1 The Epidemiology of HIV and AIDS

The picture we can draw of the HIV/AIDS epidemic is limited by the data available. To date, the AIDS case reporting system of the Centers for Disease Control and Prevention (CDC) is the only complete national population-based data available to monitor the epidemic. Although data are useful in evaluating disease prevalence and incidence, reported AIDS cases are only the clinical tip of the iceberg of effects produced by HIV infection. HIV seroprevalence surveys are informative for their description of the magnitude of the epidemic, but they represent people whose date of infection is unknown; these surveys are thus limited in their ability to characterize the current direction of the epidemic. HIV incidence data are far more informative for monitoring the current course of the epidemic. Nevertheless, because HIV infection is not reportable in all states, and because most studies of HIV have not included representative samples, these data are of limited value for generalizing to other specific populations or to the entire U.S. population. HIV surveillance data also provide information that is of limited value in forecasting the future of the epidemic. To address this limitation, some have argued (e.g., Centers for Disease Control and Prevention, 1994a; Turner et al., 1989) that a broader monitoring system of the epidemic should include precursors to AIDS and HIV infection. Better-developed behavioral epidemiologic data on known risk behaviors (i.e., sexual behavior and drug use) could provide data on sites of potential transmission and future spread.

Despite these limitations, current epidemiologic data provide valuable



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Preventing HIV Transmission: The Role of Sterile Needles and Bleach 1 The Epidemiology of HIV and AIDS The picture we can draw of the HIV/AIDS epidemic is limited by the data available. To date, the AIDS case reporting system of the Centers for Disease Control and Prevention (CDC) is the only complete national population-based data available to monitor the epidemic. Although data are useful in evaluating disease prevalence and incidence, reported AIDS cases are only the clinical tip of the iceberg of effects produced by HIV infection. HIV seroprevalence surveys are informative for their description of the magnitude of the epidemic, but they represent people whose date of infection is unknown; these surveys are thus limited in their ability to characterize the current direction of the epidemic. HIV incidence data are far more informative for monitoring the current course of the epidemic. Nevertheless, because HIV infection is not reportable in all states, and because most studies of HIV have not included representative samples, these data are of limited value for generalizing to other specific populations or to the entire U.S. population. HIV surveillance data also provide information that is of limited value in forecasting the future of the epidemic. To address this limitation, some have argued (e.g., Centers for Disease Control and Prevention, 1994a; Turner et al., 1989) that a broader monitoring system of the epidemic should include precursors to AIDS and HIV infection. Better-developed behavioral epidemiologic data on known risk behaviors (i.e., sexual behavior and drug use) could provide data on sites of potential transmission and future spread. Despite these limitations, current epidemiologic data provide valuable

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach insights into the HIV/AIDS epidemic in the United States. This chapter reviews these data with particular emphasis on the role of injection drug users. However, before reviewing these data, the panel thought it critical to provide the reader with a brief review of current knowledge of the underlying biological mechanisms involved in the transmission of the virus. The details of these behaviors and processes are important to developing an appreciation for the complexity of the issues at hand. BIOLOGICAL MECHANISMS OF TRANSMISSION Although the consensus among the research community is that the development of an effective vaccine for the human immunodeficiency virus (HIV) is still years away, significant strides have been made in biomedical research. As Rogers (1992:522) stated, ''We now know quite precisely how the virus is transmitted and how it is not and what it does to human cells and the immune mechanism, and we know enough about its structure and life-cycle to have identified multiple potential points to get at it." HIV transmission is limited to sharing of contaminated injection drug paraphernalia, sexual contact, transmission from infected mother to child, exposure to infected blood or blood products, and transplantation of infected organs or tissues. As of December 31, 1993, injection drug use and sexual contact accounted for approximately 92 percent of all adult and adolescent AIDS cases reported to CDC. We review here postulated mechanisms for transmission through activities associated with injection drug use, sexual, and perinatal transmission and detail the associated human behaviors. Injection Drug Use Transmission Injection drug use involves practices that facilitate the transmission of HIV infection. The primary category of such practices is direct needle sharing, which involves the reuse of needles and syringes that have been contaminated through prior use by an infected individual. Penetration of the needle through the skin is sufficient for contamination and subsequent transmission of HIV infection, as has been demonstrated in cases of needlestick injuries among health care workers (McCray, 1986). In instances of occupational exposure of health care workers, in which the amount of blood exposure frequently is small (Napoli and McGowan, 1987), the risk of transmission is about 3/1,000 exposures (Ippolito et al., 1994). Direct Needle Sharing The higher rates of HIV infection in injection drug users than in health

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach care workers are due to much more frequent injections (an average of one to two injections per day, according to some published surveys) and the practice of registering. Registering means that once a needle is inserted, the drug user will draw back the plunger of the syringe to examine for the presence of blood to ensure that the needle has been properly placed into a vein. Registering, then, involves contamination of both the needle itself and the hub, barrel, and plunger of the syringe. Although the syringe is typically rinsed before reuse, residual blood may adhere or remain, which may be released into the next person who uses the syringe by subsequent agitation (by drawing up and administrating the drug solution). Studies of the survivability of HIV in dried or aqueous states (Resnick et al., 1986) suggest that transmission may occur even if there is a delay of a day or more before the needle and syringe are reused by a different person. A related practice of direct needle sharing has been termed booting (Inciardi, 1990; Ouellet et al., 1991), which involves additional steps in the basic injection pattern described above. Booting is the practice performed after registering and administering the drug solution. In this process, with the needle still in the vein, the injector draws back on the plunger of the syringe to fill the barrel with blood and then reinjects the blood, sometimes repeating this practice several times. More commonly reported with cocaine than with heroin injection, this practice allegedly enhances the euphoria associated with the drug's effects. Others, however, describe the motivation for engaging in this practice as economic, that is, to wash out all traces of the drug when administering it. The volume of blood that remains in the barrel of the syringe following booting is greater than that for the practice of registering and, at least theoretically, may be associated with a higher risk of transmission to anyone who subsequently uses a booted syringe. Empirical data on the risk of transmission for the practice of booting are sparse because few injection drug users can report reliably on whether previously used syringes were booted. Nevertheless, in one study, booting was associated with increased HIV seropositivity among injection drug users (Lamothe et al., 1993). The setting in which drug injection takes place can also be related to direct sharing. A shooting gallery is a clandestine location where injection drug users go to rent needles and syringes. As used syringes are returned to a common container to be rented again, this process amounts to sequential anonymous sharing of needles and syringes (Friedland and Klein, 1987; Ouellet et al., 1991). Results of a study in which researchers tested used syringes collected from shooting galleries in Miami shed some light on the potential risk associated with injection drug use in the context of a shooting gallery. They showed that 20 percent of those syringes that had visible blood residue were positive for HIV, compared with 5.1 percent of those that had no visible blood residue (Chitwood et al., 1990). In a follow-up

