Needle Exchange and Drug Treatment More Effective HIV Prevention
By Yale School of Medicine
Dec 18, 2006, 07:00
(HealthNewsDigest.com).. New Haven, Conn.- For injection drug users, the
most productive and cost-effective approach to managing the spread of HIV is
expanding syringe exchange and drug treatment, as well as promoting
antiretroviral treatment for those already infected with HIV, according to a
new study by researchers at Yale School of Medicine.
Published in the January issue of American Journal of Public Health, the
authors, led by Yale Public Health professor Robert Heimer, found that the
Centers for Disease Control and Prevention's (CDC) new approach of promoting
HIV testing, "Advancing HIV Prevention," may not be best for injection drug
users.
Heimer, professor in the Department of Epidemiology and Public Health at
Yale School of Medicine, said the CDC policy is based on the presumption
that the HIV epidemic can be curtailed in great part by promoting HIV
testing and that more resources should go to expanded testing of high-risk
populations. However, the results reported in this study revealed that
testing was already widespread for urban injectors.
Heimer and co-authors analyzed interviews conducted with 1,543 injection
drug users in five cities, including New Haven and Hartford, CT,
Springfield, MA, Chicago, IL, and Oakland, CA. Access to sterile syringes
through syringe exchanges or at pharmacies with a prescription was not
available in all cities. Injection drug users who participated in the study
were asked if they had been tested for HIV and if they had ever been told
they were HIV positive. From this, the research team estimated what
percentage had never been tested and what percentage did not know their
status.
Ninety-three percent of injectors had been tested, and of those currently in
need of testing, 90 percent were tested in the past three years and 70
percent within the past year. Less than three percent were infected with HIV
without their knowledge. Women and syringe-exchange participants were more
likely to have been tested at least once, and in the recent past. The team
estimated the number of undetected infections among urban injection drug
users in the United States to be fewer than 40,000.
"Our results highlight the need for shifting prevention dollars for urban
injection drug users," said Heimer, who is also an associate professor of
pharmacology at Yale. "It is more important to expend scant resources on
effective primary and secondary preventive programs including access to
clean syringes and helping users get into treatment for their addiction."
Heimer emphasized needle exchange programs, substitution therapy like
methadone and buprenorphine, and engaging those injection drug users already
infected with HIV in supportive anti-retroviral therapy. He said these
approaches have been shown to decrease the incidence of new infections at
rates sufficient to save money.
"When it comes to urban injection drug users, money will be wasted on
low-impact, low-yield counseling and testing programs," said Heimer.
"Prevention programs should not be compelled to generalize and accept a
single approach to preventing disease transmission. Injection drug users
should not be lumped in with other high risk groups. Instead, tailored
programs designed with their unique needs in mind will yield better
outcomes."
Since the study was conducted, Heimer and his colleagues have been working
to immunize injection drug users against hepatitis B, as well as developing
other interventions designed to reduce HIV infections in drug using
populations.
Other authors on the study were Lauretta Grau, Erin Curtin, Kaveh Khoshnood
and Merrill Singer.
Citation: American Journal of Public Health, Vol. 97, No. 1 (January 2007)
Showing posts with label public health. Show all posts
Showing posts with label public health. Show all posts
Tuesday, December 19, 2006
Drugs: why we should medicalise, not criminalise
The TimesOnline
December 14, 2006
Mary Ann Sieghart
If you are a desperate drug addict and you are neither a trust fund babe nor a doctor with a prescription pad, you really have only three ways to pay for your habit: you steal, you deal or you sell your body. For those poor young women who have too many scruples to steal or deal, prostitution is often the only answer. Some 95 per cent of prostitutes, according to a Home Office study, are what they call “problematic drug users”.
And now five prostitutes in Suffolk have been murdered and the rest fear for their lives. One of the victims, Gemma Adams, an intelligent, piano-playing, pony-riding, middle-class girl, had turned to prostitution, like many other such women, after becoming addicted to heroin and crack. This week her parents issued photos of her in happier days, to help people understand that she was a person, not just a prostitute.
Yet even the law degrades prostitutes, valuing their lives at less than that of a middle-class, piano-playing girl. When Dianne Parry’s daughter, Hanane (another heroin addict turned prostitute), was murdered and dismembered in 2003, the Criminal Injuries Compensation Authority offered Mrs Parry only half the money that a parent of a non-prostitute would receive. It wasn’t the £5,000 that Mrs Parry cared about, but the devaluing of her daughter’s life.
And it is not just the law on compensation that should be changed. It is the law on drugs themselves. Drug addiction is a medical condition; it should not be treated as a criminal offence. The crime that results from drug addiction is a direct result of the drugs’ illegality. The organised criminal gangs, with their violence, corruption and money laundering; the street gangs, with their gun crime, stabbings and intimidation; the muggers, burglars, car thieves and shoplifters, who steal to fund their habit; the dealers who try to create new addicts; and finally, the prostitutes who put their health and lives at risk; all this crime and suffering could be wiped out if the drugs were available, free, on prescription. Some 50 to 80 per cent of prisoners are in jail for crimes related to raising money to buy drugs. Nearly half of women prisoners are there specifically for drug offences and nearly three-quarters have had a drug problem. The cost to the criminal justice system is huge. The cost to the individuals, their families and wider society is greater still.
In European cities, where heroin is available on prescription, property crimes by drug-users have dropped by as much as a half. And think of the effect that widespread prescribing would have on turf wars, gang violence, gun crime, street dealing and prostitution. An excellent report from the Transform drug policy foundation* also points out: “The largest single profit opportunity for organised crime would evaporate, and with it the largest single source of police corruption.”
