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Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
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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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

Suggested Citation:"INDEX." Institute of Medicine and . 1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: The National Academies Press. doi: 10.17226/4975.
×

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

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This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.

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