Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

194 Abstracts WeOrE1325-WeOrE1359

XIV International AIDS Conference

WeOrEl325 An employee assistance program (EAP) for drug
abuse and sexual behavior at the penitentiary
system of Rio de Janeiro - Brazi
A.C. Saad, R. Dantas, L. Poubel, M.L. Carvalho, B. Quitete, L.P. Veiga, J. Fialho,
E.J. Biondi. Desipe, Av Epitacio Pessoa 3490 ap. 1004 Lagoa, Cep 22471-000,
Rio de Janeiro - RJ, Brazil
Background: The Penitentiary System of Rio de Janeiro has an Employee Assistance Program (EAP) for most medical specialties. After treating Penitentiary
Workers for more than 4 years we realized there was a specific demanding for
this population which was stress management and substance abuse problems.
Methods: In January 2000 we started a substance abuse/dependence outpatient
program for the penitentiary workers which included not only drug problems but
sexual behavior as well. Our goal was to reduce drug use (abstinence, if possible)
and to increase safe sex behavior, for approximately 90% of this population never
use condoms in an intercourse. The patients had medical, social and psychological assistance once a week.
Results: From January 2000 to May 2001 we had 32 patients. Most of them were
male (66%); 41 years old the average; alcohol is the drug most frequently used
and gonorrhea the most frequent STD. We had one patient coming for alcohol
treatment who tested positive for HIV during his treatment at the program. 25%
of patients had a psychiatric diagnosis being 31% stress related; 59% were no
longer working with prisoners being now at an administrative function. 56% stayed
more than 4 months at treatment.
Conclusion: The challenge was to motivate people to talk about their problems
and receive specific help; they had to come to the program despite cultural, personal and peers' prejudice, what makes our sample to be considered a good
one. Talking about drugs and sex is a hard thing for a Latin country. Stress management was part of our focus because the patients' kind of work: constantly
confronted with corruption, prisoners, low payment and to diminish their anxiety
they self medicate with drugs increasing the risk for STD/AIDS. Even though there
are more workers who need help for these matters, coming to assistance is still
a problem. We need to work harder on the information of the program so other
employees can benefitiate from treatment.
Presenting author: Ana Saad, Av. Epitacio Pessoa 3490 ap.1004 Lagoa, Cep
22471-000, Rio de Janeiro - RJ, Brazil, Tel.: [phone], Fax: +55 21
2513-2755, E-mail: anasaad @netfly.com.br
WeOrE1l356 The effect of race, neighborhood, and social
network on adolescent initiation of injection drug
use among recont-onset injection drug users in
Baltimore, Maryland
C.M. Fuller1, L.N. Borrell1, S. Galea2, D. Vlahov2. 1Columbia University,
Mailman School of Public Health, 622 W 168th Street, PH- 18, New York, New
York, 10032, United States; 2New York Academy of Medicine, Center for Urban
Epidemiologic Studies, New York, United States
Background: To determine the extent to which individual-level factors (race, social network, injection risks) and contextual-level factors (neighborhood racial
composition, poverty, education levels) contribute to adolescent initiation of injection drug use (?21 yrs of age) in a population of injection drug users (IDUs).
Methods: Street-recruited IDUs from 12 neighborhoods (15-30 yrs) injecting?5
yrs. underwent HIV testing and a survey of high-risk practices, and social factors.
GEE was used to estimate the contribution of individual- and contextual-level factors on adolescent initiation while adjusting for the correlation between individuals
within neighborhoods.
Results: Of 144 IDUs: 69% female, 63% black. In the final model (individual
and contextual factors), adolescent initiates (Als) were less likely to be black
(OR=0.05), report early sharing (OR=0.37), and more likely to have dropped out
of school (OR=2.05) and report an early high-risk network soon after initiation
(OR=9.98) than adult initiates. Als were also more likely to come from neighborhoods with a high minority composition (OR=3.95) and less likely to come from
neighborhoods with a high poverty level (OR=0.28) than adult initiates. The probability of a black adolescent from a low poverty/low minority neighborhood initiating
injection was 29% compared with 84% for a black adolescent coming from a high
poverty/high minority neighborhood. The probability of a white adolescent from
a low poverty/low minority neighborhood initiating injection was 88% compared
with 96% for a white adolescent from a high poverty/high minority neighborhood.
Conclusion: These data suggest that while individual factors play a role in age
of injection initiation and high-risk behavior soon after initiation, social processes
within neighborhoods also play an independent role. Public health efforts to curb
adolescent initiation and early high-risk networks should consider the individuals?
connection to their social environment.
Presenting author: Crystal M. Fuller, 622 W. 168th Street, PH-18, New York,
New York, 10032, United States, Tel.: [phone], Fax: [phone], Email: [email protected]