Transform estimates that the prison population would fall by between a third and a half, ending overcrowding and the need to build more jails. Billions of pounds spent enforcing prohibition and coping with its consequences would be saved. Hundreds of thousands could be treated as patients rather than criminals. The number of drug-related deaths would fall dramatically. And desperate young women could be rescued from pimps, potential rapists and murderers.
At the same time, unstable countries such as Afghanistan and Colombia, which have become almost ungovernable thanks to the distorting and corrupting effects of the drugs trade, could sell their products legally to Western governments for medical use.
Of course we should try to get drug addicts off their drugs. It is good that waiting times are now shorter for rehabilitation. But treatment doesn’t work unless users really, really want to give up. And even then, they often relapse because the cravings are so strong. So it is not surprising that enforced treatment and rehabilitation is so unsuccessful. A National Audit Office report on the Government’s Drug Treatment and Testing Order, a court-administered mandatory programme for addicts, found that 80 per cent of offenders were reconvicted within two years.
It is much more sensible to prescribe a maintenance dose for addicts, which they must take under supervision so they cannot sell it on, until they are ready to try to give up. That way, they can attempt to lead a normal life, to refrain from crime, to stay off the streets, even to hold down a job, until they can wean themselves off the drugs.
read the rest...
The TimesOnline
December 14, 2006
Mary Ann Sieghart
If you are a desperate drug addict and you are neither a trust fund babe nor a doctor with a prescription pad, you really have only three ways to pay for your habit: you steal, you deal or you sell your body. For those poor young women who have too many scruples to steal or deal, prostitution is often the only answer. Some 95 per cent of prostitutes, according to a Home Office study, are what they call “problematic drug users”.
And now five prostitutes in Suffolk have been murdered and the rest fear for their lives. One of the victims, Gemma Adams, an intelligent, piano-playing, pony-riding, middle-class girl, had turned to prostitution, like many other such women, after becoming addicted to heroin and crack. This week her parents issued photos of her in happier days, to help people understand that she was a person, not just a prostitute.
Yet even the law degrades prostitutes, valuing their lives at less than that of a middle-class, piano-playing girl. When Dianne Parry’s daughter, Hanane (another heroin addict turned prostitute), was murdered and dismembered in 2003, the Criminal Injuries Compensation Authority offered Mrs Parry only half the money that a parent of a non-prostitute would receive. It wasn’t the £5,000 that Mrs Parry cared about, but the devaluing of her daughter’s life.
And it is not just the law on compensation that should be changed. It is the law on drugs themselves. Drug addiction is a medical condition; it should not be treated as a criminal offence. The crime that results from drug addiction is a direct result of the drugs’ illegality. The organised criminal gangs, with their violence, corruption and money laundering; the street gangs, with their gun crime, stabbings and intimidation; the muggers, burglars, car thieves and shoplifters, who steal to fund their habit; the dealers who try to create new addicts; and finally, the prostitutes who put their health and lives at risk; all this crime and suffering could be wiped out if the drugs were available, free, on prescription. Some 50 to 80 per cent of prisoners are in jail for crimes related to raising money to buy drugs. Nearly half of women prisoners are there specifically for drug offences and nearly three-quarters have had a drug problem. The cost to the criminal justice system is huge. The cost to the individuals, their families and wider society is greater still.
In European cities, where heroin is available on prescription, property crimes by drug-users have dropped by as much as a half. And think of the effect that widespread prescribing would have on turf wars, gang violence, gun crime, street dealing and prostitution. An excellent report from the Transform drug policy foundation* also points out: “The largest single profit opportunity for organised crime would evaporate, and with it the largest single source of police corruption.”
Transform estimates that the prison population would fall by between a third and a half, ending overcrowding and the need to build more jails. Billions of pounds spent enforcing prohibition and coping with its consequences would be saved. Hundreds of thousands could be treated as patients rather than criminals. The number of drug-related deaths would fall dramatically. And desperate young women could be rescued from pimps, potential rapists and murderers.
At the same time, unstable countries such as Afghanistan and Colombia, which have become almost ungovernable thanks to the distorting and corrupting effects of the drugs trade, could sell their products legally to Western governments for medical use.
Of course we should try to get drug addicts off their drugs. It is good that waiting times are now shorter for rehabilitation. But treatment doesn’t work unless users really, really want to give up. And even then, they often relapse because the cravings are so strong. So it is not surprising that enforced treatment and rehabilitation is so unsuccessful. A National Audit Office report on the Government’s Drug Treatment and Testing Order, a court-administered mandatory programme for addicts, found that 80 per cent of offenders were reconvicted within two years.
It is much more sensible to prescribe a maintenance dose for addicts, which they must take under supervision so they cannot sell it on, until they are ready to try to give up. That way, they can attempt to lead a normal life, to refrain from crime, to stay off the streets, even to hold down a job, until they can wean themselves off the drugs.
read the rest...
Monday, December 18, 2006
Huntsman makes tackling meth epidemic a top priority
Deseret Morning News, Friday, December 15, 2006
By Dennis Romboy
Gov. Jon Huntsman Jr. and his wife have made friends with the people in their neighborhood, including some hooked on methamphetamine.
A residential treatment center called House of Hope is a couple of doors down from the Governor's Mansion on South Temple. Their neighbors are moms who are trying to fight meth addiction, said Mike Mower, the governor's spokesman.
The Huntsmans visited women in the house and Mary Kaye Huntsman had them over for a tea party.
"The governor realizes the insidious nature of meth use and its disproportionate use among young women, often young mothers," Mower said.
To turn that tide, Huntsman's proposed state budget includes $5.1 million a year (half from Medicaid) to place 600 more women in treatment programs, giving priority to those involved with the Utah Division of Child and Family Services.
read the rest...
read the rest...
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