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Drug injecting, AIDS, and risk behaviour: potential for change and intervention strategies.

Summary 
 
The sharing of unsterile needles and syringes is a primary means by which drug users who inject put themselves at risk of HIV infection. This paper examines a sample of 127 regular illicit drug users (both in and out of treatment) in terms of injecting and needle sharing patterns, and investigates the impact of concern about AIDS upon these behaviours. Amongst those that had ever injected, it was found that 54% had substantially reduced their risk behaviour, in that they either no longer injected, or else no longer shared injecting equipment. A further 32% had to some extent reduced their risk behaviour, and only 14% staled that they had been unaffected by concern about AIDS. Those who were in contact with agencies were more likely to have substantially reduced their risk behaviour than those not in contact with agencies. Regarding the impact of HIV testing, the data suggest that it may be associated with reduced rather than increased risk behaviours, though the differences only approach significance. In two consecutive time periods, similar proportions reported that they were still sharing; but by the second time period almost all reported some attempt at change. In general, the results confirm other studies, from the USA and Britain, that have shown that drug users are not inherently irrational, and are capable of modifying their risk behaviour. Availability of clean injecting equipment was given as the prime reason for sharing, and the free supply of needles and syringes is advocated as a complement to effective health education. Aggressive outreach work is to be encouraged so as to reach those individuals unlikely to use established schemes.