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David Vlahov - One of the best experts on this subject based on the ideXlab platform.
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the influence of Needle Exchange Programs on injection risk behaviors and infection with hepatitis c virus among young injection drug users in select cities in the united states 1994 2004
Preventive Medicine, 2009Co-Authors: Deborah Holtzman, David Vlahov, Don C. Des Jarlais, Vaughn Barry, Lawrence J Ouellet, Elizabeth T Golub, Sharon M Hudson, Richard S GarfeinAbstract:Abstract Objective Our purpose was to assess whether participation in Needle Exchange Programs (NEPs) influenced incident hepatitis C virus (HCV) infection through effects on injection risk behaviors among young injection drug users (IDUs) in the United States. Methods Data were drawn from three multi-site studies carried out in four major cities that enrolled IDUs over the period 1994–2004. Bivariate and multivariate analyses were conducted to assess relationships among sociodemographic characteristics, NEP use, injection risk behaviors, and prevalent or incident HCV infection. Results Of the total participants ( n = 4663), HCV seroprevalence was 37%; among those who initially tested negative and completed follow-up at three, six, or 12 months ( n = 1288), 12% seroconverted. Nearly half of participants reported NEP (46%) use at baseline. Multivariate results showed no significant relationship between NEP use and HCV seroconversion. Controlling for sociodemographic characteristics, IDUs reporting NEP use were significantly less likely to share Needles (aOR = 0.77, 95% CI = 0.67–0.88). Additionally, controlling for sociodemographic characteristics and program use, sharing Needles, sharing other injection paraphernalia, longer injection duration, and injecting daily were all positively related to prevalent infection. Conclusions Our results suggest an indirect protective effect of NEP use on HCV infection by reducing risk behavior.
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The impact of syringe deregulation on sources of syringes for injection drug users: Preliminary findings
Aids and Behavior, 2006Co-Authors: Sherry Deren, Crystal M Fuller, Sung-yeon Kang, Don C. Des Jarlais, Charles M Cleland, David VlahovAbstract:In 2001, New York State enacted legislation to allow the provision of syringes by pharmacies and healthcare providers without prescription (ESAP, the Expanded Syringe Access Demonstration Program). A longitudinal study of IDUs (n=130) found that pre-ESAP, about half used only the safest source (Needle Exchange Programs [NEPs]). Post-ESAP implementation, ESAP sources were initiated by 14%. Frequency of injection was related to ESAP use and those who used unsafe (or possibly unsafe) sources were as likely to use ESAP as those who had previously used only NEPs. The findings indicate that providing multiple sources of safe syringes for IDUs is necessary.
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Needle Exchange Programs for the Prevention of Human Immunodeficiency Virus Infection: Epidemiology and Policy
American Journal of Epidemiology, 2001Co-Authors: David Vlahov, Don C. Des Jarlais, Eric Goosby, Paula C. Hollinger, Peter Lurie, Michael D. Shriver, Steffanie A. StrathdeeAbstract:Received for publication August 25, 2000, and accepted for publication August 22, 2001. Abbreviations: AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus. 1 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 2 Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY. 3 Chemical Dependency Research Institute, Beth Israel Medical Center, New York, NY. 4 Office of HIV/AIDS Policy, Office of the Secretary, US Department of Health and Human Services, Washington, DC. 5 Maryland State Senate, Annapolis, MD. 6 Public Citizen’s Health Research Group, Washington, DC. 7 National Association of People with AIDS, Washington, DC. Correspondence to Dr. David Vlahov, Center for Urban Epidemiologic Studies, The New York Academy of Medicine, 1216 Fifth Avenue, Room 553, New York, NY 10029 (e-mail: dvlahov@ nyam.org). Needle Exchange Programs provide a particularly compelling and informative example of the intersection between epidemiology and policy. The concept of Needle Exchange was developed and initially proposed on the basis of biologic plausibility: providing access to sterile Needles and syringes (hereafter referred to as Needles) should prevent parenteral transmission of human immunodeficiency virus (HIV) and other bloodborne pathogens, including hepatitis B and C. Nonetheless, various bans on the use of US federal funds for Needle Exchange program services have been in effect since 1988, limiting implementation and evaluation. The legislation included provisions that the ban on federal funding could be lifted only if the President of the United States or the US Surgeon General determined that Needle Exchange reduced the transmission of HIV infection and did not increase drug abuse. Indeed, the Secretary of the US Department of Health and Human Services did report in 1998 that the scientific evidence showed that Needle Exchange Programs reduced HIV incidence and did not increase drug abuse. The Surgeon General reiterated this finding in 2000 (1). The administration decided, however, that federal funds would remain unavailable for Needle Exchange. During this policy stalemate at the federal level, the number of Needle Exchange Programs has grown steadily, from none in 1987 to 160 Programs operating in 39 states, the District of Columbia, and Puerto Rico in 1999 (2). In reviewing the history of Needle Exchange Programs, a group was assembled to include perspectives from researchers, activists, and government to reflect on the role of epidemiologists in the development of Needle Exchange Programs.
