Abstract
BACKGROUND. Needle sharing has been reported to be the main cause of the rapid spread of the human immunodeficiency virus (HIV) among injecting drug users. Risk behaviors such as needle sharing are, however, the end result of complicated interaction patterns in drug user networks, which have their specific rules and rituals, and larger social structures and official drug policy. METHODS. To study these interaction patterns we examined the drug administration rituals of heroin addicts in Rotterdam, The Netherlands. Intensive ethnographic descriptions were collected by participant observation. RESULTS. In less than 10% of the observed self-injections unsafe syringes were used. In 68% of the self-injections new, sterile syringes were used. Needle sharing as a planned sequence was not observed. Sharing was determined primarily by the availability of syringes, experience with the injecting ritual, and drug craving. In all observed needle-sharing events, subjects were aware of the risks involved and undertook efforts to clean the injection equipment. CONCLUSIONS. In contrast to psychological approaches aimed at reducing individual "risk behavior," these findings suggest that HIV prevention can be made more effective if active drug injectors are organized to help themselves and their peers prevent high-risk exchange situations.
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Selected References
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- Brettle R. P. Epidemic of AIDS related virus infection among intravenous drug abusers. Br Med J (Clin Res Ed) 1986 Jun 21;292(6536):1671–1671. doi: 10.1136/bmj.292.6536.1671-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Buning E. C., Coutinho R. A., van Brussel G. H., van Santen G. W., van Zadelhoff A. W. Preventing AIDS in drug addicts in Amsterdam. Lancet. 1986 Jun 21;1(8495):1435–1435. doi: 10.1016/s0140-6736(86)91570-9. [DOI] [PubMed] [Google Scholar]
- Chaisson R. E., Moss A. R., Onishi R., Osmond D., Carlson J. R. Human immunodeficiency virus infection in heterosexual intravenous drug users in San Francisco. Am J Public Health. 1987 Feb;77(2):169–172. doi: 10.2105/ajph.77.2.169. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chitwood D. D., McCoy C. B., Inciardi J. A., McBride D. C., Comerford M., Trapido E., McCoy H. V., Page J. B., Griffin J., Fletcher M. A. HIV seropositivity of needles from shooting galleries in south Florida. Am J Public Health. 1990 Feb;80(2):150–152. doi: 10.2105/ajph.80.2.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Engelsman E. L. Dutch policy on the management of drug-related problems. Br J Addict. 1989 Feb;84(2):211–218. doi: 10.1111/j.1360-0443.1989.tb00571.x. [DOI] [PubMed] [Google Scholar]
- Goldstein A., Kalant H. Drug policy: striking the right balance. Science. 1990 Sep 28;249(4976):1513–1521. doi: 10.1126/science.2218493. [DOI] [PubMed] [Google Scholar]
- Grund J. P., Adriaans N. F., Kaplan C. D. Changing cocaine smoking rituals in the Dutch heroin addict population. Br J Addict. 1991 Apr;86(4):439–448. doi: 10.1111/j.1360-0443.1991.tb03421.x. [DOI] [PubMed] [Google Scholar]
- Grund J. P., Kaplan C. D., Adriaans N. F., Blanken P. Drug sharing and HIV transmission risks: the practice of frontloading in the Dutch injecting drug user population. J Psychoactive Drugs. 1991 Jan-Mar;23(1):1–10. doi: 10.1080/02791072.1991.10472569. [DOI] [PubMed] [Google Scholar]
- O'Donnell J. A., Jones J. P. Diffusion of the intravenous technique among narcotic addicts in the United States. J Health Soc Behav. 1968 Jun;9(2):120–130. [PubMed] [Google Scholar]
- van den Hoek J. A., van Haastrecht H. J., Coutinho R. A. Risk reduction among intravenous drug users in Amsterdam under the influence of AIDS. Am J Public Health. 1989 Oct;79(10):1355–1357. doi: 10.2105/ajph.79.10.1355. [DOI] [PMC free article] [PubMed] [Google Scholar]