Preventing HIV Transmission The Role of Sterile Needles and Bleach (1995) / Chapter Skim
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8 DIRECTIONS FOR FUTURE RESEARCH
8 DIRECTIONS FOR FUTURE RESEARCH
Pages 263-278
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From page 263... ...
Improving the effectiveness of HIV and AIDS prevention programs such as needle exchange and bleach distribution programs is an important and valid public health goal. Such improvement would be much easier to accomplish if the knowledge base were broader and more secure.
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From page 264... ...
: categorization of exposure to the intervention condition (ever/never, secondary exchangers) ; measurement of alternative sources of sterile syringes other than needle exchange programs (e.g., pharmacies, diabetics)
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From page 265... ...
Prior studies in Baltimore (Gleghorn, in press' show that about half of injection drug users had sterile sources of needles prior to the opening of the needle exchange program, which were primarily from diabetics and pharmacies in a city with a paraphernalia-but no prescription law. If needle exchange programs differentially attract people with nonsterile street sources but not those who already have sources of sterile needles, then, when comparing participants and nonparticipants, an evaluation study might show no relative reduction in lIIV incidence resulting from program participation.
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From page 266... ...
As noted in Chapter 1, sexual transmission is not uncommon among injection drug users. Unless significant efforts to determine the risk associated with indirect sharing and more efficient sexual risk reduction strategies are developed within the context of such programs, the effect of needle exchange programs on HIV incidence is likely to be somewhat limited.
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From page 267... ...
Therefore, the relative effects of different components of needle exchange programs that target different risk behaviors associated with the different transmission routes (sexual risk versus sharing of contaminated injection equipment) need to be studied.
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From page 268... ...
Also, as Chapter 2 describes in detail, the aims of needle exchange and bleach distribution programs are broader than simply providing sterile needles to injection drug users. Other goals include linking users to needed health care and social services, providing drug abuse counseling, and facilitating entry into drug treatment.
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From page 269... ...
. Do they inadvertently generate new social networks of drug users, which then may serve as a mechanism to facilitate viral spread, depending on the risk char
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From page 270... ...
Yet current epidemiologic studies have revealed that bleach disinfection, as currently practiced by injection drug users, does not appear to have a protective effect. It is therefore crucial that educational methods be developed to improve the level of compliance by injection drug users with the recommended disinfection protocol.
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From page 271... ...
O Developing a typology/demography of HIV infection that identifies high-risk groups in terms of prevalence and incidence and of risk behaviors is necessary to prevent the creation of potential epicenters. Attention should also be given to identifying subgroups or clusters within the broader defined risk groups e.g., whether there are identifiable groups at relatively different levels of risk within the population of local injection drug users.
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From page 272... ...
Chapter 3 also shows that needle exchange programs do not recruit a sizable number of young injectors. This highlights the need for recruiting study cohorts of younger individuals as part of ongoing efforts to further our understanding of injection drug use and improve AIDS prevention strategies.
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From page 273... ...
h~.~.n ~,nnortive of needle exchange programs, others have expressed concerns and reservations about their potential role in making sterile injection equipment more readily available to injection drug users. A better understanding of the beliefs, attitudes, values, and motivational factors that influence these reservations needs to be developed through both qualitative and quantitative research efforts.
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From page 274... ...
For example, more injection drug users can be found in prisons than in drug treatment programs, hospitals, and social services (Brewer and Derrickson, 1992~. It is plausible that preimprisonment drug-use behavior among incarcerated injection drug users will be more heterogeneous than that of users in treatment facilities or needle exchange programs(Vlahov end Polk, 1988~.
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From page 275... ...
For example, we need to know about the processes of addiction, about the propagation of infectious diseases, about the dynamics of social networks, about the underlying factors in personal failure and success, and about the role of sexual behaviors in the lives of injection drug users.
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From page 276... ...
. CONCLUSION The HIV epidemic in the United States is growing largely because of infection spread by contaminated needles in the population of injection drug users.
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From page 277... ...
Carlson, and D.C. McBride 1994 Incarceration and HIV risk behaviors among injection drug users: A Midwestern study.
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