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multiple access to sterile syringes for injection drug users vending machines Needle Exchange Programs and legal pharmacy sales in marseille france
European Addiction Research, 2001Co-Authors: J P Moatti, David Vlahov, Isabelle Feroni, V Perrin, Yolande ObadiaAbstract:Objective: In Marseille, southeastern France, HIV prevention Programs for injection drug users (IDUs) simultaneously include access to sterile syringes through Needle Exchange progr
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Impact of Needle Exchange Programs on Adolescent Perceptions About Illicit Drug Use
AIDS and Behavior, 2001Co-Authors: Melissa A. Marx, Steffanie A. Strathdee, Heena Brahmbhatt, Peter Beilenson, Ron Brookmeyer, Cheryl S. Alexander, David VlahovAbstract:The objective of this study was to examine the association between adolescent exposure to and understanding of Needle Exchange Programs (NEPs) and their perceptions of the impact of NEP on the decision to use illicit drugs. From November 1998 to February 1999, 9th and 10th grade students from 4 Baltimore City high schools completed surveys reporting perceptions of the effect of NEP and other factors on adolescents' decisions regarding illicit drug use. The perceived effect of NEP was compared to that of other factors, using the Wilcoxon signed rank test. The impact of seeing drug users attend NEPs on adolescents' decisions to use drugs was modeled using multiple linear regression. Among 1,110 students, 88% were African American, 58% were female, and the mean age was 15 years. The percentage of students who thought the specified factors promoted drug use follows: peer drug use, 49.9%; parents drug use, 43.5%; seeing drug users attend NEP, 11.1%; school drug education, 6.6%; and anti-drug TV advertisements, 6.1%. The percentage viewing these factors as having no influence on illicit drug use was 21.7, 19.1, 42.4, 36.9, and 29.8% respectively. Students of African American race, female gender, and those with medium/high knowledge about NEP were significantly less likely to consider NEP a promoter of drug use. These data suggest that the influence of NEPs on promoting illicit drug use among adolescents appears to be neutral compared to other factors known to be influential to this population group.
Kate Ksobiech - One of the best experts on this subject based on the ideXlab platform.
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Beyond Needle Sharing: Meta-Analyses of Social Context Risk Behaviors of Injection Drug Users Attending Needle Exchange Programs
Substance Use & Misuse, 2006Co-Authors: Kate KsobiechAbstract:This study gathered data from U.S. and international Needle Exchange Programs (NEPs). Of particular interest were outcome measures of dependent variables related to behaviors within social contexts of injection drug users (IDUs), an area not well understood. Thirty-one studies, with a total of 86 separate measures of 36 dependent variables were included. Because combining all results into a single meta-analysis would be inappropriate, dependent variables were placed into five categories for five separate meta-analyses: risky contexts, injection frequency, sharing drug paraphernalia, drug preparation, and syringe use. NEP attendance was inversely related to declines in all categorical behaviors except for “risky context.” NEP attenders are slightly more likely to be in a risky circumstance when injecting drugs than non-attenders. While injection frequency declined only slightly among NEP attenders, that result may be interpreted as a positive outcome, given the often-stated criticism that providing clean n...
