age) who recently initiated injection drug use <5 years were recruited into a dynamic cohort
study beginning 7/15/97. The first 100 participants were enrolled into the REACH
II Study using extensive street outreach methods in Baltimore, Maryland. The
following preliminary cross-sectional analysis was based upon the most recent
available data collected during the baseline visit. Patterns of drug use behaviors
within two time periods of injection initiation, before NEP ('92-'94) and after NEP

('95-'97) will be compared using chi-square tests.
Results: Study population consists of 68% female, 77% African American,
mean age 24.9 ~ 3.5 (range 16-30), 68% 12th grade education, 33% homeless, and mean age of injection initiation 22.6: 3.9 (range 10-30). Comparing
those who initiated injection drug use before (n = 42) vs those initiating after
opening NEP (n = 57), the proportion whose injection frequency increased in the
2 years following initiation was 71% vs 32%, p -.001, respectively. Similarly,