Schechter M, Strathdee SA, Currie SL, Patrick DM, Rekart ML, Montaner JS, O'Shaughnessy MV; International Conference on AIDS.

Int Conf AIDS. 1998; 12: 665-6 (abstract no. 33379).

B.C. Centre for Excellence in HIV/AIDS, Vancouver, Canada.

OBJECTIVE: It has been suggested that needle exchange programs (NEP) could play a causal rather than protective role in HIV transmission. We investigated the relationship between NEP attendance and 1) social network formation; 2) HIV seroconversion in Vancouver. METHODS: Beginning May/96, 1009 active IDUs were recruited into the Vancouver Injection Drug User Study (VIDUS) cohort. Semi-annually, IDUs underwent HIV tests and extensive interviews. At each follow-up, IDUs attending NEP were asked if they met new people at NEP locations. As of Dec/97, IDUs were asked if they had borrowed or lent needles to new people since their last visit, and if so where they had met. We also conducted a nested case-control study in which seroconverter cases (n = 52) and a random sample of HIV-negative controls (n = 548) were frequency matched by study visit attendance. The frequency of seroconversion expected among frequent NEP attenders, based on a multivariate risk model, was compared with that observed. RESULTS: After 2 follow-up cycles (1372 visits), only 3 IDUs (0.2%) reported meeting new people when attending NEP. Of 241 IDUs interviewed after Dec/97, 48 (20%) reported new injecting or needle sharing partners. Of these, only 3 (6%) reported meeting such partners at NEP. The majority of new partners were met through other IDUs (34%) or on the street (32%). None reported NEP as the most frequent place they met new injecting or sharing partners. In the case-control study, frequent NEP attendance was associated with seroconversion (OR = 2.78; 95% CI = 1.46, 5.29). However, frequent NEP attenders had a higher risk profile. After controlling for age, gender, and study visit, a multivariate model incorporating frequency of injection, binge injecting, and residing in the downtown core, predicted that 13.7% of frequent NEP attenders would have been expected to become seroconverters. This was similar to the observed rate of 11.9%. CONCLUSIONS: We found little evidence that NEPs promote the formation of high risk sharing networks. Our early analysis of HIV seroconverters suggests that associations between NEP attendance and HIV infection are explained by confounding. We suggest the notion that NEPs promote HIV transmission, at least in our setting, should be abandoned.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Canada
• Case-Control Studies
• Communicable Disease Control
• HIV Infections
• HIV Seropositivity
• Needle Sharing
• Needle-Exchange Programs
• transmission

Other ID:

• 98399063

UI: 102230244

From Meeting Abstracts