08945nam 2200673Ia 450 991082840480332120240416232623.00-309-17621-21-280-19300-X97866101930040-309-58821-90-585-02248-8(CKB)110986584751648(SSID)ssj0000226804(PQKBManifestationID)11947066(PQKBTitleCode)TC0000226804(PQKBWorkID)10259523(PQKB)10796122(MiAaPQ)EBC3375978(Au-PeEL)EBL3375978(CaPaEBR)ebr10054969(OCoLC)923260167(EXLCZ)9911098658475164819950717d1995 uy 0engurcn|||||||||txtccrPreventing HIV transmission the role of sterile needles and bleach /Jacques Normand, David Vlahov, and Lincoln E. Moses, editors1st ed.Washington, D.C. National Academy Press1995xviii, 334 p. ill., maps"Panel on Needle Exchange and Bleach Distribution Programs, Commission on Behavioral and Social Sciences and Education, National Research Council and Institute of Medicine."0-309-05296-3 Includes bibliographical references and index.Preventing HIV Transmission -- Copyright -- Contents -- Preface -- Acknowledgments -- Executive Summary -- THE PROBLEM -- THE PANEL'S CHARGE -- SCIENTIFIC ASSESSMENT OF PROGRAM EFFECTIVENESS -- Needle Exchange -- Bleach Distribution -- COMMUNITY AND LEGAL FACTORS -- RECOMMENDED COURSE OF ACTION -- NOTE -- Introduction -- DIMENSIONS OF THE PROBLEM -- RESPONSES TO THE EPIDEMIC -- THE CHARGE TO THE PANEL -- THE PANEL'S REPORT -- Information Sources -- Approach -- Organization -- NOTES -- REFERENCES -- Part 1 Dimensions of the Problem -- 1 The Epidemiology of HIV and AIDS -- BIOLOGICAL MECHANISMS OF TRANSMISSION -- Injection Drug Use Transmission -- Direct Needle Sharing -- Indirect Needle Sharing -- Risk Behaviors and Interventions -- Sexual Transmission -- Perinatal Transmission -- Conclusion -- EPIDEMIOLOGIC DATA -- HIV and AIDS Surveillance -- Mode of Acquisition of Infection -- HIV AND AIDS AMONG INJECTION DRUG USERS -- Surveillance -- Sexual Transmission Among Injection Drug Users -- Perinatal Transmission from Injection Drug Users -- SUMMARY -- Conclusions -- Recommendations -- NOTES -- REFERENCES -- 2 The Epidemiology of Injection Drug Use -- ESTIMATES OF INJECTION DRUG USERS -- Geographic Variations -- National Surveys of Drug Abuse -- National Household Survey on Drug Abuse -- Washington DC Metropolitan Area Drug Study -- Surveys of Youth -- Conclusion -- CHARACTERISTICS OF INJECTION DRUG USERS -- A National Profile -- Local Drug Use Trends and Patterns -- SUMMARY -- Recommendation -- NOTES -- REFERENCES -- 3 Needle Exchange and Bleach Distribution Programs in the United States -- INTRODUCTION -- NEEDLE EXCHANGE PROGRAMS -- Legal Issues -- Program Operations -- Sites -- Staffing -- Policies -- Hours of Operation -- On-Site Services Offered -- Items Distributed -- Characteristics of Program Participants -- Cost and Cost-Effectiveness.Organization Characteristics -- Three Simple Case Studies -- Two Complex Case Studies -- Comparisons Across Programs -- BLEACH DISTRIBUTION PROGRAMS -- Characteristics of Program Participants -- Outreach Strategies -- CONCLUSIONS -- REFERENCES -- 4 Community Views -- MORAL/ETHICAL ARGUMENTS -- PUBLIC OPINION POLLS -- AFRICAN AMERICAN VIEWS -- LATINO/HISPANIC VIEWS -- LAW ENFORCEMENT VIEWS -- HEALTH PROFESSIONAL VIEWS -- Pharmacists -- Treatment Service Providers -- Funding -- Treatment Efficacy -- Federal Regulations -- Condoning Drug Use -- SUMMARY -- CONCLUSIONS -- NOTE -- REFERENCES -- 5 The Legal Environment -- U.S. DRUG CONTROL POLICY -- Legislative/Statutory Environment -- State and Local Litigation -- DO PARAPHERNALIA AND PRESCRIPTION LAWS CONTRIBUTE TO HIV TRANSMISSION -- Needle Scarcity and Sharing -- Changes in the Laws in Connecticut -- Needle Sales -- Injection Drug Users' Behaviors -- SHOULD THE LAWS BE CHANGED -- Changing the Laws -- Consequences -- CONCLUSIONS -- RECOMMENDATIONS -- NOTE -- REFERENCES -- Part 2 The Impact of Needle Exchange and Bleach Distribution Programs -- 6 The Effectiveness of Bleach as a Disinfectant of Injection Drug Equipment -- TRANSMISSION OF HIV AMONG INJECTION DRUG USERS -- BLEACH AS A DISINFECTANT -- Definition of Terms -- The Role of