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Don Des C Jarlais - One of the best experts on this subject based on the ideXlab platform.
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geographic approaches to quantifying the risk environment drug related law enforcement and access to syringe Exchange Programmes
International Journal of Drug Policy, 2009Co-Authors: Hannah L F Cooper, Don Des C Jarlais, Samuel R. Friedman, Brian Bossak, Barbara TempalskiAbstract:Abstract The concept of the “risk environment” – defined as the “space … [where] factors exogenous to the individual interact to increase the chances of HIV transmission” – draws together the disciplines of public health and geography. Researchers have increasingly turned to geographic methods to quantify dimensions of the risk environment that are both structural and spatial (e.g., local poverty rates). The scientific power of the intersection between public health and geography, however, has yet to be fully mined. In particular, research on the risk environment has rarely applied geographic methods to create neighbourhood-based measures of syringe Exchange Programmes (SEPs) or of drug-related law enforcement activities, despite the fact that these interventions are widely conceptualized as structural and spatial in nature and are two of the most well-established dimensions of the risk environment. To strengthen research on the risk environment, this paper presents a way of using geographic methods to create neighbourhood-based measures of (1) access to SEP sites and (2) exposure to drug-related arrests, and then applies these methods to one setting (New York City [NYC]). NYC-based results identified substantial cross-neighbourhood variation in SEP site access and in exposure to drug-related arrest rates (even within the subset of neighbourhoods nominally experiencing the same drug-related police strategy). These geographic measures – grounded as they are in conceptualizations of SEPs and drug-related law enforcement strategies – can help develop new arenas of inquiry regarding the impact of these two dimensions of the risk environment on injectors’ health, including exploring whether and how neighbourhood-level access to SEP sites and exposure to drug-related arrests shape a range of outcomes among local injectors.
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hiv risk behaviour among participants of syringe Exchange Programmes in central eastern europe and russia
International Journal of Drug Policy, 2002Co-Authors: Don Des C Jarlais, Theresa Perlis, Jean-paul C. Grund, Catherine Zadoretzky, Judith Milliken, Patricia Friedmann, Stephen P. Titus, Valentina Bodrova, Elena ZemlianovaAbstract:Abstract Objective: To assess HIV risk behaviour among participants in syringe Exchanges in five Central/Eastern European cities: Prague (Czech Republic), Budapest (Hungary), Skopje (Former Yugoslavian Republic of Macedonia), Krakow (Poland) and Poltava (Ukraine), and five Russian cities: Nizhniy Novgorod, Pskov, Rostov-Na-Donu, St. Petersburg, and Volgograd. Design: Cross-sectional survey with questions on injection risk behaviours for the 30 days prior to first use of the syringe Exchange programme and for the 30 days prior to interview (while using the syringe Exchange programme). Methods: Respondents were recruited from participants of the syringe Exchanges. Structured questionnaires covering drug use and HIV risk behaviour were administered by trained interviewers. Results: 1671 respondents were interviewed across the ten Programmes. Participants in the Programmes tended to be young and relatively recent initiates into drug injection. Relatively low percentages of participants reported receptive syringe sharing (‘injecting with needles and syringes used by others') in the past 30 days, from 1 to 29% across the ten Programmes. These represented statistically significant reductions from the percentages of respondents reporting receptive syringe sharing in the 30 days prior to first use of the syringe Exchange—from 7 to 47%. Conclusions: IDUs participating in the Exchanges appear to be responding very positively in reducing sharing of needles and syringes. Syringe Exchange and other HIV prevention Programmes for injecting drug users (IDUs) in this geographic region should be expanded rapidly.