WeOrE1357 Capturing the Illusion of Injecting Drug Use
Cultures: an ethnographic approach
S. Slavin. National Centre in HIV Social Research, University of New South
Wales, PO Box 732, Darlinghurst NSW 1300, Australia
Background: Considerable interest has emerged in Western countries in recent

years in 'cultures' of injecting drug use. Social researchers increasingly employ
ethnographic methods and anthropological analyses to investigate and interpret
these 'cultures' in order to identify risk practices and the reasons for them.
Methods: Ethnographic research was conducted for 18 months from September
2000, among functional, recreational injecting drug users (IDU) in inner Sydney.
IDU (n=25) were interviewed using an open ended interview schedule. Factors
associated with injecting were recorded using eclectic fieldwork practices such
as observation and reflexive participation. These factors include: social networks;
technologies of injection; discourses of pleasure; geographies of injection; ritualisation; types of drugs; and police surveillance. Content analysis was used to
identify risks for HIV and hepatitis C infection as well as other risks associated
with illicit drug use. The social aspects of behaviours were analysed for evidence
of overarching cultural forms.
Results: Injection as a mode of drug administration does not give rise to cultural
forms or significant identity development among this group. Injecting practices are
located within a variety of existing cultural forms that intersect with injecting practices, types of drugs used, social networks, geographies and identities. Injection
rarely signifies more than the most efficacious form of drug administration. More
generally it is a consumptive practice not a productive one. The meaning of injecting practices for this group exists in relation to other cultural forms, practices
and identities (such as gay subcultures) and does not constitute a cultural form or
identity in itself or in isolation.
Conclusions: Injecting drug use must be located within broader cultural, social
and economic forms if the risks associated with it are to be correctly understood
and addressed.
Presenting author: Sean Slavin, PO Box 732, Darlinghurst NSW 1300, Australia,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
WeOrEl1358 Community acceptance of controversial HIV
prevention programs for IDUs
D.C. Des Jarlais1, M. Downing2, K. Vernon3, T.H. Riess4, N. Mulia3,
C. McKnight5, B.R. Edlin3. iBeth Israel Medical Center, New York, NY, United
States; 2Urban Health Studies & CAPS, San Francisco, United States; 3Center
for AIDS Prevention Studies, San Francisco, United States; I Urban Health Study
& CAPS, San Francisco, United States; 5Beth israel Medical Center, San
Francisco, United States
Background: Interventions such as syringe exchange and methadone maintenance have been shown to be highly effective in reducing HIV transmission
among injecting drug users (IDUs). Despite this evidence, there is continuing opposition to implementation of these programs in many countries throughout the
world, including countries experiencing HIV epidemics among IDUs.
Methods: 43 qualitative interviews were conducted with key informants in 6 U.S.
cities. Informants included AIDS prevention providers, political leaders, activists,
substance abuse and AIDS researchers, and health department directors. Key
informant interviews and documentary sources were then obtained for HIV prevention projects in 12 different developing and transitional countries (including
projects in Asia, South America, Eastern Europe, and Africa).
Results: Four different general strategies were identified for implementation of
potentially controversial HIV prevention programs:(1) Broad coalition building, (2)
Implementation by public health leaders, (3) Implementation by community activists, and (4) Implementation through research projects. Successful implementation generally occurred in two steps:(1) Activities to start programs, and (2) Consolidation and expansion to a public health scale. In the consolidation/expansion
phase, community consultation was often critical, and leadership from politicians,
public health officials, and program directors provided legitimacy and access to
resources. Research supported the safety and effectiveness of the programs.
Outside funding and pilot project/research was often used to initiate programs in
developing/transitional countries, but consolidation and expansion to scale were
often problematic in these countries.
Conclusion: Research, coalition building, activism, political leadership can all
be important tools for implementing controversial HIV prevention programs, but
better planning for large scale implementation is clearly needed.
Presenting author: Don Des Jarlais, Beth Israel Medical Center, 1st Avenue at
16th Street, New York, NY, 10003, United States, Tel.: [phone], Fax: +1
212 387 3897, E-mail: [email protected]
WeOrE1359 HIV Knowledge and Risk Behaviors among
Pakistani and Afghan Heroin Users in Quetta,
Pakistan
S.T. Zafar1, H. Brahmbhatt2, S. ul Hassan1, S.A. Strathdee2. 'NaiZindagi, 615
N. Wolfe Street, Baltimore, MD, 21205, Pakistan; 2Johns Hopkins University,
Baltimore, United States
Background: Situated on the Pakistan-Afghan border, Quetta is home to a growing number of Afghan refugees. Data on drug use behaviors in the region are

sparse. We described HIV knowledge and risk behaviors among Pakistani and
Afghan heroin users accessing services provided by Nai Zindagi, a non-profit organization assisting drug users (DUs) in Quetta.
Methods: Between 07/01 and 11/01, DUs registering for services at Nai Zindagi's
drop-in center run underwent an interviewer-administered survey on sociodemographics, injection and non-injection drug use, sexual behaviors and HIV knowl