Interrupting the social processes linked with initiation of injection drug use: results from a pilot study.

BACKGROUND: Injection drug use is a skill learned in social settings. Change the Cycle (CTC), a peer-delivered, one-session intervention, is designed to reduce among people who inject drugs (PIDs) injection initiation-related behaviours (i.e., speaking positively about injecting to non-injectors, injecting in front of non-injectors, explaining or showing a non-injector how to inject) and initiation of non-injectors. We hypothesized that participation in CTC would lead to reductions in initiation-related behaviours six months later. METHODS: Using respondent driven sampling (RDS), 98 PIDs were recruited in Toronto, Canada to participate in pilot testing of CTC. The baseline session consisted of a structured interview, the peer-delivered CTC intervention, instructions regarding RDS coupon distribution, and an invitation to return in six months for a follow-up interview. For the 84 PIDs completing the six-month interview, we compared initiation-related behaviours at baseline with six-month follow-up. RESULTS: The proportion of PIDs offering to initiate a non-injector was reduced from 8.4% (95% CI: 2.5, 15.9) at baseline to 1.59% (95% CI: 0.4, 3.7) at 6-month follow-up. The prevalence of speaking positively about injection to non-injectors also decreased significantly. The proportion of PIDs who helped a non-injector with a first injection at baseline was 6.2% (95% CI: 2.1, 11.3) and at follow-up was 3.5% (95% CI: 0.8, 7.1). Paired analyses of initiator baseline versus follow-up data showed a 72.7% reduction in initiation (95%CI: 47.7, 83.1). CONCLUSIONS: While further refinements remain to be tested, pilot study results suggest that CTC holds promise as a prevention intervention.

An indigenous plant food used by lactating mothers in west Africa: the nutrient composition of the leaves of Kigelia africana in Ghana.

Although the leaves of Kigelia africana are used to make a palm-nut soup which is consumed mainly by lactating women in many parts of sub-Saharan Africa, little is known about the nutrient qualities of this underutilized and underappreciated plant food. Leaves of Kigelia africana, called "sausage tree" in English and "nufuten" in the Twi language of Ghana, were collected in Kumasi and analyzed for their content of nutritionally important fatty acids, amino acids, minerals, and trace elements. The dried leaves contained 1.62% fatty acids, of which α-linolenic acid and linolenic acid accounted for 44% and 20%, respectively, of the total. Protein accounted for 12.6% of the dry weight and, except for lysine, its overall essential amino acid profile compared favorably to a World Health Organization protein standard for school children. Kigelia leaf contained considerable amounts of many essential elements, including calcium (7,620 µg/g), iron (161 µg/g), magnesium (2,310 µg/g), manganese (14.6 µg/g), zinc (39.9 µg/g), and chromium (0.83 µg/g); selenium, however, was not detected. These data indicate that Kigelia africana leaf compares favorably with many other commonly-consumed green leafy vegetables such as spinach and provides a rational basis for promoting the conservation and propagation of the plant and encouraging its wider use in the diets of populations in sub-Saharan Africa.

Mother-to-child transmission of GB virus C in a cohort of women coinfected with GB virus C and HIV in Bangkok, Thailand.

