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Conference Abstracts Part 2 ABSTRACTS 672 A Kral, R Anderson, N Flynn, R Bluthenthal than obvious. THE IMPACT OF LEGAL STATUS ON SYRINGE EXCHANGE PROGRAM Dangerous injection ways leads to spread of HIV- and other infections. OPERATIONS AND OUTCOMES: RESULTS FROM THE CALIFORNIA SYRINGE Weak use of safer sex and condoms lead to spread of infection among EXCHANGE STUDY IDUs sexual partners. Results: Results show us importance of outreach work, intervention, Background/Objectives: Since 2000, the legal status of syringe exchange counselling among IDUs, safer injection and safer sex education. Special programs (SEPs) in California has been based upon whether local County attention has to be paid to women for prevention spread of infection to officials (e.g. mayors) declare a public health emergency, thereby newborns. superceding existing syringe prescription and possession laws. Given that California has more SEPs than any other U.S. State, we set out to study the 674 N Srirak, S Kawichai, V Suriyanon, impact of legal status on SEP operations and injection drug users (IDUs) who use SEPs. J Jittiwutikarn, M Razak, K Rungruengthanakit, Methods: Three types of data were collected at 23 of 24 existing C Kitisri, R Khampan, S Yungyuankul, D Celentano California SEPs in 2001: 1) Annual program survey of SEP directors HIV INFECTION AND RISK BEHAVIORS AMONG DRUG USING COUPLES IN (N=23), 2) Annual budget provided by SEP directors, 3) A quantitative NORTHERN THAILAND survey of approximately 25 SEP clients from each SEP, including HIV Background/Objectives: HIV/AIDS research has shifted from studying Orasure testing (N=531). individual risk factors to understanding the social environment. A focus on Results: Illegal (n=6) and legal SEPs (n=17) were open similar number couples provides the context for identifying HIV dynamics in families. This of hours per week (Average 4 days for 15 hours vs 4 days for 18 hours, study investigated HIV infection and risk behaviours among drug using respectively). Illegal SEPs were more likely than legal SEPs to exchange < couples. 55,000 needles per year (50% vs 16%). Illegal SEPs were more likely than Methods: Between Feb 1999 and December 2000, 42 drug using legal SEPs to have a need-based distribution policy as opposed to one-for- couples admitted to Northern Drug Dependence Treatment Center (NDTC) one. Illegal SEPs were more likely than legal SEPs to report police consented to join a cross-sectional study. Face-to-face interviews and HIV problems, political problems, and supply shortages. One volunteer of an testing with pre- and post-test counseling were undertaken. illegal program was arrested and convicted for conducting syringe Results: Twenty-eight (66.7%) couples were non-IDU; 11 (25.2%) were exchange. Legal SEPs received on average over twice as much funding as IDU; and 3 reported mixed mode of administration. Most were ethnic illegal SEPs. Clients of legal SEPs reported more SEP visits per month and minorities (78.6%), and 14.3% ever incarcerated. Of 11 IDU couples, 4 fewer syringes per visit than clients of illegal SEPs. Clients of legal SEPs (36.4%) were HIV positive concordant; of 28 non-IDU couples, 1 couple were more likely than clients of illegal SEPs to use ancillary services, was discordant with female HIV positive; no HIV infection was found in including education, counseling, and HCV testing. Injection and sexual risk couples with mixed mode of use. HIV infection among Thai couples and behaviors were at similar levels among clients of legal and illegal SEPs. those ever incarcerated were 33.3% and 50%, respectively. Among IDU, Conclusions: Legalizing SEPs resulted in increased funding, increased 72% (18/25) shared injection equipment, of whom 44.4% (8/18) were HIV access to ancillary services for SEP clients and fewer political and police infected. problems. It also led to more operational regulations for SEPs, including Conclusions: The data revealed high HIV infection among couples who stipulations about whether programs can provide need-based distribution ever injected. Harm reduction, HIV and drug counseling for couples using of syringes. drugs are needed. 673 J Kalikov 676 J Oomen RISK BEHAVIOUR – FROM THE HEROINE EPIDEMIC TO THE MOST WORST ANOTHER DRUG POLICY IS POSSIBLE HIV EPIDEMICS IN EASTERN EUROPE Our proposal is to organise a plenary or thematic panel that will give the From epidemic start among IDUs in 2000, 3447 HIV cases are founded in opportunity to a range of field actors from different continents to describe Estonia. 