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

314 Abstracts WePeG6931-WePeG6935

XIV International AIDS Conference

WePeG6931I Alternatives to discharge for non-compliant drug
abuse treatment patients: a harm reduction
approach
D.A. Calsyn1, A.J. Saxon1, C.T. Rimmele', L.K. Ravicz2, F.J. DeMarco'. 'VA
Puget Sound HCS & University of Washington School of Medicine, va puget
sound hcs, 1660 south columbian way, ms:1 16ddtp, seattle, wa 98108, United
States;2 VA Puget Sound HCS, Seattle, WA, United States
Issue: Retention in opioid agonist treatment (OAT) is associated with lower HIV
seroprevalence among injection drug users (IDU) and superior drug treatment
outcomes. Despite current best practice guidelines to the contrary, many programs discharge patients who continue illicit drug use while in OAT. In abstinence
based treatment programs retention has also been associated with superior drug
treatment outcomes. A "no discharge" policy poses certain dilemmas for drug
treatment staff. Such a policy may be perceived as endorsing continued drug
use. The benefits of retaining drug-using patients in treatment could be offset if
illicit use were to increase among other patients in the program who have ceased
or reduced their use due to the discharge threat.
Description: We instituted a "minimal services" (MS) treatment track in OAT as
an alternative to discharge for patients continuing to use illicit drugs. In the abstinence based programs we have instituted "motivational" tracks based on the
principles of motivational enhancement therapy. These tracks were designed to
retain these patients in treatment and introduce contingencies to encourage abstinence.
Lessons learned: We previously demonstrated that the MS track was effective
at retaining non-compliant patients in treatment without an increase in use by
previously compliant patients. There is a need to develop additional alternative
treatments that keep non-compliant IDU and other drug treatment patients in
treatment without compromising the integrity of the treatment program. Key elements to these alternative treatment strategies are to separate non-compliant
from compliant patients, and provide active treatment with a mechanism by which
the non-compliant patients can return to the standard program.
Recommendations: 1) Evaluate effectiveness of motivation strategies in lieu of
discharge. 2) Develop strategies for informing treatment programs of alternatives
to discharge.
Presenting author: donald calsyn, va puget sound hcs, 1660 south columbian
way, ms:1 16ddtp, seattle, wa 98108, United States, Tel.: [phone], Fax:
[phone], E-mail: donald.calsyn @ med.va.gov
WePeG6932 Youth working with young IDU: health needs &
services
V. Da Ros', N. Araujo', G. Babbar2, S. Berterame2. 1UNDCP/Brazil, Brasilia,
Brazil; 2UNDCP/Headquarters, Vienna, Austria
Issues: The lack of access to health services are impacting on young people's
health needs, mainly when they are UDI and in major risk to HIV infection (or
seropositive). Young people perceive these services (often rightly) as unfriendly
to them.
Description: As part of UNDCP Youth Network activities, an international seminar was held in Brazil, September 2001, with young people working with young
IDUs. The exchange of experiences and discussions from different regions of
the world about HIV/AIDS and their link with drug use highlighted: characteristics
of young injectors compared to older, health needs of young injectors, outreach
strategies and problems in contacting young injectors, the need for youth-friendly
services, to identify key programming principles that could be considered for the
design of youth-oriented IDU and HIV prevention and approaches to reduce IDU
and HIV infection.
Lessons learned: An ideal youth friendly service for young IDUs was described
as having/being: no police near; easily reachable, free, 24 hours, easy/free transport; hotline; anonymity; easy access to HIV testing, counselling (pre- and posttest), free drug abuse and/or HIV treatment; flexible treatment to take into account
youth needs, health professional more aware of the need of IDUs, substitution -
injecting to non injecting, no sporadic provision of health services, snowball effect, non discriminatory (race, gender and drug users and non users), networked
with other services, outreach work, safe and friendly places, drop-in centres - pro
social opportunity - intermediary between street and health institutions- usually
very distant from the young people.
Recommendations: New approach from "reach out" to "bring in": young IDU as
protagonist in the development of services for them. Respond to the needs of
young IDUs together with them and empowering them in the process.
Presenting author: Vera Da Ros, SQN 210 bloco A, ap. 519, 70862-010, Brasilia,
Brazil, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeG6933 Influence of the aids epidemic and of its control
policies on the substitution of injecting by chasing
as main route of heroin administration in Spain