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HIV risk behaviour among participants of syringe Exchange Programmes in central/eastern Europe and Russia
International Journal of Drug Policy, 2002Co-Authors: Don Des C Jarlais, Theresa Perlis, Jean-paul C. Grund, Catherine Zadoretzky, Judith Milliken, Patricia Friedmann, Stephen P. Titus, Valentina Bodrova, Elena ZemlianovaAbstract:Abstract Objective: To assess HIV risk behaviour among participants in syringe Exchanges in five Central/Eastern European cities: Prague (Czech Republic), Budapest (Hungary), Skopje (Former Yugoslavian Republic of Macedonia), Krakow (Poland) and Poltava (Ukraine), and five Russian cities: Nizhniy Novgorod, Pskov, Rostov-Na-Donu, St. Petersburg, and Volgograd. Design: Cross-sectional survey with questions on injection risk behaviours for the 30 days prior to first use of the syringe Exchange programme and for the 30 days prior to interview (while using the syringe Exchange programme). Methods: Respondents were recruited from participants of the syringe Exchanges. Structured questionnaires covering drug use and HIV risk behaviour were administered by trained interviewers. Results: 1671 respondents were interviewed across the ten Programmes. Participants in the Programmes tended to be young and relatively recent initiates into drug injection. Relatively low percentages of participants reported receptive syringe sharing (‘injecting with needles and syringes used by others') in the past 30 days, from 1 to 29% across the ten Programmes. These represented statistically significant reductions from the percentages of respondents reporting receptive syringe sharing in the 30 days prior to first use of the syringe Exchange—from 7 to 47%. Conclusions: IDUs participating in the Exchanges appear to be responding very positively in reducing sharing of needles and syringes. Syringe Exchange and other HIV prevention Programmes for injecting drug users (IDUs) in this geographic region should be expanded rapidly.
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geographic proximity policy and utilization of syringe Exchange Programmes
Aids Care-psychological and Socio-medical Aspects of Aids\ hiv, 1999Co-Authors: Russell Rockwell, Theresa Perlis, Don Des C Jarlais, S R Friedman, Denise PaoneAbstract:The objective of the research was to assess the effects of geographic proximity on the utilization of syringe Exchange among injection drug users (IDUs) in New York City. Between 1994 and 1996, 805 IDUs were interviewed with a structured questionnaire. Geographic proximity was defined as living within a ten-minute walk. Eighty-one per cent of IDUs who lived close typically used a syringe Exchange compared to 59% of those who lived further away. In multiple logistic regression analysis, those who lived close remained (adjusted odds ratio of 2.89; 95% CI 2.06 to 4.06, p = 0.001) more likely to use syringe Exchange. Those who lived close were less likely to have engaged in receptive syringe sharing at last injection (adjusted odds ratio = 0.45, 95% CI 0.24 to 0.86, p = 0.015). In conclusion, locating Exchange services in areas convenient to large numbers of IDUs may be critical for prevention of HIV infection.
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Injection drug users as social actors: a stigmatized community's participation in the syringe Exchange Programmes of New York City.
AIDS care, 1998Co-Authors: A. R. Henman, Denise Paone, Don Des C Jarlais, Lee M. Kochems, Samuel R. FriedmanAbstract:Abstract 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 alsoof serving as competent collaborators in Programmes to preserve the public health. This development has important implications with regard to the evolution of official drug...
Samuel R. Friedman - One of the best experts on this subject based on the ideXlab platform.
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geographic approaches to quantifying the risk environment drug related law enforcement and access to syringe Exchange Programmes
International Journal of Drug Policy, 2009Co-Authors: Hannah L F Cooper, Don Des C Jarlais, Samuel R. Friedman, Brian Bossak, Barbara TempalskiAbstract:Abstract The concept of the “risk environment” – defined as the “space … [where] factors exogenous to the individual interact to increase the chances of HIV transmission” – draws together the disciplines of public health and geography. Researchers have increasingly turned to geographic methods to quantify dimensions of the risk environment that are both structural and spatial (e.g., local poverty rates). The scientific power of the intersection between public health and geography, however, has yet to be fully mined. In particular, research on the risk environment has rarely applied geographic methods to create neighbourhood-based measures of syringe Exchange Programmes (SEPs) or of drug-related law enforcement activities, despite the fact that these interventions are widely conceptualized as structural and spatial in nature and are two of the most well-established dimensions of the risk environment. To strengthen research on the risk environment, this paper presents a way of using geographic methods to create neighbourhood-based measures of (1) access to SEP sites and (2) exposure to drug-related arrests, and then applies these methods to one setting (New York City [NYC]). NYC-based results identified substantial cross-neighbourhood variation in SEP site access and in exposure to drug-related arrest rates (even within the subset of neighbourhoods nominally experiencing the same drug-related police strategy). These geographic measures – grounded as they are in conceptualizations of SEPs and drug-related law enforcement strategies – can help develop new arenas of inquiry regarding the impact of these two dimensions of the risk environment on injectors’ health, including exploring whether and how neighbourhood-level access to SEP sites and exposure to drug-related arrests shape a range of outcomes among local injectors.
