In 1987 experimental schemes for distributing injecting equipment to intravenous drug users to help prevent the spread of the human immunodeficiency virus were started by the government. After six ...months the schemes were found to have been reasonably successful in attracting clients but were less successful in keeping them. It has been shown that equipment can be distributed to drug users on an exchange basis. Many of the clients who were attracted to these schemes had had no treatment or other help for their drug problems.
The sexual behaviour of 142 clients of syringe-exchange schemes was measured using a questionnaire interview based survey method. Two to four months later the questionnaire was repeated to provide ...measures of behavioural change.
The majority of these clients were sexually active, 77% having one or more sexual partners in the 3 months prior to the first interview. Many of these clients (46% of those sexually active) had sexual partners who did not inject drugs.
There is evidence that this group modified their sexual behaviour towards reducing their own risk of HIV infection, with more having no sexual partners (from 23% to 31%), a reduction in those having multiple partners (from 26% to 21%) and a slight increase in those with regular partners (from 49% to 52%).
Not all clients in this group reduced their risk of infection by modifying their sexual behaviour. Some clients continued to engage in high risk sexual behaviour, having multiple partners (21%) and not using condoms (79%).
Whilst overall there is evidence of changes in the sexual behaviour of the clients towards a reduced risk of infection, we have identified an associated increase in risk of transmission from them to their sexual partners. Drug injectors who continued to have sexual partners were more likely to have sexual partners who did not inject drugs.
Fears of a crack 'epidemic' in the United Kingdom of the kind experienced in the United States remain unfounded. However, findings from an ongoing serial point HIV prevalence study indicate that the ...use and injection of crack cocaine among injecting drug users (IDUs) in London is on the increase. Data on patterns of drug use and drug injection were collected over 4 years (1990-93), from IDUs recruited from both drug treatment and community-based settings. All respondents were asked about their drug use in the 6-month period prior to interview. The use of crack cocaine increased significantly from 16% in 1990 to 59% in 1993 and the injection of crack cocaine from 1% to 27%, respectively. The findings suggest that crack cocaine is being injected more regularly, with increases over the 4-year period in those who reported injecting the drug at least once per week. In response this paper considers both the health implications of, and the treatment response to, the increasing use and injection of crack cocaine among IDUs in London.
Measures taken to reduce HIV risk by injecting drug users have been reported in many countries, but a minority of injectors continue to engage in risky practices. In an ongoing cohort study, 207 drug ...injectors were interviewed and anonymously tested for HIV antibodies in saliva in 1989. Injectors reporting recent syringe sharing were compared with those not recently sharing; injecting events where sharing did and did not take place were examined. Those recently sharing syringes differed significantly from the non‐sharers on several factors, including: use of heroin, dihydrocodeine and temazepam; injection of heroin, temazepam and prescribed methadone; accommodation and contact with other injectors; means of financial support and recent involvement in crime; secondary sources of injecting equipment and unsafe disposal; employment of HIV protective strategies; treatment contact with general practitioners; number of sexual partners and injecting status of sexual partners. The two groups were not significantly different in terms of attendance at syringe‐exchange schemes and self‐reported HIV antibody status. Syringe sharing would appear to be related to social circumstances and life‐style factors rather than just individual choices and motivation.
To assess the prevalence of HIV infection among female drug injectors involved in prostitution and female drug injectors not involved in prostitution, survey-based interviews were undertaken with 308 ...female drug injectors in 1990 and 1991. Confirmed saliva test results show 12.9% HIV prevalence among female drug injectors involved in prostitution and 14.4% HIV prevalence among drug injectors not involved in prostitution. This gives an HIV prevalence rate of 14.2% among female drug injectors overall. Findings also show that women not involved in prostitution were less likely to be in contact with a drug treatment or helping agency and were less likely to report having had an HIV test. Respondents in contact with a treatment agency and respondents involved in prostitution were more likely to be aware of their HIV status, and 72% of non-prostitute women confirmed HIV positive were unaware of their positive status. These findings of no higher HIV prevalence among female drug injectors also involved in prostitution lend some support to emerging evidence which associates HIV transmission among women prostitutes with an involvement in injecting drug use rather than with an involvement in prostitution per se. Findings also strengthen the need for greater expansion and greater accessibility of HIV testing, counselling and prevention facilities in community locales where drug injection and prostitution is prevalent.
In the 1990s, HIV/AIDS became a major threat to health, economic stability and human development in countries in eastern Europe and central Asia. Social, political and economic transition exacerbated ...the structural conditions that allowed HIV/AIDS to flourish as dramatic changes led to increasing drug injection, economic decline and failing health and healthcare systems. There is a need to address the professional and ideological opposition - even in countries considered to be fully functioning democracies - to evidence-based public health interventions like harm reduction, coupled with treating HIV/AIDS for all those in need, if countries are to provide a more effective response.
The importance of sharing infecting equipment in the transmission dynamics of HIV is well established. Comparatively less is known about the sexual behaviour of drug injectors and the risks posed to ...themselves and their sexual partners through the sexual transmission of HIV. Findings are reported from survey‐based interviews undertaken in 1991 which investigated the sexual behaviour of 516 drug injectors, both in and out of treatment in London. The majority of respondents (80%) were sexually active in the 6 months preceding interview. During this time, respondents had a mean of 2.1 non‐commercial opposite sex partners. Most (66%) had vaginal intercourse at least once a week, although 68% never used condoms with primary partners and 34% never used condoms with casual partners. Those having sexual intercourse most often were less likely to use condoms. Many had non‐injecting sexual partners, and 62% of respondents' primary and casual partners did not inject drugs. Confirmed saliva HIV test results show 10% of respondents to be antibody positive, with a higher rate of prevalence (14% positive) among those with no experience of treatment. This group were also more likely la report casual sexual intercourse. The average rate of partner change, the high proportion of drug injectors with non‐injecting partners and the infrequency of condom use within primary and casual relationships indicates the potential for HIV transmission between injectors and their non‐injecting sexual partners. The paper concludes by emphasizing the importance of outreach and community‐based intervention in safer sex health promotion.
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