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

672 Abstracts 33410-33416

12th World AIDS Conference

33410 Empowering rural medical practitioners in early
diagnosis and syndromic management of STDs
Gautam Ganguly. Cini-Child in Need Institute, Post Box No 16742, Calcutta
700027, India
Issue: There is a dearth of relevant knowledge regarding STD/HIV/AIDS among
Rural Medical Practitioners.
Description: The STD/HIV/AIDS intervention project with sex workers and their
clients started in four rural red light areas of West Bengal covering approximately
600 sex workers and 1200 clients along with the rural community.
The sex workers and their clients go to the Rural Medical Practitioners for quick
relief of their STDs due to the lack of Government infrastructures and inefficient
PHCs.
These Rural Medical Practitioners are unqualified and are mostly insensitive to
the issues. Therefore the need arises to locate these Rural Medical Practitioners
and upgrade their existing medical skills.
These Rural Medical Practitioners are hence empowered through training,
knowledge about syndromic management. They are also provided with simplified
STDs treatment Guidelines and sensitised about condom uses.
Results: (a) Increased no. of Rural medical Practitioners are aware of HIV/AIDS
(b) Full Medicines Course is prescribed by them
(c) Partner notification is done and safer sex practices are adviced
(d) Involvement of Rural Medical Practitioners in Social Marketing of condoms
Lessons Learned: Empowering Rural Medical Practitioners results in early
diagnosis and management of STDs, thereby reducing the risk of HIV/AIDS.
33411 The role of the police and penitentiary authorities in the
AIDS prevention among IDU in Geneva
Christophe Mani, Annie Piguet, Dominique Hausser. Groupe sida Geneve, rue
Pierre-Fatio, Geneva, Switzerland
Issue: The police can create hurdles to the development of needle exchange programs (seizure and/or fining bearers of syringes). Nevertheless, the attitude and
the support of the police are crucial for the success of these methods of prevention.
Project: In Geneva, political authorities have largely promoted a policy of close
collaboration between social and medical actors and the police. The different
harm reduction programs have systematically set up in dialogue with the police.
Results: Currently, the police takes directly part in the AIDS prevention among
IDU: policemen and policewomen are required to exchange used syringes against
sterile ones when they question an IDU. An awareness to this work of harm reduction by social actors is also part of the basic and continuos training of policemen
(more then 850 policemen and policewomen have been sensitised since 1995).
The medical service of the Geneva prison also distributes syringes to convicts
that wish it.
Lessons Learned: Despite the limits imposed by (il-)legality problems linked
to the use of drugs, the collaboration between social workers and police proves to
be crucial for the success of harm reduction programs. The attitude of the police
has certainly contributed to the diminution of the HIV positive rate observed in
Geneva among IDU.
33413 Impact of drug maintenance treatment on HIV-related risk
behaviours among HIV-infected drug users in France
Catherine Reynaud1, M.P. Carrieri3, M. Chesney4, Y. Obadia2. And the Manif
2000 Study Group; 1 Inserm Research Unit 379, 23 Rue S. Torrents-13006
Marseille; 2Regional Center for Disease Control, Marseille, France; 3lnstituto
Superiore di Sanita, Roma, Italy; 4CAPS, San Francisco, USA
Objectives: To assess the impact of recent changes (1995-1996) in French
public health policy towards drug maintenance treatment (diffusion of methadone
programs and buprenorphine ambulatory prescription) on risky behaviours among
HIV-infected intravenous drug users (IDUs).
Methods: Data were collected during the enrolment visit (Oct 95-Oct 96) of
the cohort MANIF 2000 of HIV-infected IDUs with CD4+ > 300, clinical CDC
stage A or B, attending in south-eastern France and inner suburbs of Paris
hospitals. Psychological and sociological characteristics as well as information
about maintenance treatment, drug use and sexual practices were obtained by a
self-administered and a face-to-face questionnaire. Three groups were compared:
still active IDUs (N = 64), active IDUs in drug maintenance treatment (N = 83)
and ex-IDUs (N = 169, of which 10% were under maintenance treatment).
Results: One hundred patients were in drug maintenance treatment, among
which 83% have been injecting drugs in the 6 months before enrolment. Significant differences (p < 0.01) were found as far as psycho-social characteristics
(unemployment, IDU or ex-IDU regular partner, been in jail, duration of drug use
>10 years, psychiatric or social consultation, depression and negative life events)
between active IDUs and ex-IDUs. Such differences were not found when comparing active IDUs whether or not under maintenance treatment. Among active
IDUs, 27.2% declared at least one needle exchange in the last six months. Needle
exchange was positively associated with polydrug use (OR = 6.6, 95% (2.6-17)),

and among respondents aged more than 30 years, with an history of prison
(OR = 3.4, 95% Cl (1.1-12.8)). Drug maintenance treatment was associated
with a significant reduction in needle exchange but only for older subjects (>30
years: OR = 0.3 95% Cl (0.1-0.9)). Active IDUs have more unprotected sex with
occasional partners than ex IDUs (OR = 2.4, 95% Cl (1.0-5.7)), but unprotected
sex with occasional partners was similar in active IDUs whether or not they were
in drug maintenance treatment.

