Jean-Paul C. Grund

Reaching the unreached : targeting hidden IDU populations with clean needles via known user groups

Needle exchange is a practical and important part of the Dutch prevention strategy to check the spread of HIV among injecting drug users (IDUs). However, needle-exchange programs are often tied to drug treatment programs that only reach a limited number of IDUs. To overcome this limitation, alternative designs are considered and initiated. This article describes a community-based approach to needle exchange that is built on empowerment of, and intense participation by, known IDUs to target unknown IDUs for delivery of clean needles. The needle-exchange patterns of the IDUs participating in this collective scheme are compared to those of other users who exchanged needles on an individual basis. It was found that this approach extended the reach of the program to a great degree and that it was well received in the IDU community. However, the results were negatively influenced by police activities aimed at closing down places where drugs were used and sold. It is concluded that engaging IDUs in peer-group-directed prevention efforts is both feasible and promising.

The HIV/AIDS Epidemic among Drug Injectors in Eastern Europe: Patterns, Trends and Determinants

Our objective is to describe recent patterns and trends in HIV and injecting drug use and to explore possible determinants of the epidemics in eastern Europe. The available data confirm a rapid spread of HIV among injecting drug users (IDUs) in the newly independent states (NIS) and suggest that all successor states of the former Soviet Union are now threatened by such epidemics, while central and southeast Europe have so far been spared from large-scale outbreaks and seem at lower risk. The future course of the epidemic in the NIS will largely depend on trends in drug injecting and on the success of harm reduction programs. Furthermore, there is potential for the further spread of HIV, via heterosexual intercourse, into the general population.

Needle and Syringe Exchange in Poland and the Former Soviet Union: A New Approach to Community-Impact Studies

This article describes a new approach to assessing the impact of needle- and syringe-exchange programs (NSEPs), designed for application in Eastern Europe and the former Soviet Union. In these parts of the world, use of a homemade opiate preparation made from poppy plants is common. The advance of AIDS has been associated with increasing use of this drug. However, NSEP might be less effective in that setting than in the West: with a liquid drug, virus transmission may take place through sharing or selling of the drug itself, even when each user has his or her own works and never shares them with others. NSEPs can be difficult to evaluate, however, particularly where users are stigmatized. Here, we propose methods to assess the community impact of NSEPs by evaluating syringes, not users. These methods involve labeling, tracking, and enumeration of syringes as well as testing of syringes for parenterally transmissible virus (e.g., human immunodeficiency virus). They allow for estimation of the total number of syringes in circulation, the average time each syringe spends circulating among users, and the rate of virus exposure among users. Examples are given of the implementation of these methods in Poland, with assessments of the community impact of local NSEPs there.