dmcanzi@watserv1.waterloo.edu (David Canzi) (08/18/90)
Medical News for July 30, 1990 to August 13, 1990
Copyright 1990: USA TODAY/Gannett National Information Network
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July 31, 1990
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AIDS FROM TRANSFUSIONS:
Some experts believe up to 460 people a year were infected with the HIV
virus as recently as 1988. Blood bankers now say the blood supply is safer
than ever and that no one should forego a necessary transfusion out of fear.
And a congressional investigation has been launched to determine whether the
blood industry responded properly during the early AIDS epidemic.
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Aug. 1, 1990
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HIV CASES ESCALATE:
The World Health Organization now estimates that 8 million to 10 million
people worldwide are infected with HIV, the virus that causes AIDS. The figure
is up from an earlier estimate of 6 million to 8 million infections and
reflects the escalating epidemic in the developing world, WHO officials say.
U.S. health officials estimate that there are 1 million HIV infections in the
USA.
AIDS INFECTIONS TARGETED:
A new push to find treatments for the variety of infections that afflict
AIDS patients will be announced at a congressional hearing Wednesday by the
National Institute of Allergy and Infectious Diseases. The AIDS virus, HIV,
breaks down the immune system and causes up to 90 percent of AIDS-related
deaths. Under the new program, six research teams will share $2.8 million in
grants.
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Aug. 2, 1990
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BLOOD IS SAFER THAN EVER:
Since 1985, the addition of the HIV antibodies test, along with tests for
hepatitis C and a rare virus called HTLV-1, have made blood safer than ever,
say medical experts. Adding to safety: More surgery patients now get the
option of donating their own blood, thus eliminating the risk. And many
physicians have cut blood use, turning to transfusions only when benefits
outweigh risks.
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Aug. 8, 1990
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BLOOD BANKS SAY SUPPLY IS SAFE:
Blood banks say the nation's supply is safer than ever, but a recent
lawsuit charging negligence in screening, before the AIDS test was developed
in 1985, has thrown the problem into the spotlight again. And while AIDS-
tainted blood transfusions are extremely rare today, thousands of people were
getting a lethal form of hepatitis from tainted blood until this year.
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Aug. 9, 1990
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BLOOD BANKS SHUN NEW AIDS TEST:
Blood banks will not routinely use a new test that can detect a rare and
distinct form of the AIDS-causing virus, which can slip past standard tests.
Cited: a national annual cost of $15 million. Large scale tests for HIV-2
have shown no evidence of transmission in the United States, says Dr. Thomas
O'Brien for the Centers for Communicable Diseases in Atlanta.
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Center for Disease Control Reports
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Morbidity and Mortality Weekly Report
Thursday August 2, 1990
Characteristics of Clients in Alcohol and Drug-Treatment Centers --
South Carolina, 1989
The South Carolina Department of Health and Environmental Control (SCDHEC)
recently evaluated characteristics of clients in detoxification programs of
selected alcohol- and drug-treatment centers to determine 1) the human
immunodeficiency virus (HIV), hepatitis B, and syphilis seropositivity of
clients; 2) the proportion of clients with histories of intravenous (IV)-drug
use; and 3) clients' drug-use and risk behaviors and attitudes. This report
presents findings of the SCDHEC evaluation.
In 1989, the 37 public, community-based alcohol- and drug-treatment
centers in South Carolina served 32,323 clients who had a primary diagnosis of
alcohol or other drug use. In South Carolina, clients who are admitted to
alcohol- and drug-treatment centers are charged for services on a sliding
scale based on their ability to pay; no one is refused service. Clients are
referred for treatment by themselves, state and local agencies, hospitals, and
emergency rooms. Inpatient services are offered for a maximum of 28 days;
outpatient services may continue indefinitely. In 1989, 86% of clients were
treated on an outpatient basis.
From April 25 through June 23, 1989, the SCDHEC surveyed and tested all
clients entering detoxification services at alcohol- and drug-treatment
centers in three urban counties (approximate population of each county:
300,000). During this period, 632 clients entered the centers and were tested
for HIV, hepatitis B surface antigen (HBsAg), and syphilis (rapid plasma
reagin (RPR)); nine (1%) were HIV-antibody positive, 21 (3%) were HBsAg
positive, and 22 (3%) had a reactive RPR.
