The moral universe of injecting drug users in the era of AIDS: sharing injecting equipment and the protection of moral standing.

Recent work on HIV counselling suggests that the protection of the moral status of the recipient is a key factor in the successful uptake of advice. This study suggests it may be equally important in the uptake of health promotion messages. A discourse analysis of the talk of 20 young injecting drug users (IDUs) identified a contradiction between their asserted self-identity as careful and socially responsible injectors, and their admission of risky lending and borrowing of injecting equipment. This contradiction was resolved by the production of discourses of exoneration, differentially tailored to the moral implications of lending and of borrowing. Lenders argued a form of 'market morality' wherein it was the duty of each to accept the consequences of his/her decisions. Lenders were therefore morally exonerated since moral failure was the 'borrowers'. Borrowing was usually depicted as 'desperate measures' for which moral culpability was disavowed because of 'powerlessness'. The exception of routine borrowing, acknowledged as risky and against community norms, was accounted for in a nihilistic discourse of indifference to infection and death. The need for a 'counter discourse' around notions of community is discussed.

Purchasing a cycle helmet: are retailers providing adequate advice?

OBJECTIVES: The aim of this study was to examine the selling of cycle helmets in retail stores with particular reference to the adequacy of advice offered about the fit and securing of helmets. METHODS: All 55 retail outlets selling cycle helmets in Christchurch, New Zealand were studied by participant observation. A research entered each store as a prospective customer and requested assistance to purchase a helmet. She took detailed field notes of the ensuing encounter and these were subsequently transcribed, coded, and analysed. RESULTS: Adequate advice for helmet purchase was given in less than half of the stores. In general the sales assistants in specialist cycle shops were better informed and gave more adequate advice than those in department stores. Those who have good advice also tended to be more good advice also tended to be more active in helping with fitting the helmet. Knowledge about safety standards was apparent in one third of sales assistants. Few stores displayed information for customers about the correct fit of cycle helmets. CONCLUSIONS: These findings suggest that the advice and assistance being given to ensure that cycle helmets fit properly is often inadequate and thus the helmets may fail to fulfil their purpose in preventing injury. Consultation between retailers and policy makers is a necessary first step to improving this situation.

Hepatitis C seroprevalence amongst injecting drug users attending a methadone programme.

AIM: To study the seroprevalence of the hepatitis C virus (HCV) amongst a population of injecting drug users and to examine the relationship between potential risk factors and HCV infection. METHODS: A sample of 116 clients attending a methadone treatment clinic in Christchurch took part in this study. Blood samples were analysed to detect antibodies to HCV and to test for HCV RNA: Serum transaminases were also measured. In addition a short questionnaire about sexual behaviour and drug use practices was self completed by all participants in strictest confidence. RESULTS: Slightly more than half the sample were female (54.3%) and most were of European origin (90.6%). The average age was 31.56 years and the average length of time they had been injecting drugs was 9.54 years. HCV antibodies were detected in 84.2% of the sample and HCV RNA in 66.1% of the sample including 75.9% amongst those who were anti-HCV positive and 16.6% amongst those who were anti-HCV negative. AST and ALT levels were elevated amongst 16.8% and 46.2% of the sample respectively. The likelihood of being anti-HCV positive increased with years of drug use and with increased sharing of injecting equipment. No significant relationship between HCV status and sexual practices was evident. Data on the history of drug using practices indicated that sharing of injecting equipment had become less common over time and access to new equipment through reliable sources had become more common with time. CONCLUSIONS: HCV is widespread amongst this population of injecting drug users suggesting the possibility of a major clinical and social problem. Despite evidence of a reduction in the sharing of injecting equipment, HCV transmission is still occurring indicating the potential for other parenterally transmitted diseases, such as HIV, to become established amongst injecting drug users. Those at high risk of HCV should be discouraged from donating blood because of the possibility of HCV seronegative infectivity.

Heterosexual behaviour and HIV risk in New Zealand: data from a national survey.

The pattern of any future major heterosexual epidemic of acquired immunodeficiency syndrome (AIDS) will depend partly on sexual behaviour and condom use among heterosexuals. This survey was designed to provide information on patterns of sexual behaviour in New Zealand. A national sample aged 18 to 54 was selected using a random method and telephone interviews were administered to 2361 people, using a questionnaire based on the protocol developed by the Global Program on AIDS of the World Health Organization. The reported mean lifetime number of partners increased with age up to 25 to 29 years for women and 30 to 34 years for men, and declined at older ages. Fifteen or more lifetime partners were reported by 17 per cent of men and 4 per cent of women. Multiple partnerships in the previous 12 months were commonest in those aged 20 to 24. In this age group, 32 per cent of men and 20 per cent of women reported two or more partners. Recent condom use for contraception was reported by 23 per cent of men and 19 per cent of women. Use was highest amongst those aged 18 to 24, and decreased sharply with age. The true proportion of the population with many sexual partners may be higher than reported. These data will be useful in modelling approaches to estimate the likelihood of future heterosexual spread of AIDS. The data on lifetime numbers of partners suggest that sexual decisions depend not just on age and sex but also on the era, and thus on changing social values about sexual behaviour.

