Injection drug users' practices and attitudes toward intervention and potential for reducing the transmission of HIV

Ascertaining the Need for a Supervised Injecting Facility (SIF): The Burden of Public Injecting in Montreal, Canada

Empirical evidence suggests that a key prerequisite for a supervised injection facility (SIF) utilization is the existence of an “open drug scene,” where users publicly inject drugs. This study seeks to determine the extent and profile of public injecting among injecting drug users (IDUs) in Montreal, Canada, where pilot SIFs are under consideration. A cross-sectional study of IDUs who injected publicly at least once in the previous month was appended to an HIV-risk surveillance study among Montreal IDUs (SurvUDI study). Of 650 SurvUDI participants interviewed between June 2001 and February 2002, 59% were eligible. A dose-response relationship emerged between intensity of public injecting and several drug-use and risk-related characteristics. Regardless of housing stability, IDUs persistently and, often preferably, publicly injected due to habit, dependence, or need to conceal their status. Despite lacking a classical open drug scene, public injecting is common among Montreal IDUs, warranting the consideration of an SIF for this population.

Public citizens, marginalized communities: the struggle for syringe exchange in Springfield, Massachusetts

Syringe exchange programs, which, in order to prevent HIV infections, provide injection drug users with sterile syringes in exchange for used ones, operate at the intersection of conflicting social and political beliefs about disease, drugs, the common good, and the law. This paper describes community opposition that emerged from diverse quarters in response to a proposed syringe exchange program (SEP) in Springfield, Massachusetts. White suburban residents and inner-city African-Americans both drew on concepts of personal responsibility and self-sufficiency as they described their opposition to SEP. Through archival research and in-depth interviews with key community figures, I show how their similar political positions resulted from highly divergent views on the role of government in caring for citizens and communities. These arguments about addiction, HIV, and community both index and turn on the unique relationships with government experienced by a range of social actors.

[The concepts of risk and prevention from the perspective of injecting drug users]

This paper provides an exploratory analysis, using a qualitative approach, to perceptions by injecting drug users (IDUs) on: (a) risks associated with injecting practices; (b) risks of HIV/AIDS; and (c) prevention of HIV/AIDS. The study was conducted in five harm reduction programs in Brazil (the AjUDE-Brasil Project). Forty semi-structured interviews were carried out. The study focuses on the concept of "risk". IDUs were mainly concerned over becoming ill and exposure to overdose and violence. IDUs dealt with individual problems in very specific ways in order to minimize them. They admitted that they were well informed about HIV/AIDS but lacked knowledge on reinfection and other bloodborne diseases. IDUs intended to follow guidelines established by health campaigns, but their addiction usually made it difficult. IDUs also suggested alternative harm reduction strategies and displayed a peculiar reading of concepts concerning sharing their injecting paraphernalia.

The social geography of AIDS and hepatitis risk: qualitative approaches for assessing local differences in sterile-syringe access among injection drug users

While significant gains have been achieved in understanding and reducing AIDS and hepatitis risks among injection drug users (IDUs), it is necessary to move beyond individual-level characteristics to gain a fuller understanding of the impact of social context on risk. In this study, 6 qualitative methods were used in combination with more traditional epidemiologic survey approaches and laboratory bioassay procedures to examine neighborhood differences in access to sterile syringes among IDUs in 3 northeastern cities. These methods consisted of (1) neighborhood-based IDU focus groups to construct social maps of local equipment acquisition and drug use sites; (2) ethnographic descriptions of target neighborhoods; (3) IDU diary keeping on drug use and injection equipment acquisition; (4) ethnographic day visits with IDUs in natural settings; (5) interviews with IDUs about syringe acquisition and collection of syringes for laboratory analysis; and (6) focused field observation and processual interviewing during drug injection. Preliminary findings from each of these methods are reported to illustrate the methods' value in elucidating the impact of local and regional social factors on sterile syringe access.

Use of needles and syringes in Miami and Valencia: observations of high and low availability

Two studies engaged in gathering data on injecting drug users (IDUs) employed supplementary resources to enhance their ethnographic components and compare patterns of use of needles/syringes (n/s) in two geographically similar but culturally distinct cities. Despite its policy of making n/s highly available at fair prices, Valencia, Spain, has markedly higher rates of HIV seroprevalence among its IDUs than does Miami, Florida, where possession of n/s is illegal. Ethnographically based models that track IDUs through choices of injection venues help to explain this difference. Inability of IDUs in Valencia to use their own domiciles as venues for injection contrasts sharply with problems of Miami IDUs, who have access to houses but have difficulty finding n/s. This research suggests that intervention in Valencia needs to focus on how people select places where they inject, and intervention in Miami needs to focus on improving availability of n/s.

HIV seroprevalence across the rural/urban continuum

While the first decade of the AIDS epidemic was characterized by high prevalence rates of AIDS infection in urban areas, there is increasing recognition of the spread of HIV into rural communities in the United States. Data from the Miami CARES cohort collected on 3,555 chronic drug users from 1988 to 1994 provide a unique opportunity to assess sociodemographic characteristics, drug-using behaviors and HIV risk behaviors related to HIV seropositivity in three communities across the rural-urban continuum: Miami, Florida; Belle Glade, Florida and Immokalee, Florida. The three very different communities studied demonstrate that HIV is no respecter of ecological site. The spread of HIV between areas and within areas is specifically correlated with the risk factors including injection drug use, use of crack cocaine, exchange of sex for money, and the rates for sexually transmitted diseases. All of these factors are shown to increase the risk of HIV so that the constellation of these practices helps determine the differential rates and spread of HIV in the three different areas.

Usuários de drogas injetáveis e infecção pelo Vírus da Imunodeficiência Humana: epidemiologia e perspectivas de intervenção

Dos cerca de 130 mil casos de aids notificados no Brasil entre 1980 e fevereiro de 1998, 21% estão diretamente relacionados ao uso de drogas injetáveis. Este artigo revisa aspectos da epidemiologia da infecção pelo HIV e outros patógenos de transmissão sangüínea, entre usuários de drogas injetáveis (UDI), visando a subsidiar as pesquisas e a implementação de propostas de intervenção em nosso meio. A população de UDI é heterogênea e, ao contrário do estereótipo, nem todos os UDI provêm de minorias masculinas das grandes áreas urbanas. Esta população está em contínua transformação, com mudanças marcantes ao longo do tempo na sua composição, hábitos e padrões de consumo. A estimativa precisa do número de UDI em uma dada localidade constitui tarefa difícil, embora disponha-se de novas metodologias, como o método de captura-recaptura. A combinação de dados provenientes de diversas fontes se mostra também indispensável. Estudos no sentido de monitorizar os padrões e tendências do uso de drogas injetáveis, segundo diferentes níveis de agregação e em intervalos regulares, permitem estimar prováveis aumentos ou decréscimos desta população e detectar mudanças relevantes nos seus comportamentos, contribuindo para orientar as estratégias de intervenção e alocação ótima de recursos. Evidências recentes demonstram que, devido à exposição parenteral e sexual aos diferentes patógenos, as infecções nesta população ocorrem precocemente, demandando intervenções prontas e abrangentes quanto aos UDI em atividade, e esforços no sentido de minimizar a transição para a via injetável e oferecimento de alternativas de tratamento clínico e para o abuso de drogas.