HIV infection among intravenous drug users: epidemiology and risk reduction
Des Jarlais, D.C.; Friedman, S.R.
Aids 1(2): 67-76
1987
ISSN/ISBN: 0269-9370 PMID: 3130084 Document Number: 371130
Published and unpublished reports on HIV seroprevalence and risk reduction among IV drug users (IVDU) are reviewed as of 1986. The seroprevalence of HIV among IVDUs varies widely by location, often with a north-south gradient. The strongest indicator of prevalence is the date of introduction of HIV, with rates as high as 50% appearing within 2 years. The behavioral risk factors are sharing injection equipment partners, using shooting galleries, being a female prostitute or a member of a minority ethnic group. There are no data yet on whether removing barriers to sterile syringes and needles or needle exchange programs is effective in cutting the spread of HIV. There are some hints that IVDUs are capable of altering risky behavior. Surveys of 2 groups of methadone maintenance client suggest increased knowledge of HIV risks and increased use of clean needles. It is reported that the black market for needles in New York City has shown increased sales, that sales of syringes with extra needles are popular, that heroin sellers are including sterile syringes with bags, and even that re-packaged used unsterile needles are enjoying a brisk profit on the street. There are suggestions that IVDUs in Amsterdam and San Francisco are altering their high risk behaviors. Data from Amsterdam shows that IVDUs have not increased their frequency of injection nor reduced their demand for drug treatment as a result of the needle exchange program. Possible prevention strategies are education of people before they initiate IV drug use; provision of ample drug treatment as a cost effective means of reducing the expense of treating AIDS patients; and providing sterile needles or teaching IVDUs how to clean syringes and needles. Probably a mixed strategy will be to reduce the risk of HIV or IVDUs.