AIDS policy response in New Zealand: consensus in crisis.

Typically, Western governments have aimed to construct consensus over HIV/AIDS policy. The history of policy formation in New Zealand is examined, and is found to reflect the general pattern. There was a deliberate strategy designed to establish the broadest possible consensus. However, partly because of this breadth, the consensus was nevertheless fraught with contradiction and tension.

Knowledge, attitudes and activities of male clients of female sex workers: risk factors for HIV.

AIMS: To examine HIV related knowledge, attitudes and practices amongst male clients of female sex workers in New Zealand. METHODS: A sample of 30 clients were contacted in the commercial sex areas of the three main urban centres. A brief structured interview was undertaken by a fully trained interviewer who was herself a sex worker. RESULTS: The respondents were aged between 20 and 60 and came from a range of occupations. A third of them were married. Most visited sex workers quite frequently and vaginal sex was the most common service purchased. Condoms were consistently used with sex workers whereas they were less commonly used with casual partners and almost never used with regular partners. Clients rarely carried condoms and took a passive role in their use with sex workers. Knowledge about HIV transmission was high but perception of HIV risk or fear of infection were low. Many of the respondents travelled both within and outside New Zealand and most used commercial sex services on their travels. CONCLUSIONS: The findings suggest that clients may be a source of HIV infection of both sex workers and their other sex partners. More detailed research is necessary to explore clients' perceptions of HIV risk and the barriers to their wider use of condoms.

The New Zealand Partner Relations Survey: methodological results of a national telephone survey.

OBJECTIVE: To implement and evaluated a national survey of sexual behaviour using computer-assisted telephone interviewing (CATI). DESIGN: A two-stage stratified national sample survey in which households were selected by random digit-dialing (RDD), with a single eligible interviewee per selected household, followed by subsample surveys of non-contacts and refusals to determine eligibility. METHODS: A 15-minute questionnaire based on the Global Programme on AIDS (GPA)/World Health Organization (WHO) protocol was administered by telephone to a nationally representative sample of 2361 respondents in the 18-54-year age group. RESULTS: The overall response rate was 63%, but lower in the cities, in the 18-24 age group, and among men. Three-quarters of surveyed non-contacts, and a quarter of re-surveyed refusals, did not meet the eligibility criteria for the study. Less than 20% of refusals cited the subject matter of the survey as the reason for refusal. Item non-response (< 1%) increased with question sensitivity, and varied by respondent age, ethnicity and partnership status. Men reported twice as many adult lifetime partners as women. CONCLUSIONS: The GPA/WHO protocol can be successfully adapted to administration by telephone, with adequate response rates and exceptionally low levels of item non-response. CATI is a cost-effective method for collecting national information on sexual behaviour in countries where there is a high level of telephone ownership. Used in conjunction with RDD, it can overcome problems of sample design in settings where there is no comprehensive population-sampling frame. Checks on item sensitivity and partner estimates suggest that acceptable levels of reliability can also be achieved.

Postpolio syndrome in New Zealand: a survey of 700 polio survivors.

AIMS: To examine the experience of postpolio syndrome amongst a group of survivors of polio currently resident in New Zealand. METHODS: A sample of 700 responded to a request for volunteers to take part in a postal survey concerning their experience of polio and postpolio symptoms. RESULTS: The mean age of respondents was 59 years. Two-thirds of them were women. The year of polio infection was between 1915 and 1962 with the majority (54%) being in the 1945-56 period. Most were under 16 years of age (73%) at the time. Paralysis and weakness in limbs and back were the most common symptoms in the acute phase of the infection. Symptoms of the postpolio syndrome were reported by significant numbers. Increasing weakness in muscle functioning in one or more area was evident amongst 38% of the sample. Generalised muscle weakness was reported by 47%, increasing muscle wastage by 17%, difficulty swallowing by 16% and shortness of breath on waking by 10%. Pain in joints was reported by 60% and excessive tiredness by 48%. After controlling for age there was little evidence that the symptoms increased with years since the acute polio infection. CONCLUSIONS: The experience of postpolio symptoms was common amongst this group of polio survivors. It is estimated that there are between 3,000 and 5,000 polio survivors in New Zealand who may be suffering postpolio symptoms. The implications of this for primary and secondary health care provision are discussed.

