Index

A

Academic research, 69

Activist groups, 75, 77, 80

ACT-UP, 86

Addiction treatment services, 63, 64, 130-132, 253, 274

and African American communities, 117-119

competition for funding, 8, 117, 126-127, 130, 254

concerns about exchange programs, 104, 126-133, 135, 136, 273

and federal regulations, 126, 132, 144

history of enrollment in, 65, 66, 96, 149, 247

professional association positions, 127-130, 307-312

referrals from exchange programs, 8, 81, 82, 89, 90, 131, 199, 208 , 211, 216, 232, 237, 249, 268, 309, 310

Administration of programs, 77, 80, 94, 268

Adolescents, see Youth and adolescents

African Americans

AIDS and HIV seroprevalence, 10, 35-36, 38, 182

bleach distribution participants, 96, 182

church leadership, 117, 118-120

community concerns, 107, 110, 111, 114-115, 116-120, 134, 136

exchange program participation, 83, 84

injection drug use, 62, 65, 67

perinatal transmission, 36

women with AIDS, 31, 35-36

Age

bleach distribution participants, 96

exchange program participation, 81, 84, 215, 226, 231-232, 268

injection drug use estimates, 61, 62

and needle sharing, 149

seroprevalence studies, 271

Agency for Health Care Policy and Research, 254

AIDS cases, 9-10, 23, 31-32, 33, 34

AIDS Outreach Program (AOP), 177



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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Index A Academic research, 69 Activist groups, 75, 77, 80 ACT-UP, 86 Addiction treatment services, 63, 64, 130-132, 253, 274 and African American communities, 117-119 competition for funding, 8, 117, 126-127, 130, 254 concerns about exchange programs, 104, 126-133, 135, 136, 273 and federal regulations, 126, 132, 144 history of enrollment in, 65, 66, 96, 149, 247 professional association positions, 127-130, 307-312 referrals from exchange programs, 8, 81, 82, 89, 90, 131, 199, 208 , 211, 216, 232, 237, 249, 268, 309, 310 Administration of programs, 77, 80, 94, 268 Adolescents, see Youth and adolescents African Americans AIDS and HIV seroprevalence, 10, 35-36, 38, 182 bleach distribution participants, 96, 182 church leadership, 117, 118-120 community concerns, 107, 110, 111, 114-115, 116-120, 134, 136 exchange program participation, 83, 84 injection drug use, 62, 65, 67 perinatal transmission, 36 women with AIDS, 31, 35-36 Age bleach distribution participants, 96 exchange program participation, 81, 84, 215, 226, 231-232, 268 injection drug use estimates, 61, 62 and needle sharing, 149 seroprevalence studies, 271 Agency for Health Care Policy and Research, 254 AIDS cases, 9-10, 23, 31-32, 33, 34 AIDS Outreach Program (AOP), 177

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach AIDS, Sexual Behavior, and Intravenous Drug Use, 57, 58 Alaska, laws, 75, 147 Alcohol and alcohol wipes, 8, 82, 170, 174, 176, 219, 254 American Academy of Psychiatrists in Alcoholism & Additions (aaPaa), 128, 307-308 American College of Addiction Treatment Administrators (ACATA), 128 , 308 American Medical Association (AMA), 127, 128, 308 American Pharmaceutical Association, 124, 125 American Psychiatric Association (APA), 127, 128, 309 American Public Health Association (APHA), 127, 128, 130, 309 American Society of Addiction Medicine (ASAM), 127, 128, 309-310 Ammonium compounds, 170-171 Amphetamine, 67 Amsterdam, Netherlands, exchange programs, 215, 226, 265 Anal intercourse, 28, 42, 218 Ann Arbor, Michigan, 69n Anslinger, Harry Jacob, 144 Anti-Drug Paraphernalia Act, 145 Arizona, public opinion, 115 Arrest, 67, 122-123, 216 perceived risk of, 149, 150, 151 Asbury Park, New Jersey, HIV prevalence, 38 Asian Americans, exchange program participation, 83, 84 Assertiveness training, 82 Assistant Secretary for Health, 7, 45-46, 69, 158, 224 Association for Drug Abuse Prevention and Treatment, 120 Association of Medical Education and Research in Substance Abuse (AMERSA), 310 Atlanta, Georgia, injection drug use estimates, 59 Attitudes, 276 Attrition, 201, 233, 275 Australia exchange program, 2 needle disposal, 6, 157-158 B Backloading, 26, 27, 187 Bacteria and bacterial infections, 27, 149, 170, 171, 172, 190 Baltimore, Maryland, 151 disinfection habits, 178, 187-188 exchange programs, 74, 226, 265 injection drug use studies, 59, 66, 187 laws, 265 prostitution study, 41 public opinion, 107, 116, 136 Bangkok, Thailand, HIV prevalence, 10, 39 Behavior change models, 86, 87 Berkeley, California, exchange programs, 86 Binge episodes, 57-58 Bisexual men, 32, 40, 218 sexual partners of, 28, 40-41 Black Election Study, 119-120 Black population, see African Americans Bleach and bleaching methods, 168, 169-172, 190, 220, 302, 303 CDC recommendations, 5, 13-14, 174-175, 188-189, 190, 191 effectiveness, 2, 82, 172-175, 186-189, 190-191, 270 Bleach distribution programs, 2, 4-5, 8, 74, 75, 82, 95-99, 175-189 , 263, 267, 276 Chicago, 177-178, 180-186, 192n education and outreach services, 5, 13, 97-99, 176, 177-181, 185-186 , 192, 270 evaluation of, 4-5, 218, 270 limitations on effectiveness, 5, 65, 186-187 participant characteristics, 96, 179