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach study carried out 2 years later (McCoy et al., 1994), researchers reported that 52 percent of the syringes showing visible traces of blood tested positive for HIV. Indirect Needle Sharing A separate category of drug injection practices can be termed indirect needle sharing because they do not directly involve passing a contaminated needle and syringe between individuals. Instead, indirect sharing involves common use of other drug preparation or injection equipment that can become contaminated. Examples include cookers, cotton, rinse water, and the drug-sharing practices called frontloading and backloading. The cooker is a small container, typically a spoon or a metal soda bottle cap, in which a drug in the form of powder is mixed with water and heated into a solution. The heat is applied only to the point of allowing the drug to become soluble; additional heating (which might have a sterilizing effect) is not applied, as this would require time to cool that a drug user in partial withdrawal is often unwilling to tolerate. Although two drug injectors might each possess their own needle and syringe (and therefore deny that they are needle sharing), a potential for cross-contamination of needles and syringes is possible if each dips and draws solution from the same cooker in the same, or possibly later, injection episodes. Cotton—sometimes cotton balls and other times cigarette filters or other similar materials—is placed into a cooker. Injectors draw up drug solution into their needles and syringes through the cotton, which is used to filter out particulate matter from the cooker. Cotton, which is submerged into the drug solution, typically is not discarded after each use. Instead, it is saved in containers to be soaked later to release residual drugs during periods when their availability is scarce. If contaminated needles are submerged in cotton, there is at least a theoretical possibility of contamination with viable virus that might lead to transmission. Rinse water refers to containers of water from which one injector will draw up and squirt out tap water between the use of needles and syringes by different individuals. As needles and syringes are dipped into this rinse water, the water becomes contaminated. Contamination increases with greater use, especially over protracted periods between water changes, and also if rinse water that has been drawn into a syringe is squirted back into the same container that is to be reused for additional rinses. Moreover, rinse water is commonly used not only for rinsing, but also for the mixing of the drug solution to be injected. With regard to sharing rinse water, it is the injection of this contaminated water that poses the greatest threat for HIV transmission, especially in the case of cocaine injection, because cocaine is water

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach soluble and does not always require heating in a cooker to be dissolved (depending on the dilutants and adulterants used). Frontloading involves the parceling out of individual portions from a mixer/distributor's syringe to the other participants' syringes by removing the needles from the receiving syringes. Backloading involves transferring the drug from one syringe to another by removing the plunger from the receiving syringes. The drug solution can also be divided by having the mixer/distributor squirt all but his or her own portion back into the cooker for each participant to draw up his or her own agreed-on individual portion. These behaviors have been described in some detail in the professional literature (Inciardi and Page, 1991; Koester et al., 1990; Koester, 1994; Turner et al., 1989; Grund et al., 1990, 1991; Jose et al., 1993; McCoy et al., 1994; Samuels et al., 1991; Zule, 1992; Page et al., 1990; Auerbach et al., 1994). Risk Behaviors and Interventions Little attention has been given to these risk behaviors in most HIV/AIDS prevention interventions aimed at injection drug users. In an in-depth ethnographic study, Koester and Hoffer (1994) reported that only 7 percent of the injectors they interviewed in their study were aware that these behaviors represented any type of risk of becoming infected. These findings are disturbing, given that over 70 percent of their study participants were participating or had participated in an HIV/AIDS intervention program. The distinction between direct and indirect needle sharing is not merely academic but reflects a dichotomy that must be considered when evaluating needle exchange and bleach distribution programs. These intervention programs are aimed at direct needle-sharing practices by providing new sterile needles or disinfectant for them. However, neither sterile needles nor their disinfection can be expected to prevent transmission due to sharing of cookers, cotton, rinse water, or frontloading/backloading. Any assessment of the reductions in HIV seroconversion rates for specific programs needs to consider these points. It would seem prudent for prevention programs to educate people about the potential dangers of indirect sharing methods and supply sterile equipment whenever possible. Finally, it must be noted that infectious agents other than HIV can be transmitted by contaminated injection equipment. Other blood-borne pathogens that have been associated with injection drug use include malaria, syphilis, hepatitis B and C viruses, and human T-lymphotrophic virus type II, as well as other bacterial pathogens that cause sepsis and endocarditis (Cherubin, 1967; Sapira, 1968; Louria et al., 1967; Levine and Sobel, 1991; Stein, 1990; Haverkos and Lange, 1990; Cherubin and Sapira, 1993; Stimmel et al., 1975; Novick et al., 1988; Kreek, 1983; Esteban et al., 1989; Donahue

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach et al., 1991; Des Jarlais et al., 1992; Selwyn and Alcabes, 1994). The recognition of multiple pathogens that can be transmitted parenterally by injection drug users is important, because development and implementation of prevention programs directed at HIV infection can be viewed more broadly as prevention programs for blood-borne pathogens in general. Sexual Transmission Sexual intercourse was implicated as a primary mode of transmission of the virus even before the etiologic agent (HIV) had been identified (Jaffe et al., 1983a, 1983b; Centers for Disease Control, 1981, 1982). However, the sexual transmission of the virus is not highly efficient, and the risk of acquiring the infection as a result of a single sexual exposure is relatively low (Friedland and Klein, 1987; Institute of Medicine, 1988; Holmberg et al., 1989). That does not mean that documented evidence of people becoming infected after one or only a few sexual contacts does not exist (Padian et al., 1988). Sexual transmission depends on the type and frequency of sexual encounters, as well as the prevalence of other risk factors (e.g., condom use). Receptive anal intercourse is particularly dangerous regardless of the sexual orientation of the individuals (Kingsley et al., 1987; Winkelstein et al., 1987), and frequent sexual exposures (vaginal or anal) to an infected partner also increase the likelihood of transmission (Padian et al., 1990; Lazzarin et al., 1991). With respect to heterosexual transmission, as with other sexually transmitted diseases, women are at higher risk than men (Aral, 1993). Nonetheless, as is also the case with other sexually transmitted diseases, transmission occurs in both directions (male-to-female and female-to-male). The differential efficiency of transmission between the sexes has led to some debate about whether current estimates of female-to-male transmission rates are accurate (Redfield et al., 1985; Haverkos and Edelman, 1985, 1988; Polk, 1985; Handsfield, 1988; Padian et al., 1991; Haverkos and Battjes, 1992; Haverkos and Needle, 1994; Haverkos, 1994). Transmission rates may also vary depending on the risk group of the originally infected partner. The risk of transmission has been shown to be lower for female partners of hemophiliacs and bisexual men and for partners of transfusion-infected persons than it is for female or male partners of injection drug users (Padian, 1987; Padian et al., 1987; Curran et al., 1988; De Gruttola and Mayer, 1988; Johnson, 1988). Delineation of the precise biological mechanisms involved in the heterosexual transmission of HIV has been complicated by the difficulty of identifying a potential series of sexual encounters in which exposure to HIV is known to have occurred each time. We know that cell-free virus is infectious for blood product recipients and that cell-associated virus can infect