Conclusion: The recent development of maintenance treatment promoted
by French authorities has not yet succeeded in suppressing injection practices
among HIV-infected IDUs but already contributed to reduce needle sharing especially among older IDUs. Our study suggests that improvement French policy for
harm reduction should be more targeted towars subgroups of HIV-infected IDUs
with history of prison or use of multiple drugs and should better associated with
preventive conselling about sexual risk behaviours.
33414 The harm reduction program in the City of Rio De Janeiro
and distribution of non-harming cutting cocaine
substances to drug dealers
Luiz Paulo Guanabara. NEPAD/UERS, Av. Epitacio Pessoa, Rio De Janeiro, RJ,
Brazil
Issue: The experience of introducing the harm reduction program to the general
public and taking it to the streets, communities, slums and IDU's networks in the
city of Rio de Janeiro has surfaced the possibility of working towards extending
harm reduction policies. Our program began distributing injecting material plus
information and health care on May 1997 and our small 168 IDUs sample showed
94.6% cocaine users (not including steroids). That number will not vary much
with greater samples. It is common knowledge that cocaine is by far the most
used injecting drug in Rio. It is easily available and cheap. But it's quality vary
immensely as the drug is cut with several different substances. Injecting Cocaine
Users (ICU's) struggle for it's purity. Otherwise the drug will not dissolve in water
and stress will take place. Also the damage to their veins will be greater as they
will most likely manage to use the drug anyway. And depending on the substance used for cutting you can expect diseases not directly related to cocaine
injecting.
Project: To extend the scope of the Program to distributing non-harming cutting
substances to drug dealers in Rio de Janeiro. Although our main concern is to
reduce IDU's harm and chances of HIV infection - and to provide them health
care - all cocaine users would benefit from such policy.
Results: Such a measure would imply less expense for the dealers which is
likely to making them accept the given cutting substance. It may also imply an
increasing consciousness regarding their role as distributors of a vastly consumed
product. Without knowing it and for commercial reasons only drug dealers in Rio
already adopt a harm reduction procedure: they do not permit the selling of
crack in the city. They know crack may jeopardize the traffic hierarchy and it's
administration as most of their employees use drugs and could start using crack
instead of cocaine or marijuana.
Lessons Learned: First we are facing a very difficult problem and aiming high
seems to be the solution for creating and implementing step by step a realistic
plan to tackle the situation and subdue the HIV spread among IDU's, their sexual
partners and offsprings. Second harm reduction studies and policies have much
more to offer regarding drug problem solutions than meet the eyes.
33415 Harm reduction: A realistic alternative for sexually active,
substance-using youth
Lisa Carver1, G.W. Harper2. 1633 Alma Avenue #12, Oakland, California 94610;
2De Paul University, Chicago, IL, USA
Issue: Sexually active, substance-using youth may not respond to traditional HIV
prevention messages that promote abstinence and 100% condom use, but may
respond to harm reduction messages.
Project: 227 truant and homeless youth participated in a year-long study in a
suburban Northern California community. The program included an initial workshop on harm reduction and skillsbuilding. Ongoing assistance with psychosocial
issues such as school, substance use and sexual risk reduction through street
outreach and a drop-in center. A pre-test was administered at the workshop with
follow-up assessments every 3 months.
Results: Although overall rates of sexual activity remained constant from the
pre-test to the 6 month follow-up, the youth decreased their number of sexual
partners (12.5% vs. 10.4% at 6 months, p <.01) and increased their condom use
during vaginal sex (58.9% vs. 69.3% at 6 months, p <.05). There was also a significant decrease in the use of drugs prior to sex as well as a decrease in the use
of drugs associated with increased sexual risk, such as alcohol (85.8% vs. 74.7%,
p <.01) and methamphetamines (crank: 33.3% vs. 26.5%, p <.001/speed:17.3%
vs. 10.5%, p <.01). There appears to be an association between increases in
self-initiated contact (5.5 per youth at 6 months) and decrease in HIV sexual risk.
Lessons Learned: Introducing harm reduction services to youth is controversial in conservative communities due to the notion that such messages "promote"
sexual activity and substance use. However, in a population which has rejected
abstinence based education, experiential activities aimed at promoting risk assessment and harm reduction offer a well-received, realistic alternative.
33416J Discrimination: A drug related harm. Working to reduce it
Graciela Touze1'2, P. Cymerman2, P. Goltzman2, G. Lasala2, D. Rossi2,

A. Sanchez2. 1Corrientes 2560 2 D 1046, Buenos Aires; 2 ntercambios, Buenos
Aires, Argentina
Issue: In Argentina, the "three epidemics" affect drug users particularly: 42% of
AIDS cases are intravenous drug users (IDUs); seroprevalence studies among
IDUs estimate 74% are infected; drug users suffer a double stigmatization and
are seen as "dangerous and guilties of spreading the virus". This perception