BACKGROUND: GB virus C (GBV-C) is an apathogenic virus that inhibits human immunodeficiency virus (HIV) replication in vitro. Mother-to-child transmission (MTCT) of GBV-C has been observed in multiple small studies. Our study examined the rate and correlates of MTCT of GBV-C in a large cohort of GBV-C-HIV-coinfected pregnant women in Thailand. METHODS: Maternal delivery plasma specimens from 245 GBV-C-HIV-infected women and specimens from their infants at 4 or 6 months of age were tested for GBV-C RNA. Associations with MTCT of GBV-C were examined using logistic regression. RESULTS: One hundred one (41%) of 245 infants acquired GBV-C infection. MTCT of GBV-C was independently associated with maternal antiretroviral therapy (adjusted odds ratio [AOR], 5.21 [95% confidence interval {CI}, 2.12-12.81]), infant HIV infection (AOR, 0.05 [95% CI, 0.01-0.26]), maternal GBV-C load (8.0 log(10) copies/mL: AOR, 86.77 [95% CI, 15.27-481.70]; 7.0-7.9 log(10) copies/mL: AOR, 45.62 [95% CI, 8.41-247.51]; 5.0-6.9 log(10) copies/mL: AOR, 9.07 [95% CI, 1.85-44.33]: reference, <5 log(10) viral copies/mL), and caesarean delivery (AOR, 0.26 [95% CI, 0.12-0.59]). CONCLUSIONS: Associations with maternal GBV-C load and mode of delivery suggest transmission during pregnancy and delivery. Despite mode of delivery being a common risk factor for virus transmission, GBV-C and HIV were rarely cotransmitted. The mechanisms by which maternal receipt of antiretroviral therapy might increase MTCT of GBV-C are unknown.

Amino acid, mineral and fatty acid content of pumpkin seeds (Cucurbita spp) and Cyperus esculentus nuts in the Republic of Niger.

Dried seeds and nuts are widely consumed by indigenous populations of the western Sahel, especially those who inhabit rural areas. In light of the need for quantitative information regarding the content of particular nutrients in these plant foods, we collected dried pumpkin (Cucurbita spp) seeds and nuts of Cyperus esculentus in the Republic of Niger and analyzed them for their content of essential amino acids, minerals and trace elements, and fatty acids. On a dry weight basis, pumpkin seed contained 58.8% protein and 29.8% fat. However, the lysine score of the protein was only 65% relative to the FAO/WHO protein standard. The pumpkin seed contained useful amounts of linoleic (92 microg/g dry weight) and the following elements (on a microg per g dry weight basis): potassium (5,790), magnesium (5,690), manganese (49.3), zinc (113), selenium (1.29), copper (15.4), chromium (2.84), and molybdenum (0.81), but low amounts of calcium and iron. Except for potassium (5,573 microg/g dry weight) and chromium (2.88 microg/g dry weight), the C. esculentis nuts contained much less of these same nutrients compared to pumpkin seeds. In conclusion, pumpkin seeds represent a useful source of many nutrients essential to humans. The data in this report should of practical value to public health officials in rural areas of sub-Saharan Africa.

Nutrient content of four edible wild plants from west Africa.

Non-cereal plant foods in the Western Sahel of Africa contribute significantly to the diets of local residents, especially during periods of grain shortages. In this paper, we analyze four such plant foods including diyan kwakwa (nut of coconut palm, Cocos nucifera L.), muricin giginya (young shoot of Borassus aethiopum), tsamiya biri (fruit of the tree, Tamarindus indica), and yari (a mixture of lichens, mainly Rimelia reticulate) that grows on ebony trees (Diospyros mespiliformis). They were analyzed for their content of amino acids, fatty acids, and minerals. Although diyan kwakwa contained the highest protein content (27.1%), its protein quality fell below the WHO standard in 3 of 8 essential amino acid categories. Yari and muricin giginya contained moderate levels of good quality protein. Only diyan kwakwa contained calorically significant amount of total fatty acid (24.7%); however, none of the plants contained useful amounts of the essential fatty acids, linoleic acid, or alpha-linolenic acid. All four plants contained useful amounts of zinc (> 12 microg/g dry weight), while yari contained the most calcium (14.7 mg/g dry weight) and iron (1.41 mg/g), and diyan kwakwa the most copper. All the four plant foods contained lesser amounts of magnesium, molybdenum, or selenium. These data indicate that the four plants contain useful amounts of various essential nutrients that could supplement the diets of populations inhabiting the Western Sahel.

Nutrient content of earthworms consumed by Ye'Kuana Amerindians of the Alto Orinoco of Venezuela.