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Injection drug users as social actors: a stigmatized community's participation in the syringe Exchange Programmes of New York City.
AIDS care, 1998Co-Authors: A. R. Henman, Denise Paone, Don Des C Jarlais, Lee M. Kochems, Samuel R. FriedmanAbstract:Abstract 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 alsoof serving as competent collaborators in Programmes to preserve the public health. This development has important implications with regard to the evolution of official drug...
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hiv incidence among injecting drug users in new york city syringe Exchange Programmes
The Lancet, 1996Co-Authors: Michael Marmor, Stephen Titus, Theresa Perlis, Benny Jose, Denise Paone, Don Des C Jarlais, Samuel R. FriedmanAbstract:Summary Background There have been no studies showing that participation in Programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-Exchange Programmes in New York City with that among non-participants. Methods We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n=280), in which multiple interviews and saliva samples were collected from participants at Exchange sites; the Vaccine Preparedness Initiative cohort (n=133 continuing Exchangers and 188 non-Exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n=1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe Exchanges. Findings HIV incidence among continuing Exchange-users in the Syringe Exchange Evaluation was 1·58 per 100 person-years at risk (95% CI 0·54, 4·65) and among continuing Exchange-users in the Vaccine Preparedness Initiative it was 1·38 per 100 person-years at risk (0·23, 4·57). Incidence among non-users of the Exchange in the Vaccine Preparedness Initiative was 5 26 per 100 person-years at risk (2·41, 11·49), and in the NADR cities, 6·23 per 100 person-years at risk (4·4, 8·6). In a pooled-data, multivariate proportional-hazards analysis, not using the Exchanges was associated with a hazard ratio of 3 35 (95% CI 1·29, 8·65) for incident HIV infection compared with using the Exchanges. Interpretation We observed an individual-level protective effect against HIV infection associated with participation in a syringe-Exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.
Péter Biró - One of the best experts on this subject based on the ideXlab platform.
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IP solutions for international kidney Exchange Programmes
Central European Journal of Operations Research, 2020Co-Authors: Radu Stefan Mincu, Péter Biró, Márton Gyetvai, Alexandru Popa, Utkarsh VermaAbstract:In kidney Exchange Programmes patients with end-stage renal failure may Exchange their willing, but incompatible living donors among each other. National kidney Exchange Programmes are in operation in ten European countries, and some of them have already conducted international Exchanges through regulated collaborations. The Exchanges are selected by conducting regular matching runs (typically every three months) according to well-defined constraints and optimisation criteria, which may differ across countries. In this work we give integer programming formulations for solving international kidney Exchange problems, where the optimisation goals and constraints may be different in the participating countries and various feasibility criteria may apply for the international cycles and chains. We also conduct simulations showing the long-run effects of international collaborations for different pools and under various national restrictions and objectives. We compute the expected gains of the cooperation between two countries with different pool sizes and different restrictions on the cycle-length. For instance, if country A allows 3-way cycles and country B allows 2-way cycles only, whilst the pool size of country A is four times larger than the pool size of country B (which is a realistic case for the relation of Spain and France, respectively), then the increase in the number of transplants will be about 2% for country A and about 37% for country B.
