The characteristics of 'new users' of cocaine and heroin unknown to treatment agencies: results from the Swiss Hidden Population Study.

AIMS: To examine the characteristics of 'new users' (i.e. first use not more than 5 years before interview) of heroin or cocaine currently unknown to treatment agencies in Switzerland, compared to 'new users' who are in treatment, as well as to 'experienced users' (i.e. first use more than 5 years before interview). METHOD: A sample of 917 users of heroin and/or cocaine users were recruited outside treatment settings by 31 privileged access interviewers and interviewed face to face using a standardized questionnaire. The study group was composed of 95 'new users' of heroin and/or cocaine who had never been in treatment. It was compared to four control groups: control group 1 (n = 48) consisting of 'new users' known to treatment agencies; control group 2 (n = 443) of 'experienced users' who reported having never had any contact with treatment agencies; control group 3 (n = 53) of 'experienced users' with some history of treatment but not in contact at the time of interview; and control group 4 (n = 166) of 'experienced users' in contact with treatment agencies. FINDINGS: Compared with 'new' and 'experienced' users in treatment (control groups 1 and 4), 'new users' unknown to treatment agencies have a less problematic profile of drug use: they inject less, use drugs less frequently, more often report the impression of controlling their drug use, have fewer health problems and fewer social difficulties. However, compared to experienced users not in contact with treatment agencies (control groups 2 and 3), the profile of drug use in the study group is more problematic. Injection-related HIV-risk behaviour is lower in the study group than in all the control groups. The analysis showed no influence of duration of drug use, gender or education over getting in touch with treatment agencies in the first five years of drug use. CONCLUSIONS: Some of the 'new users' unknown to treatment agencies can be considered as being in need of assistance. Efforts to enhance the treatment on offer should be continued. Drug users should be provided with better knowledge of how to identify signs for problem drug use and need for assistance.

Characteristics of heroin and cocaine users unknown to treatment agencies. Results from the Swiss Hidden Population Study.

The aim of this study was to compare the characteristics of heroin or cocaine users who are not in contact with drug-treatment agencies in Switzerland to the characteristics of a group who are in treatment. A sample of 917 users of heroin and/or cocaine was recruited outside treatment settings by 31 Privileged Access Interviewers. Respondents were divided into a study group of 512 heroin and/or cocaine users not following any treatment, and a control group of 238 users who were following treatment. Respondents in the no-treatment group use drugs less frequently, are less likely to inject drugs, have a more social pattern of use and more often have the impression of controlling their drug use. They have less contact with the legal system and the police, are in a better social situation and more often perceive themselves to be in good health. In both groups, respondents whose main drug of use is heroin generally have a more problematic pattern of use than those who use mainly cocaine. There are no significant differences between the two groups regarding present HIV-risk behaviour and prevention. The data show no significant association between the duration of use of heroin or cocaine and signs for problem use. These findings support the hypothesis that drug users not in treatment and drug users in treatment are two distinct populations, in terms of profile of drug use and prevalence of social or health problems that are associated to it.

Differences in sexual risk behaviour between young men and women travelling abroad from the UK.

BACKGROUND: Identification of people who most frequently engage in sexual risk behaviour while travelling abroad would be useful for the design and targeting of health education and promotion campaigns. METHODS: Eligible participants were people living in the UK aged 18-34 years who had travelled abroad without a partner in the previous 2 years. Respondents were first screened for eligibility as part of representative face-to-face and telephone surveys by a market research company. Eligible individuals who agreed to take part then underwent a computer-assisted telephone interview. Reinterviewing continued until 400 eligible people had been contacted. We also interviewed a control group of 568 young people who had travelled abroad without a partner in the previous 2 years but who did not report a new sexual relationship during their travels. FINDINGS: One in ten of the eligible participants reported sexual intercourse with a new partner. Travellers who reported a new sexual relationship abroad were also likely to report large numbers of sexual partners at home. Of the 400 people who had a new sexual partner abroad, 300 (75%) used condoms on all occasions with the new partner. Logistic regression modelling showed differences between men and women in those factors linked to the practice of unsafe or safer sex while travelling. For men, patterns of condom use abroad with casual partners (p<.0001) reflected patterns of use at home (p<0.001), whereas for women, patterns of condom use varied according to their partners' backgrounds (p<.0001). INTERPRETATION: Condoms are widely used among young travellers, but patterns of use vary by sex. Campaigns about sexual health targeted at international travellers should continue, not least because young people who meet new sexual partners abroad may be a convenient proxy group for that minority of the population who report most sexual partners at home. Such campaigns should be designed differently for men and women.

[STT arthrodesis as therapy of lunate necrosis in an advanced stage]. / Die STT-Arthrodese als Therapie der Lunatumnekrose im fortgeschrittenen Stadium.