For the Makiritare (Ye'Kuana) native people of the Alto Orinoco (Venezuela), earthworms (Anellida: Glossoscolecidae) are an important component of the diet. Two species in particular are widely consumed: 'kuru' (Andiorrhinus kuru n. sp.) and 'motto' (Andiorrhinus motto). We analysed eviscerated kuru body proper, and whole and smoked preparations of motto for their content of protein and amino acids, fatty acids and 20 minerals and trace elements. The samples contained large amounts of protein (64.5-72.9% of dry weight), essential amino acids, calcium and iron together with notable quantities of other important elements, indicating that these earthworms contain potentially useful quantities of many nutrients that are critical to the health of the humans who consume them.

Lead levels in the milk of Fulani women in Nigeria.

Levels of lead were determined in the milk of 34 Fulani women in Plateau State in northern Nigeria. The Fulani are nomadic, semi-pastoralists who inhabit the western Sahel, including the countries of Mali, Burkino Faso, the Republic of Niger, Nigeria and Chad. The mean age of the women in this study was 26.0 +/- 7.5 years and their mean body mass index (BMI, kg/m2) was 19.4 (range, 14.5-24.0). Their average parity was 4 (range, 1-10). Milk was collected 2-24 weeks postgestation (mean, 11 weeks). Fifteen of the 34 milk specimens contained measurable lead (limit of detection, 4.6 microg/dL); the milk of the other 19 women (56%) did not contain a detectable level of lead. The data were not normally distributed. The median lead concentration of all 34 milk specimens, determined by end on plasma-axial view spectrometry, was 6.7 microg/dL (range, < 4.6-130 microg/dL). Given the mean weight of the 34 infants in the study (4.6 kg) and assuming that each infant consumed 0.7 L/day of milk, the average lead intake of these exclusively breastfed infants was 9.9 microg/kg/day, a value which is twice the daily permissible intake (DPI) of 5.0 microg/g/day set by the World Health Organization in 1972. These data indicate that some exclusively breastfed Fulani infants in the Jos Plateau are at risk of injury from lead derived from their mothers' milk, and raise questions about the actual blood levels in these nursing infants and the source(s) of the maternal lead.

Correlation between the content of intermediate chain-length fatty acids and copper in the milk of Fulani women.

Intermediate chain-length fatty acids (C10-C14) in human milk triglycerides provide an easily absorbable fuel that provide a significant amount of the energy needed for growth during the first few months of life. The C10-C14 fatty acid and trace mineral content of human milk is variable. In this report we examined the relationship between the content of calcium, copper, magnesium, manganese, phosphorus, and zinc, and the weight percentage of C10-C14 fatty acids in milk from 33 Fulani women in northern Nigeria between 2 and 24 weeks post-gestation. The milk from these women contained proportions of C10-C14 fatty acids that were comparable to those reported for other populations around the world, as were the concentrations of Ca, Cu, Mg, Mn, Zn and P. Significant correlations were observed between the milk content of Cu and the wt% of C10 (P=0. 005, r=0.475), C12 (P=0.001, r=0.539), C14 (P=0.44, r=0.352) and the total intermediate chain-length fatty acids (P=0.008, r=0.450). No correlations were observed between these fatty acids and any of the other five minerals. We speculate that the relationship between Cu and fatty acids could be related to a requirement for Cu by an enzyme required for C10-C14 fatty acid biosynthesis (e.g. decanoyl deacylase) in mammary tissue, or to some unique Cu binding properties of the intermediate chain length fatty acids.

Concentration of eight trace minerals in milk and sera of mother-infant pairs in northern Nigeria.

Breastmilk from 15 healthy lactating women (21-31 years of age) from the hot, semi-arid sahel of Africa were analysed for copper, iron, zinc, magnesium, manganese, sodium, potassium, and phosphorus. Relative to published data from other populations worldwide, the milk of the Jos women appeared to contain adequate levels of magnesium, manganese, sodium, potassium, phosphorus and iron, but relatively low concentrations of zinc (1.07 micrograms/ml) and copper (170 micrograms/l). The sera of the exclusively breastfed infants nursed by these mothers contained levels of all these minerals that are within the international reference range of values. No statistically significant correlation was observed between the level of a particular mineral in the mothers' milk and the sera of their nursing infants.

