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1996-02-27
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Document 0287
DOCN M9630287
TI AIDS and injecting drug use in the United Kingdom, 1987-1993: the policy
response and the prevention of the epidemic.
DT 9603
AU Stimson GV; Department of Psychiatry, Charing Cross and Westminster
Medical; School, University of London, England.
SO Soc Sci Med. 1995 Sep;41(5):699-716. Unique Identifier : AIDSLINE
MED/96049315
AB This paper assesses policy development, service changes and trends in
HIV infection and risk behavior among injecting drug users (IDUs) in the
United Kingdom. In 1986, the U.K. was faced with the possible rapid
spread of HIV infection among IDUs. The combination of an outbreak of
HIV infection with prevalence levels of 50% or more in Edinburgh, the
recent diffusion of drug injecting, and high levels of syringe-sharing
risk behaviour, suggested that HIV infection might spread rapidly
through IDU populations. HIV prevention activities commenced in 1986 and
developed in 1987. The first report on AIDS and Drugs Misuse by the
Advisory Council on the Misuse of Drugs in 1988 was a major catalyst for
change. It supported and legitimized emergent views on new ways of
working with drug users. Between 1988 and 1993 innovative public health
projects increased the ability to target vulnerable populations through
syringe distribution, expansion of methadone treatment and outreach to
hard-to-reach populations. There were major changes in service
philosophy and practices, as ideas of harm minimization, accessibility,
flexibility and multiple and intermediate goals were developed. There is
evidence that these public health projects encouraged extensive changes
in the health behaviour of IDUs. There have been major reductions in
syringe-sharing risk behaviour and sharing syringes is no longer the
norm. Evaluation of specific interventions (e.g. syringe-exchange) shows
their importance in encouraging reductions in risk behaviour. Levels of
HIV infection in IDUs remain low by international standards. Outside of
London rates of about 1% have been reported; London has a low and
declining prevalence of infection to around 7% in 1993; previous high
levels in Edinburgh (55%) have since declined to 20%. Britain has to
date avoided the rapid increase in HIV infection among injectors that
has occurred in many parts of the world. The same period saw the
continuation of high prevalence levels in New York and many European
cities, and the explosive spread of HIV in many countries in south-east
Asia. This paper acknowledges the difficulties is proving links between
social interventions and epidemic prevention. It argues that there is
prima facie evidence for the success of public health prevention, that
the collection of intervention approaches in the U.K. had a significant
impact on IDUs behaviour, and that this has helped prevent an epidemic
of HIV infection among IDUs. The U.K. experience adds to the growing
evidence of the significance of early interventions in encouraging
behaviour change and in limiting the spread of HIV infection.
DE Acquired Immunodeficiency Syndrome/EPIDEMIOLOGY/*PREVENTION &
CONTROL/TRANSMISSION Comparative Study Cross-Cultural Comparison
Cross-Sectional Studies Disease Outbreaks/*PREVENTION & CONTROL Great
Britain/EPIDEMIOLOGY Health Policy/*TRENDS Human Incidence Needle
Sharing/STATISTICS & NUMER DATA Needle-Exchange Programs/TRENDS Risk
Factors Substance Abuse, Intravenous/EPIDEMIOLOGY/*PREVENTION &
CONTROL/ REHABILITATION Support, Non-U.S. Gov't JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).