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IP Solutions for International Kidney Exchange Programmes
arXiv: Optimization and Control, 2019Co-Authors: Péter Biró, Márton Gyetvai, Radu Stefan Mincu, Alexandru Popa, Utkarsh VermaAbstract:In kidney Exchange Programmes patients with end-stage renal failure may Exchange their willing, but incompatible living donors among each other. National kidney Exchange Programmes are in operation in ten European countries, and some of them have already conducted international Exchanges through regulated collaborations. The Exchanges are selected by conducting regular matching runs (typically every three months) according to well-defined constraints and optimisation criteria, which may differ across countries. In this work we give integer programming formulations for solving international kidney Exchange problems, where the optimisation goals and constraints may be different in the participating countries and various feasibility criteria may apply for the international cycles and chains. We also conduct simulations showing the long-run effects of international collaborations for different pools and under various national restrictions and objectives.
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Building kidney Exchange Programmes in Europe - an overview of Exchange practice and activities
Transplantation, 2019Co-Authors: Péter Biró, Bernadette J. J. M. Haase-kromwijk, Tommy Andersson, Eyjolfur Ingi Asgeirsson, Tatiana Baltesová, Ioannis Boletis, Catarina Bolotinha, Gregor Bond, Georg A. Böhmig, Lisa BurnappAbstract:Bakgrund: Considerable differences exist among the living donor Kidney Exchange Programmes (KEPs) that are in use and being built in Europe, contributing to a variation in the number of living donor transplants [6]. Efforts of European KEPs to Exchange (best) practices and share approaches to address challenges have, however, been limited.Methods: Experts from 23 European countries, collaborating on the ENCKEP COST Action, developed a questionnaire to collect detailed information on the functioning of all existing KEPs in Europe, as well as their opportunities and challenges. Following a comparative analysis, results were synthesised and interpreted by the same experts.Results: The practices, opportunities and challenges reported by 17 European countries reveal that some of the 10 operating Programmes are mature, while others are in earlier stages of development. Over 1300 transplants were performed through existing KEPs up to the end of 2016, providing approximately 8% of their countries’ living kidney donations in 2015. All countries report challenges to either initiating KEPs or increasing volumes. Some challenges are shared, whilst others differ because of differences in context (eg, country size, effectiveness of deceased donor programme) and ethical and legal considerations (eg, regarding living donation as such, nonrelated donors, and altruistic donation). Transnational initiatives have started in Central Europe, Scandinavia, and Southern Europe.Conclusions: Exchange of best practices and shared advancement of national Programmes to address existing challenges, aided by transnational Exchanges, may substantially improve access to the most (cost) effective treatment for the increasing number of patients suffering from kidney disease.
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Élődonoros vesecsereprogramok Európában. Hol tart Magyarország? Összefoglaló tanulmány az ENCKEP (European Network for Collaboration on Kidney Exchange Programmes) COST Action eddigi eredményei alapján = Kidney Exchange Programmes in Europe. What is
2018Co-Authors: Péter Biró, Adam Remport, Sándor Mihály, Lóránt Illésy, Balázs NemesAbstract:Absztrakt: A kozpontilag koordinalt vesecsereprogramokban kronikus vesebetegek cserelhetik el immunologiailag inkompatibilis elődonorjaikat egymassal. Az ENCKEP (European Network for Collaboration on Kidney Exchange Programmes) COST Action 2016 szeptembereben kezdte meg műkodeset, es azota a nemzetkozi kutatohalozatnak sikerult feltarnia, hogy mikent műkodnek a vesecsereprogramok Europaban. Ezen tanulmany celja az ENCKEP COST Action eredmenyeinek osszefoglalasa es a tervezett hazai vesecsereprogramra nezve a tanulsagok levonasa. A COST Action szamos workshopot tartott, illetve az első munkacsoportja ket europai felmerest szervezett, amelyek eredmenyeit ket kezikonyvben osszegezte; ezeket az ismereteket dolgozza fel tanulmanyunk. Europaban jelenleg 10 orszagban műkodnek nemzeti vesecsereprogramok, a legregebbi Hollandiaban (2004 ota) es a legnagyobb az Egyesult Kiralysagban, ahol az elmult 10 evben tobb mint 700 veset transzplantaltak a program kereteben. Tobb orszag jelenleg tervezi a nemzeti vesecsereprogram elinditasat, illetve nemzetkozi egyuttműkodesek is szerveződnek. A nemzeti vesecsereprogramok nagymertekben novelik a vesebetegek lehetősegeit az elődonoros atultetesre, de egy hatekony program letrehozasanak erdekeben szamos orvosi, logisztikai, optimalizalasi, etikai es jogi kerdest kell sikeresen megoldaniuk a szervezőknek. Orv Hetil. 