Of the 632 clients, 478 (76%) completed an anonymous, self-administered
questionnaire concerning drug use, HIV-transmission risk behaviors, and
attitudes regarding HIV prevention. Of the clients who completed the
questionnaire, 442 (92%) provided drug-use information. Of these, 182 (41%)
indicated they had used IV drugs at some time in the past, and 129 (29%)
indicated they had used IV drugs in the past year. The median age of the IV-
drug users (IVDUs) was 31 years (range: 12-72 years), and their median
education level was 12th grade (range: 4-16 years of school). Of the 174 for
whom gender was known, 131 (75%) were male. Of the 169 for whom race was
known, 103 (61%) were white, 63 (37%) were black, and three (2%) were other
races. Sexual preference was known for 163 IVDUs: 150 (92%) were heterosexual
and 13 (8%; nine males and four females) were homosexual/bisexual. Drug use
was reported by the nine HIV-positive persons: seven indicated IV-drug use as
their only risk behavior, one indicated a history of IV-drug use and
bisexuality, and one indicated a history of non-IV cocaine use.
Of the 182 clients who had used IV drugs, 80 (44%) reported sharing
needles or other drug-injection equipment. One hundred six (58%) indicated
that they always rinsed their drug-injection equipment after use; however,
only 16 (15%) of these used bleach when cleaning their drug-injection
equipment. Of the 182 IVDUs, 28 (15%; 16 males, 10 females, two unknown)
indicated that in the past year they had exchanged sex for money, drugs, or
other gifts. The drugs most frequently injected were cocaine (62%), heroin
(30%), and combinations of cocaine and heroin (22%).
Of 114 persons indicating how frequently they injected drugs, 43 (38%)
reported injecting daily; 34 (30%), weekly; and 37 (32%), monthly. Of the 173
persons who answered questions on condom use, 88 (51%) reported never using
condoms; 72 (42%), sometimes using condoms; and 13 (8%), always using condoms.
In regard to attitudes about HIV testing, 85% of the IVDUs indicated that
all persons in a drug-treatment program should be offered testing and
counseling at the site where drug treatment is received.
Reported by: JL Jones, MD, P Rion, MSPH, H Dowda, PhD, L Kettinger, MPH, R
Ball, MD, WB Gamble, Jr, MD, State Epidemiologist, South Carolina Dept of
Health and Environmental Control. L Nalty, MHEd, D Nalty, PhD, South Carolina
Commission on Alcohol and Drug Abuse. Editorial Note: The findings of this
evaluation by the SCDHEC have played an important role in the development of
new disease-prevention programs in South Carolina alcohol- and drug-treatment
centers. These programs include client education on the prevention of HIV
infection, hepatitis B, and sexually transmitted diseases; specific HIV-
training sessions for substance-abuse counselors; training plans for the
implementation of outreach programs; specific risk-reduction programs for
female IVDUs; condom distribution programs; and a program for counselors to
demonstrate one-on-one to clients how to clean drug-injection equipment with
bleach.
This survey (which involved 76% of clients) found that 41% of the clients
of these centers reported IV-drug use. Clients who attend alcohol- and drug-
treatment centers may not be representative of the IV-drug-using population in
a locality (1); however, they do represent a population that is accessible
through public health programs that offer counseling and testing for HIV and
other sexually transmitted diseases, partner notification, and other HIV-
related services (e.g., free and confidential CD4 lymphocyte testing with
referral to other health-care providers). These services can provide
incentives for clients to return for follow-up counseling, which is important
for behavioral change among IVDUs (2). Results of this evaluation also
indicate that greater efforts in preventive education are needed to reduce
risk factors associated with HIV transmission among IVDUs.
References
1. CDC. Coordinated community programs for HIV prevention among intravenous-
drug users--California, Massachusetts. MMWR 1989;38:370-4.
2. van den Hoek JAR, van Haastrecht HJA, Coutinho RA. Risk reduction among
intravenous-drug users in Amsterdam under the influence of AIDS. Am J Public
Health 1989;79:1355-7.
Morbidity and Mortality Weekly Report
Thursday August 9, 1990
Update: Reducing HIV Transmission in Intravenous-Drug Users Not in Drug
Treatment -- United States
In 1987, the National Institute on Drug Abuse (NIDA) initiated ongoing
demonstration projects to study and change the high-risk behaviors of both
intravenous-drug users (IVDUs) who were not enrolled in drug treatment and
their sex partners (1). The goal of the projects is to eliminate or reduce the
likelihood of human immunodeficiency virus (HIV) transmission from these two
high-risk groups. As of July 1, 1990, the projects included greater than
30,000 IVDUs and their sex partners in 41 community-based programs. This
report describes preliminary data (as of January 1990) based on follow-up
interviews of 1584 primarily less than 40-year-old, black, male IVDUs
recruited from 1987 through 1989 in Chicago, Houston, Miami, Philadelphia, and
San Francisco (Table 1, page 535).
