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

12th World AIDS Conference

Abstracts 33395-33399 669

the proportion whose crack use increased in the same time frames was 40%
before vs 11% after opening the NEP (p <.001). Increasing levels of heroin
sniffing/snorting was 38% before vs 11% after the NEP (p <.001). Levels of
needle sharing and shooting gallery use were no different between the two time
periods. Since recent studies have shown older aged initiates to engage in safer
injection practices compared to younger aged initiates, initiates in this study were.18 times less likely to increase injection frequency during the first 2 years of
initiation (-.0015) after NEP began compared to before, after adjusting for age
of initiation. Initiates were also.20 times less likely to increase crack smoking
(..004) and.25 times less likely to increase heroin sniffing/snorting after NEP
began compared to before, after adjusting for age of initiation.
Conclusion: Given the recent implementation of a city-wide NEP in Baltimore,
Maryland, there is no apparent increase in injection frequency among recently
initiating adolescent and young adult IDUs. In fact, there is preliminary evidence
of a significant decrease in injection frequency. Further, these data suggest that
NEP is not associated with increasing levels of drug use among young, recent
initiates.
33395 The need for improved reporting of HIV prevention
intervention research with drug users
Salaam Semaan1, Don Des Jarlais2, E. Sogolow1, G. Ramirez3, D. Strouse4,
L.S. Kay1, R.H. Needle5. CDC, 1600 Clifton Rd., NE Mailstop, Atlanta, GA;
2Beth Israel Medical Center, New York, NY; 3University of N. Texas, Health
Sciences Center, Forth Worth, TX; 4ASPEN System Corporation, Rockville, MD;
5National Institute of Drug Abuse, Bathesda, MD, USA
Background: Identifying effective interventions is critical to using scarce resources to prevent new HIV infections. We report here on results from the largest
effort to date to synthesize research on interventions to reduce drug use-related
HIV risk behaviors.
Methods: Drug use-related studies were selected from the Prevention Research Synthesis (PRS) database developed by the US Centers for Disease
Control and Prevention. The PRS database includes HIV intervention studies,
from 1988 to present, identified through automated and manual searches. For
inclusion in the formal synthesis, studies must: 1) link data to a specified intervention, 2) use risk behavior, STDs or HIV infection as outcome measures, and
3) include a comparison or control group.
Results: To date, 42 drug user studies meeting the above criteria have been
identified and reviewed. Typically interventions were multi-component, including
risk reduction information, HIV counseling and testing, teaching of skills and
providing means for safer behaviors, and referrals to health and social agencies.
Among the 42 studies, the four most frequently reported drug-related outcomes
were use of injecting drugs (35), use of non-injecting drugs (25), multi-person use
(sharing) of injection equipment (23), and cleaning/bleaching of needles (21). HIV
infection (incidence or prevalence) was reported as an outcome measure in only
4 studies. For any of these outcomes that were measured, only about one-half of
the studies reported the data separately for the treatment and comparison groups.
For example, this was the case for 10 of the 23 studies reporting outcome data
on "sharing" injection equipment.
Conclusions: The research on HIV interventions for drug users over the last
decade is characterized by a very diverse set of outcome measures and incomplete data reporting. It is difficult to determine the overall effects of the 42 studies
when data are not reported by treatment and comparison groups. Improved
data collection and more uniform reporting of outcomes will be essential for
research syntheses (including meta-analysis). Recommendations for collecting
and reporting of intervention and outcome data are proposed.
33396 Harm reduction in the Romany community in Vilnius
Emilis Subata', J. Cukanov2. 'Gerosios Vilties 3, Vilnius; 2Naujininku Poliklinika,
Vilnius, Lithuania
There is a Romany community in Vilnius. The community lives in very poor social
conditions. Many of them are illiterate. Out of 240 Romany of the village, 40 inject
opiates. Romany community is well known for the city authorities as the place for
drug-cooking, selling and trafficking.
Methadone maintenance treatment program was started by the NGO SLPA
and Vilnius Drug Addiction Treatment Centre in 1995. The number of clients rose
quickly up to 100. But the Romany didn't appeared in the program.
A GP, practising in the district primary health care centre, was contacted. He
was willing to participate in the methadone maintenance program among Romany.
At the start of the program 20 Romany entered the methadone program. The GP
and nurse were engaged in health education. They also provided clean needles.
There is no HIV positive Gypsy community member up to this day in spite of
intensive injection and poor social conditions in the community.
Our experience showed, that a public health approach and GP involvement in
the harm reduction activities are significantly increasing the awareness of HIV
infection in marginalised population group.