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach research needs and funding, 5, 191, 192 Bleachman, 97 Blood-borne pathogens, 27-28, 45, 149, 168, 190 workplace standard, 125 Booting, 25 Boston, Massachusetts exchange programs, 74, 86 injection drug use estimates, 59 Boulder, Colorado, exchange programs, 82, 84, 86 Breastfeeding, 30 Bureau of Narcotics, 144 Bush administration, 144 C CACTUS needle exchange program, 285-293 California Bureau of Narcotic Enforcement, 121 condom use, 42 laws, 77, 147, 175 Canada exchange program, 2, 95 needle sharing, 157 Case-control studies, 214 Amsterdam, 265 New York City, 188 Tacoma hepatitis surveillance, 242-243, 245, 246-248 Case law, 148-149 Case management, 75, 81, 82 Center for Substance Abuse Treatment (CSAT), 5, 13, 188, 190, 191 Centers for Disease Control and Prevention (CDC) AIDS case reporting system, 23, 31, 67 bleaching recommendation, 5, 13-14, 174-175, 188-189, 190, 191 Connecticut study, 123, 152, 154, 155, 156 evaluation research, 254-255 HIV infection estimates, 32, 34, 37, 38, 39 injection drug use estimates, 58-59, 63 Central Intelligence Agency, 117 Chancroid, 29 Chicago, Illinois bisexual transmission, 40-41 bleach distribution programs, 177-178, 180-186, 192n exchange programs, 84, 224-225, 293-304 HIV prevalence, 38 injection drug use, 59, 67, 224-225 intranasal heroin use, 68 public opinion, 114 Chlorine demand, 171 Churches, 117, 118-120 Circulation models, 86, 87, 228-229, 230-231, 255n, 302 Cleaning, 170, 177 Cocaine, 25, 26-27, 40, 43, 57-58, 65, 66, 67, 117. See also Crack Community availability, 149, 157 Community-based studies, 64, 66-68, 69, 265 Community concerns and responses, 5-6, 103-104, 133-137, 252, 253254, 272-273 African Americans, 107, 110, 111, 114-115, 116-120, 134, 136 Latino/Hispanic population, 117, 120-121, 134, 273 law enforcement officers, 104, 121-123, 133, 134, 136, 156, 273 moral and ethical arguments, 105-106 pharmacists, 104, 123-126, 135, 136, 156, 273 public opinion polls, 4, 104, 106-107, 108-115, 133, 136 treatment service providers, 104, 126-133, 135, 136, 273 Community Epidemiology Work Group (CEWG), 66-68, 69 Comparison and cross-sectional studies, 93, 95, 201, 202

