Index
A
Academic research, 69
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
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
AIDS, Sexual Behavior, and Intravenous Drug Use, 57, 58
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
Ann Arbor, Michigan, 69n
Anslinger, Harry Jacob, 144
Anti-Drug Paraphernalia Act, 145
Arizona, public opinion, 115
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
Australia
exchange program, 2
B
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
Bangkok, Thailand, HIV prevalence, 10, 39
Behavior change models, 86, 87
Berkeley, California, exchange programs, 86
Binge episodes, 57-58
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
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
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
Canada
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
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
Circulation models, 86, 87, 228-229, 230-231, 255n, 302
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
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
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
Counseling services, 75, 81, 82, 97, 179-180
D
Dallas, Texas, exchange programs, 74
D.C., see Washington, D.C.
DC*MADS, see Washington DC Metropolitan Area Drug Study
Decontamination, 170
Delaware, laws, 147
de Ligorio, Alphonsi Mariae, 105
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
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
Endocarditis, 27
injection drug transmission, 1, 9-10, 32, 34, 36, 37-44
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
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
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
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
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
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
Chicago studies, 180, 181-186, 303-304
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
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
Income, see Socioeconomic status
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
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
Iodine, 170
Iowa, laws, 147
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Reagan administration, 144
Recall and response bias, 201, 265
Recruitment and retention, 75, 268
Regional differences, see Geographic variation
Registering, 25
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
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
Sex, see Gender; Men; Prostitution; Sexual transmission; Women
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
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
injection drug use rates, 60
Speedball, 65
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
impacts on needle sharing, 150-151
pharmacy sales, 124, 125-126, 152-155
precedence of public health laws, 148
prostitution, 77
Statistical sensitivity, 201, 207-208
Sterilization, 169-170
Stimulants, 67
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
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
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
User-friendliness, 91-93, 94, 95, 99, 268
Utah, public opinion, 108, 113
V
W
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
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