WHO Drug Injecting Study Phase II: From Assessment to Prevention Development

World Health Organisation

The Phase I trial in the 1980's was reviewed. The study consisted of 4,400 subjects and looked at the patterns of risk behaviour between developed and developing nations. The main finding was that there was a surprising amount of similarity between nations in terms of IDU and sex risk behaviour. The Phase II study has focused on developing nations were HIV is spreading rapidly. Nations included Africa, Asia, South America, Russia and Eastern Europe. It is a structured HIV seroprevalence study by questionnaire with two sampling times at each site. So far the study has involved a two to three month rapid assessment of existing services by interview and through service providers. This has now been completed. Scientific objectives include a cross-cultural issue analysis looking at local variations in drugs injected and whether the history of IDU was a relatively new event in that region or have ancient origins. The study will lead to intervention strategic planning and implementation. The study will also investigate needle exchange programs looking at risk behaviour at sites that have these programs in place and then comparing them to regions where no needle exchange program exists. There will also be an investigation of pilot study needle exchange systems with those set up on a public health scale.

A sub study will be carried out in Thailand comparing changes in the dominant drug behaviour use for example smoking of amphetamines compared with IDU of amphetamines.This will generate data on the changes in dominant drug pattern risk behaviour. Another sub study will investigate cross border transmission of HIV; this will be carried out in conjunction with the NIH. It will need political and community level involvement on both sides of borders for this type of study to be successful. Government officials will be required to meet on a regular basis to monitor cross border activities. Again this will lead to a model of cross border transmission with a subsequent prevention policy being put in place. Many of the activities in the Asian region are generally small scale in size because most countries in this area don't regard risk behaviour for transmission of HIV in IDUs as a public health activity. Further the laws and political will tends to be ill-defined to allow intervention to take place. All these studies will lead to policy recommendations not only at the regional level but also globally.