Toronto street youth and HIV/AIDS: prevalence, demographics, and risks.

PURPOSE: The purposes of this study were: (a) to identify human immunodeficiency virus (HIV) prevalence in Toronto street youth through paired blood and saliva specimens; (b) to identify the HIV risk and prevention behaviors of street involved youth; and (c) to identify demographic or other factors that may contribute to the risk of street youth becoming infected with HIV/acquired immunodeficiency syndrome (AIDS) in the future. METHODS: This was a cross-sectional convenience study of street-involved youth aged 14-25 years. The youth participated in interviews to identify HIV-related knowledge and personal risk and preventive behaviors. Following interviews, they were asked to provide a saliva sample, blood spot, or both. They could refuse one or both samples without jeopardizing their involvement or receiving an honorarium. Two males were the only participants who declined to provide a sample. RESULTS: Fifteen of 695 (2.2%) youth tested positive for HIV infection. All were male, ranging in age from 18 to 25 years. Same and opposite sex, intravenous (IV) drug use, prostitution, and incarceration were risk factors associated with positive HIV test results. The rate of HIV infection was seven times greater for the group 20 years of age and older (20-25) compared to the younger group aged 14-9 years. The proportion testing positive for HIV from small cities, towns, and rural communities in Ontario was 40%; yet, they represented 21% of the study population. Most (57%) youth had been on their own for no more than 3 years and had moved frequently. Nearly two thirds (60%) had stayed in hostels or homeless shelters in the previous 6 months. CONCLUSION: Street youth in Canada are at high risk of HIV infection with their risk increasing with age. Unprotected (same and opposite) sex, IV drug use, prostitution and incarceration were linked to their HIV infections. The high level of mobility identified by street youth challenges governments, communities, and public health officials to develop appropriate prevention strategies and to carefully monitor the spread of HIV infection in this vulnerable population.

Prevalence of Mycobacterium tuberculosis infection among injection drug users in Toronto.

BACKGROUND: Injection drug users are at increased risk of Mycobacterium tuberculosis infection and active tuberculosis (TB). The primary objective of this study was to determine the prevalence of M. tuberculosis infection among injection drug users in Toronto, as indicated by a positive tuberculin skin test result. An additional objective was to identify predictors of a positive skin test result in this population. METHODS: A cross-sectional study was carried out involving self-selected injection drug users in the city of Toronto. A total of 171 participants were recruited through a downtown Toronto needle-exchange program from June 1 to Oct. 31, 1996. RESULTS: Of 167 subjects tested, 155 (92.8%) returned for interpretation of their skin test result within the designated timeframe (48 to 72 hours). Using a 5-mm cut-off, the prevalence rate of positive tuberculin skin test results was 31.0% (95% confidence interval 23.8% to 38.9%). Birth outside of Canada and increasing age were both predictive of a positive result. INTERPRETATION: There is a high burden of M. tuberculosis infection in this population of injection drug users. The compliance observed with returning for interpretation of skin test results indicates that successful TB screening is possible among injection drug users.

Analysis of nutritional components of eight famine foods of the Republic of Niger.