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Connecticut needle deregulation, 154-155 New York City, 89-90 see also General Accounting Office review; University of California (Lurie) report Condoms, 8, 13, 42, 44, 75, 82, 176, 177, 179, 181, 199, 211, 213, 218, 219, 254 Confounding factors, 188, 201, 266-267, 275 Connecticut laws, 123, 147, 152-155 public opinion, 112, 113 Consolidation of programs, 151, 267 Constitutionality of drug laws, 147-148 Contact time, 170, 172, 173, 186 Contextual factors, 149 Cookers, 26, 27, 65, 82, 169, 186 Cooperation and coordination among programs, 267 Costs and cost effectiveness, 86-88, 99 Cotton, 26, 27, 82, 181 Counseling services, 75, 81, 82, 97, 179-180 Crack, 43, 179 and women, 34, 41-42 D Dallas, Texas, exchange programs, 74 D.C., see Washington, D.C. DC*MADS, see Washington DC Metropolitan Area Drug Study Deaths, 67, 68, 182 Decontamination, 170 Delaware, laws, 147 de Ligorio, Alphonsi Mariae, 105 Deliveries, 77, 79 Demographic characteristics, 64-66, 82-84, 99, 143, 149, 268, 269 AIDS and HIV seroprevalence, 10, 31, 40, 45, 271 see also Age; Gender; Race and ethnicity; Socioeconomic status Demonstration and research projects, 11, 64-66, 95-99, 179-180, 181 , 220 Denver, Colorado bleach distribution program, 97 public opinion, 115 Deontologist approach, 106 Department of Health and Human Services, 11. See also Assistant Secretary for Health; Center for Substance Abuse; Centers for Disease Control and Prevention; National Institute on Drug Abuse; Public Health Service; Surgeon General Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriation Act (P.L. 102-394), 7, 11, 12, 253 Detroit, Michigan, injection drug use estimates, 59 Diabetics, 151, 153 Dialysis machines, 175 Differential bias, 265 Discarded needles, 8, 80, 99, 136, 157, 200, 216, 217, 226, 237, 251 Disinfection, 168-169, 170, 171, 172-174, 190 Disposal, see Discarded needles Drug abuse, see Injection drug use Drug abuse treatment, see Addiction treatment services E Education and outreach, 8, 13, 27, 75, 81-82, 199, 236, 267 bleach distribution programs, 5, 13, 97-99, 176, 177-181, 185-186, 192, 270 Eligibility for services, 80, 81, 90, 156, 267 Emergency rooms, 67, 216, 274 Endocarditis, 27 Epidemiologic data, 9-10, 23-24 AIDS cases, 9-10, 23, 31-32, 33, 34

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach HIV infection rates, 10, 32 injection drug transmission, 1, 9-10, 32, 34, 36, 37-44 injection drug use, 10, 57-69 Montréal study, 289-293 perinatal transmission, 43-44 research needs, 270-272 sexual transmission, 1, 9-10, 32, 34-36, 40-43 Ethanol, see Alcohol and alcohol wipes Ethics, see Morality and ethics Ethnicity, see Latino/Hispanic population; Race and ethnicity Ethnographic research, 67, 223, 271 disinfection strategies, 175-176, 270 needle sharing, 27, 150 Evaluation research, 91, 254-255, 264-270 F Federal regulation, 125, 143-145 constitutionality, 147-148 exchange program funding, 2, 7, 11-12, 253 reflecting moral arguments, 105 treatment services, 126, 132, 144 Feedback processes, 268 Females, see Women Fixed sites, 77, 79, 80, 235 Focus group studies, 215 Forecasting of drug use, 68, 69 Fort Worth, Texas, injection drug use estimates, 59 France exchange program, 2 needle sharing, 157 Fraternal Order of Police, 121 Frequency of injection drug use, 4, 57-58, 65, 149, 207, 213, 224225, 252 in Chicago study, 293-302 Frontloading, 26, 27, 187 Funding disinfection research, 5, 191, 192 of exchange programs, 2, 7, 8, 11-12, 82, 88, 94, 99, 253 for research programs, 276 of treatment services, 8, 117, 126-127, 130, 254 G Gays, see Homosexuality Gender exchange program participation, 83, 84, 232, 233 injection drug use estimates, 62, 65 and needle sharing, 149 seroprevalence studies, 37-38, 271 see also Men; Women General Accounting Office review, 11, 92, 118, 201, 205-208, 255n, 275 Genocidal theories, 107, 116, 117, 118, 134 Geographic variation HIV infection rates, 10, 37-39, 40, 45, 64, 271, 272 injection drug use, 59-60, 64, 66, 271 Germicides, 170, 172 Great Britain, exchange program, 2 H Harrison Narcotic Act, 143-144 Head shops, 144 Health care services, 75, 81, 82, 236-237, 268 disinfection recommendations, 174-175 facilities as exchange sites, 77, 79 workers' needlestick injuries, 24-25 Heckman method, 300 Hemodialysis machines, 175 Hemophiliacs, sexual partners of, 28 Hepatitis (HBV, HCV), 27, 45, 149, 168, 172, 190, 238, 251, 310 surveillance and seroprevalence studies, 235, 240-243, 245, 246-248 , 271, 272, 276 Heroin, 25, 40, 57-58, 60, 65, 66, 67, 68 Heterosexual cases and transmission, 10, 28, 31, 32, 34-35, 218

