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

670 Abstracts 33400-33404

12th World AIDS Conference

never done an HIV testing or simply do not know the result of the test. Regarding
the distribution/exchange of the preserving material the numbers are: 285 Kits,
7.456 condoms, 3.329 syringes/needles and 6.720 leaflets.
Lessons Learned: According to the results achieved we once more verify
the highly risky HIV contamination behaviour to which IDUs expose themselves
regarding both their sexual habits and sharing of used injecting material. We also
testify their lack of interest for health care facilities and HIV testing, stressing the
importance of the prevention measures proposed by the harm reduction program
in the city of Rio de Janeiro, Brasil.
S33400 Reduction in injection risk behavior among users of the
Seattle syringe exchange
Holly Hagan, J.P. McGough, H. Thiede, T.J. Yu, M.J. Fields, S.G. Hopkins,
E.R. Alexander. 1Seattle-King County Dept. of Public Health, 106 Prefontaine
Place South, Seattle, WA, USA
Background: We examined the relationship between syringe exchange use and
subsequent injection risk behavior in a cohort of Seattle area injection drug users
studied 6/94 to 1/98.
Methods: 1077 participants who had injected during the one year follow-up
period were classified according to the proportion of their syringes obtained from
the exchange at the baseline and follow-up periods (table). The relative risks (RR)
of sharing injection equipment during follow-up were calculated for exchange use
categories, adjusted for baseline duration and frequency of injection, and syringe
sharing at baseline.
Results:
Former, Regular, Sporadic, New, Never,
n = 112 n = 450 n = 269 n = 92 n =154
Proportion of syringes from exchange
at Baseline >0 -50% i 50% 0 0
during Follow-up 0 -0 -0 0 0
Mean years injecting 14.7 17.1 14.6 14.1 13.1
Inject daily (baseline) 41% 75% 51% 59% 44%
Syringe sharing 53% 46% 50% 62% 50%
Adjusted RR (95% confidence limits) sharing injection equipment during follow-up:
Shared syringes 1.0 (Ref.) 2.04 (1.3, 3.1) 2.82 (1.6, 4.9) 3.19 (1.6, 6.3) 1.81 (.99, 3.3)
Shared cooker 1.0 2.72 (1.6, 4.4) 2.89 (1.7, 4.9) 3.61 (1.8, 7.1) 1.56 (.9, 2.8)
Share cotton 1.0 2.14 (1.3, 3.5) 2.34 (1.4, 3.9) 3.73 (1.9, 7.4) 1.20 (.7, 2.1)
Conclusions: Former exchange users were significantly less likely to share
injection equipment, while new exchangers remained at risk shortly after starting
to use the exchange. Although the confidence intervals overlap, the data suggest
decreasing risk with increasing use of the exchange, and that exchangers who
continue to inject unsafely should receive additional risk reduction interventions.
33401 Harm reduction - defeating institutional and social
barriers
Nemora Barcellos', E.M.F. Mattos2, M. Conte2, R.H. Mayer2, D. Siqueira2,
G.B. Winckler2, G.B.P. Rigotti2. Rua Fonseca Guimaraes 205; 2Health State
Secretariat, Porto Alegre, RS, Brazil
Background: - Because of HIV infection increase among injectable drug users
(IDU), nowadays the responsible for the biggest numbers of new AIDS cases
in Rio Grande do Sul, Brazil, the harm reduction projects implantation, largely
rejected by public institutions and brazilian society became imperious but the
failure of former implantation required new strategies.
Methods: - Representing members from main institutions in drug prevention,
repression, use handling, abuse and traffic, state and municipal narcotic council,
judiciary power, politicians, civil associations and local main media communicators were searched by HIV/AIDS specialists, from the Rio Grande do Sul state,
to show the project and sensitize to avoid abrupt reactions and opinions, based
in an idea and in a law constructed before AIDS epidemic.
Results: - In Porto Alegre, Rio Grande do Sul, the project was impacted without
the police, juridical or social major problems that happened in other cities form
Brazil. The strategy used collaborated with initial purpose amplification, with the
assimilation of the changing syringes process by the institutional attendance services and with the society respect for the executors. The only residual resistance
still in the police force who doesn't incorporated the harm reduction philosophy
but tolerate the harm reduction activities.
Conclusions: - The careful implantation planning of a harm reduction project
with the appreciation of society fears and direct technical information can bring
great benefits and be a good weapon to break down barriers. The strategy of
open information promoted also the internal development of the harm reduction
project staff and the interaction between the technicians, the outreach workers,
the community and their relationship net.

