Objective: To determine whether needle and syringe exchange programs represent feasible sites to describe the prevalence of HIV and related risk behaviour among injecting drug users. Design: Cross-sectional survey. Setting: 21 needle and syringe exchange programs in all Australian jurisdictions. Participants: All persons attending the needle and syringe exchange programs over one week in March 1995 were eligible to participate in the study once. Intervention: Needle and syringe exchange attenders were asked to complete a brief, self-administered questionnaire and provide a finger-prick blood sample. Main outcome measures: Prevalence of HIV antibody, drug injecting and sexual behaviour, and survey cost. Results: Completed questionnaires with blood samples suitable for testing were provided by 1005 (42%) of 2373 individuals who attended the needle and syringe exchange programs during the survey week. Women were more likely than men to participate in the survey but there was no difference in the response rate by age group. The HIV prevalence was 2.1% and was significantly higher in men who described themselves as homosexual, compared to men who described themselves as heterosexual (22.5% v. 0.7%; P<0.001). Thirty-one per cent of respondents reported using a syringe after someone else in the preceding month. Conclusion: Cross-sectional surveys of needle exchange clients offer a practical method for monitoring risk behaviour and seroprevalence of bloodborne viral infections.
In Australia a police project incorporating four parallel trials was established to test a new model of illicit drug law enforcement, which gives greater emphasis to harm reduction at the community level. The project was based on a community-policing model developed in the United Kingdom and involved establishing a community based consultation structure comprising an implementation oriented Drug Action Team (DAT) and support oriented Drug Reference Group (DRG). Two of the trials operated in Western Australia: one in Geraldton, a small regional city; and the other in Mirrabooka, a large, diverse, metropolitan region within Perth. The project officers were faced with a number of challenges and had to develop strategies to overcome these. One of the important issues was the effect of continual changes in membership of DATs, and consequent fluctuating levels of enthusiasm and commitment. The size and composition of the DATs also had an impact on how they operated. Other issues included the management of different agency agendas and recognition that the project would only operate for a limited time. How the project officers dealt with these issues in their development of the DAT/DRG model and how the two trial sites incorporated harm reduction into illicit drug policing are presented and discussed.2
The Youth AIDS and Drugs (YAD) Study is a study of young people who inject drugs, and their risk of the transmission of HIV through needle sharing and/or unsafe sex. One hundred and five people, aged less than 21, 75% of whom were current or recent injectors, undertook in-depth interviews which were tape recorded, transcribed and analysed qualitatively. This paper focuses on the ways in which the young people in the group attempted to manage the risk of needle sharing. Needle sharing in the study group was not common behaviour. Almost all injectors employed one of four major Risk Management Strategies some of which included the possibility of sharing unbleached needles with a friend or a lover. These strategies were strongly related to beliefs that such friends and lovers were well enough known by the individual for there to be very little risk. The implications of these findings for health promotion with young people who inject drugs in Perth, a city of low IDU seroprevalence, are outlined.
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