Faculty Bibliography

The initial period in the establishment of syringe exchange projects is often characterized by overt conflict: between community AIDS activists, on the one hand, and public officials and political leaders who remain ideologically opposed to the introduction of measures perceived as condoning illicit drug use. In this context, professionals concerned with legitimating the new institutions of syringe exchange may sometimes neglect aspects of their everyday logistics and social organization, obscuring the important choices which have to be made to carry these initiatives forward. In particular, the contrast between formally-constituted institutions-the "storefront" or "community-based" syringe exchange programs (SEPs)-and the model of low-threshold syringe availability through pharmacies, vending machines, and user networks, is here presented not as an either/or choice but rather as a pair of complementary strategies which respond to diverse needs and target different populations. The advantages and disadvantages of each particular approach make it likely that maximum effectiveness will be achieved through a combination of every possible form of needle distribution, each tailored to specific and cultural circumstances. The case is here examined in the light of the experience of the SEPs in New York City, from their clandestine origins in 1990 through their first years of official functioning in 1992-1996.

The causes of death among injecting drug users. (IDUs) are still being discussed worldwide. We analysed the causes of death among IDUs attending 26 centres for drug users in North-Eastern Italy from 1985 to 1994. The study of a total number of 1,022 deaths reveals the following: (1) AIDS has become the primary cause of death among IDUs since 1991 and is rising even in an area with a moderate HIV seroprevalence; (2) the mean age of death in AIDS patients proved higher than among patients who died of other causes (which may be due to the long incubation period of AIDS); (3) our data do not reveal higher HIV seroprevalence among IDUs who died of overdose and suicide as opposed to IDUs who died of other causes; (4) the mortality rate in IDUs is significantly higher when compared to that of the general population in the same age group.

OBJECTIVE:Acquired immunodeficiency syndrome (AIDS) was formally identified among injecting drug users (IDUs) in 1981, and research on preventing human immunodeficiency virus (HIV) infection among drug injectors began shortly thereafter. At the time this research was begun, there was a general assumption that drug user (who were called drug abusers at that time) were too self-destructive and their behavior too chaotic for them to change their behavior to avoid infection with HIV. This chapter reviews the history of research on implementation of programs for prevention of HIV infection among IDUs. METHODS:Reviews of both research and program implementation research were conducted. Consultative discussions of issues and findings were conducted with researcher in the United States and other countries. RESULTS:An extremely large amount of useful information has accumulated during the pat 15 years. We now know that the great majority of IDUs will change their injecting behavior in response to the threat of AIDS and that these behavior changes are effective in reducing HIV transmission among drug injectors. Additional insight is needed regarding the apparent insufficiency of some prevention programs to control HIV, the transmission dynamics of rapid HIV spread, and the persistence of moderate to high incidence of HIV infection in high seroprevalence populations. Despite the current research knowledge base, implementation of effective prevention programs in may countries is nonexistent to incomplete. CONCLUSIONS:The most important barrier to reducing HIV transmission among drug injectors is not a lack of knowledge but the failure to implement effective prevention programs in may parts of the world.

AIMS/OBJECTIVE:Drug scenes (social and spatial drug-using and drug-selling environments) have complex role structures. Many drug injectors earn money or drugs as drug or syringe sellers, hit doctors (people who help others to inject) commercial sex workers, or in other roles. This paper aims to measure "role behaviors" of drug injectors; describe which drug injectors are more likely to engage in such role behaviors; and to determine whether roles are related to elements of HIV risk. DESIGN/METHODS:Cross-sectional study of drug injectors. SETTING/METHODS:Bushwick, a section of Brooklyn, New York, a major location for injection drug use and drug sales. PARTICIPANTS/METHODS:Seven hundred and sixty-seven street-recruited drug injectors. MEASUREMENTS/METHODS:Participants were interviewed about their roles, behaviors, socio-demographics and risk networks; sera were collected and assayed for HIV and hepatitis B core antibody. FINDINGS/RESULTS:Socio-demographic variables are related to role-holding in complex ways. Economic need is generally associated with engaging in drug-scene role behaviors. Holders of these roles are at greater behavioral and network risk for HIV and other blood-borne infections than are other drug injectors. They also engage in extensive communication with other drug users, including discussion of HIV risk reduction. CONCLUSION/CONCLUSIONS:Role behaviors can be measured in quantitative studies, and seem to be related to HIV risk. Role-holders may be strategic targets for risk-reduction campaigns. It seems feasible and advisable to measure drug scene role-holding in research on drug users.

In 1992, New York State Department of Health regulations provided for fully legal syringe exchange programmes in the state. The policies and procedures mandated that: 'Each program must seek to recruit ... for inclusion on its advisory board ... program participants ... Programs are also urged to establish other advisory bodies, such as Users' Advisory Boards made up of program participants, to provide input and guidance on program policies and operations.' The inclusion of drug users as official advisors to the legal programmes was seen as a method for incorporating the views of the consumers of the service in operational decisions. The 1992 regulations implied a new public image for users of illicit psychoactive drugs: active drug users were seen to be capable not only of self-protective actions (such as avoiding HIV infection), but also of serving as competent collaborators in programmes to preserve the public health. This development has important implications with regard to the evolution of official drug policy, since it will be difficult in future to treat IDUs simply as the passive objects of state intervention. Whether as individuals or representatives of a wider population of illicit drug users, they have acquired a legitimacy and sense of personal worth which would have been unthinkable in previous periods.