In the western Sahel, indigenous plants become important staples when cereal harvests are inadequate to support populations inhabiting that region of Africa. The purpose of this study was to assess the nutrient content of several of these edible wild plants. The leaves of the following seven plant foods were analyzed: Ziziphus mauritiana, Cerathotheca sesamoides, Moringa oleifera, Leptadenia hastata, Hibiscus sabdarifa, Amaranthus viridis, and Adansonia digitata. The fatty acid, vitamin E, carotenoid, selected mineral and amino acid contents of these plant foods were determined. These same analyses were performed on the fruit of the Adanisonia digitata. In quantitative and qualitative terms, Amaranthus viridis was found to be an excellent source of protein. Its amino acid composition compared favorably to that of a World Health Organization (WHO) protein standard. It also contained considerable amounts of the two fatty acids that are essential in humans (linoleic and alpha-linolenic) and a number of minerals including iron, magnesium. calcium and zinc. The leaves of Hibiscus sabdarifa contained an appreciable quantity of protein the composition of which was comparable to the WHO standard. The mineral content of the leaves of this plant was also exceptionally high; noteworthy was its high zinc content. H. sabdarifa also contained significant quantities of the two essential fatty acids. Ziziphus mauritiana was an excellent source of the essential fatty acid linoleic acid and several of the metals including iron, calcium, magnesium and zinc. Its content of other essential nutrients, however, was rather low. In general, Adansonia digitata leaves were nutritionally superior to the fruit of the tree; however, the fruit did contain useful quantities of potassium, phosphorus, zinc and alpha-linolenic acid. The Leptadenia hastata leaves were an especially good source of lutein and beta-carotene. These data should be useful to the people who inhabit the western Sahel in helping them devise healthy diets during times when cereal staples are in short supply.

Ultrasonic extraction and field-portable anodic stripping voltammetry for the determination of lead in workplace air samples.

An on-site, field-portable analytical method for the determination of lead in workplace air samples, based on the use of ultrasonic extraction and anodic stripping voltammetry (ASV), was evaluated. Workplace air samples were obtained using a standard method involving particulate collection onto mixed cellulose ester membrane filters. Samples were collected at work sites where airborne particulates were generated from the abrasive blasting of lead-containing paint on highway bridges. Ultrasonic extraction (UE) of air filter samples in diluted nitric acid, followed by portable ASV, was used for the determination of lead. Also, performance evaluation samples consisting of reference materials of known lead concentration were subjected to the UE-ASV procedure for lead determination. Confirmatory analyses of the air filters and performance evaluation samples subjected to the UE-ASV lead measurement method were conducted by hotplate digestion in concentrated nitric acid and 30% hydrogen peroxide, followed by inductively coupled plasma-atomic emission spectrometric (ICP-AES) determination of lead. Recoveries of lead from performance evaluation materials (when using the UE-ASV method) were found to be quantitative. The performance of the UE-ASV method for lead in air filters was found to be acceptable, as evaluated by comparison with results from hotplate strong acid digestion followed by ICP-AES analysis. Based on the results of this study, the ultrasonic extraction/portable ASV procedure demonstrates potential for the on-site determination of lead in personal breathing zone and area air samples.

Community pharmacist perspectives on HIV/AIDS and interventions for injection drug users in Canada.

In several countries, community pharmacies play a major role in the provision of HIV prevention services to injection drug users (IDUs). In this study, results from a national Canadian Survey of Community Pharmacies and HIV/AIDS Prevention are used to describe pharmacists' perspectives on HIV/AIDS and services to IDUs, and explore the relationship between personal and organizational characteristics and the level of support for HIV/AIDS prevention initiatives. A mailed questionnaire was directed to a random sample of 2,017 pharmacist owner-managers. The response rate was 84.6%. Results suggest that current services to IDUs primarily are limited to discretionary needle and syringe sales to non-diabetics, with almost three-quarters supportive. Staff safety was an important consideration in the provision of this service (77%), while remuneration was the lowest (27%). Community pharmacists were most comfortable with the provision of counselling, advice and literature (X = 2.6) and environmental and technological interventions (X = 2.4) and least supportive of provision of services as part of a programme (X = 1.6) and legalization of drugs or prescription of methadone (X = 1.9). Female pharmacists were more likely to support preventive measures such as the provision of counselling or advice, and males were more likely to promote legislative change. Pharmacists appear generally willing to expand their services in the fight against HIV/AIDS. However, it is not feasible to expect uniform programmes to be immediately introduced. While organizational, educational and policy changes may facilitate programme development, individual pharmacy and pharmacist discretion remains important.