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach High school students, 63 Hispanic population, see Latino/Hispanic population HIV infection rates and seroprevalence among infants, 29 geographic variation, 10, 37-39, 40, 45, 64, 271, 272 impacts of needle exchange programs, 86-88, 199, 211, 214, 216, 220 -224, 229, 234, 240, 266 surveillance and monitoring, 10, 23, 32, 38-39, 45-46, 271-272, 276 HIV seroconversion, 45, 272 Chicago studies, 180, 181-186, 303-304 incubation period, 169, 266 Montréal study, 221-223, 286-293 New Haven study, 227-228, 229, 234 San Francisco study, 282-285 Tacoma studies, 237, 240, 244-245 timing relative to program participation, 266, 284 HIV testing and counseling, 75, 81, 82, 179-180, 237 HIV transmission mechanisms, see Injection drug use; Perinatal transmission; Sexual transmission Homeless population, 60, 61 Homosexuality, 1, 9, 28, 32, 34, 36, 40, 218. See also Men, who have sex with men Hours of operation, 81, 86, 265, 267 Houston, Texas, injection drug use estimates, 59 Human T-lymphotrophic viruses (HTLV), 27, 168, 190 Hydrogen peroxide, 170, 174, 176 I Illegal exchange operations, 75, 77, 81, 82, 92, 99, 148 Illinois, laws, 77, 147 Income, see Socioeconomic status Incubation period, 169, 266 Indirect needle sharing, 26-28, 44, 65, 169, 179, 186-187, 266, 267 , 272 Infants, see Perinatal transmission Initiation of drug use, 4, 83, 99, 133, 200, 208, 215, 225-226, 231 -232, 248-250, 252, 269 Injection drug use behaviors and use patterns, 7, 25-28, 39-40, 57-58, 65, 67, 68, 69 , 149, 271 and Connecticut needle legalization, 154-155 duration of, 83, 84, 96, 149, 215, 226, 232 frequency of, 4, 57-58, 65, 149, 207, 213, 224-225, 252 geographic variation, 59-60, 64, 66, 271 HIV infection rates, 1, 9-10, 32, 34, 36, 37-44 HIV transmission mechanisms, 2, 24-28, 149, 167-169, 172-173, 186187 lifetime prevalence, 61 low-seroprevalence areas, 39 and perinatal transmission, 2, 10, 29, 31, 43-44 and sexual transmission, 2, 28, 36, 40-43, 44, 96, 218, 266-267 social networks, 65-66, 149, 269-270, 271, 272 subgroups, 66, 271-272 surveillance and monitoring, 7, 10, 57-69 type of drug, 40, 60, 65, 66, 69, 149 see also Addiction treatment services; Bleach and bleaching methods; Bleach distribution programs; Demographic characteristics; Needle exchange programs; Needle sharing Institutionalized population, 60, 61. See also Prisons and prisoners International Conference on AIDS, 221 Interviewer bias, 265 Intranasal heroin use (snorting), 60, 68

