AEGiS-14IAC: Cross-national research methods for adapting interventions for injecting drug users (IDUs). (Lessons from the WHO Drug Injecting Study).

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Cross-national research methods for adapting interventions for injecting drug users (IDUs). (Lessons from the WHO Drug Injecting Study).

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no.. MoOrD1065)

Perlis T, Jarlais DD, Poznyak V, Monteiro M, Stimson G, Fitch C
National Development and Research Institutes, Inc., New York, United States

BACKGROUND: Injecting drug use (IDU) and HIV among IDUs are spreading rapidly in developing/transitional (D/T) countries. Effective interventions exist mostly in industrialized countries. Controlling current/emerging epidemics requires data collection that is locally relevant but also permits cross-national comparisons.

METHODS: Procedures for Phase II of the WHO Drug Injecting Study built upon lessons learned from Phase I (implemented in Athens, Bangkok, Glasgow, London, Madrid, New York, Rome, Rio de Janeiro, Santos, Sydney, Toronto) in order to improve cross-cultural standardized research methods. Rapid Assessment was followed by a questionnaire survey of IDUs and serological testing for HIV/HBV/HCV. Centralized design of the survey protocol, questionnaire, database structure, and data collation process was accompanied by flexibility in adapting the protocol to local conditions.

RESULTS: 15 cities (Bangkok, Beijing, Bogota, Hanoi, Kharkiv, Lagos, Minsk, Nairobi, Penang, Rio de Janeiro, Rosario, St. Petersburg, Santos, Salvador City, Tehran) are participating. Rapid assessment permitted local investigators to evaluate the feasibility of treatment and street-based recruitment, target the latter to areas of high drug activity, design appropriate sampling plans, identify site-specific risk behaviors, and modify the questionnaire accordingly. Results from both Phases I and II show critical issues in generalizability of successful interventions. Community/peer support for behavior change and degree of stigmatization of HIV/AIDS and IDU affect potential risk reduction. High rates of unsafe sexual behavior are common across sites, but vary by partner type.

CONCLUSION: Limited resources, local attitudes, and legal barriers may hinder adoption of HIV harm reduction/prevention efforts in D/T countries. Research methods that produce both locally and cross-nationally valid data are needed to adapt effective HIV prevention programs to different settings.

Keywords: AEGIS, Risk-Taking, Research, Federal Government, HIV Infections, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Substance-Related Disorders, London, New York, Rome, nursing

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