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach cell lines in vitro. We simply do not know the relative contributions of cell-free and cell-associated HIV transmission in various at-risk circumstances, including drug injection and sexual contact. Furthermore, viral factors that may influence the efficiency of transmission are so far poorly understood, i.e., certain strains of HIV may be more easily transmitted than other strains. It is not yet known whether specific viral genotypic or phenotypic attributes influence the efficiency of viral transmission. Transmission is known to be facilitated by a compromise of the integrity of mucosal surfaces and the presence of other sexually transmitted diseases, such as syphilis and chancroid, particularly in the recipient (Johnson and Laga, 1988). By increasing circulating lymphocytes and macrophages that may harbor HIV at the site of local infection, the presence of sexually transmitted diseases may potentially increase infectiousness as well. As a result, the prevalence of sexually transmitted diseases in a population of individuals at risk for HIV infection can significantly alter the efficiency of virus spread. If a virus-transmitting donor has advanced HIV disease, the recipient may also be more likely to become infected. Furthermore, infection by an advanced-stage donor is associated with a higher incidence of acute viral syndrome in the recipient (Laga et al., 1989). These phenomena may be due to increased viral load in the transmitter or to increased virulence of the transmitted strains of HIV (which may be present after a long period of infection), or both. Infectiousness may also increase over time because plasma-associated and cell-associated viral load increases with disease progression, and studies show that the presence of HIV RNA is more likely to occur in the semen of men with lower CD4+ cell counts. Perinatal Transmission Female injection drug users or partners of male injection drug users represent the largest number of HIV-infected women of childbearing age, constituting a sizable threat for perinatal transmission of HIV. The transmission of HIV from an infected mother to her offspring may occur in utero, during the birth process (intrapartum), or at some time following birth (postpartum) by breast-feeding. The relative frequency of the different timings of infection has not been clearly defined and may vary among different populations and locales. Approximately 25 to 30 percent of neonates born to HIV-seropositive mothers become infected (Boylan and Stein, 1991; Vermund et al., 1992; Mofenson, 1992). For infants born to HIV-seropositive mothers, the transplacental transfer of maternal anti-HIV antibodies complicates the accurate estimate of the number of infants infected in utero versus those infected during or after birth.1 Furthermore, because many HIV-infected pregnant women are unaware

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach of their infection, the opportunity for the early diagnosis and treatment of their infected infants frequently may be missed. Similarly, interventions to prevent postpartum transmission, such as avoidance of breast-feeding, are not available to women who do not know that they are infected with HIV. Such interventions may also not be recommended in regions of the world where risks of HIV transmission are overshadowed by risks for other adverse health outcomes (e.g., diarrheal disease) among infants who are not breast-fed. In perinatal transmission, a variety of factors, usually associated with latter-stage disease, including the presence of maternal p24 antigenemia and low maternal CD4+ lymphocyte counts at the time of conception, correlate with the likelihood of infection of a neonate. Additional risk factors in perinatal transmission include high maternal CD8+ T-lymphocyte counts, placental membrane inflammation, and maternal fever. It is likely that many HIV infections in infants are acquired at birth through contact with contaminated blood or secretions. Among twins born to HIV-infected mothers, a higher risk of HIV infection is seen in the firstborn, even for twins delivered by cesarean section, suggesting that factors related to the delivery process affect the risk of infection. The fact that both the virus donor and the recipient are known in the case of perinatal HIV infection provides potential opportunities for interventions to decrease the risk of viral transmission. Recent studies have shown that antiviral treatment of an HIV-infected mother with zidovudine (AZT) can significantly decrease the likelihood of HIV infection in her offspring (Connor et al., 1994). The availability of an effective intervention to decrease perinatal HIV transmission has increased interest in screening pregnant women for the presence of HIV infection so that perinatal HIV infection may be limited. Conclusion In summary, much is known about the various modes of HIV transmission. However, it is not possible to provide accurate estimates of their relative efficiency. It is difficult to identify accurate denominators for the numbers of individuals and encounters in which exposure has occurred; moreover, transmission of the virus depends on factors other than the mode of exposure. The dose of virus transferred (inoculum size), the frequency of exposure, differences in host susceptibility, variations in infectiousness of an infected person over time, and the differences in virulence among HIV isolates, as well as the presence of factors such as particular sexual practices and the presence of sexually transmitted diseases, may all influence the likelihood of transmission.

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach EPIDEMIOLOGIC DATA In this section we first review general epidemiologic trends in HIV and AIDS and then review data particular to injection drug users. HIV and AIDS Surveillance As of June 1994, AIDS had claimed over 243,000 lives in the United States, and 401,749 cases of AIDS had been reported to CDC. On January 1, 1993, CDC revised its AIDS surveillance case definition for adolescents and adults to include three additional clinical conditions and one laboratory marker of immunosuppression.2 This expansion made for a broader case definition, resulting in a large increase in AIDS cases reported across all subpopulation groups. In 1993, 105,990 new adolescent and adult AIDS cases were reported, representing a 127 percent increase over the 46,791 cases reported in 1992. There were 5,228 pediatric AIDS cases reported to CDC as of December 31, 1993. In 39 percent of cases, the mother was an injection drug user, and in an additional 17 percent of cases she had sex with an injection drug user. Thus, over half of all pediatric AIDS cases are associated with the HIV epidemic among injection drug users. This is likely to be a lower bound estimate because the risk factors for the mother were unknown for an additional 21 percent of pediatric cases. In 1992, AIDS had become the eighth leading cause of death in the United States. Among women ages 25 to 44, AIDS was the fourth leading cause of death; for men in this age group, AIDS was the leading cause of death, surpassing unintentional injuries, heart disease, cancer, suicide, and homicide (Centers for Disease Control and Prevention, 1994b). Moreover, in New Jersey and New York, AIDS has been reported to be the leading killer among African American women between the ages of 20 and 40 (Kaplan, 1993). In addition to race, the risk to women also appears to be heavily skewed by social class (Epstein et al., 1993; Hu et al., 1993; Kaplan, 1993; Phillips et al., 1993; Fife and Mode, 1992). As discussed below, the largest recent increases in case reporting were observed for adolescents, women, racial/ethnic minorities, and individuals infected through injection drug use and heterosexual contact. The dynamic nature of the epidemic is illustrated by the temporal changes in dissemination within the United States. In 1984, two cities—New York and San Francisco—reported half of all AIDS cases in this country; as of December 1993, those two cities accounted for 18 percent of new cases. These two cities have also differed in the distribution of AIDS cases by mode of exposure: in San Francisco the majority of cases are related to men who have sex with men; in New York the majority of cases are related