33402 Taking it to the street: Shooting gallery needle exchange
site for drug injectors at highest HIV risk
Judith Porter1, Gilbert Perez2. P Dept of Sociology, Bryn Mawr College, Bryn
Mawr, PA 19010; 2Prevention Point Philadelphia, Philadelphia PA, USA
Issue: Users of shooting galleries (commercial drug injection sites) are at highest
risk for HIV. A van-based needle exchange site, providing HIV testing, medical
care, and social service referrals in an area with a high concentration of shooting

galleries effectively provides AIDS risk reduction to hard to reach injection drug
users.
Project: Once a week, for 15 months, Prevention Point Philadelphia has operated a full service needle exchange site from a large van parked in an area
with a high concentration of shooting galleries. Other AIDS organizations provide
medical students and HIV testing personnel. Bilingual program staff offer social
service and drug treatment referrals and standard needle exchange services.
Gallery owners were asked to publicize these services. Data were collected from
a survey of exchangers and weekly data on site operation.
Results: During 15 months, 58,604 needles were exchanged; there were 2393
individual exchanges returning needles for 3452 people. 75% of exchangers
used area shooting galleries. The inducement of exchanging needles attracted
the hardest to reach drug users, especially homeless, Spanish speaking Puerto
Ricans who were regular users of area galleries (the site averaged 26% Puerto
Rican), a percentage which increased over time. Many of these individuals had
not previously used preventive medical care or social services. Doctors visits
averaged five per site, and HIV tests averaged 3 per site. Introduction of the
oral HIV test increased the number of people tested. Drug treatment and social
service referrals provided a continuum of care with agencies staffing the site.
Data indicate that the site attracted both gallery owners exchanging needles for
large numbers of people as well as individual users.
Lessons Learned: Locating a full-service, van based needle exchange site
adjacent to a large cluster of galleries, staffed in cooperation with several AIDS
programs, successfully reached the highest risk exchangers with safe injection
equipment, medical care, HIV testing, and service referrals and reached not only
the individual drug user but social networks through gallery owners who served
as gatekeepers.
133403 Still working after all these years: Increasing evidence of
needle exchange program (NEP) effectiveness in studies
published since 1993
Peter G. Lurie1, E. Drucker2, A. Knowles3. 'CAPS, U Cal, 74 New Montgomery,
6th Fl. San Francisco, California, 94105; 2Montefiore Medical Center, Bronx, NY;
3University of Michigan, Ann Arbor, Ml, USA
Objective: In 1993, we summarized all research then available on the efficacy
and potential adverse effects of NEPs. The present study analyzes results of all
studies published since then.
Methods: We conducted a computerized literature review using the keyword
"needle exchange" for English language articles published from 1993 through the
end of 1997. Books with articles on NEPs were also included, but abstracts from
conferences were not. We included only articles that addressed NEP impact upon
drug use rates, injection-risk behaviors, hepatitis and HIV.
Results: The 23 studies identified, some looking at multiple outcomes, were
notable for the use of a wider range of evaluation designs, more frequent use of
comparison groups in the behavioral studies and larger prospective studies as
compared with those in our 1993 report. The results of the studies are summarized
in the Table.

Outcome
Drug use rates
Injection risk
Blood-borne pathogen transmission

Beneficial
NEP effect
6 studies
10 studies
6 studies

Neutral
NEP effect
2 studies
1 study
4 studies

Adverse
NEP effect
1 study
0 studies
2 studies

Conclusion: A significant preponderance of recent evidence further strengthens the evidence of NEP efficacy and the apparent lack of associated adverse
effects. The combination of NEPs, efforts to increase syringe availability by
modifying restrictive laws and regulations, and outreach to increase pharmacist
involvement in syringe sales continues to hold promise for reducing the toll of HIV
infection drug users, their sex partners and their offspring.
S33404 1Yaroslavl (Russia) harm-reduction project for drug
injectors: Impact results
Heather Madray', B. Sergeyev2, T.P. Rumyantseva3, T. Oparina4,
V.L. Volkanevsky5, R.S. Broadhead1, D.D. Heckathorn1. 1 Univ of Connecticut,
Dept of Sociology, U-68 Storrs, CT 06269-2068, USA; 2University of Toronto,
Ontario, Canada; 3Center for the Study of Public Opinion, Yaroslavl; 4 Yaroslavl
Friends Helping Friends Project, Yaroslavl; 5 Yaroslavl AIDS Prevention Center,
Yaroslavl, Russia
Issue: We report on the effectiveness of the first outreach and needle exchange
program in Russia to reduce HIV risk behavior in injection drug users (IDUs).
Project: The Yaroslavl (Russia) Harm Reduction project, or 'Friends Helping
Friends', is one of thirteen projects in central and Eastern Europe that make up the
International Harm Reduction Development Program, funded by The Lindesmith
Society/Open Society Institute in New York City, along with funds provided by
the state and province of Yaroslavl. This project is modeled after, and receives
technical support from, the Eastern Connecticut Health Outreach project in the
United States. The Yaroslavl project utilizes a mobile needle exchange as well
as a peer-driven outreach to educate IDUs concerning the risks associated with
unsafe injection and sexual behavior, as well as offer testing services for HIV and
sexually transmitted diseases. The project relies on active drug users, rather than
professional outreach workers, to educate their peers concerning safer behavior
and recruit them to a project storefront for a knowledge test, extensive interview,