Preventing HIV transmission : the role of sterile needles and bleach

Preventing HIV transmission the role of sterile needles and bleach

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Detalles Bibliográficos
Autores Corporativos: National Research Council (U.S.). Panel on Needle Exchange and Bleach Distribution Programs (-), Institute of Medicine (U.S.)
Otros Autores: Normand, Jacques, 1954- (-), Vlahov, David, Moses, Lincoln E.
Formato: Libro electrónico
Idioma:Inglés
Publicado: Washington, D.C. : National Academy Press 1995.
Edición:1st ed
Materias:
Needle exchange programs > United States.
Chlorine and derivatives as disinfectants.
AIDS (Disease) > United States > Prevention.
Ver en Biblioteca Universitat Ramon Llull:https://discovery.url.edu/permalink/34CSUC_URL/1im36ta/alma991009820305906719
Tabla de Contenidos:
  • Preventing HIV Transmission
  • Copyright
  • Contents
  • Preface
  • Acknowledgments
  • Executive Summary
  • THE PROBLEM
  • THE PANEL'S CHARGE
  • SCIENTIFIC ASSESSMENT OF PROGRAM EFFECTIVENESS
  • Needle Exchange
  • Bleach Distribution
  • COMMUNITY AND LEGAL FACTORS
  • RECOMMENDED COURSE OF ACTION
  • NOTE
  • Introduction
  • DIMENSIONS OF THE PROBLEM
  • RESPONSES TO THE EPIDEMIC
  • THE CHARGE TO THE PANEL
  • THE PANEL'S REPORT
  • Information Sources
  • Approach
  • Organization
  • NOTES
  • REFERENCES
  • Part 1 Dimensions of the Problem
  • 1 The Epidemiology of HIV and AIDS
  • BIOLOGICAL MECHANISMS OF TRANSMISSION
  • Injection Drug Use Transmission
  • Direct Needle Sharing
  • Indirect Needle Sharing
  • Risk Behaviors and Interventions
  • Sexual Transmission
  • Perinatal Transmission
  • Conclusion
  • EPIDEMIOLOGIC DATA
  • HIV and AIDS Surveillance
  • Mode of Acquisition of Infection
  • HIV AND AIDS AMONG INJECTION DRUG USERS
  • Surveillance
  • Sexual Transmission Among Injection Drug Users
  • Perinatal Transmission from Injection Drug Users
  • SUMMARY
  • Conclusions
  • Recommendations
  • NOTES
  • REFERENCES
  • 2 The Epidemiology of Injection Drug Use
  • ESTIMATES OF INJECTION DRUG USERS
  • Geographic Variations
  • National Surveys of Drug Abuse
  • National Household Survey on Drug Abuse
  • Washington DC Metropolitan Area Drug Study
  • Surveys of Youth
  • Conclusion
  • CHARACTERISTICS OF INJECTION DRUG USERS
  • A National Profile
  • Local Drug Use Trends and Patterns
  • SUMMARY
  • Recommendation
  • NOTES
  • REFERENCES
  • 3 Needle Exchange and Bleach Distribution Programs in the United States
  • INTRODUCTION
  • NEEDLE EXCHANGE PROGRAMS
  • Legal Issues
  • Program Operations
  • Sites
  • Staffing
  • Policies
  • Hours of Operation
  • On-Site Services Offered
  • Items Distributed
  • Characteristics of Program Participants
  • Cost and Cost-Effectiveness.
  • Organization Characteristics
  • Three Simple Case Studies
  • Two Complex Case Studies
  • Comparisons Across Programs
  • BLEACH DISTRIBUTION PROGRAMS
  • Characteristics of Program Participants
  • Outreach Strategies
  • CONCLUSIONS
  • REFERENCES
  • 4 Community Views
  • MORAL/ETHICAL ARGUMENTS
  • PUBLIC OPINION POLLS
  • AFRICAN AMERICAN VIEWS
  • LATINO/HISPANIC VIEWS
  • LAW ENFORCEMENT VIEWS
  • HEALTH PROFESSIONAL VIEWS
  • Pharmacists
  • Treatment Service Providers
  • Funding
  • Treatment Efficacy
  • Federal Regulations
  • Condoning Drug Use
  • SUMMARY
  • CONCLUSIONS
  • NOTE
  • REFERENCES
  • 5 The Legal Environment
  • U.S. DRUG CONTROL POLICY
  • Legislative/Statutory Environment
  • State and Local Litigation
  • DO PARAPHERNALIA AND PRESCRIPTION LAWS CONTRIBUTE TO HIV TRANSMISSION
  • Needle Scarcity and Sharing
  • Changes in the Laws in Connecticut
  • Needle Sales
  • Injection Drug Users' Behaviors
  • SHOULD THE LAWS BE CHANGED
  • Changing the Laws
  • Consequences
  • CONCLUSIONS
  • RECOMMENDATIONS
  • NOTE
  • REFERENCES
  • Part 2 The Impact of Needle Exchange and Bleach Distribution Programs
