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HIV and AIDS: a clinician's response

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Full textFull text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (237K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. 601 Selected References These references are in PubMed. This may not be the complete list of references from this article. Newmeyer JA. The intravenous drug user and secondary spread of AIDs. J Psychoactive Drugs. 1988 Apr-Jun;20(2):169–172. [PubMed]
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Intravenous drug users are the second largest group to develop the acquired immunodeficiency syndrome, and they are the primary source for heterosexual and perinatal transmission in the United States and Europe. Understanding long-term trends in the spread of human immunodeficiency virus among intravenous drug users is critical to controlling the acquired immunodeficiency syndrome epidemic. Acquired immunodeficiency syndrome surveillance data and seroprevalence studies of drug treatment program entrants are used to trace seroprevalence trends among intravenous drug users in the borough of Manhattan. The virus entered this drug-using group during the mid-1970s and spread rapidly in 1979 through 1983. From 1984 through 1987, the seroprevalence rate stabilized between 55% and 60%--well below hepatitis B seroprevalence rates. This relatively constant rate is attributed to new infections, new seronegative persons beginning drug injection, seropositive persons leaving drug injection, and increasing conscious risk reduction.
Article
• Ninety-six confirmed heroin addicts requesting a heroin maintenance prescription were randomly allocated to treatment with injectable heroin or oral methadone. Progress was monitored throughout the next 12 months by research workers operating independently of the clinic. Heroin can be seen as maintaining the status quo, with the majority continuing to inject heroin regularly and to supplement their maintenance prescription from other sources; it was associated with a continuing intermediate level of involvement with the drug subculture and criminal activity. Refusal to prescribe heroin while offering oral methadone constituted a more confrontational response and resulted in a higher abstinence rate, but also a greater dependence on illegal sources of drugs for those who continued to inject. Those offered oral methadone tended to polarize toward high or low categories of illegal drug use and involvement with the drug subculture, and were more likely to be arrested during the 12-month follow-up. There was no difference between the two groups in terms of employment, health, or consumption of nonopiate drugs. Refusal to prescribe heroin resulted in a significantly greater drop out from regular treatment.
Article
Discusses the dynamics of organizing iv drug users to deal with acquired immune deficiency syndrome (AIDS) issues, drawing on theories of how social movements organize. Organizations of drug users in New York and in the Netherlands are described. AIDS-related foci for organizing include efforts at prevention and psychosocial support for the ill. Conditions for organizational success include avoidance of suppression by society, external support, time to organize, and leadership. Implications for AIDS education are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The formation of drug control policy in Britain in the first three decades of the twentieth century is reviewed. Pharmaceutical controls over sales, based on professional self–regulation gave way to controls on possession and use during the First World War. These war–time restrictions were the basis of the 1920 Dangerous Drugs Act which fulfilled Britain's international treaty obligations. During the 1920s, the Home Office attempted to establish a penal policy on the American model; the Rolleston Report of 1926 established the ‘British system’ of drug control. The ‘political'significance of British drug control in this period, in particular its polemical use in the struggles to liberalise American drug policies in the 1960s, has inhibited a more developed analysis of policy. The tensions over policy and the 1926 Report were not simply battles between rival conceptions of control or a ‘victory’ for the ‘medical model’. This approach ignores the control aspects of both penal and medical views and the complexity of the interactions between them. The 1926 Report was not a ‘medical victory’ but/the result of an accommodation and collaboration between medical and bureaucratic elites with similar interests at stake.
Article
Stored blood samples from 164 intravenous drug abusers who attended a Scottish general practice were tested for HTLV-III/LAV (human T cell lymphotropic virus type III/lymphadenopathy associated virus) infection. Of those tested, 83 (51%) were seropositive, which is well above the prevalence reported elsewhere in Britain and Europe and approaches that observed in New York City. The timing of taking samples of negative sera and continued drug use suggest that as many as 85% of this population might now be infected. The infection became epidemic in late 1983 and early 1984, thereafter becoming endemic. The practice of sharing needles and syringes correlated with seropositivity, which, combined with the almost exclusive intravenous use of heroin and other behavioural patterns, may explain the high prevalence of HTLV-III/LAV infection in the area. Rapid and aggressive intervention is needed to control the spread of infection.