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach to injection drug use. Figure 1.1 illustrates the variation in AIDS incidence rates across states. Moreover, a closer look at selected metropolitan area AIDS cases reported in 1993 reveals some substantial variations within and across regions (Table 1.1). In contrast to surveillance data on AIDS, precise estimates of HIV infection rates in the total U.S. population remain problematic. National estimates rely on mathematical models that back calculate HIV incidence from AIDS surveillance data as well as a composite of HIV seroprevalence data from numerous sources: states' reporting and screening of newborns, blood donors, armed forces recruits, Job Corps participants, persons attending alternative testing sites and sexually transmitted disease clinics, admissions to drug abuse treatment centers and prisons, and various other sentinel populations.3 Over the years, the Public Health Service (PHS) has estimated that there are between 600,000 and 1.2 million HIV-infected people in the United States and that approximately 40,000 new infections occur each year among adults and adolescents (U.S. Public Health Service, 1986; Centers for Disease Control, 1987, 1990a; MacQuillan et al., 1993). A discussion of the large observed variations in PHS estimates over the years is presented in Vermund (1991). Mode of Acquisition of Infection Important trends in the mode of acquisition of the HIV infection can be discerned. In this country and throughout the world, the majority of HIV infections are sexually transmitted (Roper et al., 1993). In most of the world, over 75 percent of HIV infections are due to heterosexual behavior, approximately 15 percent to homosexual behavior, and a relatively small proportion to injection drug use. However, in the United States, men who have sex with men account for the largest number of reported AIDS cases (54 percent of all reported cases, that is, 193,652 cases as of December 31, 1993). Yet a review of the percentage of annual AIDS cases (Figure 1.2), classified according to CDC's exposure categories, reveals that the proportion of cases of men who have sex with men has decreased steadily over the years (from 74 percent in 1981 to 47 percent in 1993), while the proportion of cases of exposure from injection drug use has steadily increased over the last 13 years (from 12 percent in 1981 to 28 percent in 1993). In the United States, gay and bisexual men are still the largest risk group for HIV infection and disease. Drug users constitute the next-largest risk group, although there is a large overlap between these groups. Recent CDC estimates of HIV prevalence and incidence (Holmberg, 1993, 1994) indicate that the HIV/AIDS epidemic in the United States is being driven by three subepidemics: (1) injection drug users and their sexual partners and offspring (especially in the northeastern United States; Miami, Florida; and

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach FIGURE 1.1 Annual incidence rates of AIDS for adults and adolescents per 100,000 population, for cases reported in 1993 in the United States. SOURCE: Valdiserri, 1994.

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach of HIV in population subgroups of injection drug users (e.g., youth, women) in the United States. Given the serious public health threat associated with HIV infection among injection drug users, their sexual partners and offspring, the Assistant Secretary for Health should ensure that AIDS prevention efforts targeted to injection drug users are expanded specifically to include behavioral interventions in order to limit the further spread of HIV infection. AIDS behavioral prevention efforts need to target direct and indirect needle sharing and the sexual practices of injection drug users and their sex partners. NOTES 1.   The presence of maternal anti-HIV antibodies precludes an accurate diagnosis of HIV infection in infants by serologic methods. Other methods for diagnosis of neonatal infection, including HIV culture, immune-complex dissociated p24 (a viral core protein) assays, and polymerase chain reaction analyses permit the early diagnosis of HIV infection, but these techniques are expensive and not universally available. 2.   The additional clinical conditions are pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer, whereas the new laboratory marker of severe immunosuppression consists of a CD4+ T-lymphocyte count >200 per milliliter. 3.   A detailed presentation of CDC's family of seroprevalence surveys is presented in a special issue of Public Health Reports (1990). 4.   These disproportionately large increases in AIDS cases in 1993 were due to CDC's revised definition of AIDS. REFERENCES Allen, D.M., I.M. Onorato, and T.A. Green 1992 HIV infection in intravenous drug users entering drug treatment, United States, 1988 to 1989. American Journal of Public Health 82(4):541-545. Angarano, G., G. Pastore, L. Monno, T. Santantonio, N. Luchena, and O. Schiraldi 1985 Rapid spread of HTLV-III infection among drug addicts in Italy. Lancet 2(8467):1302. Anthony, J.C., D. Vlahov, K.E. Nelson, S. Cohn, J. Astemborski, and L. Solomon 1991 New evidence on intravenous cocaine use and the risk of infection with human immunodeficiency virus type 1. American Journal of Epidemiology 134(10):1175-1189. Aral, S.O. 1993 Heterosexual transmission of HIV: The role of other sexually transmitted infections and behavior in its epidemiology, prevention and control. Annual Review of Public Health 14:451-467. Astemborski, J., D. Vlahov, D. Warren, L. Solomon, and K.E. Nelson 1994 The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users. American Journal of Public Health 84(3):382-387.

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Auerbach, J.D., C. Wypijewska, and H.K.H. Brodie, eds. 1994 AIDS and Behavior: An Integrated Approach. Washington, DC: National Academy Press. Battjes, R.J., and R. Pickens 1988 AIDS Transmission Risk Behaviors Among Intravenous Drug Abusers (IVDAs). Presented at the Fourth International AIDS Conference, Stockholm, June 12-16. Battjes, R.J., R.W. Pickens, and Z. Amsel 1991 HIV infection and AIDS risk behaviors among intravenous drug users entering methadone treatment in selected U.S. cities. Journal of Acquired Immune Deficiency Syndromes 4:1148-1154. Battjes, R.J., R.W. Pickens, H.W. Haverkos, and Z. Sloboda 1994 HIV risk factors among injecting drug users in five U.S. cities. AIDS 8:681-687. Boylan, L., and Z.A. Stein 1991 The epidemiology of HIV infection in children and their mothers—Vertical transmission. Epidemiology Reviews 13:143-177. Brookmeyer, R. 1991 Reconstruction and future trends of the AIDS epidemic in the United States. Science 253:37-42. Caskey, W.R., and R.B. Wathey 1982 Female Addiction: A Longitudinal Study. Lexington, MA: Lexington Books. Centers for Disease Control 1981 Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men—New York City and California. Morbidity and Mortality Weekly Report 30:305-308. 1982 Persistent, generalized lymphadenopathy among homosexual males. Morbidity and Mortality Weekly Report 31:249-252. 1987 Human immunodeficiency virus infection in the United States: A review of current knowledge. Morbidity and Mortality Weekly Report 36(suppl. S-6):1-48. 1990a HIV prevalence estimates and AIDS case projections for the United States: Report based upon a workshop. Morbidity and Mortality Weekly Report 39(RR-16):1-31. 1990b Behaviors for HIV transmission among intravenous-drug users not in drug treatment—United States, 1987-1989. Morbidity and Mortality Weekly Report 39(16):273-276. 1991 Drug use and sexual behaviors among sex partners of injecting-drug users—United States, 1988-1990. Morbidity and Mortality Weekly Report 40(49):855-860. 1992 Update: Acquired immunodeficiency syndrome—United States, 1992. Morbidity and Mortality Weekly Report 42:547-551, 557. 1994a CDC HIV/AIDS Prevention 5(2). 1994b HIV/AIDS Surveillance Report 5(4). Chaisson, R.E., P. Bacchetti, D. Osmond, B. Brodie, M.A. Sande, and A.R. Moss 1989 Cocaine use and HIV infection in intravenous drug users in San Francisco. Journal of the American Medical Association 261(4):561-565. Cherubin, C. 1967 The medical sequelae of narcotic addiction. Archives of Internal Medicine 67:23-33. Cherubin, C.E., and J.D. Sapira 1993 The medical complications of drug addiction and the medical assessment of the IV drug users: Twenty-five years later. Archives of Internal Medicine 119:1017-1028.