Sexual practices, sexually transmitted diseases and other risk factors for HIV among injecting drug users.

Data were collected from 814 clients attending anonymously for counselling before tests for human immunodeficiency virus (HIV) infection at the Burnett Clinic in Auckland. Just over 10 per cent of clients (n = 83) reported ever having injected drugs. This group was matched according to age, gender, ethnicity and sexual orientation with an equal sized control group drawn from clients who had not injected drugs. The groups were compared in terms of their sexual practices, sexual partnerships, other drug use, current and past health status and their perception of HIV risk. The injecting drug users reported more sex partners than the nonusers, they were less likely to be in a relationship and they were less likely to be monogamous. Vaginal and oral sex were the most common practices in both groups but anal sex was more common among users than the nonusers. Regular condom use was reported by less than a quarter of each group. The health status of drug users was generally poorer than that of the nonusers. They reported greater use of alcohol and other drugs, more mental health problems, and more symptoms of ill health. They also had experienced more sexually-transmitted diseases. Only 1 per cent of users and 2 per cent of nonusers tested positively for HIV, although users saw themselves and their partners as at greater risk of HIV infection than the nonusers.

Sexually transmitted diseases amongst a sample of people seeking HIV testing.

AIMS: To examine the incidence of sexually transmitted diseases according to gender, age, sexual orientation, sexual behaviour and drug use. METHODS: Data were collected from 814 clients attending anonymously for HIV testing at the Burnett Centre in Auckland. During pretest counselling clients were asked questions designed to assess their risk of HIV infection including a detailed history of sexually transmitted diseases (STDs). RESULTS: Amongst attenders 44% reported at least one lifetime STD including 16% reporting more than one. Multiple STDs were not associated with gender or sexual orientation but they were associated with the practice of anal sex and with a history of multiple sex partners. Alcohol and drug use were also related to multiple STDs. For men the most common STD was NSU with 20% of them reporting it whereas for women genital warts was the most common reported by 18%. Amongst those under 20 years 9% reported genital warts, 7% NSU and 6% chlamydia. CONCLUSIONS: The findings confirm that it is sexual practices which put people at risk of infection from STDs rather than their sexual orientation. They also draw attention to the role that drugs and alcohol play in the practice of unsafe sex and the consequent transmission of STDs. Finally they suggest that screening for STDs as well as HIV in AIDS clinics should be encouraged.

Condom use in anal intercourse amongst people who identify as homosexual, heterosexual or bisexual.

AIMS: to study condom use amongst those who practice anal intercourse. METHODS: a sample of 814 clients attending anonymously for pretest counselling for HIV infection at the Burnett Clinic, Auckland, gave detailed information about their sexual behaviour. RESULTS: insertive or receptive anal intercourse was reported in 39% of clients. This included 89% among homosexual men, 78% among bisexual men, 17% among heterosexual men and 21% among heterosexual women. In those practising anal intercourse concomitant condom use was reported by 71% of homosexual men, 53% of bisexual men, 16% of heterosexual men and 7% of heterosexual women. Those most likely to use condoms were homosexual men, prostitutes, those with multiple partners and those with an HIV infected partner. Those least likely to use condoms were heterosexual men or women. CONCLUSIONS: whilst substantial changes in sexual practices appear to have been made in the homosexual community, heterosexuals practising anal intercourse have made few such changes. More explicit AIDS education may be necessary which acknowledges that anal intercourse is practised by heterosexuals and advises condom use accordingly.

PIP: This study examined condom use among those practicing anal intercourse. 814 clients attending anonymously for pretest counseling for HIV infection at the Burnett Clinic, Auckland, New Zealand, provided detailed information concerning their sexual behavior. Insertive or receptive anal intercourse was reported in 39% of the clients, including 89% among homosexual men, 78% among bisexual men, 17% among heterosexual men, and 21% among heterosexual women. In those who practiced anal intercourse, there was also concomitant condom use reported by 71% of homosexual men, 53% of bisexual men, 16% of heterosexual men, and 7% of heterosexual women. Those most likely to use condoms were homosexual men, prostitutes, those who had multiple partners, and those with an HIV-infected partner. Those least likely to use condoms were heterosexual men and women. While significant changes in sexual practice appear to have been made in the homosexual community, heterosexuals who practice anal intercourse have not made many changes. More explicit AIDS education may be necessary which acknowledges that anal intercourse is practiced by heterosexuals and which advises condom use accordingly.

Changes in sexual practices and some HIV related attitudes in New Zealand: 1987-9.

