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From page 321... ... Index A Academic research, 69 Activist groups, 75, 77, 80 ACT-UP, 86 Addiction treatment services, 63, 64, 130-132, 253, 274 and African American communities, 117-119 competition for funding, 8, 117, 126 127, 130, 254 concerns about exchange programs, 104, 126-133, 135, 136, 273 and federal regulations, 126, 132, Age 144 history of enrollment in, 65, 66, 96, 149, 247 professional association positions, 127-130, 307-312 referrals from exchange programs, 8, 81, 82, 89, 90, 131, 199, 208, 211, 216, 232, 237, 249, 268, 309, 310 Administration of programs, 77, 80, 94, 268 Adolescents, see Youth and adolescents 321 African Americans AIDS and HIV seroprevalence, 10, 35-36, 38, 182 bleach distribution participants, 96, 182 church leadership, 117, 118-120 community concerns, 107, 110, 111, 114-115, 116-120, 134, 136 exchange program participation, 83, 84 injection drug use, 62, 65, 67 perinatal transmission, 36 women with AIDS, 31, 35-36 bleach distribution participants, 96 exchange program participation, 81, 84, 215, 226, 231-232, 268 injection drug use estimates, 61, 62 and needle sharing, 149 seroprevalence studies, 271 Agency for Health Care Policy and Research, 254 AIDS cases, 9-10, 23, 31-32, 33, 34 AIDS Outreach Program (AOP) Read the entire page →
From page 322... ... , 127, 128, 309-310 Ammonium compounds, 170-171 Amphetamine, 67 Amsterdam, Netherlands, exchange programs, 215, 226, 265 Anal intercourse, 28, 42, 218 Ann Arbor, Michigan, 69n Anslinger, Harry Jacob, 144 Anti-Drug Paraphernalia Act, 145 Arizona, public opinion, 115 Arrest, 67, 122-123, 216 perceived risk of, 149, 150, 151 Asbury Park, New Jersey, HIV prevalence, 38 Asian Americans, exchange program participation, 83, 84 Assertiveness training, 82 Assistant Secretary for Health, 7, 4546, 69, 158, 224 Association for Drug Abuse Prevention and Treatment, 120 Association of Medical Education and Research in Substance Abuse (AMERSA) , 310 Atlanta, Georgia, injection drug use estimates, 59 INDEX Attitudes, 276 Attrition, 201, 233, 275 Australia exchange program, 2 needle disposal, 6, 157-158 B Backloading, 26, 27, 187 Bacteria and bacterial infections, 27, 149, 170, 171, 172, 190 Baltimore, Maryland, 151 disinfection habits, 178, 187- 188 exchange programs, 74, 226, 265 injection drug use studies, 59, 66, 187 laws, 265 prostitution study, 41 public opinion, 107, 116, 136 Bangkok, Thailand, HIV prevalence, 10, 39 Behavior change models, 86, 87 Berkeley, California, exchange programs, 86 Binge episodes, 57-58 Bisexual men, 32, 40, 218 sexual partners of, 28, 40-41 Black Election Study, 119- 120 Black population, see African Americans Bleach and bleaching methods, 168, 169-172, 190, 220, 302, 303 CDC recommendations, 5, 13- 14, 174-175, 188-189, 190, 191 effectiveness, 2, 82, 172-175, 186189, 190-191, 270 Bleach distribution programs, 2, 4-5, 8, 74, 75, 82, 95-99, 175-189, 263, 267, 276 Chicago, 177-178, 180-186, 192n education and outreach services, 5, 13, 97-99, 176, 177-181, 185186, 192, 270 evaluation of, 4-5, 218, 270 limitations on effectiveness, 5, 65, 186-187 participant characteristics, 96, 179 Read the entire page →
From page 323... ... AIDS case reporting system, 23, 31, 67 bleaching recommendation, 5, 13-14, 174-175, 188-189, 190, 191 Connecticut study, 123, 152, 154, 155, 156 evaluation research, 254-255 323 HIV infection estimates, 32, 34, 37, 38, 39 injection drug use estimates, 58-59, 63 Central Intelligence Agency, 117 Chancroid, 29 Chicago, Illinois bisexual transmission, 40-41 bleach distribution programs, 177178, 180-186, 192n exchange programs, 84, 224-225, 293-304 HIV prevalence, 38 injection drug use, 59, 67, 224-225 intranasal heroin use, 68 public opinion, 114 Chlorine demand, 171 Churches, 117, 118-120 Circulation models, 86, 87, 228-229, 230-231, 255n, 302 Cleaning, 170, 177 Cocaine, 25, 26-27, 40, 43, 57-58, 65, 66, 67, 117. See also Crack Community availability, 149, 157 Community-based studies, 64, 66-68, 69, 265 Community concerns and responses, 56, 103-104, 133-137, 252, 253254, 272-273 African Americans, 107, 110, 111, 114-115, 116-120, 134, 136 Latino/Hispanic population, 117, 120-121, 134, 273 law enforcement officers, 104, 121123, 133, 134, 136, 156, 273 moral and ethical arguments, 105-106 pharmacists, 104, 123-126, 135, 136, 156, 273 public opinion polls, 4, 104, 106107, 108-115, 133, 136 treatment service providers, 104, 126-133, 135, 136, 273 Community Epidemiology Work Group (CEWG) Read the entire page →
From page 324... ... DC* MADS, see Washington DC Metropolitan Area Drug Study Deaths, 67, 68, 182 Decontamination, 170 Delaware, laws, 147 de Ligorio, Alphonsi Mariae, 105 Deliveries, 77, 79 Demographic characteristics, 64-66, 82 84, 99, 143, 149, 268, 269 AIDS and HIV seroprevalence, 10, 31, 40, 45, 271 see also Age; Gender; Race and ethnicity; Socioeconomic status INDEX Demonstration and research projects, 11, 64-66, 95-99, 179-180, 181, 220 Denver, Colorado bleach distribution program, 97 public opinion, 115 Deontologist approach, 106 Department of Health and Human Services, 11. Read the entire page →