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Chitwood, D.D., C.B. McCoy, J.A. Inciardi, D.C. McBride, M. Comerford, E. Trapido, H.V. McCoy, J.B. Page, J. Griffin, M.A. Fletcher, et al. 1990 HIV seropositivity of needles from shooting galleries in South Florida. American Journal of Public Health 80:150-152. Cohen, J.B. 1991 Why women partners of drug users will continue to be at high risk for HIV infection. Journal of Addiction Diseases 10:99-110. Cohen, J., L. Hauer, and C. Wofsy 1989 Women and intravenous drugs: Parenteral and heterosexual transmission of HIV. Journal of Drug Issues 19:39-56. Connor, E.M., R.S. Sperling, R. Gelber, P. Kiselev, G. Scott, J.J. O'Sullivan, R. Van Dyke, M. Bey, W. Shearer, R.L. Jacobson, E. Jimenez, E. O'Neill, B. Bazin, J.-F. Delfraissy, M. Culnane, R. Coombs, M. Elkins, J. Moye, P. Stratton, and J. Balsley 1994 Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. New England Journal of Medicine 331(18):1173-1180. Curran, J.W., H.W. Jaffe, A.M. Hardy, W.M. Morgan, R. M. Selik, and T.J. Dondero 1988 Epidemiology of HIV infection and AIDS in the United States. Science 239:610-616. De Gruttola, V., and K.H. Mayer 1988 Assessing and modeling heterosexual spread of the human immunodeficiency virus in the United States. Review of Infectious Diseases 10:138-150. Des Jarlais, D.C. 1994 Epidemiology of HIV Among Intravenous Drug Users. Presentation at the meeting of the Panel on Needle Exchange and Bleach Distribution Programs, January 7. Des Jarlais, D.C., and S.R. Friedman 1988a HIV infection among persons who inject illicit drugs: Problems and prospects. Journal of Acquired Immune Deficiency Syndromes 1:267-273. 1988b HIV and intravenous drug use. AIDS 2(1):S65-S69. Des Jarlais, D.C., S.R. Friedman, D.M. Novick, J.L. Sotheran, P. Thomas, S.R. Yancovitz, D. Mildvan, J. Weber, M.J. Kreek, and R. Maslansky 1989 HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987. Journal of the American Medical Association 261(7):1008-1012. Des Jarlais, D.C., S.R. Friedman, K. Choopanya, S. Vanichseni, and T.P. Ward 1992 International epidemiology of HIV and AIDS among injecting drug users. AIDS 6:1053-1068. Des Jarlais, D.C., S.R. Friedman, J.L. Sotheran, J. Wenston, M. Marmor, S.R. Yancovitz, B. Frank, S. Beatrice, and D. Mildvan 1994 Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992. Journal of the American Medical Association 271(2):121-127. Donahue, J.G., K.E. Nelson, A. Muñoz, D. Vlahov, L.L. Rennie, E.L. Taylor , A.J. Saah, S. Cohn, N.J. Odaka, and H. Farzadegan 1991 Antibody to hepatitis C virus among cardiac surgery patients, homosexual men, and intravenous drug users in Baltimore, Maryland. American Journal of Epidemiology 134(10):1206-1211. Donoghoe, M.C. 1992 Sex, HIV and the injecting drug user. British Journal of Addiction 87:405-416.

OCR for page 23
Preventing HIV Transmission: The Role of Sterile Needles and Bleach Drucker, E., and S.H. Vermund 1989 Estimating population prevalence of human immunodeficiency virus infection in urban areas with high rates of intravenous drug use: A model of the Bronx in 1988. American Journal of Epidemiology 130(1):133-142. Dwyer, R., D. Richardson, M.W. Ross, A. Wodak, M.E. Miller, and J. Gold 1994 A comparison of HIV risk between women and men who inject drugs. AIDS Education and Prevention 6(5):379-389. Edlin, B.R., K.L. Irwin, S. Faruque, et al. 1994 Intersecting epidemics: Crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. New England Journal of Medicine 331(21):1422-1427. Epstein, M.R., G.A. Conway, C.R. Hayman, et al. 1993 Youth, Poverty and HIV: Trends in HIV Prevalence in a National Job Training Program, 1988-1992 . Paper presented at the 121st meeting of the American Public Health Association, San Francisco, CA. Esteban, J.I., R. Esteban, Viladomiu, J.C. Talavera-Lupez, A. Gonzalez, J.M. Hernandez, M. Roget, V. Vargas, J. Genesca, M. Buti, et al. 1989 Hepatitis C antibodies among risk groups in Spain. Lancet 2(8658):294-297. Fife, D., and C. Mode 1992 AIDS prevalence by income group in Philadelphia. Journal of Acquired Immune Deficiency Syndromes 6:1111-2225. Fordyce, E.J., S. Blum, A. Balanon, and R.L. Stoneburner 1991 A method for estimating HIV transmission rates among female sex partners of male intravenous drug users. American Journal of Epidemiology 133(6):590-598. Friedland, G.H., and R.S. Klein 1987 Transmission of the human immunodeficiency virus. New England Journal of Medicine 317(18):1125-1135. Friedman, S.R., J.L. Sotheran, A. Abdul-Quader, B.J. Primm, D.C. Des Jarlais, P. Kleinman, C. Mauge, D.S. Goldsmith, W. el-Sadr, and R. Maslansky 1987 The AIDS epidemic among blacks and Hispanics. Millbank Quarterly 65(Suppl 2):455-499. Greenberg, J., D. Schnell, and R. Colon 1992 Behavior of crack cocaine users and their impact on early syphilis intervention. Sexually Transmitted Diseases 19:346-350. Grinspoon, L., and J. Bakalar 1985 Cocaine: A Drug and Its Social Evolution. New York, NY: Basic Books. Grund, J.P., C.D. Kaplan, N.F. Adiraans, P. Blanken, and J. Huisman 1990 The limitations of the concept of needle sharing: The practice of frontloading. AIDS 4(8):819-821. Grund, J.P. C.D. Kaplan, and N.F.P. Adriaans 1991 Needle sharing in the Netherlands: An ethnographic analysis. American Journal of Public Health 81(12):1602-1607. Hahn, R.A., I.M. Onorato, S. Jones, and J. Dougherty 1989 Prevalence of HIV infection among intravenous drug users in the United States. Journal of the American Medical Association 261(18):2677-2684. Hand, I..L, A. Wiznia, R.T. Checola, M.H. Kim, L.M. Noble, T.J. Daley, and J.J. Yoon 1992 Human immunodeficiency virus seropositivity in critically ill neonates in the South Bronx. Pediatric Infectious Disease Journal 11(1):39-42. Handsfield, H.H. 1988 Heterosexual transmission of human immunodeficiency virus. Journal of the American Medical Association 260(13):1943-1944.