Two fully national samples of 1000 New Zealanders aged 16-60 were interviewed in 1987 and in 1989 about their sexual practices and related attitudes to HIV/AIDS matters. The data were gathered by means of a self completed questionnaire which was part of a larger interview undertaken in the respondents' own homes. Precautions were taken to ensure confidentiality, anonymity and privacy. There were significant differences in the reporting of sexual behaviour during the two year study period. The proportion of the sexually active reporting three or more sex partners in the previous year fell from 12% to 8%. The proportion reporting "always" or "often" using condoms rose from 13% to 18% and those reporting permanent changes to sexual behaviour because of AIDS rose from 16% to 26%. Changes towards safer sexual practices were more common amongst males, the young, the unmarried and those with multiple sex partners. Findings concerning attitudes to HIV/AIDS related matters showed an increase in the population's perceived risk of the virus to both themselves and others. For example the proportion who felt everyone was at risk rose from 71% in 1987 to 80% in 1989. There was also evidence of increased victim blaming of the person who caught HIV infection or other sexually transmitted diseases. Finally there was evidence of the need for more action on AIDS. In 1987 35% felt that enough was being done whereas this had dropped to 27% by 1989.

PIP: 1000 New Zealanders aged 16-60 were interviewed in 1987 and 1989 in 2 national samples about their sexual practices and attitudes regarding HIV and AIDS. The surveys were conducted to help evaluate the effectiveness of AIDS prevention efforts carried out by the Department of Health over the period 1985-89. The proportion of sexually active respondents reporting 3 or more sex partners in the previous year fell from 12% to 8% between surveys. The proportion always or often using condoms increased from 13% to 18%, while those reporting permanent change in sexual behavior due to AIDS increased from 16% to 26%. Adoption of safer sex practices was most prevalent among males, the young, the unmarried, and those with multiple sex partners. Overall, the population perceived greater risk of HIV to themselves and others over the period. Respondents also increasingly considered those infected with HIV and/or other sexually transmitted diseases to deserve their infections and ultimate illnesses. While real, positive change in sexual behavior took place as a result of AIDS and HIV, the population's increasing lack of concern and compassion for the infected deserves attention.

Knowledge about HIV/AIDS amongst the New Zealand public: 1987-9.

Surveys of knowledge about AIDS were carried out in 1987 and again in 1989 amongst national samples of 1000 adult New Zealanders. During this period there was a general increase in knowledge about AIDS and a decrease in misconceptions about it. By 1989 97% of the sample knew that the virus could be transmitted through heterosexual activity and 99% knew the risks of needle sharing. Ninety-one percent knew there were no risks from touching and 80% no risks from sharing cutlery and crockery. The pattern of knowledge about AIDS was uneven throughout the population. Those with lower educational levels and those of Maori and Pacific Island descent were the least knowledgeable and the most desirous of more information. The major means of risk reduction, condom use and no needle sharing, were well known on both survey occasions. However, knowledge about limitation in partner numbers and avoidance of casual sex was less apparent in 1989 than 1987. Misconceptions about the dangers of blood donation and transfusion seem to have reduced. Only 4% now see blood donors as very much at risk down from 9% in 1987 and 32% see blood transfusion recipients as very much at risk down from 55% in 1987. Younger people appeared to know more about the transmission of the AIDS virus than did older people but they knew less about risk reduction methods.

Infection control procedures among New Zealand general practitioners: changes since the emergence of HIV infection.

A random sample of 1000 general practitioners in New Zealand were surveyed to assess their infection control procedures in the surgery, particularly since the emergence of the human immunodeficiency virus (HIV). Forty three per cent of the sample routinely used surgical gloves for minor surgical procedures, 8% used gloves for venepuncture, and 7% for blood glucose testing. Thirty two per cent reported a change in glove use since the emergence of HIV infection. Changes in sterilization procedures were also studied. Thirty eight per cent of the sample reported increased use of disposable equipment, and 38% reported changes in the sterilization solution used. Increased time spent by equipment in the sterilizer was reported by 33% of respondents and increased use of an autoclave by 18%. In general, women were more likely to have adopted infection control procedures than men. Infection control was also more common among those doctors having the greatest number of patients requesting HIV testing.

AIDS and general practice.

Using a postal questionnaire, a random sample of 1000 general practitioners throughout New Zealand were surveyed about their contacts with patients concerning AIDS or HIV infection and about their needs for information on AIDS related matters. A response rate of 86% was achieved. Almost all doctors (95%) had had some contact with patients concerning AIDS during the previous 12 months and 86% had had at least one request for the HIV antibody test. Taking blood samples for HIV testing was quite commonly performed by the doctor in the surgery, rather than referring the patient elsewhere. Referral to a specialist AIDS or STD clinic was rare. Continuing education was requested by most doctors. Specific information topics of interest included personal safety, patient care and ethical issues.