High rates of drug use, but low rates of HIV risk behaviours among injecting drug users during incarceration in Dutch prisons.

AIMS: To determine levels of injecting drug use and sexual risk behaviours in injecting drug users during and immediately following imprisonment in The Netherlands. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey of drug injectors attending methadone clinics, a sexually transmitted disease clinic and a central research site in Amsterdam. The mean age of the 188 participants was 35 years, 78% were male and 34% had HIV antibodies. MEASUREMENTS: Self-reported drug use and sexual behaviours during the last period of imprisonment in Dutch prisons within the previous 3 years and injecting drug use in the week following release from prison. FINDINGS: A period of imprisonment in the preceding 3 years was reported by 188 (41%) of 463 interviewed drug injectors. The mean duration of last imprisonment was 3.6 months. Any use of cannabis, heroin or cocaine during imprisonment was reported by 55%, 37% and 20%, respectively. Five injectors (3%) admitted to having injected in prison, but no sharing of needles and syringes was reported. Vaginal or anal sex was reported by two (1%) of the men and none of the women. Relapse to drug injecting during the week following release from prison was reported by 78/186 (42%) participants, in most cases (34%) at the very first day of release. Drug use behaviours during imprisonment were similar for those who were designated current injectors at the time of imprisonment and those who were not, but injecting in the first week following release from prison was far higher among 'current' injectors (63%) than among those who were not (11%). CONCLUSIONS: Contrary to findings from other countries, low levels of HIV risk behaviours occur among imprisoned drug injectors in The Netherlands. Intra-prison HIV preventive measures should be considered taking into account the nationally, regionally or locally varying conditions within the existing prisons.

[Little HIV risk behavior in drug users during detention in Dutch penitentiaries]. / Weinig HIV-risicogedrag bij drugsgebruikers tijdens detentie in Nederlandse strafinrichtingen.

OBJECTIVE: To assess levels of HIV risk behaviour in injecting drug users during and immediately following prison terms in the Netherlands. DESIGN: Descriptive. SETTING: Municipal Health Service, Amsterdam, the Netherlands. METHODS: Injecting drug users taking part in a follow-up study on HIV infection were interviewed on injecting drug use and vaginal and anal sexual contact during their last prison term in the 3 years preceding the interview and on injecting drug use in the week following release from prison. RESULTS: A prison term in the preceding 3 years was reported by 188 (41%) of 463 interviewed drug injectors. The mean age of the 188 was 35.5 years: 146 (78%) were males, 63 (34%) had HIV antibodies, and the mean duration of latest prison term was 3.6 months. Some use of cannabis, heroin, or cocaine in prison was reported by 104 (55%), 69 (37%), and 38 (20%) respectively. Five injectors (3%) reported having injected in prison: in 4 cases once and in 1 case 3 times. No sharing of needles and syringes was reported. Vaginal or anal sex was reported by 2 (1%) of the men and none of the women. Relapse to drug injecting during the week following release from prison was reported by 78/186 (42%) participants, in most cases (34%) on the very day of release. CONCLUSION: Contrary to findings from other countries, low levels of HIV risk behaviour occur among imprisoned drug injectors in the Netherlands. Although noninjecting drug use in prison is common, drug injecting and the sharing of injecting equipment is rare. There appear to be no grounds for making clean needles and syringes available in Dutch prisons.

Predictors of mortality in the Amsterdam cohort of human immunodeficiency virus (HIV)-positive and HIV-negative drug users.

The impact of human immunodeficiency virus (HIV) infection and other risk factors on mortality was studied in a cohort of Dutch injection drug users and drug users who did not inject. Participants were recruited between 1985 and 1992 and followed up through 1993. Vital status was ascertained through repeat visit information, supplemented by population register data. A total of 77 deaths were recorded among 632 drug users, for a mortality rate per 1,000 person-years of 7 for HIV-negative noninjection drug users, 18 for HIV-negative injection drug users, and 64 for HIV-positive injection drug users. In multivariate analyses, limited to injection drug users, a positive HIV serostatus, age above 40 years, and using benzodiazepines several times daily were significantly associated with an elevated risk of death, both for death from all causes and for death preceding acquired immunodeficiency syndrome (AIDS) diagnosis (pre-AIDS). For pre-AIDS death, the adjusted relative risk associated with HIV infection was 2.2 (95% confidence interval 1.3-3.7). Only 38% of HIV-infected injection drug users who died were diagnosed with AIDS. However, 76% of HIV-infected injection drug users who died without AIDS diagnosis had evidence of immunosuppression (CD4 count < 500/microliters). Daily use of methadone and participation in needle and syringe exchange schemes were not associated with lower mortality rates. This study illustrates in a group of injection drug users with a 30% HIV seroprevalence and a high background mortality the profound influence on mortality that HIV infection has gained.