From page 325... ... INDEX HIV infection rates, 10, 32 injection drug transmission, 1, 9-10, 32, 34, 36, 37-44 injection drug use, 10, 57-69 Montreal study, 289-293 perinatal transmission, 43-44 research needs, 270-272 sexual transmission, 1, 9-10, 32, 3436, 40-43 Ethanol, see Alcohol and alcohol wipes Ethics, see Morality and ethics Ethnicity, see Latino/Hispanic population; Race and ethnicity Ethnographic research, 67, 223, 271 disinfection strategies, 175-176, 270 needle sharing, 27, 150 Evaluation research, 91, 254-255, 264 270 F Federal regulation, 125, 143-145 constitutionality, 147-148 exchange program funding, 2, 7, 12, 253 reflecting moral arguments, 105 treatment services, 126, 132, 144 Feedback processes, 268 Females, see Women Fixed sites, 77, 79, 80, 235 Focus group studies, 215 Forecasting of drug use, 68, 69 Fort Worth, Texas, injection drug use estimates, 59 France exchange program, 2 needle sharing, 157 Fraternal Order of Police, 121 Frequency of injection drug use, 4, 5758, 65, 149, 207, 213, 224-225, 252 in Chicago study, 293-302 Frontloading, 26, 27, 187 Funding disinfection research, 5, 191, 192 of exchange programs, 2, 7, 8, 1112, 82, 88, 94, 99, 253 325 for research programs, 276 of treatment services, 8, 117, 126127, 130, 254 G Gays, see Homosexuality Gender exchange program participation, 83, 84, 232, 233 injection drug use estimates, 62, 65 and needle sharing, 149 seroprevalence studies, 37-38, 271 see also Men; Women General Accounting Office review, 11, 92, 118, 201, 205-208, 255n, 275 Genocidal theories, 107, 116, 117, 118, 134 Geographic variation HIV infection rates, 10, 37-39, 40, 45, 64, 271, 272 injection drug use, 59-60, 64, 66, 271 Germicides, 170, 172 11- Great Britain, exchange program, 2 H Harrison Narcotic Act, 143-144 Head shops, 144 Health care services, 75, 81, 82, 236237, 268 disinfection recommendations, 174175 facilities as exchange sites, 77, 79 workers' needlestick injuries, 24-25 Heckman method, 300 Hemodialysis machines, 175 Hemophiliacs, sexual partners of, 28 Hepatitis (HBV, HCV) , 27, 45, 149, 168, 172, 190, 238, 251, 310 surveillance and seroprevalence studies, 235, 240-243, 245, 246248, 271, 272, 276 Heroin, 25, 40, 57-58, 60, 65, 66, 67, 68 Heterosexual cases and transmission, 10, 28, 31, 32, 34-35, 218 Read the entire page →
From page 326... ... , 27, 168, 190 Hydrogen peroxide, 170, 174, 176 Illegal exchange operations, 75, 77, 81, 82, 92, 99, 148 Illinois, laws, 77, 147 Income, see Socioeconomic status Incubation period, 169, 266 INDEX indirect needle sharing, 26-28, 44, 65, 169, 179, 186-187, 266, 267, 272 Infants, see Perinatal transmission Initiation of drug use, 4, 83, 99, 133, 200, 208, 215, 225-226, 231-232, 248-250, 252, 269 Injection drug use behaviors and use patterns, 7, 25-28, 39-40, 57-58, 65, 67, 68, 69, 149, 271 and Connecticut needle legalization, 154-155 duration of, 83, 84, 96, 149, 215, 226, 232 frequency of, 4, 57-58, 65, 149, 207, 213, 224-225, 252 geographic variation, 59-60, 64, 66, 271 HIV infection rates, 1, 9-10, 32, 34, 36, 37-44 lIIV transmission mechanisms, 2, 24-28, 149, 167-169, 172-173, 186-187 lifetime prevalence, 61 low-seroprevalence areas, 39 and perinatal transmission, 2, 10, 29, 31, 43-44 and sexual transmission, 2, 28, 36, 40-43, 44, 96, 218, 266-267 social networks, 65-66, 149, 269 270, 271, 272 subgroups, 66, 271-272 surveillance and monitoring, 7, 10, 57-69 type of drug, 40, 60, 65, 66, 69, 149 see also Addiction treatment services; Bleach and bleaching methods; Bleach distribution programs; Demographic characteristics; Needle exchange programs; Needle sharing Institutionalized population, 60, 61. See also Prisons and prisoners International Conference on AIDS, 221 Interviewer bias, 265 Intranasal heroin use (snorting) Read the entire page →
From page 327... ... INDEX Iodine, 170 Iowa, laws, 147 Items distributed, 82, 94, 99 Iterative research processes, 268 J Jail, see Prisons and prisoners Judicial rulings, 147-149, 156 K Kaplan model, 86, 87, 228-229, 230231, 255n, 302 L Laboratory studies disinfection methods, 173-174, 190, 270 field procedures, 270 Latino/Hispanic population AIDS and HIV seroprevalence, 36, 38 bleach distribution participants, 96 community concerns, 117, 120-121, 134, 273 exchange program participation, 83, Men 84 injection drug transmission, 10 injection drug use estimates, 62, 65 women with AIDS, 36 Law enforcement officers concerns about exchange programs, 104, 121-123, 133, 134, 136, 156, 273 education of, 155- 156 harassment of drug users, 121, 155 needlestick risk, 121, 122, 155, 237 Legal issues, see Federal regulation; Judicial rulings; Paraphernalia laws; Prescription laws; State and local laws Limits on exchanges, 80-81, 90, 99, 156, 235-236, 268, 269 Longitudinal studies, 131, 180 327 Los Angeles, California HIV prevalence, 38, 39 injection drug use estimates, 59 Louisiana, prescription laws, 124 Lurie study, see University of California report M Mail Order Drug Paraphernalia Act, 145, 148 Maine, laws, 147 Malaria, 27 Males, see Men Manchester, U.K., exchange programs, 91 -92 Maricopa County, Arizona, public opinion, 114 Martinez, Robert, 144 Maryland, public opinion, 107, 112, 116, 136 Massachusetts laws, 77, 147 public opinion, 114 Maternity, see Perinatal transmission Mathematical models, 38-39, 86, 87, 88 circulation, 86, 87, 228-229, 230231, 255n, 302 AIDS and HIV cases, 31, 37-38, 182 bleach distribution participants, 96, 182 exchange program participation, 83, 99 heterosexual transmission, 10, 34, 35 homosexual, 1, 9, 28, 32, 34, 36, 40, 218 injection drug use estimates, 62 who have sex with men, 32-36 Methadone maintenance, 37, 38, 41, 130-131, 132, 151, 178, 226, 237, 270 Methodological problems and limitations, 3-4, 15, 200-204, 304-305 Chicago study, 224-225, 299-302, 304 Read the entire page →
From page 328... ... , 60, 62, 63 National Institute on Drug Abuse (NIDA) bleach distribution studies, 74, 95, 179 bleaching recommendation, 5, 13, 188, 190, 191 HIV infection estimates, 38 injection drug use estimates, 58, 61, 66, 69, 183 risk behavior surveys, 178 National Institutes of Health, 254-255 Necessity defense, 148 NEED exchange, 86 Needle exchange programs, 2, 4, 11, 74, 75-95, 99, 263, 264-270, 276 administration, 77, 80, 94, 268 ancillary on-site services, 7, 13, 75, 81-82, 94, 99, 254, 268 costs and cost effectiveness, 86-88, 99 and discarded needles, 8, 80, 99, 136, 157, 200, 216, 217, 226, 237, 251 education and information services, 8, 13, 75, 81-82, 199, 236, 267 eligibility rules, 80, 81, 90, 156, 267 Read the entire page →