2018; 159(46): 1905–1912. | Abstract: Patients with end-stage renal disease may Exchange their willing, but incompatible donors among each other in centrally coordinated kidney Exchange Programmes. The aim of this writing is to summarise the results of the ENCKEP COST Action, and describe the lessons learned with regard to the plans for the Hungarian kidney Exchange programme. The ENCKEP COST Action had several workshops since 2016 September, and its first working group conducted two surveys that they summarised in two handbooks; our description is based on these resources. There are already 10 national kidney Exchange Programmes in Europe, the oldest is in the Netherlands (operating since 2004) and the largest in the United Kingdom, where already more than 700 patients received a kidney through this programme in the last ten years. There are a number of countries with plans to start a kidney Exchange programme, and international collaborations are also getting established in several regions. Kidney Exchange Programmes can significantly increase the opportunities of the kidney patients for getting living donor transplants, but for the successful operation of a kidney Exchange programme the organisers have to resolve several medical, logistic, optimisation, ethical and legal issues. Orv Hetil. 2018; 159(46): 1905–1912.
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Élődonoros vesecsereprogramok Európában. Hol tart Magyarország? Összefoglaló tanulmány az ENCKEP (European Network for Collaboration on Kidney Exchange Programmes) COST Action eddigi eredményei alapján
Orvosi hetilap, 2018Co-Authors: Péter Biró, Adam Remport, Sándor Mihály, Lóránt Illésy, Balázs NemesAbstract:Patients with end-stage renal disease may Exchange their willing, but incompatible donors among each other in centrally coordinated kidney Exchange Programmes. The aim of this writing is to summarise the results of the ENCKEP COST Action, and describe the lessons learned with regard to the plans for the Hungarian kidney Exchange programme. The ENCKEP COST Action had several workshops since 2016 September, and its first working group conducted two surveys that they summarised in two handbooks; our description is based on these resources. There are already 10 national kidney Exchange Programmes in Europe, the oldest is in the Netherlands (operating since 2004) and the largest in the United Kingdom, where already more than 700 patients received a kidney through this programme in the last ten years. There are a number of countries with plans to start a kidney Exchange programme, and international collaborations are also getting established in several regions. Kidney Exchange Programmes can significantly increase the opportunities of the kidney patients for getting living donor transplants, but for the successful operation of a kidney Exchange programme the organisers have to resolve several medical, logistic, optimisation, ethical and legal issues. Orv Hetil. 2018; 159(46): 1905-1912.
Steffanie A. Strathdee - One of the best experts on this subject based on the ideXlab platform.
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exploring stakeholder perceptions of acceptability and feasibility of needle Exchange Programmes syringe vending machines and safer injection facilities in tijuana mexico
International Journal of Drug Policy, 2009Co-Authors: Morgan M Philbin, Carl A Latkin, Andrea Mantsios, Remedios Lozada, Patricia Case, Robin A Pollini, Jorge Alvelais, Carlos Magisrodriguez, Steffanie A. StrathdeeAbstract:Abstract Background Injection drug use is a growing public health crisis along the U.S.–Mexican border and rising rates of blood-borne infections highlight the pressing need for harm reduction interventions. We explored the acceptability and feasibility of such interventions in Tijuana, a city adjacent to San Diego, California. Methods Using in-depth qualitative interviews conducted from August 2006–March 2007 with 40 key stakeholders – pharmacists, legal professionals, health officials, religious officials, drug treatment providers, and law enforcement personnel – we explored the acceptability and feasibility of interventions to reduce drug-related harm in Tijuana, Mexico. Interviews were taped with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included barriers, structural limitations, and suggestions for implementation. Results Topics included acceptance and feasibility of needle Exchange Programmes (NEPs), syringe vending machines, and safer injection facilities (SIFs), structural barriers and suggestions for implementation. Of these interventions, NEPs were deemed the most acceptable (75%); however, only half believed these could be feasibly implemented, citing barriers involving religion, police, and lack of political will, public awareness, and funding. Conclusions Increasing HIV infection rates among injection drug users in Tijuana have prompted interest in public health responses. Our results may assist policy strategists in implementing social-structural interventions that will help create enabling environments that facilitate the scale-up and implementation of harm reduction in Tijuana.