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Return Rates for Needle Exchange Programs: A Common Criticism Answered
Harm Reduction Journal, 2004Co-Authors: Kate KsobiechAbstract:This study searched the available Needle Exchange program (NEP) literature for return rate data. A total of 26 articles were found. The overall worldwide return rate was 90%, although this ranged from a low of 15% to a high of 112%. U.S. NEP return rates were gathered from only eight studies, indicating a clear need for more data, although U.S. return rates were comparable to those from NEPs outside of the U.S. One underlying assumption made by opponents of NEPs is that IDUs will not return Needles to the distribution site, thereby potentially increasing the risk of health problems to the surrounding community from exposure to contaminated Needles. This study's results suggest that NEPs are relatively successful in taking in used Needles, although it is generally unclear where the Needles were originally acquired, and if IDUs return their own Needles, or are returning Needles for a social network. Ways for AIDS Service Organizations to capitalize on these brief encounters with IDUs, as well as public policy implications of the findings, are discussed.
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Return Rates for Needle Exchange Programs: A Common Criticism Answered
Harm Reduction Journal, 2004Co-Authors: Kate KsobiechAbstract:This study searched the available Needle Exchange program (NEP) literature for return rate data. A total of 26 articles were found. The overall worldwide return rate was 90%, although this ranged from a low of 15% to a high of 112%. U.S. NEP return rates were gathered from only eight studies, indicating a clear need for more data, although U.S. return rates were comparable to those from NEPs outside of the U.S. One underlying assumption made by opponents of NEPs is that IDUs will not return Needles to the distribution site, thereby potentially increasing the risk of health problems to the surrounding community from exposure to contaminated Needles. This study's results suggest that NEPs are relatively successful in taking in used Needles, although it is generally unclear where the Needles were originally acquired, and if IDUs return their own Needles, or are returning Needles for a social network. Ways for AIDS Service Organizations to capitalize on these brief encounters with IDUs, as well as public policy implications of the findings, are discussed.
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Risky Sexual Behaviors and HIV/Disease Knowledge of Injection Drug Users Attending Needle Exchange Programs
Journal of HIV AIDS & Social Services, 2004Co-Authors: Kate KsobiechAbstract:ABSTRACT A meta-analysis of worldwide Needle Exchange Program research was conducted with fourteen studies, looking at the impact of Needle Exchange Programs (NEPs) on the sexual risk behaviors and HIV/disease knowledge of injection drug users. Based on the limited data available to date (a total of 14 studies), two conclusions were drawn. First, HIV/disease knowledge does increase with NEP attendance. Second, risky sexual behaviors do not appear to decrease with NEP attendance, and may in fact increase. Neither of these areas has been investigated nearly as often as risky drug behaviors among NEP attend-ers. Focusing on disease knowledge and reducing risky sexual behaviors of NEP clients are both key areas for AIDS Service Organization staff to consider when developing HIV risk reduction interventions for injection drug users (IDUs).
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risky sexual behaviors and hiv disease knowledge of injection drug users attending Needle Exchange Programs
Journal of Hiv\ aids & Social Services, 2004Co-Authors: Kate KsobiechAbstract:ABSTRACT A meta-analysis of worldwide Needle Exchange Program research was conducted with fourteen studies, looking at the impact of Needle Exchange Programs (NEPs) on the sexual risk behaviors and HIV/disease knowledge of injection drug users. Based on the limited data available to date (a total of 14 studies), two conclusions were drawn. First, HIV/disease knowledge does increase with NEP attendance. Second, risky sexual behaviors do not appear to decrease with NEP attendance, and may in fact increase. Neither of these areas has been investigated nearly as often as risky drug behaviors among NEP attend-ers. Focusing on disease knowledge and reducing risky sexual behaviors of NEP clients are both key areas for AIDS Service Organization staff to consider when developing HIV risk reduction interventions for injection drug users (IDUs).
Josiah D. Rich - One of the best experts on this subject based on the ideXlab platform.
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Active and Former Injection Drug Users Report of HIV Risk Behaviors During Periods of Incarceration
Substance Abuse, 2001Co-Authors: Jennifer G. Clarke, Michael D. Stein, Lucy Hanna, Mindy Sobota, Josiah D. RichAbstract:American prisons have increasing numbers of inmates incarcerated for drug offenses. This population is at high risk for HIV-infection and may continue HIV transmission risk behaviors while incarcerated. We find that 31% of injection drug users with a history of imprisonment had used illicit drugs in prison, and nearly half of these persons had injected drugs while incarcerated. Male gender and number of times incarcerated were associated with drug use in prison. Interventions for drug-using prisoners that are advocated in some European prisons, such as Needle Exchange Programs and methadone maintenance, need attention in the United States.