  • 6 The Effectiveness of Bleach as a Disinfectant of Injection Drug Equipment
  • TRANSMISSION OF HIV AMONG INJECTION DRUG USERS
  • BLEACH AS A DISINFECTANT
  • Definition of Terms
  • The Role of Cleaning in Disinfection
  • Susceptibility of HIV to Disinfection
  • Laboratory Studies
  • CDC Recommendations
  • BLEACH DISTRIBUTION PROGRAMS
  • Program Evaluation
  • The Chicago Experience
  • Limitations of Bleach Disinfection
  • Impact of Bleach Disinfection on HIV Transmission
  • SUMMARY
  • Conclusions
  • Recommendations
  • NOTES
  • REFERENCES
  • 7 The Effects of Needle Exchange Programs
  • POTENTIAL OUTCOMES
  • Possible Positive Outcomes
  • Possible Negative Outcomes
  • THE PANEL'S APPROACH TO THE EVIDENCE.
  • The Traditional Approach: Considering the Preponderance of the Evidence
  • An Alternative Approach: Looking at the Patterns of Evidence
  • Rationale
  • Ruling In Plausibility
  • The Panel's Synthesis
  • U.S. GENERAL ACCOUNTING OFFICE REVIEW
  • Procedure
  • Results
  • UNIVERSITY OF CALIFORNIA REPORT
  • Procedure
  • Results
  • Possible Positive Outcomes
  • Reduction in High-Risk Behavior
  • Increased Referrals to Drug Treatment
  • Reduction in HIV Infection Rates
  • Possible Negative Outcomes
  • Increase in Program Participant Drug Use
  • Increase in New Initiates to Injection Drug Use
  • Increased Drug Use in the Community
  • Increase in Number of Contaminated Needles Unsafely Discarded
  • Summary
  • EVIDENCE FROM RECENT STUDIES
  • Possible Positive Outcomes
  • Reduction in Risk Behavior
  • Reduction in HIV Infection Rates
  • Possible Negative Outcomes
  • Program Participant Drug Use
  • New Initiates to Injection Drug Use
  • Discarded Needles and Syringes
  • THE NEW HAVEN STUDIES
  • Program Implementation
  • Estimated Effects on HIV Incidence
  • Assessment of the Models
  • New Initiates to Injection Drug Use
  • Enrollment in Drug Treatment
  • Alternative Explanations
  • Summary
  • THE TACOMA STUDIES
  • The Program
  • HIV Seroprevalence Studies
  • Hepatitis Surveillance and Case Reporting
  • Hepatitis B and C Case-Control Study
  • Interview Studies with Injection Drug Users
  • Potential Alternative Explanations
  • Program Effects on New Initiates to Drug Use or Abuse
  • SUMMARY
  • Conclusions
  • Recommendations
  • NOTES
  • REFERENCES
  • 8 Directions for Future Research
  • RESEARCH ON PROGRAM EFFECTIVENESS
  • Needle Exchange Evaluation
  • Categorization of Exposure to Intervention Condition
  • Measurement of Alternative Sources of Sterile Syringes
  • Community-Based Studies
  • Appropriate Selection of Respondents.
  • Temporal Association of Participation in Programs and HIV Seroconversion
  • Accounting for Alternative Risk Behaviors
  • Consolidation and Coordination of Program Effects
  • Program Characteristics
  • RESEARCH ON BLEACH EFFICACY IN DISINFECTION
  • EPIDEMIOLOGIC RESEARCH
  • RESEARCH ON COMMUNITY ISSUES
  • OTHER FUTURE RESEARCH ISSUES
  • Deregulation of Syringe Sale and Possession
  • Incarcerated Populations
  • Randomized Trial of Needle Exchange Programs
  • BROADER ISSUES
  • CONCLUSION
  • REFERENCES
  • Appendixes
  • APPENDIX A Description and Review of Research Projects in Three Cities
  • SAN FRANCISCO
  • Review
  • MONTREAL
  • Needle Exchange Evaluation Project
  • Seroincidence
  • Data from Correctional Institutions
  • Review
  • Epidemiologic Study
  • Seroprevalence
  • Seroincidence
  • Review
  • CHICAGO
  • Demand for Free Needles and Their Effect on Injecting Frequency and Needle Use
  • Review
  • Effects of Exchange Use on HIV Risk Behavior and Incidence
  • Review
  • CONCLUSION
  • REFERENCES
  • APPENDIX B Professional Association Positions on Needle Exchange and Bleach Distribution Programs
  • APPENDIX C Biographical Sketches
  • Index.

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