Preventing HIV Transmission The Role of Sterile Needles and Bleach (1995) / Chapter Skim
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A DESCRIPTION AND REVIEW OF RESEARCH PROJECTS IN THREE CITIES
A DESCRIPTION AND REVIEW OF RESEARCH PROJECTS IN THREE CITIES
Pages 281-306
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From page 281... ...
SAN FRANCISCO The investigators (Hahn et al., 1995) collected data on demographic, sexual, and drug-use risk behaviors, treatment experience, living arrangements, HIV status, needle exchange participation, and number of needles exchanged through a structured interview in order to "examine use of the needle exchange program in San Francisco in the first two years after its commencement" (p.
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From page 282... ...
3~. This study recruited 1,093 injection drug users from nine methadone maintenance and 21-day detoxification programs from 1989 through 1990, following the November 1988 opening of the Prevention Point needle exchange program in San Francisco.
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From page 283... ...
These findings were interpreted by the authors as indicating that needle exchange programs attract a high-risk, chaotic, and indigent population of injection drug users. The authors conclude that needle exchange programs are well suited for implementing HIV preventive interventions, in view of their findings that such programs provide direct access to high-risk injectors.
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From page 284... ...
Estimating in this way would substantially impact the reported seroconversion rates for needle exchange users and nonusers by changing their estimated time of becoming infected. A drastic change in the number of seroconversions occurring among needle exchange user and nonuser subgroups would result: five of the seven seroconversions among needle exchange users would be classified as having occurred prior to their participation in the needle exchange program.
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From page 285... ...
The second is a prospective epidemiologic study of HIV infection among injection drug users in Montreal that was initiated in 1988, one year prior to the opening of the needle exchange program (Bruneau et al., 1995; Lamothe et al., 19951. Needle Exchange Evaluation Project The evaluation study (Hankies et al., 1994)
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From page 286... ...
The sample of incarcerated injection drug users was originally recruited as part of an ongoing TABLE A.1 HIV Prevalence Among Montreal Needle Exchange Participants Year Seropositive Total Proportion (%) 95% CI 1990 49 442 11.1 8.4 to 14.4 1991 51 345 14.8 11.3 to 19.0 1992 45 270 16.7 12.4 to 21.7 SOURCE: Adapted from Evaluating Montreal's Needle Exchange CACTUS-Montreal (Hankies et al., 1994:86)
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, and 98 percent indicated that they had received the services they had requested. An analysis of the serology test results shows that the overall HIV prevalence rate among incarcerated injection drug users was 10 percent (29/ 293~.
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in 1992. To assess the potential effect of needle exchange participation on HIV prevalence, the investigators relied on data collected from a sample of incarcerated injection drug users who were part of an ongoing research project with another objective: identifying risk factors for HIV infection among inmates.
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initiated a prospective epidemiologic study of HIV infection among injection drug users in September 1988. Active injection drug users who had injected drugs in the past 6 months were recruited from the street (with offers of free HIV testing and precounseling)
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In addition to needle exchange program participation, variables found to be associated with seropositivity at entry included: education, income level, and the number of sex partners in the last 6 months. Furthermore, several drug-use risk behaviors were found to be associated with HIV positivity at entry, including: drug of choice; number of times injected drugs in the last month; participated in the needle exchange during the last 6 months; injected drugs in shooting galleries during last 6 months; injected drugs while in prison; ever shared injection equipment; acquaintances known to be HIV positive; and ever shared injection equipment with .
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. Review As with the other research discussed above, biases in parameter estimates due to the use of limited sampling strategies pose serious concerns for the generalizability of these findings either to the population of injection drug users or to the population of needle exchange program users in Montreal.
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Another noteworthy consideration is that injection drug users who do not use the needle exchange program in Montreal have access to sterile injection equipment through pharmacies (there is a pharmacy a block away from the exchange program that sells syringes and is open 24 hours a day)
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From page 293... ...
The Chicago needle exchange program was initiated in 1992. Before the program was initiated, these investigators had been monitoring trends in risk behaviors and HIV incidence among out-of-treatment injection drug users in an effort to assess the impact of an extensive outreach HIV intervention program (discussed in detail in Chapter 61.
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From page 294... ...
Other structured interview measures included the number of injection drug user associates and coinhabitants, various injecting and sexual HIV-related risk behaviors, the extent of self-reported frequency of worry about becoming infected with HIV via injection drug use, and having enough money. A two-step approach was used to assess the effect of free needles on needle exchange participants' current drug use (drug expenditure and current injection frequency)
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From page 295... ...
2.6 (1.2) .13 .16 .10 .076 SOURCE: From Needle Exchange in Chicago: The Demand for Free Needles and Their Effect on Injecting Frequency and Needle Use (O'Brien et al., l995a:Table 3)
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From page 296... ...
The second step of the analyses called for using two-stage least-squares regressions to estimate the effects of free needles on drug expenditure, current injection frequency, and number of times a needle is used. If the coefficients for free needles (i.e., extra needles)
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From page 297... ...
They also state that the positive effect of extra needles exchanged on drug expenditures implies that exchangers spend more for drugs than can be expected from only their level of weekly cash income and in proportion to the number of extra needles. The current injection frequency equations indicate that, when past injection frequency is incorporated into the model while using the 1988 and 1992 cohorts, the latter does not contribute to explaining variations in the current level of injection frequency.
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From page 298... ...
. Using data from their 1994 cohort, the investigators regressed information reported by injection drug users regarding how long they keep a used needle on use of the exchange program, needles used per week, risky injecting, HIV status, handing off a used needle, and number of times a needle was used for injecting.
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From page 299... ...
The estimates of drug expenditures and current injection frequency were positively associated with the number of needles exchanged. These authors infer that access to free needles results in increased drug expenditure and injection frequency among exchange users.
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of a needle exchange program. To the extent that needle exchange use is not well predicted, then the selection model may have little effect on parameter estimates.
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From page 301... ...
For example, data reported in the manuscript are inconsistent with records maintained by the Chicago needle exchange program. That is, the exchange records show a mean of 15 needles obtained per week by exchangers compared with a mean of 30 per week (with a standard error of 37)
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From page 302... ...
Data from the 1994 interview and HIV serology test results of current injection drug users from all three cohorts (n = 728; 1988, 1992, and 1994 data) , as well as data from the 1993 follow-up of the 1988 and 1992 cohorts (n = 405)
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From page 303... ...
of the total sample having used the exchange in the past 4 weeks, which also represents approximately 21 percent of all injection drug users who had used the program at least once since February 1, 1994. With respect to HIV risk behaviors assessed in 1994, a comparison of needle exchange users and nonusers revealed no statistically significant difference in the proportion of study participants reporting having engaged in injection drug use risk behaviors, whereas nonusers were found to be more likely to report multiple sex risk (43 compared with 40 percent)
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From page 304... ...
about the effect of needle exchange programs on risk behaviors and HIV In addition, none of these studies has used adequate sampling strategies to ensure that risk behavior and HIV prevalence and incidence estimates are representative of the injection drug-using populations who use and do not use the respective exchange programs. Nonetheless, the studies have reported measures of associations although there is some question about the populations to which they apply that are sizable and should be further studied with proper study designs, measurement, and
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From page 305... ...
Hankins, C 1994 Appendix E in The Proceedings of the Meeting on HIV Infection Among Injection Drug Users in Canada, Montreal, Quebec, December 12-13.
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From page 306... ...
Lorvick 1994 Syringe and needle exchange as HIV/AIDS prevention for injecting drug users. Journal of the American Medical Association 271 (2)
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