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Iodine, 170 Iowa, laws, 147 Items distributed, 82, 94, 99 Iterative research processes, 268 J Jail, see Prisons and prisoners Judicial rulings, 147-149, 156 K Kaplan model, 86, 87, 228-229, 230-231, 255n, 302 L Laboratory studies disinfection methods, 173-174, 190, 270 field procedures, 270 Latino/Hispanic population AIDS and HIV seroprevalence, 36, 38 bleach distribution participants, 96 community concerns, 117, 120-121, 134, 273 exchange program participation, 83, 84 injection drug transmission, 10 injection drug use estimates, 62, 65 women with AIDS, 36 Law enforcement officers concerns about exchange programs, 104, 121-123, 133, 134, 136, 156 , 273 education of, 155-156 harassment of drug users, 121, 155 needlestick risk, 121, 122, 155, 237 Legal issues, see Federal regulation; Judicial rulings; Paraphernalia laws; Prescription laws;State and local laws Limits on exchanges, 80-81, 90, 99, 156, 235-236, 268, 269 Longitudinal studies, 131, 180 Los Angeles, California HIV prevalence, 38, 39 injection drug use estimates, 59 Louisiana, prescription laws, 124 Lurie study, see University of California report M Mail Order Drug Paraphernalia Act, 145, 148 Maine, laws, 147 Malaria, 27 Males, see Men Manchester, U.K., exchange programs, 91-92 Maricopa County, Arizona, public opinion, 114 Martinez, Robert, 144 Maryland, public opinion, 107, 112, 116, 136 Massachusetts laws, 77, 147 public opinion, 114 Maternity, see Perinatal transmission Mathematical models, 38-39, 86, 87, 88 circulation, 86, 87, 228-229, 230-231, 255n, 302 Men AIDS and HIV cases, 31, 37-38, 182 bleach distribution participants, 96, 182 exchange program participation, 83, 99 heterosexual transmission, 10, 34, 35 homosexual, 1, 9, 28, 32, 34, 36, 40, 218 injection drug use estimates, 62 who have sex with men, 32-36 Methadone maintenance, 37, 38, 41, 130-131, 132, 151, 178, 226, 237 , 270 Methodological problems and limitations, 3-4, 15, 200-204, 304-305 Chicago study, 224-225, 299-302, 304

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach confounding factors, 188, 201, 266-267, 275 cost effectiveness, 87-88 injection drug use estimates, 58, 60-61, 272 Montréal study, 287-289, 291-293 randomized trials, 201, 202, 274-275 respondent characterization, 58, 64-66, 83, 96, 264-265 San Francisco study, 283-285 selection and sampling, 39, 64, 221, 246, 247-248, 266, 283, 284-285 , 288, 291 seroprevalence studies, 23, 32, 38-39, 182-185, 271-272 temporal relationships, 266, 284 Methylphenidate, 67 Metropolitan areas, 59, 66-67 Miami, Florida disinfection habits, 178-179 HIV infection, 32 injection drug use rates, 10 shooting gallery studies, 25-26 Mid-City Consortium to Combat AIDS, 175, 177 Midwest/Central region AIDS and HIV cases, 34, 37 injection drug use, 10, 59-60, 67 Milan, Italy, HIV prevalence, 10, 39 Milwaukee, Wisconsin, exchange programs, 74 Minnesota, exchange programs, 74 Minority groups, see African Americans; Latino/Hispanic population; Race and ethnicity Mobile sites, 77, 79, 80, 235 Model Drug Paraphernalia Act, 145 Monitoring, see Surveillance and monitoring Monitoring the Future Survey, 63 Montréal, Canada, exchange programs, 221-223, 265, 285-293 Morality and ethics, 105-106 of randomized trials, 201, 202, 275 N Narcotic Drug Import and Export Act, 144 Nashua, New Hampshire, 69n National AIDS Demonstration Research (NADR) studies, 64-66, 95-99, 179-180, 181, 220 National Association of Chain Drug Stores, 124-125 National Association of Psychiatric Health Systems (NAPHS), 129, 311 National Association of Social Workers (NASW), 127, 129, 311-312 National Association of State Alcohol and Drug Abuse Directors (NASADAD) , 129, 312 National Consortium of Chemical Dependency Nurses, Inc. (NCCDN), 312 National Household Survey on Drug Abuse (NHSDA), 60, 62, 63 National Institute on Drug Abuse (NIDA) bleach distribution studies, 74, 95, 179 bleaching recommendation, 5, 13, 188, 190, 191 HIV infection estimates, 38 injection drug use estimates, 58, 61, 66, 69, 183 risk behavior surveys, 178 National Institutes of Health, 254-255 Necessity defense, 148 NEED exchange, 86 Needle exchange programs, 2, 4, 11, 74, 75-95, 99, 263, 264-270, 276 administration, 77, 80, 94, 268 ancillary on-site services, 7, 13, 75, 81-82, 94, 99, 254, 268 costs and cost effectiveness, 86-88, 99 and discarded needles, 8, 80, 99, 136, 157, 200, 216, 217, 226, 237 , 251 education and information services, 8, 13, 75, 81-82, 199, 236, 267 eligibility rules, 80, 81, 90, 156, 267