In these projects, IVDUs were recruited through community-based outreach
workers who were familiar with the neighborhoods in which the programs
operate, were often former drug users, and had access to neighborhoods in
which drugs were used. Eligibility criteria for participants included
intravenous (IV)-drug use during the 6 months before recruitment and no
enrollment in a drug-treatment program during the 30 days before recruitment.
Clients were paid for their participation. The return rates for participants
from initial to follow-up interviews were greater than 65% in four cities--
ranging from 45% (Houston) to 78% (Philadelphia).
The specific interventions to reduce risk behaviors varied by city but
included one or more of the following: 1) individual and group counseling, 2)
efforts to build peer support for behavior change, and/or 3) demonstration and
practice of behaviors that reduce risk. All interventions emphasized
termination of IV-drug use. IVDUs were urged to start drug treatment as soon
as it became available to them. In all cities, the programs strongly
encouraged those who did not stop IV-drug use to 1) stop sharing drug-
injection equipment (e.g., needles and syringes, drug-cooking implements, and
rinse water); 2) use only sterile needles and syringes from unopened packages;
and/or 3) disinfect drug-injection equipment with bleach or other appropriate
agents. The interventions related to sexual activity advocated celibacy and,
for persons who were sexually active, safer sexual practices, including use of
condoms and reduction of the number of sex partners.
Fourteen percent to 35% of IVDUs participating in the first follow-up
interview had entered a drug-treatment program during the approximately 6
months after enrollment (Table 1). Forty-nine percent to 75% of IVDUs reported
stopping or decreasing their frequency of drug injection during the
approximately 6 months between the initial intervention and follow-up
interview (Table 1)--including 16%-47% who reported stopping all use of IV
drugs.(Continued on page 535)
In all five cities, the percentage of IVDUs who reported not sharing drug-
injection equipment with friends increased in the approximately 6 months
between initial and follow-up interviews, as did the percentage of IVDUs who
reported not borrowing previously used drug-injection equipment (Table 1).
Thirty-four percent (Houston) to 59% (Chicago) of IVDUs reported decreased
sharing of drug-injection equipment; 22% (San Francisco) to 37% (Chicago) of
IVDUs reported decreased borrowing of drug-injection equipment.
Of those who continued to inject drugs at follow-up, except for those who
reported always using new needles, 20%-39% of IVDUs reported increased use of
bleach for cleaning drug-injection equipment (Table 1). Eleven percent to 43%
of IVDUs reported consistent use of bleach.
Regular condom use with a steady sex partner increased in three cities to
12%-16% (Table 2). Regular condom use with multiple sex partners increased in
four cities to 10%-27%.
Reported by: MY Iguchi, PhD, School of Osteopathic Medicine, Univ of Medicine
and Dentistry of New Jersey, Camden, New Jersey. J Watters, PhD, Univ of
California, San Francisco; P Biernacki, PhD, Youth Environment Study
Corporation, San Francisco, California. CB McCoy, PhD, DD Chitwood, PhD, Univ
of Miami, Florida. W Wiebel, PhD, Univ of Illinois, Chicago. J Liebman, MS, L
Kotranski, PhD, Philadelphia Health Management Corporation, Pennsylvania. M
Williams, PhD, Affiliate Systems Corporation, Houston, Texas. BS Brown, PhD,
National Institute on Drug Abuse, Alcohol, Drug Abuse, and Mental Health
Administration. Office of the Director, Center for Prevention Svcs, CDC.
Editorial Note: IV-drug use is an important factor in the transmission of HIV
(2). Of the 117,781 persons with acquired immunodeficiency syndrome (AIDS)
reported in the United States in 1989, 36,356 (30.8%) are in a risk-behavior
category directly or indirectly related to IV-drug use (3).
IVDUs are difficult to reach and influence with traditional public health
education and other prevention interventions (4). Although drug-treatment
centers can serve the dual purpose of drug treatment and HIV prevention, an
estimated 80% of active IVDUs are not in treatment (National Association of
State Alcohol and Drug Abuse Directors, unpublished data). New approaches and
more effective strategies for reaching IVDUs not in drug treatment are needed
to decrease drug use and stem the HIV epidemic.
