Transmission of HIV among drug addicts in three French cities: implications for prevention.

In 1988, the Institute for Epidemiological Research on Drug Dependence conducted an ethnographic study designed to assess the results of liberalization of the sale of syringes. In that study, drug addicts were found to have gradually altered their customary practices by limiting the sharing of syringes. Two years later, a second study was conducted to further assess the behavioural changes under way. The whole survey covered 359 subjects--165 in Paris, 110 at Marseille and 93 at Metz. Almost all the subjects stated that they knew about the risks of transmission of the human immunodeficiency virus (HIV) by needle and during unprotected sexual intercourse. Almost all of them (98 per cent) knew that syringes were freely sold at pharmacies. Most of them (84 per cent) felt that they were generally well informed on the subject of AIDS and the ways in which the virus was transmitted. Prostitutes accounted for 17 per cent of the sample, with more women (32 per cent) than men (13 per cent) included in that category. The overwhelming majority of the subjects bought their syringes at pharmacies, and the trend towards the non-sharing of syringes was confirmed, a change in behaviour that has emerged mainly since 1987. Among the "new generation" of drug addicts, namely those who began to inject after 1987, the changes are reflected in a much lower rate of infection--2 per cent instead of 28 per cent of the total. About a third of the subjects, however, continued to engage in practices involving a certain level of risk. In a global context, including subjects who do not know how to properly clean a syringe, a variety of usually ineffective practices are followed, for example rinsing with water, lemon juice, or scent. The use of bleach remained limited, and few people considered cleaning with it. Liberalization of the sale of syringes seems to be essential to the prevention of AIDS among drug addicts. But this measure is not enough in itself. Apart from the overall problems of looking after the health of drug addicts and ensuring access to medical care, certain specific measures remain highly desirable. Of particular importance is the dissemination of information clearly describing effective methods of sterilizing syringes (including the use of bleach).