Article
During 1985 many drug abusers who lived in Edinburgh were found to be infected with the human immunodeficiency virus (HIV). As a result an alternative counselling and screening clinic for testing for antibodies to HIV was established for use by drug abusers. Four hundred and forty one patients were counselled in the first year, and over 60% were either drug abusers or their sexual contacts. One hundred and fourteen (26%) patients were positive for HIV antibody, and 100 (88%) of these were current or former drug abusers. The HIV seropositivity rate in drug abusers was 52% but was only 7% in their sexual contacts. Services were provided for these people as well as counselling before and after the test. The cost of this counselling service for the first year was 27,000 pounds or 61.22 pounds per patient. The unexpected mobility of 23% of the Edinburgh drug abusers, particularly to other areas of Britain, suggests that similar services need to be set up elsewhere.
Article
In summary, it can be stated that Amsterdam has a wide variety of helping modalities. Approximately 70 percent of the city's 7,000 drug addicts are in contact with this helping system. In The Netherlands, no evidence could be found to support the fear that low-threshold methadone programs keep addicts away from drug-free treatment. Figure 1 shows that the number of addicts entering drug-free treatment doubled in the period 1981-85 (most popular has been the drug-free aftercare). This is even more striking since the estimated number of addicts did not increase in that same period. So, instead of keeping addicts away from treatment, low-threshold programs and outreach activities may have been effective tools in motivating addicts to enter drug-free treatment. Figure 2 shows the rise of the mean age of drug addicts, while figure 3 indicates that the percentage of addicts under 22 years decreases (14.4 percent in 1981 and 5.1 percent in 1986). Since the total number of addicts is quite stable, this may suggest that heroin is becoming less attractive to young people.
Article
Some questions that have frequently been raised in drug treatment include the extent to which drug users switch to alcohol as an outcome of drug treatment, how alcohol use affects the outcomes of drug treatment, and whether combined treatment of drug and alcohol users is a desirable approach. There is also much interest in the extent of alcohol use prior to, during, and subsequent to treatment among clients in various types of drug treatment programs. These questions were not the principal focus of the Drug Abuse Reporting Program (DARP) program, but were addressed in several studies that form the basis for this report. With the follow-up studies that obtained extensive 6- and 12-year posttreatment data on substantial samples of this population, the DARP represents one of the most extensive data files on drug abuse treatment ever compiled. PostDARP alcohol use by the majority of clients followed in the postDARP surveys was moderate. The significant predictors of mortality risk were alcohol consumption, changes in pattern of opioid use, age, and marital status. Addicts who were at high risk of dying (a) consumed large amounts of alcohol (over 8 oz per day), (b) had continued drug problems and also consumed alcohol, (c) were over 36 years of age, and (d) were not married. Heavy alcohol consumption was the strongest predictor, with a rate of 29.7 deaths per 1000 person years; this rate is close to three times as high as that of 11 per 1000 for those who drank less than 4 oz per day.
Article
Ninety-six confirmed heroin addicts requesting a heroin maintenance prescription were randomly allocated to treatment with injectable heroin or oral methadone. Progress was monitored throughout the next 12 months by research workers operating independently of the clinic. Heroin can be seen as maintaining the status quo, with the majority continuing to inject heroin regularly and to supplement their maintenance prescription from other sources; it was associated with a continuing intermediate level of involvement with the drug subculture and criminal activity. Refusal to prescribe heroin while offering oral methadone constituted a more confrontational response and resulted in a higher abstinence rate, but also a greater dependence on illegal sources of drugs for these who continued to inject. Those offered oral methadone tended to polarize toward high or low categories of illegal drug use and involvement with the drug subculture, and were more likely to be arrested during the 12-month follow-up. There was no difference between the two groups in terms of employment, health, or consumption of nonopiate drugs. Refusal to prescribe heroin resulted in a significantly greater drop out from regular treatment.
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