These preliminary results, which show an overall reduction in high-risk
behaviors of IVDUs, suggest that participation in outreach and intervention
programs can influence entry into drug-treatment programs and reduce drug-
injection behaviors associated with increased risk for HIV transmission. The
lowest rates for IVDUs entering drug-treatment programs were in Miami and
Houston, where capacities of publicly funded drug-treatment programs are
limited. Stronger evidence of the considerable impact that this approach could
have if implemented nationwide would be provided if the results at other sites
prove to be consistent with these preliminary results.
A related study in San Francisco (5) suggests that outreach programs
affect even the behaviors of IVDUs in the community who did not participate
directly in the interventions. Cross-sectional samples of approximately 500
IVDUs recruited at 6-month intervals during 1986 and 1989 revealed that the
introduction of outreach programs to IVDUs in 1986 corresponded with the start
of communitywide increases in bleach use (from 3% in 1986 to 86% in 1989).
The Health Behavior Projects in Newark and Jersey City, New Jersey, have
shown that IVDUs can be recruited directly from the street and community to
enter drug-treatment programs when drug treatment is made more accessible. In
these projects, 49% of 1884 IVDUs who participated in intake interviews
subsequently entered 21- or 90-day methadone treatment programs at no charge
(M.Y. Iguchi, unpublished data, 1990).
The results reported here reflect the effectiveness of street outreach
combined with additional behavior-change interventions such as HIV counseling
and testing. An additional strength of the projects may be the use of
nontraditional outreach workers to recruit IVDUs into treatment. As in other
studies (4), reported reductions in drug-use risk behaviors were larger than
reductions in sexual risk behaviors.
Recruiting drug users into and keeping them in well-managed, effective
drug-treatment programs can reduce risk behaviors for HIV infection (6). This
strategy is essential to all HIV-prevention programs for drug users.
Additional strategies are needed to reach drug users not in treatment
programs. Since peers may influence former drug users to use drugs, drug-
treatment and HIV-prevention programs need to provide long-term, repeated
contacts with IVDUs who have returned to the community after drug treatment.
Street/community outreach is an important element of a comprehensive
program to reach IVDUs in a variety of settings (including drug-treatment
centers, public health clinics, free-standing HIV counseling and testing
programs, correctional facilities, and health-care facilities such as
hospitals and emergency rooms) and is best coordinated at the community level
to assure maximum coverage and effectiveness (7). Project TRUST in Boston (8)
and South Carolina's survey of clients in alcohol- and drug-treatment centers
(9) are efforts to meet the specific needs of IVDUs for HIV prevention.
Continuous reassessment is important in determining how outreach can be most
effectively used in HIV and drug-treatment programs.
References
1. CDC. Risk behaviors for HIV transmission among intravenous-drug users not
in drug treatment--United States, 1987-1989. MMWR 1990;39:273-6.
2. CDC. HIV/AIDS surveillance report. Atlanta: US Department of Health and
Human Services, Public Health Service, January 1990:9.
3. CDC. HIV/AIDS surveillance report. Atlanta: US Department of Health and
Human Services, Public Health Service, July 1990:8.
4. Turner CF, Miller HG, Moses LE, eds. AIDS sexual behavior and intravenous
drug use. Washington, DC: National Academy Press, 1989.
5. Watters JK, Cheng Y, Segal M, Lorvick J, Case P, Carlson J. Epidemiology
and prevention of HIV in intravenous drug users in San Francisco, 1986-1989
(Abstract). Vol 2. VI International Conference on AIDS. San Francisco, June
20-24, 1990:116.
6. Hartel D, Selwyn PA, Schoenbaum EE, Klein RS, Friedland GH. Methadone
maintenance treatment (MMTP) and reduced risk of AIDS and AIDS-specific
mortality in intravenous drug users (IVDUs) (Abstract). Book 2. IV
International Conference on AIDS. Stockholm, June 12-16, 1988:395.
7. CDC. Coordinated community programs for HIV prevention among intravenous-
drug users--California, Massachusetts. MMWR 1989;38:369-74.
8. CDC. Counseling and testing intravenous-drug users for HIV infection--
Boston. MMWR 1989;38:489-90,495-6.
9. CDC. Characteristics of clients in alcohol- and drug-treatment centers--
South Carolina, 1989. MMWR 1990;39:519-20.
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Volume 3, Number 29 August 13, 1990
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Editor: David Dodell, D.M.D.
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David Canzi