The results of STT-fusion for treatment of advanced Kienböck's disease were investigated in a retrospective study. The follow-up included 25 of 28 patients, the average follow-up time was 39 months. Pain relief, range of motion, grip strength and X-ray findings were the most important criteria for rating the results. On the one hand, there was a decrease of range of motion, but on the other hand, grip strength improved markedly. Of course, one part of the decrease of pain is caused by the performed partial denervation of the wrist. However, the decrease of pain was impressive.

The Swiss Hidden Population Study: practical and methodological aspects of data collection by privileged access interviewers.

In order to recruit heroin and/or cocaine users outside treatment settings, recruitment of subjects through Privileged Access Interviewers (PAI) was tested and implemented in the Swiss Hidden Population Study. This article discusses practical aspects of the PAI method as well as issues of reliability and validity. From June 1994 to June 1995, 31 Privileged Access Interviewers were recruited in the main regions of Switzerland. They conducted 943 standardized interviews altogether, of which 917 could be considered valid. Fifty-four per cent of the respondents correspond to the criteria of the target population. The PAI method collects reliable data in a relatively short amount of time, given adequate means of control. Analysis of the age distribution and of the patterns of drug use in our sample shows that the question of validity is mainly linked to the diversity of the milieus from which PAIs recruit the respondents. Encouraging PAIs to do as many interviews as possible did not skew the data. Hence, well-founded inferences on a PAI generated database relies on the analysis of qualitative information on the ways in which the Privileged Access Interviewers have recruited their respondents.

[Exchange of syringes or apprenticeship? The buses of Bienne and Geneva]. / Echange de seringues ou apprentissage? Les bus de Bienne et Genève.

In Switzerland, the health ministry (Office Fédéral de la Santé Publique) has systematically encouraged the evaluation of low threshold services. In this article, we discuss the evaluation of two of these: the buses for syringes exchange in Geneva and Bienne, the implementation of these two services, the success obtained and the contacts established. Even if the design of such an evaluation was relatively complicated, with one monitoring and two specific surveys, the principal aim of this article is not to measure the efficacy as such but to show how an learning process has occurred between the actors: government, administration, police, service's team, drug's users and neighbourhood's inhabitants. The efficacy for a long period of time and the implementation's success are largely linked to such learning processes.

[Drug users outside medical treatment: methodological and practical aspects]. / Consommateurs de drogues hors traitement médical: Aspects méthodologiques et pratiques.

A legal context that classifies the consumption of heroin and cocaine as an illegal act, poses a considerable methodological challenge to research on users of these substances. This is in particular the case for research on those users who are not in treatment and, therefore, cannot be recruited through treatment settings. In a research project on heroin and/or cocaine users outside treatment settings, a sample of 917 individuals was recruited through "Privileged Access Interviewers" in the whole of Switzerland. In the first part of this article, we discuss matters of reliability as well as of validity concerning this method of data collection. In the second part of the article, we discuss the use of low threshold syringe exchange schemes by the user groups represented in the sample. Only intravenous drug users frequent those services - they are however a minority in the sample (n = 238). In several regions of Switzerland syringe exchange schemes do not exist. Where they do exist, they appear to correspond to a need which they are able to cover largely. In the regions without such services, intravenous drug users get their supply of syringes more frequently from pharmacies. However, pharmacies do not compensate the absence of specific syringe exchange schemes. In regions without such schemes, injections with used syringes are more frequent. Thus, regarding Aids-Prevention, there is an urgent need to develop syringe exchange schemes in all parts of the country.

Does a condom-promoting strategy (the Swiss STOP-AIDS campaign) modify sexual behavior among adolescents?

OBJECTIVE: To measure sexual behavior changes (especially the use of condoms) among adolescents after 5 years of a population-based acquired immunodeficiency syndrome prevention strategy at the national and regional level. DESIGN: Two comparative cross-sectional surveys by self-administered questionnaires were conducted in 1987 and 1990. SETTING: Two similar samples of 16- to 19-year-old apprentices. The two samples, 1987 (n = 1359) and 1990 (n = 817), are comparable in terms of sex, age, profession, and location. RESULTS: The percentage of boys who say they are sexually active has remained the same (75%) and has slightly increased among younger girls (65% to 75%, NS). The average number of partners has remained steady for boys and girls. Regular use of any contraceptive device has remained steady among girls (75%) and increased among boys (1987, 38%; 1990, 54%; P < .001). In 1987 as well as in 1990, the condom was the most widely used method (> 90%), followed by the pill (50%), withdrawal (20%), and chemicals (5%). Rates were about the same for both sexes. Rates of irregular use of condoms increased among boys and girls (P < .01); regular use of condoms increased among boys (22% to 34%, P < .01) and girls (10% to 27%, P < .001); use of the pill has slightly decreased. CONCLUSIONS: During a 5-year period, the Swiss "STOP-AIDS" campaign and local interventions had had no real effect on the rate of sexual activity of apprentices but had had a positive effect on the use of contraception and condoms. The prevention strategy should (and will) be maintained in the future.