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public opinion about syringe Exchange Programmes in the usa an analysis of national surveys
International Journal of Drug Policy, 2003Co-Authors: Jon S Vernick, Scott Burris, Steffanie A. StrathdeeAbstract:Abstract Background : Despite scientific evidence demonstrating their effectiveness, syringe Exchange programs (SEPs) have not been as widely embraced by policy-makers in the USA as in some other nations. One reason for this disjunction between science and policy may be the effect of public opinion. Methods : To better understand the role of public opinion in shaping SEP policies, we undertook a systematic search for all reported U.S. national surveys asking about support or opposition to SEPs. Relevant polls were identified through a national database of public opinion questions, and a similar search of a newspaper database. We present the survey findings. The wording of poll questions and the agenda of organisations sponsoring the polls are also examined. Results : Twenty-one questions from 14 different polls conducted from 1987 to 2000 were identified. Support for SEPs ranged from 29 to 66%. Surveys conducted by organisations with a public health agenda were more likely to suggest support for SEPs than those sponsored by organisations with a "family values" perspective. Question wording appeared to strongly influence support for SEPs. Poll questions that referred to "drug addicts" were less likely to indicate majority support for SEPs than those that avoided loaded terms or that provided public health information to respondents. Discussion : Public opinion regarding SEPs is very malleable, strongly affected by question wording or other biases of organisations sponsoring the polls. Therefore, there may be no clear national consensus on the desirability of SEPs. Our findings are particularly relevant for national policy, such as federal funding for SEPs.
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Evaluating effectiveness of syringe Exchange Programmes: current issues and future prospects
Social science & medicine (1982), 2000Co-Authors: Francisco I. Bastos, Steffanie A. StrathdeeAbstract:Although a large body of international literature has found syringe Exchange Programmes (SEPs) to be associated with reduced incidence of blood borne pathogens among injection drug users, recent studies have fuelled controversy surrounding SEP effectiveness. Existing studies are observational in nature and have seldom considered ecologic aspects affecting SEP functioning and evaluation. The authors apply concepts from infectious disease epidemiology to discuss the direct and indirect effects of SEP upon the spread of blood borne pathogens in drug users, their social networks and the broader community. Further, the authors discuss social policies, particularly drug control policies, which have directly and/or indirectly limited SEP functioning at local and national levels. A critical review of the literature suggests that biases common to observational studies can account for higher HIV incidence among SEP attenders relative to non-attenders. Strong selection factors often lead high-risk drug users to be over-represented among SEP attenders. Failure to account for these factors and the indirect effects of SEPs can bias interpretations of programme effectiveness. Future SEP evaluations should consider behavioural data, the local ethnographic context, the prevalence of infectious disease in the groups under study and the structural components of SEP that are most and least effective at reducing incidence of blood borne pathogens. Hierarchical models that take into account the ecological dimensions of SEP are recommended as an approach for future studies. Beyond methodologic concerns, the authors discuss social, legal and programmatic obstacles that must be overcome in order to maximise SEP effectiveness.