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach in foreign countries, 2, 11, 205, 206, 210 funding, 2, 7, 8, 11-12, 82, 88, 94, 99, 253 hours of operation, 81, 86, 265, 267 illegal operations, 75, 77, 81, 82, 92, 99, 148 impact on HIV transmission and infection rates, 86-88, 199, 211, 214, 216, 220-224, 229, 234, 240, 266 and initiation of drug use, 4, 83, 99, 133, 200, 208, 215, 225-226 , 231-232, 248-250, 252, 269 items distributed, 82, 94, 99 legal issues, 6, 75-77, 92-93, 94, 148-149 limits on syringes exchanged, 80-81, 90, 99, 156, 235-236, 268, 269 needle sharing impacts, 199, 206, 207, 211, 212, 218, 219, 220, 251, 302-304 organizational and operational characteristics, 75, 77-82, 89-95, 267-270 participation, 75, 82-84, 268, 269 policies, 80-81, 267-268 as promoting and increasing drug use, 4, 105, 122, 126, 127, 132-133 , 200, 214-216, 217, 224-226, 251-252 siting and location, 77, 79-80, 82, 90, 94, 99, 267 staffing, 80, 82, 89, 93, 94 treatment referrals, 8, 81, 82, 89, 90, 131, 199, 208, 211, 216, 232, 237, 249, 268, 309, 310 see also Community concerns and responses; under names of individual jurisdictions, for descriptions and studies of specific programs Needle sales and distribution, 151, 265 availability, see Community availability deregulation of, 136, 147, 152-158, 273 from diabetics, 265 and disposal of needles, 124, 125, 154, 157-158, 273 laws restricting, 6, 8, 75-77, 78, 122, 144, 147, 152, 156-157, 158 from pharmacies, 123-126, 136, 150, 152-155, 265 renting, 25-26, 65, 219 scarcity, see Needle sharing. relation to needle scarcity by secondary exchangers, 91-92, 206, 264-265 see also Needle exchange programs Needle sharing, 2, 10, 24-26, 39-40, 44, 45, 65, 159n, 167-168, 186 , 272 and Connecticut needle legalization, 154-155 factors in, 149, 150-151 impacts of exchange programs, 199, 206, 207, 211, 212, 218, 219, 220, 251, 302-304 indirect, 26-28, 44, 65, 169, 179, 186-187, 266, 267, 272 relation to needle scarcity, 10, 150-151 as ritual, 150 Needlestick injuries, 136, 216 of health care workers, 24-25 of law enforcement officers, 121, 122, 155, 237 Netherlands exchange program, 2 needle sharing, 157 Newark, New Jersey injection drug use estimates, 59 intranasal heroin use, 68 New Hampshire, laws, 147 New Haven, Connecticut, exchange programs, 84, 86, 205, 226-234, 302 New Jersey AIDS cases, 31 laws, 147 New Orleans, Louisiana, pharmacy sales, 124

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach New York City AIDS and HIV prevalence, 10, 31-32, 38, 39, 223 bleach distribution program, 177-178 exchange programs, 84, 86, 89-90, 91, 92-93, 120, 121, 136, 218-220 , 223-224 injection drug use studies, 59, 60, 175, 187 intranasal heroin use, 68 public opinion, 108, 110, 111, 113 women at risk, 41 New York State AIDS cases, 31 laws, 77, 147 North Dakota, laws, 147 Northeastern region AIDS and HIV cases, 32, 34, 37, 38, 39 condom use, 42 injection drug use rates, 10, 59, 60 O Observational epidemiologic studies, 274, 275 Occupational Safety and Health Administration (OSHA), 125, 155 Office of National Drug Control Policy, 105, 144 One-for-one exchange programs, 80, 90, 156, 216, 235, 268, 302 Ordinary least squares (OLS) method, 300, 301 P Paraphernalia laws, 7, 75, 76, 121, 136, 144-147, 156-157 Baltimore, 265 constitutionality, 147 federal, 145 impacts on needle sharing, 6, 123, 150, 151, 158 as tool for arresting dealers, 122-123 Pediatric cases, 31, 36, 37 Pennsylvania, laws, 147 Pentazocine, 67 Perinatal transmission, 29-30, 31, 46n and injection drug use, 2, 10, 29, 31, 43-44 Pharmacists and pharmacies, 104, 123-126, 135, 136, 156, 273 and Connecticut needle sale law, 123, 152-155 drug-user incidents and problems, 124, 125, 153-154 education of, 155, 156 foreign studies, 124 Phenmetrazine, 67 Philadelphia, Pennsylvania injection drug use estimates, 59 seroprevalence study, 39 Plausibility, 203-204 Population characteristics, see Demographic characteristics Portland, Oregon, exchange programs, 84, 86, 216, 220, 226 Pregnancy, see Perinatal transmission Prescription laws, 6, 8, 75-77, 78, 121, 122, 123, 144, 145-147, 152, 156, 157, 158, 265 constitutionality, 147-148 federal, 143-144 as tool for arresting dealers, 122-123 Prevention Point program, 282 Prisons and prisoners bleach distribution participants, 96 injection drug use estimates, 64, 65 Montréal study, 286-287, 288-289 prevention research, 274 Professional associations, 127-130, 307-312 Programmatic research, 268 Promotion and increase of drug use, 4, 105, 122, 126, 127, 132-133 , 200, 214-216, 217, 224-226, 251-252 Proportionalist approach, 105-106 Prospective studies, 202 community-based, 265 Connecticut needle deregulation, 152-154