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Strategies to optimize the impact of Needle Exchange Programs.
The AIDS reader, 2000Co-Authors: Josiah D. Rich, Larkin L Strong, M. Mehrotra, Grace E. MacalinoAbstract:In the United States today, half of all new HIV infections are injection drug use-associated, many of which are a result of the reuse and sharing of contaminated syringes. Thus, providing access to sterile syringes for injection drug users is an important part of preventing HIV transmission. Needle Exchange Programs (NEPs) have been established as one successful approach to providing sterile injection equipment. The medical literature shows that these Programs are effective in decreasing both syringe sharing and HIV incidence in injection drug users. In addition, many NEPs are also beneficial because they provide other injection drug use-relevant services. There are several strategies that can be adopted in order to optimize the impact of Needle Exchange Programs, at both the community and national levels. These include establishing NEPs in communities that need them, expanding and improving those that already exist, and implementing such Programs on a larger national scale with the provision of federal funds.
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Needle Exchange program participation by anabolic steroid injectors, United States 1998
Drug and Alcohol Dependence, 1999Co-Authors: Josiah D. Rich, Craig K. Foisie, Christopher W. Towe, Brian P. Dickinson, Michelle Mckenzie, Christopher M. SalasAbstract:A significant number of people are currently misusing and abusing anabolic steroids. Hepatitis B, C, and HIV have all been documented to occur among anabolic steroid injectors (ASIs), most likely from the sharing of injection equipment. A survey was administered to 42 Needle Exchange Programs (NEPs) from 17 states in the US to determine ASI participation. Sixty percent of the NEPs surveyed reported having at least some ASIs as participants, however, only 512 ASIs were identified among the 36 000 total monthly participants (1.4%). With the expanding number of NEPs in the US, it is possible to reach a higher proportion of ASIs with clean syringes and education, thus offering the means to prevent the spread of infection in this population.
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Short communication Needle Exchange program participation by anabolic steroid injectors, United States 1998
1999Co-Authors: Josiah D. Rich, Craig K. Foisie, Christopher W. Towe, Brian P. Dickinson, Michelle Mckenzie, Christopher M. SalasAbstract:A significant number of people are currently misusing and abusing anabolic steroids. Hepatitis B, C, and HIV have all been documented to occur among anabolic steroid injectors (ASIs), most likely from the sharing of injection equipment. A survey was administered to 42 Needle Exchange Programs (NEPs) from 17 states in the US to determine ASI participation. Sixty percent of the NEPs surveyed reported having at least some ASIs as participants, however, only 512 ASIs were identified among the 36 000 total monthly participants (1.4%). With the expanding number of NEPs in the US, it is possible to reach a higher proportion of ASIs with clean syringes and education, thus offering the means to prevent the spread of infection in this population. © 1999 Elsevier Science Ireland Ltd. All rights reserved.
Jean Vincelette - One of the best experts on this subject based on the ideXlab platform.
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ORIGINAL CONTRIBUTIONS High Rates of HIV Infection among Injection Drug Users Participating in Needle Exchange Programs in Montreal: Results of a Cohort Study
2016Co-Authors: Jean VinceletteAbstract:Needle Exchange Programs (NEPs) are designed to prevent human immunodeficiency virus (HIV) transmis-sion among injection drug users. Although most studies report beneficial effects in terms of behavior modification, a direct assessment of the effectiveness of NEPs in preventing HIV infection has been lacking. A cohort study was conducted to assess the association between risk behaviors and HIV seroprevalence and seroincidence among injection drug users in Montreal, Canada. The association between NEP use and HIV infection was examined in three risk assessment scenarios using intensive covariate adjustment for empirical confounders: a cross-sectional analysis of NEP use at entry as a determinant of seroprevalence, a cohort analysis of NEP use at entry as a predictor of subsequent seroconversion, and a nested case-control analysis of NEP participation during follow-up as a predictor of seroconversion. From September 1988 to January 1995,1,599 subjects were enrolled with a baseline seroprevalence of 10.7%. The mean follow-up period was 21.7 months. The adjusted odds ratio for HIV seroprevalence in injection drug users reporting recent NEP use was 2.2 (95 % confidence interval 1.5-3.2). In the cohort study, there were 89 incident cases of HIV infection with a cumulative probability of HIV seroconversion of 33 % for NEP users and 13 % for nonusers (p < 0.0001). In the nested case-control study, consistent NEP use was associated with HIV seroconversion during follow-up (odds ratio = 10.5, 95 % confidence interval 2.7-41.0). Risk elevations for HIV infection associate
