Johns Hopkins Gazette: July 10, 1995

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

     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

     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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