From page 329... ... relation to needle scarcity by secondary exchangers, 91-92, 206, 264-265 see also Needle exchange programs Needle sharing, 2, 10, 24-26, 39-40, 44, 45, 65, l59n, 167-168, 186, 272 and Connecticut needle legalization, 154-155 factors in, 149, 150-151 impacts of exchange programs, 199, 206, 207, 211, 212, 218, 219, 220, 251, 302-304 indirect, 26-28, 44, 65, 169, 179, 186- 187, 266, 267, 272 relation to needle scarcity, 10, 150151 as ritual, 150 Needlestick injuries, 136, 216 of health care workers, 24-25 of law enforcement officers, 121, 122, 155, 237 Netherlands exchange program, 2 needle sharing, 157 Newark, New Jersey injection drug use estimates, 59 intranasal heroin use, 68 New Hampshire, laws, 147 New Haven, Connecticut, exchange programs, 84, 86, 205, 226-234, 302 AIDS cases, 31 laws, 147 New Orleans, Louisiana, pharmacy sales, 124 Read the entire page →
From page 330... ... method, 300, 301 M Paraphernalia laws, 7, 75, 76, 121, 136, 144-147, 156-157 Baltimore, 265 constitutionality, 147 federal, 145 impacts on needle sharing, 6, 123, 150, 151, 158 as tool for arresting dealers, 122-123 Pediatric cases, 31, 36, 37 INDEX Pennsylvania, laws, 147 Pentazocine, 67 Perinatal transmission, 29-30, 31, 46n and injection drug use, 2, 10, 29, 31, 43-44 Pharmacists and pharmacies, 104, 123 126, 135, 136, 156, 273 and Connecticut needle sale law, 123, 152-155 drug-user incidents and problems, 124, 125, 153-154 education of, 155, 156 foreign studies, 124 Phenmetrazine, 67 Philadelphia, Pennsylvania injection drug use estimates, 59 seroprevalence study, 39 Plausibility, 203-204 Population characteristics, see Demographic characteristics Portland, Oregon, exchange programs, 84, 86, 216, 220, 226 Pregnancy, see Perinatal transmission Prescription laws, 6, 8, 75-77, 78, 121, 122, 123, 144, 145-147, 152, 156, 157, 158, 265 constitutionality, 147-148 federal, 143-144 as tool for arresting dealers, 122-123 Prevention Point program, 282 Prisons and prisoners bleach distribution participants, 96 injection drug use estimates, 64, 65 Montreal study, 286-287, 288-289 prevention research, 274 Professional associations, 127- 130, 307 312 Programmatic research, 268 Promotion and increase of drug use, 4, 105, 122, 126, 127, 132-133, 200, 214-216, 217, 224-226, 251-252 Proportionalist approach, 105- 106 Prospective studies, 202 community-based, 265 Connecticut needle deregulation, 152-154 Read the entire page →
From page 331... ... HIV infection estimates, 32 injection drug use estimates, 58 Tuskegee Syphilis Study, 107 Public opinion polls, 4, 104, 106-107, 108-115, 133, 136 Puerto Rico HIV infection, 34 injection drug use rates, 10 Pure Food and Drug Act, 143 Q Quality assurance programs, 268 R Race and ethnicity AIDS and HIV seroprevalence, 31, 34, 36, 37, 40, 271 and ancillary services, 268 -- -in = bleach distribution participants, 96 175, 215 exchange program participation, 83, 99 homosexual transmission, 34 injection drug transmission, 10, 36 injection drug use estimates, 62 women with AIDS, 36 see also African Americans; Asian Americans, exchange program participation; Latino/Hispanic population; White population Randomized trials, 201, 202, 203, 274 275 Rangel, Charles, 117, 118- 119 Reagan administration, 144 Recall and response bias, 201, 265 Recruitment and retention, 75, 268 Regional differences, see Geographic variation 331 Registering, 25 Relapse, 130, 131, 132 Rhode Island exchange programs, 74 laws, 147 Rinse water, 26-27, 65, 169, 176, 186 Risk knowledge and perception, 149, 150-151 Riverside, California, injection drug use estimates, 59 Roving vans, 77, 79 Running partners, 65 Rural areas, 69n S San Diego, California, injection drug use, 67 San Francisco, California AIDS cases, 31 bleach distribution program, 97, 175-176, 177, 187, 188, 217-218 condom use, 42 exchange programs, 84, 121, 219, 223, 226, 281-285 iniection drug use estimates, 59. young program participants, 83 San Juan, Puerto Rico, injection drug use, 59, 60 School-distance zoning, 90 Screening and counseling services, 75, 81, 82, 90, 91, 97, 179-180, 236237 Secondary and surrogate exchangers, 81, 236, 264-265 Selection and sampling bias, 39, 64, 221, 246, 247-248, 283, 284-285, 288, 291 Sepsis, 27 Seroconversion, see HIV seroconvers~on Serrano, Yolanda, 120, 121 Sex, see Gender; Men; Prostitution; Sexual transmission; Women Read the entire page →
From page 332... ... studies; National Household Survey on Drug Abuse; Prospective studies; Public opinion polls; Randomized trials; Surveillance and monitoring; University of California (Lurie) report; Washington DC Metropolitan Area Drug Study; Youth Risk Behavior Survey Syphilis, 27, 29, 42, 107 Read the entire page →
From page 333... ... MADS) , 61-63, 70n Washington State exchange programs, 148 public opinion, 108-111 Western region AIDS and HIV cases, 35, 37, 38 injection drug use rates, 10, 59 White population AIDS and HIV seroprevalence, 36, 38, 182 bleach distribution participants, 96, 182 exchange program participation, 83, 84, 233 injection drug use, 62, 65, 67 women with AIDS, 36 Wishart Drug Problems Centre, 89 Women AIDS and HIV seroprevalence, 1, 31, 34-36, 37-38, 40 bleach distribution participants, 96 and crack, 34, 41-42 exchange program participation, 8, 83, 84, 254 Read the entire page →
From page 334... ... injection drug use csOmates, 62, 63 sexual transmission risk, 28, 34-33, 40-43 ~ ~/~o Perinata1 transmission Youth and adolescents AIDS and HIV seroprevalence, 31, }t 38, ~ 83 exchange program parUcipadon,8, 81,83,213,234,272 bomosexua1 ~ansmission,34 i~echon drug use, 61,63,213, 272 Youth Risk Bebovior Survey, 63 Zidovudine (AZT) Read the entire page →