OCR for page 23
Preventing HIV Transmission: The Role of Sterile Needles and Bleach Hartel, D., E. Schoenbaum, P. Selwyn, I. Fleming, A. Gapuchin, and G. Friedland 1992 Gender Differences in Drug Use and AIDS Mortality Among Intravenous Drug Users. Eighth International Conference on AIDS, Amsterdam. Haverkos, H. 1994 Reporting AIDS in New York City. Journal of the American Medical Association 271(4):273-274. Haverkos, H, and R. Battjes 1992 Female-to-male transmission of HIV. Journal of the American Medical Association 268:1855. Haverkos, H.W., and R. Edelman 1985 Female-to-male transmission of AIDS. Journal of the American Medical Association 254(8):1035-1036. 1988 The epidemiology of acquired immunodeficiency syndrome among heterosexuals. Journal of the American Medical Association 260(13):1922-1929. Haverkos, H.W., and W.R. Lange 1990 Serious infections other than human immunodeficiency virus among intravenous drug users. Journal of Infectious Diseases 161:894-902. Haverkos, H., and R. Needle 1994 Reporting AIDS in New York City. Journal of the American Medical Association 271(4):273-274. Holmberg, S.D. 1993 Emerging epidemiological patterns in the USA. Presented at the Sixth Annual Meeting of the National Cooperative Vaccine Development Group for AIDS, Alexandria, Va., October 30-November 4. 1994 Panel on Injection Drug Users and the HIV Epidemic: Understanding the Regional Differences in Prevalence, Incidence, and Risk Factors for Transmission. Public Health and Diversity: Opportunities for Equity, American Public Health Association's 122nd Annual Meeting and Exhibition, Washington, D.C., November 2. Holmberg, S.D., C.R. Horsburgh, Jr., J.W. Ward, and H.W. Jaffe 1989 Biologic factors in the sexual transmission of human immunodeficiency virus. Journal of Infectious Diseases 1601(1):116-125. Hu, D.J., R. Frey, S. Costa, et al. 1993 AIDS Rates and Sociodemographic Variables in the Newark, New Jersey, Metropolitan Area . Paper presented at the Ninth International Conference on AIDS, Berlin, Germany. Inciardi, J. 1990 AIDS—A strange disease of uncertain origins. American Behavioral Scientist 33:397-407. Inciardi, J., and J. Page 1991 Drug sharing among intravenous drug users. AIDS 5(6):772-773. Institute of Medicine 1988 Confronting AIDS: Update 1988. Washington, DC: National Academy Press. Ippolito, G., G. DeCarli, V. Puro, N. Petrosillo, C. Arici, B. Bertucci, L. Bianciardi, L. Bonazzi, A. Cestrone, M. Daglio, et al. 1994 Device-specific risk of needlestick injury in health care workers. Journal of the American Medical Association 272(8):607-610. Jaffe, H.W., D.J. Bregman, and R.M. Selik 1983a Acquired immune deficiency syndrome in the United States: The first 1,000 cases. Journal of Infectious Disease 48:339-345. Jaffe, H.W., K. Choi, P.A. Thomas, H.W. Haverkos, D.M. Auerbach, M.E. Guinan, M.F.

OCR for page 23
Preventing HIV Transmission: The Role of Sterile Needles and Bleach Rogers, T.J. Spira, W.W. Darrow, M.A. Kramer, S.M. Friedman, J.M. Monroe, A.E. Friedman-Kien, L.J. Laubenstein, M. Marmor, B. Safai, S.K. Dritz, S.J. Crispi, S.L. Fannin, J.P. Orkwis, A. Kelter, W.R. Rushing, S.B. Thacker, and J.W. Curran 1983b National case-control study of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men: Part I. Epidemiologic results. Annals of Internal Medicine 99:145-151. Jaffe, H.W., W.W. Darrow, D.F. Echenberg, P.M. O'Malley, J.P. Getchell, V.S. Kalyanaraman, R.H. Byers, D.P. Drennan, E.H. Braff, J.W. Curran, and D.P. Francis 1985 The acquired immunodeficiency syndrome in a cohort of homosexual men. A six-year follow-up study. Annals of Internal Medicine 103:210-214. Johnson, A.M. 1988 Heterosexual transmission of human immunodeficiency virus. British Medical Journal 296:1017-1020. Johnson, A.M., and M. Laga 1988 Heterosexual transmission of HIV. AIDS Suppl 1:S49-S56. Jose, B., S.R. Friedman, A. Neaigus, R. Curtis, J.P. Grund, M.F. Goldstein, T.P. Ward, and D.C. Des Jarlais 1993 Syringe-mediated drug-sharing (backloading): A new risk factor for HIV among injecting drug users. AIDS 7(12):1653-1660. Kaplan, M.S. 1993 Women and AIDS: Toward a Feminist Conception of Social Prevention. Paper presented at the 121st annual meeting of the American Public Health Association, San Francisco, CA. Kingsley, L.A., R. Detels, R. Kaslow, B.F. Polk, C.R. Rinaldo, Jr., J. Chmiel, K. Detre, S.F. Kelsey, N. Odaka, D. Ostrow, et al. 1987 Risk factors for seroconversion to human immunodeficiency virus among male homosexuals: Results from the Multicenter AIDS Cohort Study. Lancet 1(8529):345-349. Kitayaporn, D., C. Uneklabh, B.G. Weninger, et al. 1994 Incidence determined retrospectively among drug users in Bangkok, Thailand. AIDS 1994:1443-1450. Klee, H., J. Faugier, C. Hayes, T. Boulton, and J. Morris 1990 Factors associated with risk behavior among injecting drug users. AIDS 2:133-145. Koester, S.K. 1994 Copping, running and paraphernalia laws: Contextual variables and needle risk behavior among injection drug users in Denver. Human Organization 53(3). Koester, S.K., and L. Hoffer 1994 Indirect sharing: Additional HIV risks associated with drug injection. AIDS and Public Policy Journal Summer:100-105. Koester, S.K., R. Booth, and W. Wiebel 1990 The risk of transmission from sharing water, drug mixing containers, and cotton filters among intravenous drug users. International Journal on Drug Policy 1(6):28-30. Kreek, M.J. 1983 Health consequences associated with the use of methadone. Pp. 456-482 in Research on the Treatment of Narcotic Addiction, J.R. Cooper, F. Altman, B.S. Brown, and D. Czechowicz, eds. Rockville, MD: National Institute on Drug Abuse. Laga, M., H. Taelman, P. Van der Stuyft, et al. 1989 Advanced immunodeficiency as a risk factor for heterosexual transmission of HIV. AIDS 3:361-366.