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do needle Exchange Programmes increase the spread of hiv among injection drug users an investigation of the vancouver outbreak
AIDS, 1999Co-Authors: Martin T Schechter, Steffanie A. Strathdee, Peter G A Cornelisse, Sue L Currie, David M Patrick, Michael L Rekart, M V OshaughnessyAbstract:Objective: An association between needle Exchange attendance and higher HIV prevalence rates among injecting drug users (IDU) in Vancouver has been interpreted by some to suggest that needle Exchange Programmes (NEP) may exacerbate HIV spread. We investigated this observed association to determine whether needle Exchange was causally associated with the spread of HIV. Design and method: Prospective cohort study of 694 IDU recruited in the downtown eastside of Vancouver. Subjects were HIV-negative at the time of recruitment and had injected illicit drugs within the previous month. Results: Of 694 subjects, the 15-month cumulative HIV incidence was significantly elevated in frequent NEP attendees (11.8 ± 1.7 versus 6.2 ± 1.5% ; log-rank P = 0.012). Frequent attendees (one or more visits per week) were younger and were more likely to report: unstable housing and hotel living, the downtown eastside as their primary injecting site, frequent cocaine injection, sex trade involvement, injecting in 'shooting galleries', and incarceration within the previous 6 months. The Cox regression model predicted 48 seroconversions among frequent attendees; 47 were observed. Although significant proportions of subjects reported obtaining needles, swabs, water and bleach from the NEP, only five (0.7%) reported meeting new friends or people there. When asked where subjects had met their new sharing partners, only one out of 498 respondents cited the needle Exchange. Paired analysis of risk variables at baseline and the first follow-up visit did not reveal any increase in risk behaviours among frequent attendees, regardless of whether they had initiated drug injection after establishment of the NEP. Conclusions: We found no evidence that this NEP is causally associated with HIV transmission. The observed association should not be cited as evidence that NEP may promote the spread of HIV. By attracting higher risk users, NEP may furnish a valuable opportunity to provide additional preventive/support services to these difficult-to-reach individuals.
Theresa Perlis - One of the best experts on this subject based on the ideXlab platform.
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hiv risk behaviour among participants of syringe Exchange Programmes in central eastern europe and russia
International Journal of Drug Policy, 2002Co-Authors: Don Des C Jarlais, Theresa Perlis, Jean-paul C. Grund, Catherine Zadoretzky, Judith Milliken, Patricia Friedmann, Stephen P. Titus, Valentina Bodrova, Elena ZemlianovaAbstract:Abstract Objective: To assess HIV risk behaviour among participants in syringe Exchanges in five Central/Eastern European cities: Prague (Czech Republic), Budapest (Hungary), Skopje (Former Yugoslavian Republic of Macedonia), Krakow (Poland) and Poltava (Ukraine), and five Russian cities: Nizhniy Novgorod, Pskov, Rostov-Na-Donu, St. Petersburg, and Volgograd. Design: Cross-sectional survey with questions on injection risk behaviours for the 30 days prior to first use of the syringe Exchange programme and for the 30 days prior to interview (while using the syringe Exchange programme). Methods: Respondents were recruited from participants of the syringe Exchanges. Structured questionnaires covering drug use and HIV risk behaviour were administered by trained interviewers. Results: 1671 respondents were interviewed across the ten Programmes. Participants in the Programmes tended to be young and relatively recent initiates into drug injection. Relatively low percentages of participants reported receptive syringe sharing (‘injecting with needles and syringes used by others') in the past 30 days, from 1 to 29% across the ten Programmes. These represented statistically significant reductions from the percentages of respondents reporting receptive syringe sharing in the 30 days prior to first use of the syringe Exchange—from 7 to 47%. Conclusions: IDUs participating in the Exchanges appear to be responding very positively in reducing sharing of needles and syringes. Syringe Exchange and other HIV prevention Programmes for injecting drug users (IDUs) in this geographic region should be expanded rapidly.
