Risk behaviours for HIV infection among injecting drug users attending a drug dependency clinic.

Hart, Graham; Sonnex, C; Petherick, Anna; Johnson, Anne M; Feinmann, C; Adler, Michael

doi:10.1136/bmj.298.6680.1081

Cited by 36 publications

(12 citation statements)

References 14 publications

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“…A national evaluation of schemes for exchanging needles found that seven per cent of clients had shared injecting equipment while in custody, but the number of clients who had been in prison was not known.4 A study of risk behaviours for HIV infection among injecting drug users attending a drug dependency unit in central London found that out of 32 who had been in prison in recent years eight had shared injecting equipment. 5 The Parole Release Scheme has estimated that every year 20 000 of the prisoners who have passed through the system have taken illicit drugs,6 but there have been no studies focusing specifically on risk behaviours for HIV infection among injecting drug users in prison. We therefore studied a group of injecting drug users in London, all of whom had been in prison since 1982, to determine the degree of illicit drug use in prisons, the prevalence of risk behaviours for HIV infection, and the uptake of available treatment with drugs within the prison system.…”

Section: Introductionmentioning

confidence: 99%

Risk behaviours for HIV infection among drug users in prison.

Carvell

Hart

1990

BMJ

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Objective-To study a group of injecting drug users to establish the degree of iilicit drug Results -The average time spent in custody before the study was 20-6 months (range 1-72). Most prosecutions were directly or indirectly related to drug taking. 47 Ofthe 50 respondents reported taking at least one illicit drug while in custody; 33 by injection, 26 of whom had shared injecting equipment. 30 Had been treated for drug dependency by the prescribing of drugs while in prison. While in custody, one woman and four men (with a mean of seven (range 2-16) male partners) had had sex. Between periods spent in custody, men reported having a mean of eight (range 0-90) female partners and women a mean of one (range 0-3) male partner. Three men had had sex with other men, with a mean of six (range 2-11) partners. Since their last period in custody, men had had a mean of two (range 0-18) female partners and women had had a mean of two (range 1-3) male partners. Five men had also had male partners.

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Section: Introductionmentioning

confidence: 99%

Risk behaviours for HIV infection among drug users in prison.

Carvell

Hart

1990

BMJ

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“…Lower syringe sharing rates (of around 9%) were found in a subsequent evaluation of syringe-exchanges in Wales [74]. Low and declining sharing rates were reported from a single site study of a major stand-alone London syringe-exchange [75], from six syringe-exchange and community recruited samples in London and South-West England [76], among drug dependence clinic attenders [16,77], general practice patients in Scotland [78,53,79], and among treatment and community recruited samples in London, Glasgow and Edinburgh [51,80,17]. Comparable studies in London, Glasgow and Edinburgh, using a six-month period for self report (as opposed to one month) found significant reductions from 1990 to 1991 in Glasgow and London in the percentage of injectors receiving used needles and syringes and a levelling from 1991 to 1992 [67,[81][82][83].…”

Section: Behavioural Change and Low And Stable Hiv Pre~alence Ratesmentioning

confidence: 99%

“…For example, in 1986, 63% of an Edinburgh agency sample reported sharing syringes at least once a week [12]. The published studies (mainly from Edinburgh and London) showed between 59% and 83% of injectors reporting sharing syringes (there were variations between studies in definitions, time periods, sampling and recall methods) [12,6,[13][14][15][16]. Confirmatory retrospective data for Edinburgh (collected in 1992) confirm this picture with 67% of injectors reporting sharing syringes during any year up to 1986 [17].…”

Section: The Situation In 1986 and 1987mentioning

confidence: 99%

Aids and injecting drug use in the United Kingdom, 1987–1993: The policy response and the prevention of the epidemic

Stimson

1995

Social Science & Medicine

200

105

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Abstract--This paper assesses policy development, service changes and trends in HIV infection and risk behaviour among injecting drug users (IDUs) in the United Kingdom. In 1986, the U.K. was faced with the possible rapid spread of HIV infection among IDUs. The combination of an outbreak of HIV infection with prevalence levels of 50% or more in Edinburgh, the recent diffusion of drug injecting, and high levels of syringe-sharing risk behaviour, suggested that HIV infection might spread rapidly through IDU populations. HIV prevention activities commenced in 1986 and developed in 1987. The first report on AIDS and Drugs Misuse by the Advisory Council on the Misuse of Drugs in 1988 was a major catalyst for change. It supported and legitimized emergent views on new ways of working with drug users. Between 1988 and 1993 innovative public health projects increased the ability to target vulnerable populations through syringe distribution, expansion of methadone treatment and outreach to hard-to-reach populations. There were major changes in service philosophy and practices, as ideas of harm minimization, accessibility, flexibility and multiple and intermediate goals were developed. There is evidence that these public health projects encouraged extensive changes in the health behaviour of IDUs. There have been major reductions in syringe-sharing risk behaviour and sharing syringes is no longer the norm. Evaluation of specific interventions (e.g. syringe-exchange) shows their importance in encouraging reductions in risk behaviour. Levels of HIV infection in IDUs remain low by international standards. Outside of London rates of about 1% have been reported; London has a low and declining prevalence of infection to around 7% in 1993; previous high levels in Edinburgh (55%) have since declined to 20%. Britain has to date avoided the rapid increase in HIV infection among injectors that has occurred in many parts of the world. The same period saw the continuation of high prevalence levels in New York and many European cities, and the explosive spread of HIV in many countries in south-east Asia. This paper acknowledges the difficulties is proving links between social interventions and epidemic prevention. It argues that there is prima facie evidence for the success of public health prevention, that the collection of intervention approaches in the U.K. had a significant impact on IDUs behaviour, and that this has helped prevent an epidemic of HIV infection among IDUs. The U.K. experience adds to the growing evidence of the significance of early interventions in encouraging behaviour change and in limiting the spread of HIV infection.

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“…In the U.K. only 118 cases of AIDS had been reported amongst intravenous drug users up to 31 December 1989, but 1,819 reports of HIV positive intravenous drug users had been received. A large proportion of these have been reported in Edinburgh where a substantial level of infection (at least 50% seropositive) has developed amongst the population of intravenous drug users (Robertson et al, 1986;Brettle et al, 1987;Hart et al, 1989). 8.7 The prevalence of HIV infection amongst intravenous drug users in some parts of the U.S.A. has lead to a serious public health problem (Weinberg & Murray, 1988).…”

Section: Blood Productsmentioning

confidence: 97%