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HIV prevalence and risk behavior among injecting drug users who participate in "low-threshold" methadone programs in Amsterdam.

C Hartgers, A van den Hoek, P Krijnen and R A Coutinho

Municipal Health Service, Department of Public Health and Environment, Amsterdam, The Netherlands.

INTRODUCTION. After the onset of the HIV epidemic, the hope arose that the "harm reduction" approach of the Amsterdam "low-threshold" methadone programs would have a function in controlling the spread of HIV among injecting drug users (IDUs). METHODS. To find evidence for this assumption, 386 IDUs participating in an HIV study between 1985 and 1989 were studied. Long-term regular participants in low-threshold methadone programs were compared with short-term and/or irregular participants. RESULTS. Controlling for possible confounders, long-term regular participants had a slightly increased but not statistically significant risk of being HIV infected. With regard to current drug use, they injected daily and shared needles as often as did short-term and/or irregular participants. CONCLUSIONS. The results suggest that the Amsterdam low-threshold methadone programs fail to diminish HIV risk behavior. If these programs want to have a positive effect on the spread of HIV, expansion of existing HIV prevention efforts, an increase in the daily methadone dose level, and measures to enforce regular attendance may be required.

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