Cleaning in Disinfection -- Susceptibility of HIV to Disinfection -- Laboratory Studies -- CDC Recommendations -- BLEACH DISTRIBUTION PROGRAMS -- Program Evaluation -- The Chicago Experience -- Limitations of Bleach Disinfection -- Impact of Bleach Disinfection on HIV Transmission -- SUMMARY -- Conclusions -- Recommendations -- NOTES -- REFERENCES -- 7 The Effects of Needle Exchange Programs -- POTENTIAL OUTCOMES -- Possible Positive Outcomes -- Possible Negative Outcomes -- THE PANEL'S APPROACH TO THE EVIDENCE.The Traditional Approach: Considering the Preponderance of the Evidence -- An Alternative Approach: Looking at the Patterns of Evidence -- Rationale -- Ruling In Plausibility -- The Panel's Synthesis -- U.S. GENERAL ACCOUNTING OFFICE REVIEW -- Procedure -- Results -- UNIVERSITY OF CALIFORNIA REPORT -- Procedure -- Results -- Possible Positive Outcomes -- Reduction in High-Risk Behavior -- Increased Referrals to Drug Treatment -- Reduction in HIV Infection Rates -- Possible Negative Outcomes -- Increase in Program Participant Drug Use -- Increase in New Initiates to Injection Drug Use -- Increased Drug Use in the Community -- Increase in Number of Contaminated Needles Unsafely Discarded -- Summary -- EVIDENCE FROM RECENT STUDIES -- Possible Positive Outcomes -- Reduction in Risk Behavior -- Reduction in HIV Infection Rates -- Possible Negative Outcomes -- Program Participant Drug Use -- New Initiates to Injection Drug Use -- Discarded Needles and Syringes -- THE NEW HAVEN STUDIES -- Program Implementation -- Estimated Effects on HIV Incidence -- Assessment of the Models -- New Initiates to Injection Drug Use -- Enrollment in Drug Treatment -- Alternative Explanations -- Summary -- THE TACOMA STUDIES -- The Program -- HIV Seroprevalence Studies -- Hepatitis Surveillance and Case Reporting -- Hepatitis B and C Case-Control Study -- Interview Studies with Injection Drug Users -- Potential Alternative Explanations -- Program Effects on New Initiates to Drug Use or Abuse -- SUMMARY -- Conclusions -- Recommendations -- NOTES -- REFERENCES -- 8 Directions for Future Research -- RESEARCH ON PROGRAM EFFECTIVENESS -- Needle Exchange Evaluation -- Categorization of Exposure to Intervention Condition -- Measurement of Alternative Sources of Sterile Syringes -- Community-Based Studies -- Appropriate Selection of Respondents.Temporal Association of Participation in Programs and HIV Seroconversion -- Accounting for Alternative Risk Behaviors -- Consolidation and Coordination of Program Effects -- Program Characteristics -- RESEARCH ON BLEACH EFFICACY IN DISINFECTION -- EPIDEMIOLOGIC RESEARCH -- RESEARCH ON COMMUNITY ISSUES -- OTHER FUTURE RESEARCH ISSUES -- Deregulation of Syringe Sale and Possession -- Incarcerated Populations -- Randomized Trial of Needle Exchange Programs -- BROADER ISSUES -- CONCLUSION -- REFERENCES -- Appendixes -- APPENDIX A Description and Review of Research Projects in Three Cities -- SAN FRANCISCO -- Review -- MONTREAL -- Needle Exchange Evaluation Project -- Seroincidence -- Data from Correctional Institutions -- Review -- Epidemiologic Study -- Seroprevalence -- Seroincidence -- Review -- CHICAGO -- Demand for Free Needles and Their Effect on Injecting Frequency and Needle Use -- Review -- Effects of Exchange Use on HIV Risk Behavior and Incidence -- Review -- CONCLUSION -- REFERENCES -- APPENDIX B Professional Association Positions on Needle Exchange and Bleach Distribution Programs -- APPENDIX C Biographical Sketches -- Index.Needle exchange programsUnited StatesChlorine and derivatives as disinfectantsAIDS (Disease)United StatesPreventionNeedle exchange programsChlorine and derivatives as disinfectants.AIDS (Disease)Prevention.616.97/9205Normand Jacques1954-1663928Vlahov David1671318Moses Lincoln E103130National Research Council (U.S.).Panel on Needle Exchange and Bleach Distribution Programs.Institute of Medicine (U.S.)MiAaPQMiAaPQMiAaPQBOOK9910828404803321Preventing HIV transmission4033806UNINA