RESUMO
OBJECTIVE: To measure changes in self-reported risk behaviour for HIV infections and HIV seroprevalence among injecting drug user (IDU) clients of an outreach harm-reduction programme in Kathmandu, Nepal. METHODS: The Lifesaving and Lifegiving Society (LALS) of Kathmandu began providing sterile injecting equipment and education to Nepalese IDU in 1991. A sample of these IDU were interviewed and tested for HIV each year from 1991 through 1994. RESULTS: Indicators of unsafe injecting fell, as knowledge of HIV rose more in 1994 for those who had been in touch with LALS for longer. Indicators of unsafe sex did not change. HIV seroprevalence remained low, 1.6% in 1991 and 0% in 1994. CONCLUSION: We conclude that programmes for the prevention of HIV spread among IDU are possible and effective in Asia, and are urgently needed.
PIP: To reduce the high rate of human immunodeficiency virus (HIV) infection among intravenous drug users in Nepal, the Lifesaving and Lifegiving Society of Kathmandu has been distributing sterile injecting equipment in exchange for contaminated materials since 1991. In addition, community health outreach workers affiliated with the program provide condoms and bleach, HIV counseling and education, and primary health care to about 750 of the estimated 1500-2000 intravenous drug users in the Kathmandu valley. Of the 48,386 client contacts in 1991-94, over half involved syringe exchange. During this period, 586 randomly selected clients were selected for interviews and serologic testing. The number of times drug users shared equipment declined from 14 times per week in the 1991 subsample to once a day or less in the 1993 and 1994 subsamples. Knowledge of HIV infection rose from 58% in 1991 to almost 100% in 1994, while the proportion of drug users considering themselves at risk of HIV increased from 25% to 47%. There were no significant changes in HIV seropositivity (1.6% in 1991) during the study period, and no new cases were recorded in 1993 or 1994. This finding confirms the effectiveness of needle/syringe exchange programs in controlling the spread of HIV infection among intravenous drug users.