Assessing HIV prevention among injecting drug users in European Community countries: a review.

By September 30th 1991, 19,579 cases of AIDS among injecting drug users had been reported in Europe. HIV seroprevalence rates among drug injectors vary from less than 5% in some cities, to over 50% in others. Since the estimated number of drug injectors in Europe is between 750,000 and 1,000,000, HIV is a considerable threat to drug injectors, their sex partners and their off-spring, affecting large numbers of citizens in the European region. This paper gives an overview of the magnitude of the drugs/AIDS problem in the European region, and the concrete measures that have been taken to prevent HIV infection among drug users. Data from the evaluation of methadone programmes, needle and syringe exchange schemes and data on sexual behaviour change of drug users are critically reviewed. Limitations of the methods used for the evaluation of prevention activities are also discussed. Based on all the material reviewed, the main conclusions are the following: AIDS is a greater threat to public health than problem drug use, more accurate and reliable evaluation methods need to be utilized at European Community level, a combination of prevention measures should be used in order to reduce the further spread of HIV infection among injecting drug users.

Evaluation of AIDS prevention among homosexual and bisexual men in Switzerland.

Attitudinal and behavioural change among gay men in Switzerland was measured between 1987 and 1990 to evaluate the effectiveness of AIDS prevention activities. The methodology used included a self-administered questionnaire published in Swiss gay magazines and distributed by gay organizations (N = 795 in 1987, N = 720 in 1990) and in-depth interviews with men recruited through advertisements and through the questionnaire (N = 42 in 1987, N = 24 in 1990). The two independent sampling procedures yielded similar samples with regard to socio-demographic characteristics, allowing comparisons to be made between the 1987 and 1990 data. Personal confrontation with AIDS (knowing someone who is HIV-positive, or who is ill or dead from AIDS) increased significantly during the period but more adequate ways of coping developed. Behavioural change towards safer sex began well before the first study. The majority of responding homosexuals have adapted their sexual behaviour to the new situation created by AIDS and generally maintain a protective behaviour. However, "exceptions" (condom rupture or episodes of non-protection) are not infrequent and should deserve more attention. Three indicators of sexual behaviour (number of sexual partners, anal sex and use of condom and oral sex with ejaculation), reported for the last 3 months before each study, exhibit few changes between 1987 and 1990: number of partners remained stable, unprotected oral sex decreased. Anal sex slightly increased, the use of condoms remaining stable. Sixty-seven percent of the sample knew their serostatus in 1990 (57% in 1987), and 13% of these stated that they were HIV+ (14% in 1987).

[The AIDS problem in Burundi and its prevention among young people]. / Le problème du SIDA au Burundi et la prévention auprès des jeunes.

PIP: Since 1986, in Burundi, the operational budget for control of sexually transmitted diseases and AIDS is almost all financed by foreign aid. Effectuated expenses correspond to about 50% in 1989 and about 60% in 1990, indicating administrative delays and inadequate human resources to distribute the allocated budget. In 1992, the number of new cases of AIDS was 4000 for adults and 1500 for children. Estimated numbers for 1997 are 9000 and 3700, respectively. The estimated 1992 HIV prevalence rate was 15% for urban and semi-urban areas and 1-2% for rural areas. There are likely more HIV/AIDS cases than are reported. HIV prevalence is much higher in women than in men. Some uneducated youth think that condoms contain HIV so they do not consider condoms to be effective. Most students think primary schools must convey abstinence as the HIV prevention message. In Bujumbura, most parents would favor condom distribution to youth and to their own children. The number of condoms on the market and interventions targeted to adolescents have been rather limited. The national AIDS control program funded by UNICEF promotes sexual responsibility through health education campaigns and improving access to condoms. Approaches to reach the uneducated youth include mobilization and training of promoters. So far, no data on implementation of this project or on use of its education materials have been available. Messages spread by the Office of Rural Education and the Office of Studies and Programs of Secondary Education were confusing because one emphasized abstinence and the other condom use. The two partners must agree on the messages. The government of Burundi must become greatly involved in and reaffirm their commitment to the fight against AIDS. This will yield massive mobilization of the population to reduce HIV transmission and combat the epidemic.^ieng

[Patient compliance in ambulatory medical care]. / Compliance des patients en milieu médical ambulatoire.