OCR for page 23
Preventing HIV Transmission: The Role of Sterile Needles and Bleach Lamothe, F., J. Bruneau, R. Coates, J.G. Rankin, J. Soto, R. Arshinoff, M. Brabant, J. Vincelette, and M. Fauvel 1993 Seroprevalence of and risk factors for HIV-1 infection in injection drug users in Montréal and Toronto: A collaborative study. Canadian Medical Association Journal 149(7):945-951. Lampinen, T.M. 1992 Prevalence of Human Immunodeficiency Virus Type I Among Chicago Injecting Drug Users. Thesis submitted in partial fulfillment of the requirements of the Master of Science in Public Health Sciences in the Graduate College of the University of Illinois at Chicago School of Public Health, Chicago. Lange, W.R., F.R. Snyder, D. Lozovsky, V. Kaistha, M.A. Kaczaniuk, and J.H. Jaffe 1988 Geographic distribution of human immunodeficiency virus markers in parenteral drug abusers. American Journal of Public Health 7(4):443-446. Lazzarin, A., A. Saracco, M. Musicco, and A. Nicolosi 1991 Man-to-woman transmission of the human immunodeficiency virus. Risk factors related to sexual behavior, man's infectiousness, and woman's susceptibility. Italian Study Group on HIV Heterosexual Transmission (published erratum appears in Archives of Internal Medicine April 1992, 152[4]:876). Archives of Internal Medicine 151(12):2411-2416. Levine, D.P., and J.D. Sobel, eds. 1991 Infections in Intravenous Drug Abusers. New York, NY: Oxford University Press. Lewis, D.K., and J.K. Watters 1991 Sexual risk behavior among heterosexual intravenous drug users: Ethnic and gender variations. AIDS 5:77-83. Louria, D.B., T. Hensle, and J. Rose 1967 The major medical complications of narcotic addition. Annals of Internal Medicine 67:1-32. MacQuillan, G.M., M. Khare, T.M. Ezzati, et al. 1993 The seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1991 [abstract 21]. P. 59 in Program and Abstracts: The First National Conference on Human Retroviruses and Related Infections. Washington, DC: National Foundation for Infectious Diseases, American Society for Microbiology. Mandell, W., D. Vlahov, C. Latkin, M. Oziemkowska, and S. Cohn 1994 Correlates of needle sharing among injection drug users. American Journal of Public Health 84(6): 920-923. Marmor, M., D.C. Des Jarlais, H. Cohen, S.R. Friedman, S.T. Beatrice, N. Dubin, W. El-Sadr, D. Mildvan, S. Yancovitz, U. Mathur, and R. Holzman 1987 Risk factors for infection with human immunodeficiency virus among drug abusers in New York City. AIDS 1:39-44. McCoy, C.B., P. Shapshak, S.M. Shah, H.V. McCoy, J.E. Rivers, J.B. Page, D.D. Chitwood, N.L. Weatherby, J.A. Inciardi, D.C. McBride, D.C. Mash, and J.K. Watters 1994 HIV-1 Prevention: Interdisciplinary studies and reviews on efficacy of bleach and compliance to bleach prevention protocols. Pp. 255-283 in Proceedings, Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: National Academy Press. McCray, E. 1986 Occupational risk of the acquired immunodeficiency syndrome among health care workers. New England Journal of Medicine 314(17):1127-1132.

OCR for page 23
Preventing HIV Transmission: The Role of Sterile Needles and Bleach Metzger, D.S., G.E. Woody, A.T. McLellan, C.P. O'Brien, P. Druley, H. Navaline, D. DePhilippis, P. Stolley, and E. Abrutyn 1993 Human immunodeficiency virus seroconversion among intravenous drug users in-and out-of-treatment: An 18-month prospective follow-up. Journal of Acquired Immune Deficiency Syndromes 6:1049-1056. Mofenson, L.M. 1992 Preventing mother to infant HIV transmission: What we know so far. The AIDS Reader March/April:42-51. Mondanaro, J. 1990 Treatment of Women with Chemical Dependency Problems. Lexington, MA: Lexington Press. Morse, D.L., L. Lessner, M.G. Medvesky, D.M. Glebatis, and L.F. Novick 1991 Geographic distribution of newborn HIV seroprevalence in relation to four sociodemographic variables. American Journal of Public Health 81(Suppl):25-29. Napoli, V.M., and J.E. McGowan, Jr. 1987 How much blood is in a needlestick? [letter] Journal of Infectious Diseases 155(4):828. Neal, J.J., C.A. Ciesielski, and P.L. Fleming 1993 Heterosexually Acquired AIDS in the United States: The Next Epidemic Wave. Paper presented at the 121st annual meeting of the American Public Health Associations, San Francisco, CA. Nelson, K., D. Vlahov, and S. Cohn 1991 Sexually transmitted diseases in a population of intravenous drug users: Association with seropositivity to the human immunodeficiency virus (HIV). Journal of Infectious Diseases 164:457-463. Nelson, K.E., D. Vlahov, L. Solomon, S. Cohn, and A. Muñoz in press Temporal trends of incident HIV infection in a cohort of injection drug users in Baltimore, Maryland. Archives of Internal Medicine. Nicolosi, A., M.L. Correa Leite, M. Musicco, S. Molinari, and A. Lazzarin 1992 Parenteral and sexual transmission of human immunodeficiency virus in intravenous drug users: A study of seroconversion. American Journal of Epidemiology 135(3):225-233. North, R.L., and K.H. Rothenberg 1993 Partner notification and the threat of domestic violence against women with HIV infection. New England Journal of Medicine 329:1194-1196. Novick, D.M., P. Farci, T.S. Croxsan, M.B. Taylor, C.W. Schneebaum, M.E. Lai, N. Bach, R.T. Senie, A.M. Gelb, and M.J. Kreek 1988 Hepatitis D virus and human immunodeficiency virus antibodies in parenteral drug abusers who are hepatitis B surface antigen positive. Journal of Infectious Diseases 158(4):795-803. Novick, D.M., H.L Trigg, D.C. Des Jarlais, S.R. Friedman, D. Vlahov, and M.J. Kreek 1989 Cocaine injection and ethnicity in parenteral drug users during the early years of the human immunodeficiency virus (HIV) epidemic in New York City. Journal of Medical Virology 29:181-185. Ouellet, L., A. Jimenez, W. Johnson, et al. 1991 Shooting galleries and HIV disease: Variations in places for injecting illicit drugs. Crime and Delinquency 37:64-85. Padian, N.S. 1987 Heterosexual transmission of acquired immunodeficiency syndrome: International perspectives and national projections. Review of Infectious Diseases 9:947-960.