80% were among IDUs. Estimated number of IDUs in Ida-Virumaa their experiences with current drug policies and exchange their ideas for 8000-12000. the changes that are needed as well as future campaigns to obtain these In 2000 Counselling and Needle Exchange (NE) project (IHRD) starts in changes. The aim of this seminar is to identify common ground between Narva with NE and counselling. In 2001, supported by state, 20 NE people who are convinced of the need to implement a fundamental reform counsellors started in 6 towns in Ida-Virumaa. of international drug legislation and to produce a well-established common Objectives: For HIV/AIDS epidemic control (WHO) its necessary capture analysis of the issue, as well as a proposal for an alternative drug policy by NE at least 60-70% IDUs. Now over 3000 IDUs in Ida-Virumaa is model based on social criteria, and a common strategy to obtain changes. captured – 25% of risk group. Research helps preventative work among When fear will sooner or later be replaced by insight, by knowledge, by IDUs, woman, their newborn babies. confidence, those who use fear as a political weapon will become Target group: IDUs, mostly heroin users ridiculous. So when the panel title insists that another, more effective drug Methods: Anonymous questionnaire in 6 cities in Ida-Virumaa for first policy is possible, it is to indicate that we should work on politicians at visitors. every level and position to respond. Politicians need to realise that it them Results: 2930 IDUs questioned in 6 months. who can take a first step towards a truly different drug policy, one that Age: 12-14 (62); 15-19 (1576); 20-29 (1230); 30-39 (62) includes just and efficient measures concerning the issues of production, Sex: 2288 m, 642 f. distribution and consumption of both illegal and legal drugs. It must be a Reasons: 71% – curiosity; 20% – friends influence. policy that is coherent and in agreement with social, economic, health and Habits: 91% use water for cleaning; 45% share needle with 1, more human rights policies that the United Nations should promote, not IDUs, 40% get clean needles at NE; 31% in pharmacies. undermine. Sexual behaviour: 90% – 2, more partners in 1 year, 50% – 4 and more. 40% use condoms seldom or never, 15% claim regularity. 677 J Marsden, G Stillwell 77% believe in risk of getting HIV sexually, only 66% believe in risk through needle. 36% interested in HIV tests. RANDOMISED TRIAL OF A BRIEF MOTIVATIONAL INTERVENTION FOR Other infections: 48% has Hepatitis B, C or both. YOUNG PSYCHOSTIMULANT USERS Conclusions: IDUs are mostly young, 56% are under 20 yo. Objectives: A study was undertaken to develop and evaluate the efficacy of 22% are women. Spreading HIV sexually and among newborns is more a brief motivational intervention designed for use with young non-injecting 151 15th INTERNATIONAL CONFERENCE on the Reduction of Drug Related Harm psychostimulant users not in treatment. Methods: A two group randomised among IDUs, which accordingly in the beginning of the 90s counted almost controlled trial with follow-up at six months was employed to evaluate the 80%-85%. intervention. Participants in the experimental arm received a self-complete In the year of 1994, a first "experimental" MMP developed for several assessment, a motivational interview and information materials. The IDUs emerged in the Institute of Psychiatry and Neurology in Warsaw. control arm participants received only the assessment and information Despite of satisfying experience achieved by the program, no further materials. The baseline and follow-up sessions were conducted in a range attempts of this sort of help was being made for IDUs. Among main of specialist drug agencies and community sites. A team of young drug reasons one could have traced lack of legacy and stubborn objectiveness of workers from two agencies were trained to deliver the intervention. patients. In 1997, the Parliament approved the Law against drug addiction. Results: In total 342 young (16 to 22 years old) out-of-treatment This Law releases the substitution treatment and describes its psychostimulant users whose primary stimulant was crack cocaine, conditions. That’s how 10 MMPs for 800 persons emerged in Poland, 38,5 cocaine hydrochloride, or ecstasy were recruited: 87.4% participants were million inhabitants, 40000 opiate IDUs. followed-up. At follow-up 49% of participants reported attempting a harm In March, 1998, a MMP for HIV-infected IDUs raised in Chorzow within reduction change because of some aspect of the intervention. The efficacy the Centre for AIDS Diagnostics and Therapy. of the intervention was examined across eight domains on 16 measures. The analysis of specific questionnaires created in the very beginning For the whole sample there were significant improvements across time for and gradually updated shows a tremendous change in vast social spheres. most outcome measures in both arms of the trial. Differences at follow-up One of the aspects of the analysis lies in comparison of legal and illegal between the experimental and control conditions were statistically revenues before and during the participation in the program and makes it significant for attempting a harm reduction change, reduction of overall possible to observe the metamorphosis within the patients in the growth of frequency of crack cocaine, cocaine hydrochloride, ecstasy use, application financial incomes and reduction of illegal sources.
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