       Document 0287
 DOCN  M9630287
 TI    AIDS and injecting drug use in the United Kingdom, 1987-1993: the policy
       response and the prevention of the epidemic.
 DT    9603
 AU    Stimson GV; Department of Psychiatry, Charing Cross and Westminster
       Medical; School, University of London, England.
 SO    Soc Sci Med. 1995 Sep;41(5):699-716. Unique Identifier : AIDSLINE
       MED/96049315
 AB    This paper assesses policy development, service changes and trends in
       HIV infection and risk behavior among injecting drug users (IDUs) in the
       United Kingdom. In 1986, the U.K. was faced with the possible rapid
       spread of HIV infection among IDUs. The combination of an outbreak of
       HIV infection with prevalence levels of 50% or more in Edinburgh, the
       recent diffusion of drug injecting, and high levels of syringe-sharing
       risk behaviour, suggested that HIV infection might spread rapidly
       through IDU populations. HIV prevention activities commenced in 1986 and
       developed in 1987. The first report on AIDS and Drugs Misuse by the
       Advisory Council on the Misuse of Drugs in 1988 was a major catalyst for
       change. It supported and legitimized emergent views on new ways of
       working with drug users. Between 1988 and 1993 innovative public health
       projects increased the ability to target vulnerable populations through
       syringe distribution, expansion of methadone treatment and outreach to
       hard-to-reach populations. There were major changes in service
       philosophy and practices, as ideas of harm minimization, accessibility,
       flexibility and multiple and intermediate goals were developed. There is
       evidence that these public health projects encouraged extensive changes
       in the health behaviour of IDUs. There have been major reductions in
       syringe-sharing risk behaviour and sharing syringes is no longer the
       norm. Evaluation of specific interventions (e.g. syringe-exchange) shows
       their importance in encouraging reductions in risk behaviour. Levels of
       HIV infection in IDUs remain low by international standards. Outside of
       London rates of about 1% have been reported; London has a low and
       declining prevalence of infection to around 7% in 1993; previous high
       levels in Edinburgh (55%) have since declined to 20%. Britain has to
       date avoided the rapid increase in HIV infection among injectors that
       has occurred in many parts of the world. The same period saw the
       continuation of high prevalence levels in New York and many European
       cities, and the explosive spread of HIV in many countries in south-east
       Asia. This paper acknowledges the difficulties is proving links between
       social interventions and epidemic prevention. It argues that there is
       prima facie evidence for the success of public health prevention, that
       the collection of intervention approaches in the U.K. had a significant
       impact on IDUs behaviour, and that this has helped prevent an epidemic
       of HIV infection among IDUs. The U.K. experience adds to the growing
       evidence of the significance of early interventions in encouraging
       behaviour change and in limiting the spread of HIV infection.
 DE    Acquired Immunodeficiency Syndrome/EPIDEMIOLOGY/*PREVENTION &
       CONTROL/TRANSMISSION  Comparative Study  Cross-Cultural Comparison
       Cross-Sectional Studies  Disease Outbreaks/*PREVENTION & CONTROL  Great
       Britain/EPIDEMIOLOGY  Health Policy/*TRENDS  Human  Incidence  Needle
       Sharing/STATISTICS & NUMER DATA  Needle-Exchange Programs/TRENDS  Risk
       Factors  Substance Abuse, Intravenous/EPIDEMIOLOGY/*PREVENTION &
       CONTROL/  REHABILITATION  Support, Non-U.S. Gov't  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