OCR for page 23
Preventing HIV Transmission: The Role of Sterile Needles and Bleach Padian, N., L. Marquis, D.P. Francis, R.E. Anderson, G.W. Rutherford, P.M. O'Malley, and W. Winkelstein, Jr. 1987 Male-to-female transmission of human immunodeficiency virus. Journal of the American Medical Association 258(6):788-790. Padian, N., J. Wiley, and S. Glass 1988 Anomalies of Infectivity in the Heterosexual Transmission of HIV. Paper presented at the Fourth International Conference on AIDS, Stockholm. Padian, N., P.J. Hitchcock, R.E. Fullilove, 3d, V. Kohlstadt, and R. Burnham 1990 Report of the NIAID Study Group on Integrated Behavioral Research for Prevention and Control of Sexually Transmitted Diseases. Part I: Issues in defining behavioral risk factors and their distribution . Sexually Transmitted Diseases 17(4):200-204. Padian, N.S., S.C. Shiboski, and N.P. Jewell 1991 Female-to-male transmission of human immunodeficiency virus. Journal of the American Medical Association 266(12):1664-1667. Padian, N., S. Shiboski, E. Vittinghoff, and N. Hessol 1994 Heterosexual transmission of HIV in Northern California: 1984-1993. Presented at the Society for Epidemiologic Research, Miami. Page, J.B., D. Chitwood, P. Smith, N. Kane, and D. McBride 1990 Intravenous drug use and HIV infection in Miami. Medical Anthropology Quarterly 4(4):56-71. Phillips, R.K., N. Salem, and S.R. Novey 1993 Targeting HIV/AIDS Services to Meet Growing Needs of Underserved Populations in Los Angeles County. Paper presented at the 121st annual meeting of the American Public health Association, San Francisco, CA. Polk, B.F. 1985 Female-to-male transmission of AIDS. Journal of the American Medical Association 254(22):3177-3178. Prevots, D.R., D.M. Allen, J.S. Lehman, T.A. Green, L.R. Petersen, and M. Gwinn 1995 Trends in HIV Seroprevalence Among Injection Drug Users Entering Drug Treatment Centers, United States, 1988-1993. Paper presented at the Second National Conference on Human Retroviruses and Related Infections, Abstract 312. In press, American Journal of Epidemiology. Primm, B.J., L.S. Brown, B.S. Gibson, and A. Chu 1988 The Range of Sexual Behaviors of Intravenous Drug Abusers. Presented at the Fourth International AIDS Conference, Stockholm, June 12-16. Ralph, N., and C. Spigner 1986 Contraceptive practices among female heroin addicts. American Journal of Public Health 76:1016-1017. Redfield, R.R., P.D. Markham, S.Z. Salahuddin, M.G. Sarngadharan, A.J. Bodner, T.M. Folks, W.R. Ballou, D.C. Wright, and R.C. Gallo 1985 Frequent transmission of HTLV-III among spouses of patients with AIDS-related complex and AIDS. Journal of the American Medical Association 253(11):1571-1573. Resnick, L., K. Veren, S.Z. Salahuddin, et al. 1986 Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments. Journal of the American Medical Association 255:53-68. Robertson, J.R., A.B.V. Bucknall, P.D. Welsby, J.J. Roberts, J.M. Inglis, J.F. Peutherer, and R.P. Brettle 1986 Epidemic of AIDS-related virus (HTLV-III/LAV) infection among intravenous drug users. British Medical Journal 292(6519):527-529.

OCR for page 23
Preventing HIV Transmission: The Role of Sterile Needles and Bleach Rogers, D.E. 1992 Report card on our national response to the AIDS epidemic: Some A's, too many D's. American Journal of Public Health 82(4):522-524. Roper, W. L., H. B. Peterson, and J. W. Curran 1993 Commentary: Condoms and HIV/STD prevention—Clarifying the message. American Journal of Public Health 83(4):501-503. Ross, M.W., A. Wodak, and J. Gold 1992 Sexual behaviour in injecting drug users. Journal of Psychology and Human Sexuality 5:89-104. Samuels, J.F., D. Vlahov, J.C. Anthony, L. Solomon, and D.D. Celentano 1991 The practice of ''frontloading" among intravenous drug users: Association with HIV-antibody. AIDS 5(3):343. Sapira, J.D. 1968 The narcotic addict as a medical patient. American Journal of Medicine 45:555-588. Saxon, A., D.A. Calsyn, S. Whittaker, and G. Freeman 1991 Sexual behavior of intravenous drug users in treatment. Journal of Acquired Immune Deficiency Syndromes 4:938-944 Schoenbaum, E.E., D. Hartel, P.A. Selwyn, R.S. Klein, K. Davenny, M. Rogers, C. Feiner, and G. Friedland 1989 Risk factors for human immunodeficiency virus infection in intravenous drug users. New England Journal of Medicine 321(13):874-879. Selwyn, P.A., and P.A. Alcabes 1994 The Potential Impact of Needle Exchange Programs on Health Outcomes Other Than HIV and Drug Use. Paper commissioned by the Panel on Needle Exchange and Bleach Distribution Programs. Selwyn, P.A., R.J. Carter, E.E. Schoenbaum, V.J. Robertson, R.S. Klein, and M.F. Rogers 1989 Knowledge of HIV antibody status and decisions to continue or terminate pregnancy among intravenous drug users. Journal of the American Medical Association 261(24):3567-3571. Solomon, L., J. Astemborski, D. Warren, A. Muñoz, S. Cohn, D. Vlahov, and K. Nelson 1993 Difference in risk factors for human immunodeficiency virus type-1 seroconversion among male and female intravenous drug users. American Journal of Epidemiology 137(8):892-898. Stein, M.D. 1990 Medical complications of intravenous drug use. Journal of General Internal Medicine 5:249-257. Stimmel, B., S. Vernace, and F. Schaffner 1975 Hepatitis B surface antigen and antibody in asymptomatic drug users. Journal of the American Medical Association 243:1135-1138. Turner, C., H. Miller, and L. Moses, eds. 1989 AIDS: Sexual Behavior and Intravenous Drug Use. National Research Council. Washington, DC: National Academy Press. U.S. Public Health Service 1986 Coolfont report: A PHS plan for prevention and control of AIDS and the AIDS virus. Public Health Reports 101:341-348. 1994 Fight against HIV/AIDS moves to new fronts. Prevention Report, Office of Disease Prevention and Health Promotion. Washington, DC: U.S. Department of Health and Human Services. Valdiserri, R. 1994 Presentation at HIV Prevention: Looking Back, Looking Ahead: Targeted and

OCR for page 23
Preventing HIV Transmission: The Role of Sterile Needles and Bleach Universal Approaches to Reducing the Risk of HIV Transmission, New York Academy of Medicine, September 20. Vermund, S.H. 1991 Changing estimates of HIV-1 seroprevalence in the United States. Journal of NIH Research 3:77-81. Vermund, S.H., M.A. Galbraith, S.C. Ebner, A.R. Sheon, and R.A. Kaslow 1992 Human immunodeficiency virus/acquired immunodeficiency syndrome in pregnant women. Annals of Epidemiology 2(6):773-803. Vlahov, D., A. Muñoz, J.C. Anthony, S. Cohn, D.D. Celentano, and K.E. Nelson 1990 Association of drug injection patterns with antibody to human immunodeficiency virus type 1 among intravenous drug users in Baltimore, Maryland. New England Journal of Medicine 123(5):847-856. Weiss, R., and S. Mirin 1987 Cocaine. Washington, DC: American Psychiatric Press. Winkelstein, W., Jr., M. Samuel, N.S. Padian, J.A. Wiley, W. Lang, R.E. Anderson, and J.A. Levy 1987 The San Francisco Men's Health Study, III: Reduction in human immunodeficiency virus transmission among homosexual/bisexual men, 1982-86. American Journal of Public Health 77(6):685-689. Worth, D. 1988 Self-Help Interventions with Women at High Risk of HIV Infection. Montefiore Medical Center, New York City. 1989 Sexual decision-making and AIDS: Why condom promotion among vulnerable women is likely to fail. Studies in Family Planning 20(6):297-307. Zule, W.A. 1992 Risk and reciprocity: HIV and the injection drug user. Journal of Psychoactive Drugs 24(3):243-249.