From page 321...

... Index A Academic research, 69 Activist groups, 75, 77, 80 ACT-UP, 86 Addiction treatment services, 63, 64, 130-132, 253, 274 and African American communities, 117-119 competition for funding, 8, 117, 126 127, 130, 254 concerns about exchange programs, 104, 126-133, 135, 136, 273 and federal regulations, 126, 132, Age 144 history of enrollment in, 65, 66, 96, 149, 247 professional association positions, 127-130, 307-312 referrals from exchange programs, 8, 81, 82, 89, 90, 131, 199, 208, 211, 216, 232, 237, 249, 268, 309, 310 Administration of programs, 77, 80, 94, 268 Adolescents, see Youth and adolescents 321 African Americans AIDS and HIV seroprevalence, 10, 35-36, 38, 182 bleach distribution participants, 96, 182 church leadership, 117, 118-120 community concerns, 107, 110, 111, 114-115, 116-120, 134, 136 exchange program participation, 83, 84 injection drug use, 62, 65, 67 perinatal transmission, 36 women with AIDS, 31, 35-36 bleach distribution participants, 96 exchange program participation, 81, 84, 215, 226, 231-232, 268 injection drug use estimates, 61, 62 and needle sharing, 149 seroprevalence studies, 271 Agency for Health Care Policy and Research, 254 AIDS cases, 9-10, 23, 31-32, 33, 34 AIDS Outreach Program (AOP)