Nutrient content of the edible leaves of seven wild plants from Niger.

Wild plants play an important role in the diet of the inhabitants of Niger. These plants tend to be drought-resistant and are gathered both in times of plenty as well as times of need. Used in everyday cooking, famine foods may be an important source of nutrients. The goal of this study was to investigate the nutritional role of wild plants in the nigérien diet. To this end, leaves of seven plants species were analyzed for their mineral, amino acid and fatty acid contents: Ximenia americana, Amaranthus viridus, Corchorus tridens, Hibiscus sabdarifa, Maerua crassifolia, Moringa oleifera, and Leptadenia hastata. Ximenia americana contained large amounts of calcium. Large quantities of iron were present in Amaranthus viridus. All seven plants contained significant amounts of selenium and phosphorus. Corchorus tridens contained the most protein (19-25% dry weight), and its composition compared favorably to the World Health Organization's standard for essential amino acids. Moringa oleifera contained 17% protein and compared favorably with the WHO standard. Corchorus tridens contained the largest amounts of the two essential fatty acids linoleic and alpha-linolenic acids. These results reinforce the growing awareness that wild edible plants of the Western Sahel can contribute useful amounts of essential nutrients, including amino acids, fatty acids and trace minerals, to human diets.

The role of policy in community pharmacies' response to injection-drug use: results of a nationwide Canadian survey.

The response rate to this survey reflects the salience of the topic and the professional concern about and interest in issues presented by HIV. The HIV/AIDS epidemic has presented pharmacists with one of the greatest challenges to their professional training, ethics, and practice. It further expedites a current re-examination that is occurring among community pharmacies concerning their roles in community health practices. In response to HIV there have been dramatic and unprecedented changes in pharmacy policy and practices. Clearly, some community pharmacies have led the way and influenced policy and practices. In view of the recent introduction of many of these policies and practices, it is likely that change will continue. Survey respondents were, in general, very comfortable with an expanded role involving counseling, health promotion, and disease prevention, consistent with a broader role for community pharmacies in general that has been recently advocated. Community pharmacies serve all areas of the country, in communities large and small; many are open seven days a week, and some provide extended hours of service. Community pharmacies may provide an important complement to community outreach programs as a source of clean needles and syringes for IDUs in most communities, and as an alternative service in some communities where more elaborate programs are not feasible. Safer needle use, as part of a health-promotion approach, is divergent from conventional practice. While major changes have occurred, it appears that there has been some polarization of attitudes and response. The explanation for this is not simple, and further analysis is required to determine the full impact from several ethical perspectives that include professional, business, and public health viewpoints. We have highlighted the role that policy has in moving toward preventive and harm-reduction approaches. From a policy perspective, we have found that support from the federal government, regulatory bodies, and professional associations may be an important catalyst to pharmacists' participation in programs. Further, it does not appear to be possible to implement such policies without professional development and continuing education, and collaboration with the community. Based on data on knowledge and educational need, we believe that our study population's lowest levels of information were in such areas as the role of methadone in HIV prevention and the availability of needle-exchange programs. As with other health-promotion campaigns, additional skills training may be important. Movement forward with expanded preventive and harm-reduction strategies by pharmacies will require careful planning. It is anticipated that change in this area will be incremental in nature, and that it is necessary to introduce programs and services into community pharmacies gradually. Successful implementation will require extensive community development and collaboration with other health professionals, public health officials, police, groups who represent IDUs, and persons living with HIV/AIDS. Careful monitoring and evaluation of these programs will be necessary to enhance their effectiveness.

Reducing volunteer bias: using left-over specimens to estimate rates of HIV infection among inmates in Ontario, Canada.