During February and March 1987, 313 private practitioners and 35 outpatients clinics in the cantons of Vaud et Fribourg participated in the study "Ambulatory medical practice". A representative sample of more than 17,800 records was collected and analysed from the 110,000 weekly consultations. In this paper we discuss the patient flow in ambulatory medical care. Overall, patient flows appear to be influenced more by practitioner and patient characteristics than by contextual factors such as medical density. In private practice the proportion of patients who are appointed and indeed attend the consultation is 50%; in outpatient clinics only 30%. The patient's compliance (probability of keeping an appointment) depends on one hand of the physicians' specialty and, on the other hand, it decreases when the appointment rate increases.

[Prevention in general practice--results of a study of ambulatory health care in the Waadt and Freiburg cantons]. / Prävention in der Arzt-praxis--Resultate einer Untersuchung über die ambulante Gesundheitsversorgung in den Kantonen Waadt und Freiburg.

Data on medical consultations were collected from a representative sample of self-employed physicians showing that prevention activities comprised only a small proportion of ambulatory medical care. Preventive acts are more frequent among pediatricians and gynecologists, however. The current health system favours therapeutic aspects of medicine over preventive aspects: Lack of adequate training of physicians and modes of payment for medical acts tend to discourage prevention by doctors.

[The attitude of hospital personnel to AIDS]. / Les attitudes du personnel hospitalier face au sida.

Caregivers of 13 hospital services in Switzerland--confronted at various degrees with the aids problem--have been interviewed. The study indicates that hospital caregivers still strongly fear an HIV infection through professional contacts. At the same time they have difficulties to balance correctly risks at work against risks in their private lives. The attitudes of caregivers might negatively influence patient care. They could, however, be modified by a better management of aids related information in hospitals.

Ambulatory medical care for the elderly in Switzerland.

Data from a study on ambulatory medical care in two Swiss cantons are used to describe the characteristics of consultations delivered to patients 65 years old and over. The differences with younger patients are presented. The elderly generally suffer from different diseases, and their problems are often chronic. Primary care concerns three-quarters of visits. Medical problems are very frequent and important among this population. It is important to know their specific needs in order to adapt medical practice to them and to be aware of the complexity of the aging process in industrialized societies.

[Patients in ambulatory care]. / La population consultante en milieu ambulatoire.

A study on ambulatory medical care has been conducted in the cantons of Vaud and Fribourg in february-march 1987. The characteristics of patients visiting a private doctor and those of outpatients in hospitals are described. At private offices women older than 15 years consult more often than men; children (0-4 years) and elderly are the groups of population who consult most. In ambulatory services of hospitals, men are more present than women; children aged 0 to 4 years and adults aged 15 to 39 years use most these services. Use of ambulatory care varies with regions and days of the week. In urban regions, people have more medical visits. On Thursdays and weekends, there are less consultations but they are more often urgent.

[Sexuality of adolescents in the time of AIDS. Results of a survey of 1398 students in Vaud]. / La sexualité des adolescents à l'heure du SIDA. Résultats d'une enquête auprès de 1398 apprentis vaudois.

PIP: During March and April 1987, students at the Professional School of the Society of Industry and Commerce in Lausanne were invited to view an animated exhibit on prevention of sexually transmitted diseases and AIDS. 3 months later, a self-administered 12-item multiple choice questionnaire was distributed to a representative sample of students at the school and to students at a similar vocational school not exposed to the preventive intervention. This work presents a descriptive analysis of the knowledge of sexually transmitted diseases, attitudes toward condom use, and sexual behavior of a sample of 1398 students aged 16-19 at the 2 schools. 1009 male and 350 female students returned usable questionnaires. The preponderance of males was explained by the type of mainly manual professional training offered at the schools. 2/3 of the students lived in Lausanne or other urban areas. 10% were found to be well informed, 70% relatively well informed, and 20% poorly informed about AIDS and other sexually transmitted diseases. 75-98% responded correctly to a list of questions about transmission modes of HIV infection, a higher proportion than found in American studies of comparable cohorts. 94% of males and 76% of females had handled condoms and 58% of males and 17% of females had bought them, but only 23% of males and 10% of females used them regularly. 76% of males and 66% of females were sexually active; by age 19, over 90% of both sexes were sexually active. 20% of males and 40% of females had 1 partner. 40% of the sample had 2-4 partners, and 40% of males and 20% of females had 5 or more partners. 45% of males and 63% of females had used contraception since their 1st sexual relation, but 20% of males and 13% of females had never used contraception. There was no significant difference in attitude toward condoms or in condom use between respondents with different numbers of partners. The data indicate that these students are well informed on the whole about the transmission of AIDS and other sexually transmitted diseases, but that they have difficulty in putting their knowledge into practice. The figures should be interpreted cautiously and limitations in the representativeness of the sample and in the survey methodology should be kept in mind. Individual counseling by physicians treating adolescents and preventive actions in schools and elsewhere should be intensified to help adolescents modify their behavior and make it more congruent with their level of knowledge.^ieng