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From page 322...

... , 127, 128, 309-310 Ammonium compounds, 170-171 Amphetamine, 67 Amsterdam, Netherlands, exchange programs, 215, 226, 265 Anal intercourse, 28, 42, 218 Ann Arbor, Michigan, 69n Anslinger, Harry Jacob, 144 Anti-Drug Paraphernalia Act, 145 Arizona, public opinion, 115 Arrest, 67, 122-123, 216 perceived risk of, 149, 150, 151 Asbury Park, New Jersey, HIV prevalence, 38 Asian Americans, exchange program participation, 83, 84 Assertiveness training, 82 Assistant Secretary for Health, 7, 4546, 69, 158, 224 Association for Drug Abuse Prevention and Treatment, 120 Association of Medical Education and Research in Substance Abuse (AMERSA) , 310 Atlanta, Georgia, injection drug use estimates, 59 INDEX Attitudes, 276 Attrition, 201, 233, 275 Australia exchange program, 2 needle disposal, 6, 157-158 B Backloading, 26, 27, 187 Bacteria and bacterial infections, 27, 149, 170, 171, 172, 190 Baltimore, Maryland, 151 disinfection habits, 178, 187- 188 exchange programs, 74, 226, 265 injection drug use studies, 59, 66, 187 laws, 265 prostitution study, 41 public opinion, 107, 116, 136 Bangkok, Thailand, HIV prevalence, 10, 39 Behavior change models, 86, 87 Berkeley, California, exchange programs, 86 Binge episodes, 57-58 Bisexual men, 32, 40, 218 sexual partners of, 28, 40-41 Black Election Study, 119- 120 Black population, see African Americans Bleach and bleaching methods, 168, 169-172, 190, 220, 302, 303 CDC recommendations, 5, 13- 14, 174-175, 188-189, 190, 191 effectiveness, 2, 82, 172-175, 186189, 190-191, 270 Bleach distribution programs, 2, 4-5, 8, 74, 75, 82, 95-99, 175-189, 263, 267, 276 Chicago, 177-178, 180-186, 192n education and outreach services, 5, 13, 97-99, 176, 177-181, 185186, 192, 270 evaluation of, 4-5, 218, 270 limitations on effectiveness, 5, 65, 186-187 participant characteristics, 96, 179

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From page 323...

... AIDS case reporting system, 23, 31, 67 bleaching recommendation, 5, 13-14, 174-175, 188-189, 190, 191 Connecticut study, 123, 152, 154, 155, 156 evaluation research, 254-255 323 HIV infection estimates, 32, 34, 37, 38, 39 injection drug use estimates, 58-59, 63 Central Intelligence Agency, 117 Chancroid, 29 Chicago, Illinois bisexual transmission, 40-41 bleach distribution programs, 177178, 180-186, 192n exchange programs, 84, 224-225, 293-304 HIV prevalence, 38 injection drug use, 59, 67, 224-225 intranasal heroin use, 68 public opinion, 114 Chlorine demand, 171 Churches, 117, 118-120 Circulation models, 86, 87, 228-229, 230-231, 255n, 302 Cleaning, 170, 177 Cocaine, 25, 26-27, 40, 43, 57-58, 65, 66, 67, 117. See also Crack Community availability, 149, 157 Community-based studies, 64, 66-68, 69, 265 Community concerns and responses, 56, 103-104, 133-137, 252, 253254, 272-273 African Americans, 107, 110, 111, 114-115, 116-120, 134, 136 Latino/Hispanic population, 117, 120-121, 134, 273 law enforcement officers, 104, 121123, 133, 134, 136, 156, 273 moral and ethical arguments, 105-106 pharmacists, 104, 123-126, 135, 136, 156, 273 public opinion polls, 4, 104, 106107, 108-115, 133, 136 treatment service providers, 104, 126-133, 135, 136, 273 Community Epidemiology Work Group (CEWG)

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From page 324...