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high rates of hiv infection among injection drug users participating in Needle Exchange Programs in montreal results of a cohort study
American Journal of Epidemiology, 1997Co-Authors: Julie Bruneau, Francois Lamothe, Eduardo L Franco, Nathalie Lachance, Marie Desy, J Soto, Jean VinceletteAbstract:: Needle Exchange Programs (NEPs) are designed to prevent human immunodeficiency virus (HIV) transmission among injection drug users. Although most studies report beneficial effects in terms of behavior modification, a direct assessment of the effectiveness of NEPs in preventing HIV infection has been lacking. A cohort study was conducted to assess the association between risk behaviors and HIV seroprevalence and seroincidence among injection drug users in Montreal, Canada. The association between NEP use and HIV infection was examined in three risk assessment scenarios using intensive covariate adjustment for empirical confounders: a cross-sectional analysis of NEP use at entry as a determinant of seroprevalence, a cohort analysis of NEP use at entry as a predictor of subsequent seroconversion, and a nested case-control analysis of NEP participation during follow-up as a predictor of seroconversion. From September 1988 to January 1995, 1,599 subjects were enrolled with a baseline seroprevalence of 10.7%. The mean follow-up period was 21.7 months. The adjusted odds ratio for HIV seroprevalence in injection drug users reporting recent NEP use was 2.2 (95% confidence interval 1.5-3.2). In the cohort study, there were 89 incident cases of HIV infection with a cumulative probability of HIV seroconversion of 33% for NEP users and 13% for nonusers (p < 0.0001). In the nested case-control study, consistent NEP use was associated with HIV seroconversion during follow-up (odds ratio = 10.5, 95% confidence interval 2.7-41.0). Risk elevations for HIV infection associated with NEP attendance were substantial and consistent in all three risk assessment scenarios in our cohort of injection drug users, despite extensive adjustment for confounders. In summary, in Montreal, NEP users appear to have higher seroconversion rates then NEP nonusers.
Renee Edgington - One of the best experts on this subject based on the ideXlab platform.
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A Collaborative Evaluation of a Needle Exchange Program for Youth
Health Education & Behavior, 1999Co-Authors: Rebecca L. Weiker, Renee Edgington, Michele D. KipkeAbstract:Limited research has been conducted to examine the effectiveness of existing HIV prevention and harm reduction interventions targeted to injection drug-using youth. Moreover, although there are a growing number of Needle Exchange Programs being developed for youth throughout the United States, the effects of these services have yet to be systematically evaluated. This article describes a collaborative evaluation conducted by the Division of Adolescent Medicine, Childrens Hospital Los Angeles, and Clean Needles Now, a Needle Exchange serving young injection drug users. The evaluation employed a multimethod research design that included both qualitative and quantitative methods. Findings are presented about how a community-based agency’s service delivery philosophy can affect the design and implementation of an evaluation. Lessons learned from this collaborative evaluation are presented, including the potential benefits of incorporating harm reduction principles into research activities.
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Drug-Injecting Street Youth: A Comparison of HIV-Risk Injection Behaviors Between Needle Exchange Users and Nonusers
AIDS and Behavior, 1997Co-Authors: Michele D. Kipke, Jennifer B. Unger, Raymond Palmer, Renee EdgingtonAbstract:Injection drug use, the second most common risk factor associated with HIV infection in the United States after sexual transmission, is especially prevalent among street youth, many of whom routinely share their drug injection equipment. To prevent sharing behavior among street youth, a Needle Exchange program for youth was established in Hollywood, California. This study compared the drug use and Needle-sharing behaviors of youth who were users of the Needle Exchange with those of youth who were not. Results indicate that while demographic characteristics and drug injection frequency were similar in the two groups, Needle Exchange users were significantly less likely to share Needles, share other injection equipment, use other drugs to help them “come down,” use unsterile Needles when “high” or “craving” drugs, and report difficult access to sterile Needles. These findings suggest that Needle Exchange Programs may reduce Needle-sharing behavior among street youth.
