Treatment Out Of Reach For Younger IV Users Marc Kusinitz -------------------------------- JHMI Office of Public Affairs The rules for getting into some drug treatment programs may be setting up a lethal catch-22 for many intravenous drug users at high risk for infection with the AIDS virus, according to results of a Baltimore study conducted by researchers at Johns Hopkins. In the study of thousands of Baltimore IV drug users over a four-year period, the investigators found that eligibility rules requiring years of demonstrated, repeated drug abuse "would appear to reduce the potential effectiveness of drug treatment as an AIDS prevention strategy." Untreated abusers just continue the risky behavior of sharing hypodermic needles, according to the authors of the article, published in the June 26 issue of Archives of Internal Medicine. Drug treatment programs should drop eligibility requirements that block younger, less experienced IV drug users from treatment, and addicts should have access to programs that provide clean needles and syringes, the researchers said. "We found that younger drug users who were seronegative had a higher risk of becoming infected than did older users," said Kenrad Nelson, professor of epidemiology at the School of Public Health. "The implication is clear. By the time drug abusers are eligible to get treatment, they already are through the stage when they are at highest risk for getting HIV from a contaminated needle. That means drug treatment programs are probably less effective in stopping the spread of AIDS than they could be." Some 2,960 study participants, all with a history of IV drug use, were recruited by the ALIVE (AIDS Linked to the Intravenous Experience) program through community promotion. At the start of the study, 2,247 IV drug users (75.9 percent) were HIV-negative (did not have antibodies against HIV-1 in their blood) and were considered uninfected. The researchers followed up 1,523 and found 188 had become infected by December 1992. Nelson's team also reported a modest decline in the number of HIV infections among drug users who continued to inject illegal drugs between the last half of 1988 and the first half of 1992. "But most of that decrease occurred among women, who had a higher rate of HIV infection than the men did early in the study," he said. "So overall, the rate of infection among IV drug users continues to be about 4 percent per year, despite efforts to educate this population of the dangers of sharing needles." The Hopkins researchers found that seroconversion (developing antibodies to HIV-1, a sure sign of infection) was most common among females younger than 35, with the next highest rate among males under 35. "Previous studies by us and others have shown that populations of drug abusers who receive treatment, including unrestricted legal access to sterile needles, generally have lower rates of HIV infection. What we've shown here is that uninfected addicts tend to be older people who have undergone drug treatment and have access to sterile needles." The HIV problem among young female abusers, who are usually initiated into injecting illicit drugs by older men, is especially serious, according to Nelson. "It may be that women have a higher risk of infection from using contaminated needles," said Liza Solomon, director of the ALIVE program. "Women often have sex with infected men, sometimes in exchange for drugs or for money to buy drugs, and are definitely more at risk than men for becoming infected by HIV from sex." In Baltimore, there are only about 3,000 places in treatment facilities for 30,000 addicts, the authors said. In addition, many abusers inject cocaine as well, and there are no programs that offer treatments for this form of drug abuse. Other authors of the study include David K. Vlahov, Sylvia Cohn and Alvaro Munoz. The work was support by research grants from the National Institute on Drug Abuse.
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