... DC* MADS, see Washington DC Metropolitan Area Drug Study Deaths, 67, 68, 182 Decontamination, 170 Delaware, laws, 147 de Ligorio, Alphonsi Mariae, 105 Deliveries, 77, 79 Demographic characteristics, 64-66, 82 84, 99, 143, 149, 268, 269 AIDS and HIV seroprevalence, 10, 31, 40, 45, 271 see also Age; Gender; Race and ethnicity; Socioeconomic status INDEX Demonstration and research projects, 11, 64-66, 95-99, 179-180, 181, 220 Denver, Colorado bleach distribution program, 97 public opinion, 115 Deontologist approach, 106 Department of Health and Human Services, 11.

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From page 325...

... INDEX HIV infection rates, 10, 32 injection drug transmission, 1, 9-10, 32, 34, 36, 37-44 injection drug use, 10, 57-69 Montreal study, 289-293 perinatal transmission, 43-44 research needs, 270-272 sexual transmission, 1, 9-10, 32, 3436, 40-43 Ethanol, see Alcohol and alcohol wipes Ethics, see Morality and ethics Ethnicity, see Latino/Hispanic population; Race and ethnicity Ethnographic research, 67, 223, 271 disinfection strategies, 175-176, 270 needle sharing, 27, 150 Evaluation research, 91, 254-255, 264 270 F Federal regulation, 125, 143-145 constitutionality, 147-148 exchange program funding, 2, 7, 12, 253 reflecting moral arguments, 105 treatment services, 126, 132, 144 Feedback processes, 268 Females, see Women Fixed sites, 77, 79, 80, 235 Focus group studies, 215 Forecasting of drug use, 68, 69 Fort Worth, Texas, injection drug use estimates, 59 France exchange program, 2 needle sharing, 157 Fraternal Order of Police, 121 Frequency of injection drug use, 4, 5758, 65, 149, 207, 213, 224-225, 252 in Chicago study, 293-302 Frontloading, 26, 27, 187 Funding disinfection research, 5, 191, 192 of exchange programs, 2, 7, 8, 1112, 82, 88, 94, 99, 253 325 for research programs, 276 of treatment services, 8, 117, 126127, 130, 254 G Gays, see Homosexuality Gender exchange program participation, 83, 84, 232, 233 injection drug use estimates, 62, 65 and needle sharing, 149 seroprevalence studies, 37-38, 271 see also Men; Women General Accounting Office review, 11, 92, 118, 201, 205-208, 255n, 275 Genocidal theories, 107, 116, 117, 118, 134 Geographic variation HIV infection rates, 10, 37-39, 40, 45, 64, 271, 272 injection drug use, 59-60, 64, 66, 271 Germicides, 170, 172 11- Great Britain, exchange program, 2 H Harrison Narcotic Act, 143-144 Head shops, 144 Health care services, 75, 81, 82, 236237, 268 disinfection recommendations, 174175 facilities as exchange sites, 77, 79 workers' needlestick injuries, 24-25 Heckman method, 300 Hemodialysis machines, 175 Hemophiliacs, sexual partners of, 28 Hepatitis (HBV, HCV) , 27, 45, 149, 168, 172, 190, 238, 251, 310 surveillance and seroprevalence studies, 235, 240-243, 245, 246248, 271, 272, 276 Heroin, 25, 40, 57-58, 60, 65, 66, 67, 68 Heterosexual cases and transmission, 10, 28, 31, 32, 34-35, 218

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From page 326...

... , 27, 168, 190 Hydrogen peroxide, 170, 174, 176 Illegal exchange operations, 75, 77, 81, 82, 92, 99, 148 Illinois, laws, 77, 147 Income, see Socioeconomic status Incubation period, 169, 266 INDEX indirect needle sharing, 26-28, 44, 65, 169, 179, 186-187, 266, 267, 272 Infants, see Perinatal transmission Initiation of drug use, 4, 83, 99, 133, 200, 208, 215, 225-226, 231-232, 248-250, 252, 269 Injection drug use behaviors and use patterns, 7, 25-28, 39-40, 57-58, 65, 67, 68, 69, 149, 271 and Connecticut needle legalization, 154-155 duration of, 83, 84, 96, 149, 215, 226, 232 frequency of, 4, 57-58, 65, 149, 207, 213, 224-225, 252 geographic variation, 59-60, 64, 66, 271 HIV infection rates, 1, 9-10, 32, 34, 36, 37-44 lIIV transmission mechanisms, 2, 24-28, 149, 167-169, 172-173, 186-187 lifetime prevalence, 61 low-seroprevalence areas, 39 and perinatal transmission, 2, 10, 29, 31, 43-44 and sexual transmission, 2, 28, 36, 40-43, 44, 96, 218, 266-267 social networks, 65-66, 149, 269 270, 271, 272 subgroups, 66, 271-272 surveillance and monitoring, 7, 10, 57-69 type of drug, 40, 60, 65, 66, 69, 149 see also Addiction treatment services; Bleach and bleaching methods; Bleach distribution programs; Demographic characteristics; Needle exchange programs; Needle sharing Institutionalized population, 60, 61. See also Prisons and prisoners International Conference on AIDS, 221 Interviewer bias, 265 Intranasal heroin use (snorting)

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From page 327...

