[Attitudes and practices of drug users confronted with the risks of contamination by human immunodeficiency virus (HIV) and hepatitis B and C viruses]. / Les attitudes et les pratiques des usagers de drogues confrontés aux risques de contamination par le virus de l'immunodéficience humaine (VIH) et les virus des hépatites B et C.

This study has been conducted in Lille, Marseille, Metz, Paris and its suburbs using an ethnographic methodology. A total number of 1,703 subjects using injectable drugs have been interviewed in the streets and in treatments centers. The result of the study are as follows: sharing syringes did progressively decrease since 1988; reusing syringes and sharing of the injection equipment maintained itself during the same time period; a decrease of HIV seroprevalence; a massive HVC contamination; qualitative and quantitative data do suggest the important role played by the multiple use of the same syringes and the sharing of the injection equipment.

[The consumption of "crack" in Paris in 1993. Epidemiological and ethnographic data]. / La consommation du "crack" à Paris en 1993. Données épidémiologiques et ethnographiques.

In France, trends of cocaine use have been increasing regularly since 1980. "Crack" has been noticed for the first time in 1987. "Crack" is a smokable form of cocaine which is easily processed starting from cocaine hydrochloride. In 1993 a very important spread of "crack" use has been observed by our street team. It is very clear that "crack" use has been underestimated in Paris. The medical and social management of addicts could be severely affected by this new phenomenon.

[Methods for AIDS prevention: importance and limitations of use of bleach]. / Les modes de prévention du sida: intérêt et limites de l'utilisation de l'eau de Javel.

The authors are discussing the interest of promoting the use of bleach as a powerful disinfectant among drug users. Following the researches conducted in the United States of America, the use of bleach has been introduced on an experimental basis in Paris. This action-research allowed to meet 1500 drug users who have received bleach and prevention materials. The evaluation of the action was conducted on a sample of 478 subjects. It was found that bleach could be used by addicts for syringe decontamination. The communication strategy implies a direct personal contact and a non judgmental message. Syringes must be carefully cleaned and rinsed at least twice with bleach in order to allow a one minute contact. In the absence of a new syringe the use of bleach provides a reasonable means of risk reduction if detoxification cannot be achieved.

Transmission of HIV among drug addicts in three French cities: implications for prevention.

In 1988, the Institute for Epidemiological Research on Drug Dependence conducted an ethnographic study designed to assess the results of liberalization of the sale of syringes. In that study, drug addicts were found to have gradually altered their customary practices by limiting the sharing of syringes. Two years later, a second study was conducted to further assess the behavioural changes under way. The whole survey covered 359 subjects--165 in Paris, 110 at Marseille and 93 at Metz. Almost all the subjects stated that they knew about the risks of transmission of the human immunodeficiency virus (HIV) by needle and during unprotected sexual intercourse. Almost all of them (98 per cent) knew that syringes were freely sold at pharmacies. Most of them (84 per cent) felt that they were generally well informed on the subject of AIDS and the ways in which the virus was transmitted. Prostitutes accounted for 17 per cent of the sample, with more women (32 per cent) than men (13 per cent) included in that category. The overwhelming majority of the subjects bought their syringes at pharmacies, and the trend towards the non-sharing of syringes was confirmed, a change in behaviour that has emerged mainly since 1987. Among the "new generation" of drug addicts, namely those who began to inject after 1987, the changes are reflected in a much lower rate of infection--2 per cent instead of 28 per cent of the total. About a third of the subjects, however, continued to engage in practices involving a certain level of risk. In a global context, including subjects who do not know how to properly clean a syringe, a variety of usually ineffective practices are followed, for example rinsing with water, lemon juice, or scent. The use of bleach remained limited, and few people considered cleaning with it. Liberalization of the sale of syringes seems to be essential to the prevention of AIDS among drug addicts. But this measure is not enough in itself. Apart from the overall problems of looking after the health of drug addicts and ensuring access to medical care, certain specific measures remain highly desirable. Of particular importance is the dissemination of information clearly describing effective methods of sterilizing syringes (including the use of bleach).