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HIV risk behaviour among participants of syringe Exchange Programmes in central/eastern Europe and Russia
International Journal of Drug Policy, 2002Co-Authors: Don Des C Jarlais, Theresa Perlis, Jean-paul C. Grund, Catherine Zadoretzky, Judith Milliken, Patricia Friedmann, Stephen P. Titus, Valentina Bodrova, Elena ZemlianovaAbstract:Abstract Objective: To assess HIV risk behaviour among participants in syringe Exchanges in five Central/Eastern European cities: Prague (Czech Republic), Budapest (Hungary), Skopje (Former Yugoslavian Republic of Macedonia), Krakow (Poland) and Poltava (Ukraine), and five Russian cities: Nizhniy Novgorod, Pskov, Rostov-Na-Donu, St. Petersburg, and Volgograd. Design: Cross-sectional survey with questions on injection risk behaviours for the 30 days prior to first use of the syringe Exchange programme and for the 30 days prior to interview (while using the syringe Exchange programme). Methods: Respondents were recruited from participants of the syringe Exchanges. Structured questionnaires covering drug use and HIV risk behaviour were administered by trained interviewers. Results: 1671 respondents were interviewed across the ten Programmes. Participants in the Programmes tended to be young and relatively recent initiates into drug injection. Relatively low percentages of participants reported receptive syringe sharing (‘injecting with needles and syringes used by others') in the past 30 days, from 1 to 29% across the ten Programmes. These represented statistically significant reductions from the percentages of respondents reporting receptive syringe sharing in the 30 days prior to first use of the syringe Exchange—from 7 to 47%. Conclusions: IDUs participating in the Exchanges appear to be responding very positively in reducing sharing of needles and syringes. Syringe Exchange and other HIV prevention Programmes for injecting drug users (IDUs) in this geographic region should be expanded rapidly.
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geographic proximity policy and utilization of syringe Exchange Programmes
Aids Care-psychological and Socio-medical Aspects of Aids\ hiv, 1999Co-Authors: Russell Rockwell, Theresa Perlis, Don Des C Jarlais, S R Friedman, Denise PaoneAbstract:The objective of the research was to assess the effects of geographic proximity on the utilization of syringe Exchange among injection drug users (IDUs) in New York City. Between 1994 and 1996, 805 IDUs were interviewed with a structured questionnaire. Geographic proximity was defined as living within a ten-minute walk. Eighty-one per cent of IDUs who lived close typically used a syringe Exchange compared to 59% of those who lived further away. In multiple logistic regression analysis, those who lived close remained (adjusted odds ratio of 2.89; 95% CI 2.06 to 4.06, p = 0.001) more likely to use syringe Exchange. Those who lived close were less likely to have engaged in receptive syringe sharing at last injection (adjusted odds ratio = 0.45, 95% CI 0.24 to 0.86, p = 0.015). In conclusion, locating Exchange services in areas convenient to large numbers of IDUs may be critical for prevention of HIV infection.
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hiv incidence among injecting drug users in new york city syringe Exchange Programmes
The Lancet, 1996Co-Authors: Michael Marmor, Stephen Titus, Theresa Perlis, Benny Jose, Denise Paone, Don Des C Jarlais, Samuel R. FriedmanAbstract:Summary Background There have been no studies showing that participation in Programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-Exchange Programmes in New York City with that among non-participants. Methods We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n=280), in which multiple interviews and saliva samples were collected from participants at Exchange sites; the Vaccine Preparedness Initiative cohort (n=133 continuing Exchangers and 188 non-Exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n=1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe Exchanges. Findings HIV incidence among continuing Exchange-users in the Syringe Exchange Evaluation was 1·58 per 100 person-years at risk (95% CI 0·54, 4·65) and among continuing Exchange-users in the Vaccine Preparedness Initiative it was 1·38 per 100 person-years at risk (0·23, 4·57). Incidence among non-users of the Exchange in the Vaccine Preparedness Initiative was 5 26 per 100 person-years at risk (2·41, 11·49), and in the NADR cities, 6·23 per 100 person-years at risk (4·4, 8·6). In a pooled-data, multivariate proportional-hazards analysis, not using the Exchanges was associated with a hazard ratio of 3 35 (95% CI 1·29, 8·65) for incident HIV infection compared with using the Exchanges. Interpretation We observed an individual-level protective effect against HIV infection associated with participation in a syringe-Exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.