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Prostitution, 41, 42, 43, 222 for drugs, 41-42 Public Health Impact of Needle Exchange Programs in the United States and Abroad, see University of California (Lurie) report Public Health Service (PHS) HIV infection estimates, 32 injection drug use estimates, 58 Tuskegee Syphilis Study, 107 Public opinion polls, 4, 104, 106-107, 108-115, 133, 136 Puerto Rico HIV infection, 34 injection drug use rates, 10 Pure Food and Drug Act, 143 Q Quality assurance programs, 268 R Race and ethnicity AIDS and HIV seroprevalence, 31, 34, 36, 37, 40, 271 and ancillary services, 268 bleach distribution participants, 96 exchange program participation, 83, 99 homosexual transmission, 34 injection drug transmission, 10, 36 injection drug use estimates, 62 women with AIDS, 36 see also African Americans; Asian Americans, exchange program participation; Latino/Hispanic population; White population Randomized trials, 201, 202, 203, 274-275 Rangel, Charles, 117, 118-119 Reagan administration, 144 Recall and response bias, 201, 265 Recruitment and retention, 75, 268 Regional differences, see Geographic variation Registering, 25 Relapse, 130, 131, 132 Rhode Island exchange programs, 74 laws, 147 Rinse water, 26-27, 65, 169, 176, 186 Risk knowledge and perception, 149, 150-151 Riverside, California, injection drug use estimates, 59 Roving vans, 77, 79 Running partners, 65 Rural areas, 69n S San Diego, California, injection drug use, 67 San Francisco, California AIDS cases, 31 bleach distribution program, 97, 175-176, 177, 187, 188, 217-218 condom use, 42 exchange programs, 84, 121, 219, 223, 226, 281-285 injection drug use estimates, 59, 175, 215 young program participants, 83 San Juan, Puerto Rico, injection drug use, 59, 60 School-distance zoning, 90 Screening and counseling services, 75, 81, 82, 90, 91, 97, 179-180 , 236-237 Secondary and surrogate exchangers, 81, 236, 264-265 Selection and sampling bias, 39, 64, 221, 246, 247-248, 283, 284-285 , 288, 291 Sepsis, 27 Seroconversion, see HIV seroconversion Serrano, Yolanda, 120, 121 Sex, see Gender; Men; Prostitution; Sexual transmission; Women