G. Barrio 1, L. De la Fuente2, M.J. Bravo', T. Bruqal3, L. Royuela', N. Ntihez4.
'Centro Universitario de Salud Ptiblica, Madrid, Spain; 2Secretarfa del Plan
Nacional sobre el Sida. Instituto de Salud Carlos III, Madrid, Spain; 3lnstitut
Municipal de Salut Publica, Centro Nacional de Epidemiologia, Instituto de Salud
Carlos III, Madrid, Spain; 4 Delegaci6n Provincial de Educaci6n, Sevilla, Spain
Background: The substitution of injecting by chasing as main route of heroin

administration that occurred in Spain since the mid-eighties has been generally
considered as a consequence of the AIDS epidemic.
Methods: We describe the temporal and geographical (by region) trend of the
percentage of users admitted to heroin dependence treatment that use the injected route (IDU) and of annual rate of change in this percentage (CR). We analyse its ecological correlation (Spearman's r) with the AIDS rate in each region
and with an indicator of the degree of implementation of MTs.
Results: Injecting has been gradually replaced by chasing following a clear geographical Southeast to Northwest oriented gradient. This gradient has not been
observed nor in AIDS incidence nor in the implementation of harm reduction policies. Spearman's correlation of the AIDS rate in 1986-1990 with the percentage
of IDUs in 1991 was r=0,23 (p>0,05), and with the CR between 1991 and 1996
was r=0,06. The correlation between MT and CR was r=0,4 (p>0,05). Some of
the regions that first began methadone treatments have continued to show high
levels of IDUs, whereas other regions that practically had not introduced theses
treatments presented the highest CRs.
Conclusions: Although it seems obvious that AIDS incidence and prevention
policies must have been a determinant factor of all this process, the geographical
trend we showed in the evolution of chasing and the absence of correlation with
these phenomena allows us to think that these were not the most determinant
factors of this regional differences. It is necessary to think of other factors, possibly of a cultural nature or market-related. Further research about these factors is
needed in order to prevent a possible outbreak of the HIV epidemic among IDUs
in case their relationship with the adoption of chasing should reverse in coming
years.
Presenting author: Luis De la fuente, Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, C/ Sinesio Delgado 6, 28029 Madrid, Spain, Tel.:
[phone], Fax: [phone], E-mail: Ifuente @ isciii.es
WePeG6934 Not-so-silent epidemic: gay drug use in the
context of HIV: policy,research and prevention
issues
A.PR Pach', E.M. Gorman2, K. Nelson2, A. Scrol2, E. Amato2, T. Applegate2,
C. Clark, 2, S. Feest2. 'NORC-Univ of Chicago, 1113 lancaster rd, takoma park,
md, United States; 2San Jose State University, San JoseCA, United States
Issues: between 1991-2001 treatment admissions for methamphetamines and
club drugs e.g. Ecstasy increased 1000% in many us western counties. By the
same token, between 1996-2001 gay/bisexual menrepresented the majority of incident aids cases in many of those states and a plurality of idu aids cases with
meth with club drugs i.e. Ecstasy, gamma hydroxil butyrate, ketamine being widely
documented.
Description: the nida funded substance use risk exploration (sure) project undertook ethnographic and epidemiological assessment in western washington state
and san jose,ca between 1998-2001. Two hundred fourteen (214) interviews were
completed of which 132 were gay/bisexual men.
Lessons learned: this multimethod, project revealed a complex world of contiguous and overlapping social ecologies, some age/cohort based, others geographical,sex or drug venue oriented, striking in their intensity and complementarity in
use of sex and drugs.subjects ages rtanged from 18-59, with a mean age of 33;
nearly 40% were men olf color: latinos, african-americans,asian-pacific islanders,
native americans.all reported using meth alone or in combination with a club drug
or alcohol during the previous 60 days. Twenty-three percent (23%) reported idu
histories, particularly of meth, but also heroin and cocaine; 11% reported injecting in the previous 30 days. Men described social pressure to experiment and use
drugs: to enhance sexual prowess, to engage in repritive tasks, to self-medicate
symptoms of hiv, depression, grief and multiple loss. Urban vs rural men exhibited
different patterns of use, as did men <35 vs >35; there were some ethnic drug
pattern differences.
Recommendations: there is urgent need to undertake additional research with
this large, yet
Often hidden dual risk population as well as to review policy priorities in terms
of allocation of prevention and treatment resources. Community education efforts
including linkages to drug treatment must be developed.
Presenting author: alfred pach, 1113 lancaster rd, takoma park, md, United
States, Tel.: [phone], Fax: [phone], E-mail: pach-al@norcmail.
uchicago.edu
WePeG6935 Families at Risk: An innovative intervention
program for women in substance abuse treatment
K. Williams. Haymarket Center, Haymarket Center, Health Education Unit, 120
North Sangamon, Chicago, IL 60607, United States
Option 2
Issues: As the number of substance abuse-related HIV infections among women
continues grow, addictions treatment providers have a unique opportunity to as
sist women "at risk" or living with HIV.
Description: Our large, urban, multi-program facility has devloped a unique program for women of color. We have designed a recovery home setting for women,
who may bring with her up to two children, to address: substance abuse, parenting skills, relationships, and other social factors that impact her risks related to
HIV. This intense program, where the women and children may reside for up to
one year, utilizes a client-centered approach to encourage the women to explore