33397 Criminal laws and their impact on the establishment of
harm reduction measures in South America
Martin E. Vazquez Acuha. Talcahuano 550 Floor 6 Of 1605, Buenos Aires City,
Argentina
Issue: Laws penalizing use and possession of drugs in South America not

only violate human rights of users but also seriously jeopardize harm reduction
activities.
Project: In the first place, the laws regulating the subject of drugs in countries
such as Argentina, Brazil, Chile, Uruguay and Venezuela were analyzed and systemized. Then, research was done on the impact of these laws among drug users
from a human rights perspective and also on the way this legislation influences
the development of harm reduction programs by health authorities and NGO's.
Results: We could verify that laws in the above mentioned countries punishing
drug consumption violate human rights and clearly prevent the contact between
users and health institutions. We established that despite harm reduction measures are not expressly prohibited, there are two opposing views: Organisms in
charge of drug control, i.e. prosecutors, police and most judges, consider such
measures instigation to drug consumption and thus an illegal activity (a crime);
authorities in charge of health issues (mainly those involved in the fight against
AIDS), on the other hand consider these measures protective of public health
and, therefore, legal. These oposing views led to, with the exception of some
Brazilian states, the lack of harm reduction programs run by the government or
NGOs.
Lessons Learned: Reality makes it necessary to modify criminal laws on
the subject, not only by decriminalizing drug consumption but also by including
regulations authorizing harm reduction activities in order for health agencies and
NGOs to develop these activities with no interference. An apropiate strategy would
be to let legislators and the government know the results achieved in different
countries and to highligth that non-establishment of these measures contributes
to the spread of the AIDS epidemic.
33398 Recruiting out-of-treatment injection drug users (IDUs)
into drug treatment: Effects on reducing HIV risk-related
behavior
Robert E. Booth, C.F. Kwiatkowski. 1643 Boulder St. Denver Colorado 80211:
Univ of SO CO School of medicine Denver CO, United States
Background: Despite knowledge of risk behaviors associated with HIV infection,
25% to 35% of IDUs report injecting with needles/syringes others have used without disinfecting. New strategies are needed that hold the possibility of reducing
or eliminating drug injection. To assess the effect of substance abuse treatment
in reducing HIV risk behaviors, 270 out-of-treatment IDUs were recruited into a
longitudinal study.
Methods: Subjects were randomly assigned to either an intervention that emphasized drug cessation, based on principals of motivational interviewing (MI), or
to an intervention that stressed safer drug injection, referred to as harm reduction
(HR). In addition, half of the subjects in each condition were offered 90 days of
free treatment.
Results: Overall, 38% entered treatment, including 29% who had to pay for
their treatment and 46% who received free treatment (p -.01). IDUs who entered treatment were more likely to be at high risk than those who did not enter
treatment (e.g., 85% and 74%, respectively, reported sharing the drug solution).
Both those who entered and did not enter treatment reduced their risk behaviors
significantly, however, the magnitude of change was greater among those who
entered treatment. In addition, the frequency of injecting heroin was significantly
lower at follow (p <.001) for those who entered treatment.
Conclusion: Substance abuse treatment is an important strategy for reducing
HIV-related risk behaviors among out-of-treatment IDUs.
S33399 The relevance of the harm reduction program for
injecting drug users in Rio de Janeiro, Brazil
Wulmar S. Bastos, Jr.1, Wulamr S. Bastos Jr2, P.R. Telles3, C.M. Sampaio4,
L.P. Guanabara4. 1Rua Fonseca Tele 121/40 Andar Rio de Janeiro- RJ Cep
20940-200; 2Nepad/Verg/Credeq Rio de Janeiro RJ;
3Nepad/Verg/Peb-Coppe-Faperg Rio de Janeiro RJ; 4Rio de Janeiro RJ, Brazil
Issue: About 25% of 112.000 cases of AIDS notified to the Brazilian Health
Ministry (MS - August 1997) were of IDUs. Although only 5 or 6% of those cases
come from the city of Rio de Janeiro, a number which could be considered
inexpressive, the population of Rio is composed of about 9 million inhabitants.
This fact changes the importance of the the city as a source of HIV infection.
Project: From March 1996 the strategies of the harm reduction program (HRP)
for UDIs in Rio were put into practice (a partnership between the Brazilian Health
Ministry and UNDCP implemented by NEPAD/UERJ - University of the State
of Rio de Janeiro). The first contact with an IDU happened on May 1997. The
strategies aim at reducing HIV infection among IDUs by means of prevention,
education and intervening measures. Among those techniques we emphasize
the distribution/exchange of prevention material such as a kit containg: a printed
leaflet with information about preserving methods and addresses of treatment facilities, condoms, purified water, NaCI, swab with alcohol, syringes, needles, etc.;
information regarding HIV testing and specialized treatment for both HIV/AIDS
and drug abuse. We have used a brief research instrument based on the one
from the Australian HRP so to trace a basic profile of the IDUs attended at the

project's main office.
Results: From May 1997 to January 1998, 168 IDUs voluntarily filled the
research instrument. Regarding the profile of the UDIs our sample shows: 85.7%
male; average 32 years old; average of first injection 19.7 years old; cocaine
is the most used drug: use frequency of 12.1 days a month; 8.7 times a day.
51.3% have already share syringes/needles; 33.3% have had sexual relations in
exchange for money/drugs; 20.8% have never used condoms and 40.4% have