Reducing HIV/AIDS high-risk behavior among injection drug users: peers vs. education.

This study examines the effects of peer groups and education on risk behavior for HIV among injection drug users (IDUs). The sample consisted of 682 participants in the Eastern Connecticut Health Outreach project, which compares traditional and peer-driven outreach interventions for IDUs. Participants are educated about safer injecting, subsequently administered a risk-reduction knowledge test, and given an extensive interview. Logistic regression shows that education alone is not a significant factor in reducing risky behavior in IDUs among the behaviors studied. A significant interaction was found between peer support for safer use and personal saliency of peer attitudes for both syringe and water sharing. Neither peer attitudes nor education affected cooker sharing. These results suggest that while education may be an important component in any intervention, it is not alone sufficient to reduce risky behavior. Our findings suggest that peer-directed interventions may be useful in reducing some forms of risk behavior among IDUs.

The impact of a needle exchange's closure.

OBJECTIVE: The Windham, Connecticut, needle exchange closed in May 1997 after becoming embroiled in a public controversy in which it was blamed for the city's drug problem, discarded syringes, and even the economic decline of the city itself. The authors interviewed injection drug users and conducted a community survey of discarded drug paraphernalia to explore the effects of the needle exchange's closure. METHODS: After the needle exchange was closed in March 1997, the authors re-recruited former participants in an AIDS prevention research project, the majority of whom were clients of the needle exchange. The authors analyzed responses from these respondents' pre-closure interviews and from III post-closure initial interviews and 78 post-closure follow-up interviews as well as data on discarded syringes and "dope bags". RESULTS: Following the closure of the needle exchange, significant increases were found in the percentage of respondents who reported an unreliable source as their primary source of syringes, in respondents' reports of the frequency of reusing syringes, and in the percentage of respondents who reported sharing of syringes. Surveys of outdoor drug-use areas found that the closure of the needle exchange did not reduce the volume of discarded syringes and other drug-injection debris. CONCLUSIONS: The problems in Windham that led to the closure of the exchange still remain, and the city's drug injectors are engaging in higher levels of HIV risk behavior.