OBJECTIVE: To estimate the prevalence of HIV-1 infection among adult and young offenders admitted to remand facilities in the province of Ontario, Canada, by using a design that reduces volunteer bias. METHODS: A study using a modified anonymous HIV-surveillance design was conducted with urine specimens routinely collected from male and female entrants to all Ontario jails, detention and youth centres between February and August 1993. Information on sex, age, and history of injecting drug use was also collected. Urine was screened using a modified commercial HIV enzyme-linked immunosorbent assay kit and confirmed using a modified in-house Western blot assay. RESULTS: Data were obtained on 10,530 adult men, 1518 adult women, 1480 young male offenders, and 92 young female offenders. Urine specimens were available for 88% of new entrants. Of the entrants, 1% (n = 163) refused to have their urine used for research. Refusals were not associated with history of injecting drug use. Overall rates of HIV-1 infection were 1% for adult men, 1.2% for adult women, and 0% for young offenders. Both the rates of infection and prevalence of injecting drug use varied across facilities and geographic regions. Overall, 13% of adult men, 20% of adult women, 3% of young male offenders, and 2% of young female offenders reported a history of injecting drug use. Rates of infection were highest among self-reported injecting drug users. Rates of HIV were 3.6% for adult men and 4.2% for adult women who injected compared with 0.6 and 0.5%, respectively, for non-injecting drug users. CONCLUSIONS: The use of unlinked left-over specimens is an important tool for measuring HIV-prevalence rates and should be encouraged. The results indicate that HIV rates are much higher among those entering prisons than in the general population. The pattern of HIV in Ontario prisons is similar to that reported in Europe and the United States. We are optimistic that these data will stimulate much needed efforts towards education and health promotion, and open the door to further research in Canadian prisons.

A comparison of the determinants of safe injecting and condom use among injecting drug users.

A sample of 582 injecting drug users were interviewed as part of an evaluation of an AIDS prevention programme for drug users. This paper examines the biographic and predispositional determinants of five HIV preventive behaviours--equipment sharing (not receiving and not giving) and and condom use (with regular partners, casual partners and sex clients). A two-stage sequential approach was adopted for a logistic regression analysis. Initially, to model each of the five preventive behaviours, biographical and drug use variables were entered. In a second set of models, behavioural predisposition factors were included. Age, drug use and prison experience correlate with variables in both models, although not consistently in the same direction. While a predisposition to reject sharing correlates with safer rejecting and condom use, the predisposition to safer sex only correlates with condom use. Needle exchange programmes that only target the individual would seem to be inadequate. To enhance targeted interventions changes in public and agency policy that create a social environment conductive to behaviour change are required.

PIP: Interviews were conducted with 582 intravenous (IV) drug users aged 16-55 (85.9% of whom were male) living in Toronto, Canada, so researchers could examine the biographic and predispositional determinants of HIV preventive behaviors: equipment sharing (not receiving and not giving) and condom use (with regular partners, casual partners, and sex clients). This study was part of an evaluation of one of Canada's first HIV prevention programs for IV drug users, which included education, counseling, needle and syringe exchange, and an environmental campaign to Keep the Needles Off the Street. Cocaine was the most commonly abused drug (95.4%) in the last six months. Condom use was highest with sex clients (53.1%), followed by regular partner (43.1%) and casual partner (30.8%). The researchers had adopted a two-stage sequential approach for a logistic regression analysis. They first applied biographical and drug use variables to model each of the preventive behaviors. They then included the behavioral predisposition factors in a second set of models. Younger IV drug users were more likely to practice safer sex and safer needle use than older IV drug users. IV drug users who had been in prison were more likely to use condoms with sex clients and not to give used equipment to others. Among all substance types, only heroin and barbiturate use were linked to sexual risk. The predisposition to reject equipment sharing related to safe injecting and condom use, while the predisposition to accept safer sex only related to condom use, suggesting that the mechanisms for behavior change associated with safer sex and equipment sharing may vary. Needle exchange programs exist for IV drug users and focus only on the individual. These findings suggest that these programs appear to be ineffectual. Improvement of targeting and prevention strategies, including creation of a social environment conducive to change, is needed.