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Sexually transmitted diseases, 29, 45, 75, 81, 82, 272, 274 Sexual transmission, 1, 9-10, 24, 28-29, 31, 32, 34-36, 40-43, 182 , 184 and crack use, 41-42 homosexual, 1, 9, 28, 32, 34, 36, 40, 218 and injection drug use, 2, 28, 36, 40-43, 44, 96, 218, 266-267 prevention of, 45, 46, 82, 211, 213, 218, 220 social networks, 272 women at risk, 28, 34-35, 40-43 see also Condoms; Prostitution Shooting galleries, 25-26, 40, 149, 179, 218 Single-time users, 264 Siting and location, 77, 79-80, 82, 90, 94, 99, 267 Situational factors, 149 Snorting, 60, 68 Social desirability effects, 246 Social networks, 65-66, 149, 269-270, 271, 272, 276 and bleach distribution programs, 180, 181 Social sercices, 7, 13, 75, 81-82, 94, 99, 254, 268 Socioeconomic status, 268 Sodium hypochlorite, see Bleach and bleaching methods South Carolina, laws, 147 Southern region AIDS and HIV cases, 35, 37-38 injection drug use rates, 60 Speedball, 65 Staffing, 80, 82, 89, 93, 94 Starter needles, 80, 216 State and local laws, 75-77, 144-147, see also under names of individual jurisdictions challenges to, 147-149 constitutionality, 147-148 deregulation and repeal, 147, 152-155, 156, 157, 158, 275 drug-free zones, 77, 90 impacts on needle sharing, 150-151 pharmacy sales, 124, 125-126, 152-155 precedence of public health laws, 148 prostitution, 77 Stationary vans, 77, 79 Statistical sensitivity, 201, 207-208 Sterilization, 169-170 Stimulants, 67 Storefronts, 77, 79 Street sites, 77, 79 Subpopulations, see Demographic characteristics Substance Abuse and Mental Health Services Administration (SAMHSA), 60. See also Center for Substance Abuse Supreme Court, 147 Surgeon General, 2, 7, 11, 253 Surrogates, see Secondary and surrogate exchangers Surveillance and monitoring at community and local level, 7, 38-39, 66-68, 69, 255, 268-269, 271 of injection drug use, 7, 10, 57-69 see also Epidemiologic data Surveys and studies, see Case-control studies; Community-based studies; Comparison and cross-sectional studies; Epidemiologic data; Ethnographic research; General Accounting Office review; Mathematical models; Methodological problems and limitations; Monitoring the Future Survey; National AIDS Demonstration Research (NADR) studies; National Household Survey on Drug Abuse; Prospective studies; Public opinion polls; Randomized trials; Surveillance and monitoring; University of California (Lurie) report; Washington DC Metropolitan Area Drug Study; Youth Risk Behavior Survey Syphilis, 27, 29, 42, 107

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Syringes, see Bleach and bleaching methods; Bleach distribution programs; under terms beginning Needle in this index Systematic measurement error, 292, 301 T Tacoma, Washington, 69n exchange programs, 82, 84, 86, 205, 234-250 Tacoma Pharmacy Exchange, 86 Tagged syringes, 92-93 Texas condom use, 42 injection drug use estimates, 59 The Works, 82 Time and temporal variation, 64, 266, 284 of injection equipment availability, 149, 157 Track marks, 81 Transient populations, 60, 61 Transmission mechanisms, see Injection drug use; Needle sharing; Perinatal transmission; Sexual transmission Treatment, see Addiction treatment services Trend analysis, 68 Tripelennamine, 67 Ts and blues, 67 Tuberculosis, 75, 81, 82, 90, 91, 237 Tuskegee Syphilis Study, 107 Two-stage least-squares (2SLS) procedure, 299, 300-301 U Underground exchanges, see Illegal exchange operations Unemployment, injection drug use estimates, 65 Uniform Controlled Substances Act, 145 Uniform Crime Reports (UCR), 216 University of California (Lurie) report, 13, 74, 75, 86, 124, 201, 208-217, 275 Urinalysis data, 67, 216 User-friendliness, 91-93, 94, 95, 99, 268 Utah, public opinion, 108, 113 V Vans, 77, 79 Volunteers, 80, 82, 93 W Walk routes, 77, 79 Washington, D.C. exchange programs, 84, 90-91, 136 injection drug use estimates, 59 laws, 147 Washington DC Metropolitan Area Drug Study (DC*MADS), 61-63, 70n Washington State exchange programs, 148 public opinion, 108-111 Western region AIDS and HIV cases, 35, 37, 38 injection drug use rates, 10, 59 White population AIDS and HIV seroprevalence, 36, 38, 182 bleach distribution participants, 96, 182 exchange program participation, 83, 84, 233 injection drug use, 62, 65, 67 women with AIDS, 36 Wishart Drug Problems Centre, 89 Women AIDS and HIV seroprevalence, 1, 31, 34-36, 37-38, 40 bleach distribution participants, 96 and crack, 34, 41-42 exchange program participation, 8, 83, 84, 254

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach injection drug use estimates, 62, 65 sexual transmission risk, 28, 34-35, 40-43 see also Perinatal transmission Y Youth and adolescents AIDS and HIV seroprevalence, 31, 34, 38, 40, 83 exchange program participation, 8, 81, 83, 215, 254, 272 homosexual transmission, 34 injection drug use, 61, 63, 215, 272 Youth Risk Behavior Survey, 63 Z Zidovudine (AZT), 30