... INDEX Iodine, 170 Iowa, laws, 147 Items distributed, 82, 94, 99 Iterative research processes, 268 J Jail, see Prisons and prisoners Judicial rulings, 147-149, 156 K Kaplan model, 86, 87, 228-229, 230231, 255n, 302 L Laboratory studies disinfection methods, 173-174, 190, 270 field procedures, 270 Latino/Hispanic population AIDS and HIV seroprevalence, 36, 38 bleach distribution participants, 96 community concerns, 117, 120-121, 134, 273 exchange program participation, 83, Men 84 injection drug transmission, 10 injection drug use estimates, 62, 65 women with AIDS, 36 Law enforcement officers concerns about exchange programs, 104, 121-123, 133, 134, 136, 156, 273 education of, 155- 156 harassment of drug users, 121, 155 needlestick risk, 121, 122, 155, 237 Legal issues, see Federal regulation; Judicial rulings; Paraphernalia laws; Prescription laws; State and local laws Limits on exchanges, 80-81, 90, 99, 156, 235-236, 268, 269 Longitudinal studies, 131, 180 327 Los Angeles, California HIV prevalence, 38, 39 injection drug use estimates, 59 Louisiana, prescription laws, 124 Lurie study, see University of California report M Mail Order Drug Paraphernalia Act, 145, 148 Maine, laws, 147 Malaria, 27 Males, see Men Manchester, U.K., exchange programs, 91 -92 Maricopa County, Arizona, public opinion, 114 Martinez, Robert, 144 Maryland, public opinion, 107, 112, 116, 136 Massachusetts laws, 77, 147 public opinion, 114 Maternity, see Perinatal transmission Mathematical models, 38-39, 86, 87, 88 circulation, 86, 87, 228-229, 230231, 255n, 302 AIDS and HIV cases, 31, 37-38, 182 bleach distribution participants, 96, 182 exchange program participation, 83, 99 heterosexual transmission, 10, 34, 35 homosexual, 1, 9, 28, 32, 34, 36, 40, 218 injection drug use estimates, 62 who have sex with men, 32-36 Methadone maintenance, 37, 38, 41, 130-131, 132, 151, 178, 226, 237, 270 Methodological problems and limitations, 3-4, 15, 200-204, 304-305 Chicago study, 224-225, 299-302, 304

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From page 328...

... , 60, 62, 63 National Institute on Drug Abuse (NIDA) bleach distribution studies, 74, 95, 179 bleaching recommendation, 5, 13, 188, 190, 191 HIV infection estimates, 38 injection drug use estimates, 58, 61, 66, 69, 183 risk behavior surveys, 178 National Institutes of Health, 254-255 Necessity defense, 148 NEED exchange, 86 Needle exchange programs, 2, 4, 11, 74, 75-95, 99, 263, 264-270, 276 administration, 77, 80, 94, 268 ancillary on-site services, 7, 13, 75, 81-82, 94, 99, 254, 268 costs and cost effectiveness, 86-88, 99 and discarded needles, 8, 80, 99, 136, 157, 200, 216, 217, 226, 237, 251 education and information services, 8, 13, 75, 81-82, 199, 236, 267 eligibility rules, 80, 81, 90, 156, 267

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From page 329...

... relation to needle scarcity by secondary exchangers, 91-92, 206, 264-265 see also Needle exchange programs Needle sharing, 2, 10, 24-26, 39-40, 44, 45, 65, l59n, 167-168, 186, 272 and Connecticut needle legalization, 154-155 factors in, 149, 150-151 impacts of exchange programs, 199, 206, 207, 211, 212, 218, 219, 220, 251, 302-304 indirect, 26-28, 44, 65, 169, 179, 186- 187, 266, 267, 272 relation to needle scarcity, 10, 150151 as ritual, 150 Needlestick injuries, 136, 216 of health care workers, 24-25 of law enforcement officers, 121, 122, 155, 237 Netherlands exchange program, 2 needle sharing, 157 Newark, New Jersey injection drug use estimates, 59 intranasal heroin use, 68 New Hampshire, laws, 147 New Haven, Connecticut, exchange programs, 84, 86, 205, 226-234, 302 AIDS cases, 31 laws, 147 New Orleans, Louisiana, pharmacy sales, 124

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From page 330...

