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Impact of drug maintenance treatment on HIV-related risk behaviours among HIV-infected drug users in France. The Manif 2000 Study Group.


Int Conf AIDS. 1998;12:672 (abstract no. 33413). Unique Identifier :

OBJECTIVES: To assess the impact of recent changes (1995-1996) in French public health policy towards drug maintenance treatment (diffusion of methadone programs and buprenorphine ambulatory prescription) on risky behaviours among HIV-infected intravenous drug users (IDUs). METHODS: Data were collected during the enrolment visit (Oct 95-Oct 96) of the cohort MANIF 2000 of HIV-infected IDUs with CD4+ > 300, clinical CDC stage A or B, attending in south-eastern France and inner suburbs of Paris hospitals. Psychological and sociological characteristics as well as information about maintenance treatment, drug use and sexual practices were obtained by a self-administered and a face-to-face questionnaire. Three groups were compared: still active IDUs (N = 64), active IDUs in drug maintenance treatment (N = 83) and ex-IDUs (N = 169, of which 10% were under maintenance treatment). RESULTS: One hundred patients were in drug maintenance treatment, among which 83% have been injecting drugs in the 6 months before enrolment. Significant differences (p < 0.01) were found as far as psycho-social characteristics (unemployment, IDU or ex-IDU regular partner, been in jail, duration of drug use > 10 years, psychiatric or social consultation, depression and negative life events) between active IDUs and ex-IDUs. Such differences were not found when comparing active IDUs whether or not under maintenance treatment. Among active IDUs, 27.2% declared at least one needle exchange in the last six months. Needle exchange was positively associated with polydrug use (OR = 6.6, 95% (2.6-17)), and among respondents aged more than 30 years, with an history of prison (OR = 3.4, 95% CI (1.1-12.8)). Drug maintenance treatment was associated with a significant reduction in needle exchange but only for older subjects (> 30 years: OR = 0.3 95% CI (0.1-0.9)). Active IDUs have more unprotected sex with occasional partners than ex IDUs (OR = 2.4, 95% CI (1.0-5.7)), but unprotected sex with occasional partners was similar in active IDUs whether or not they were in drug maintenance treatment. CONCLUSION: The recent development of maintenance treatment promoted by French authorities has not yet succeeded in suppressing injection practices among HIV-infected IDUs but already contributed to reduce needle sharing especially among older IDUs. Our study suggests that improvement French policy for harm reduction should be more targeted towars subgroups of HIV-infected IDUs with history of prison or use of multiple drugs and should better associated with preventive conselling about sexual risk behaviours.

MEETING ABSTRACTS France/EPIDEMIOLOGY Human HIV Infections/EPIDEMIOLOGY/*PREVENTION & CONTROL Odds Ratio Questionnaires *Risk-Taking Sex Behavior Substance Abuse, Intravenous/COMPLICATIONS/*DRUG THERAPY/ PSYCHOLOGY


Information in this article was accurate in December 30, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.