... method, 300, 301 M Paraphernalia laws, 7, 75, 76, 121, 136, 144-147, 156-157 Baltimore, 265 constitutionality, 147 federal, 145 impacts on needle sharing, 6, 123, 150, 151, 158 as tool for arresting dealers, 122-123 Pediatric cases, 31, 36, 37 INDEX Pennsylvania, laws, 147 Pentazocine, 67 Perinatal transmission, 29-30, 31, 46n and injection drug use, 2, 10, 29, 31, 43-44 Pharmacists and pharmacies, 104, 123 126, 135, 136, 156, 273 and Connecticut needle sale law, 123, 152-155 drug-user incidents and problems, 124, 125, 153-154 education of, 155, 156 foreign studies, 124 Phenmetrazine, 67 Philadelphia, Pennsylvania injection drug use estimates, 59 seroprevalence study, 39 Plausibility, 203-204 Population characteristics, see Demographic characteristics Portland, Oregon, exchange programs, 84, 86, 216, 220, 226 Pregnancy, see Perinatal transmission Prescription laws, 6, 8, 75-77, 78, 121, 122, 123, 144, 145-147, 152, 156, 157, 158, 265 constitutionality, 147-148 federal, 143-144 as tool for arresting dealers, 122-123 Prevention Point program, 282 Prisons and prisoners bleach distribution participants, 96 injection drug use estimates, 64, 65 Montreal study, 286-287, 288-289 prevention research, 274 Professional associations, 127- 130, 307 312 Programmatic research, 268 Promotion and increase of drug use, 4, 105, 122, 126, 127, 132-133, 200, 214-216, 217, 224-226, 251-252 Proportionalist approach, 105- 106 Prospective studies, 202 community-based, 265 Connecticut needle deregulation, 152-154

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From page 331...

... HIV infection estimates, 32 injection drug use estimates, 58 Tuskegee Syphilis Study, 107 Public opinion polls, 4, 104, 106-107, 108-115, 133, 136 Puerto Rico HIV infection, 34 injection drug use rates, 10 Pure Food and Drug Act, 143 Q Quality assurance programs, 268 R Race and ethnicity AIDS and HIV seroprevalence, 31, 34, 36, 37, 40, 271 and ancillary services, 268 -- -in = bleach distribution participants, 96 175, 215 exchange program participation, 83, 99 homosexual transmission, 34 injection drug transmission, 10, 36 injection drug use estimates, 62 women with AIDS, 36 see also African Americans; Asian Americans, exchange program participation; Latino/Hispanic population; White population Randomized trials, 201, 202, 203, 274 275 Rangel, Charles, 117, 118- 119 Reagan administration, 144 Recall and response bias, 201, 265 Recruitment and retention, 75, 268 Regional differences, see Geographic variation 331 Registering, 25 Relapse, 130, 131, 132 Rhode Island exchange programs, 74 laws, 147 Rinse water, 26-27, 65, 169, 176, 186 Risk knowledge and perception, 149, 150-151 Riverside, California, injection drug use estimates, 59 Roving vans, 77, 79 Running partners, 65 Rural areas, 69n S San Diego, California, injection drug use, 67 San Francisco, California AIDS cases, 31 bleach distribution program, 97, 175-176, 177, 187, 188, 217-218 condom use, 42 exchange programs, 84, 121, 219, 223, 226, 281-285 iniection drug use estimates, 59. young program participants, 83 San Juan, Puerto Rico, injection drug use, 59, 60 School-distance zoning, 90 Screening and counseling services, 75, 81, 82, 90, 91, 97, 179-180, 236237 Secondary and surrogate exchangers, 81, 236, 264-265 Selection and sampling bias, 39, 64, 221, 246, 247-248, 283, 284-285, 288, 291 Sepsis, 27 Seroconversion, see HIV seroconvers~on Serrano, Yolanda, 120, 121 Sex, see Gender; Men; Prostitution; Sexual transmission; Women

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From page 332...

... studies; National Household Survey on Drug Abuse; Prospective studies; Public opinion polls; Randomized trials; Surveillance and monitoring; University of California (Lurie) report; Washington DC Metropolitan Area Drug Study; Youth Risk Behavior Survey Syphilis, 27, 29, 42, 107

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From page 333...

... MADS) , 61-63, 70n Washington State exchange programs, 148 public opinion, 108-111 Western region AIDS and HIV cases, 35, 37, 38 injection drug use rates, 10, 59 White population AIDS and HIV seroprevalence, 36, 38, 182 bleach distribution participants, 96, 182 exchange program participation, 83, 84, 233 injection drug use, 62, 65, 67 women with AIDS, 36 Wishart Drug Problems Centre, 89 Women AIDS and HIV seroprevalence, 1, 31, 34-36, 37-38, 40 bleach distribution participants, 96 and crack, 34, 41-42 exchange program participation, 8, 83, 84, 254

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From page 334...

... injection drug use csOmates, 62, 63 sexual transmission risk, 28, 34-33, 40-43 ~ ~/~o Perinata1 transmission Youth and adolescents AIDS and HIV seroprevalence, 31, }t 38, ~ 83 exchange program parUcipadon,8, 81,83,213,234,272 bomosexua1 ~ansmission,34 i~echon drug use, 61,63,213, 272 Youth Risk Bebovior Survey, 63 Zidovudine (AZT)

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INDEX Pages 321-334

INDEX
Pages 321-334