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January 12, 1994, Vol 271, No. 2 >
ARTICLE | January 12, 1994

'Into Whatever Houses I Enter': Title and subTitle BreakHIV and Injecting Drug Use FREE

Alan A. Wartenberg, MD
[+] Author Affiliations

Reprint requests to Addiction Recovery Program, Faulkner Hospital, 1153 Centre St, Boston, MA 02130 (Dr Wartenberg).


JAMA. 1994;271(2):151-152. doi:10.1001/jama.1994.03510260083034
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References

From the very beginning of the human immunodeficiency virus (HIV) epidemic in the United States it was apparent that two major populations were affected: gay and bisexual men and injecting drug users (IDUs). Educational efforts aimed at behavioral change to reduce acquisition and transmission of the virus were considered the first line of defense. Such efforts had considerable impact in the gay and bisexual community, resulting in reductions in risk behaviors.1 However, many clinicians held the belief that behavioral change would be difficult, if not impossible, in the population of IDUs.2,3

There have been several indications that positive lifestyle changes and improved medical outcomes in IDUs can occur. It has been demonstrated that IDUs enrolled in a methadone program can receive primary care with high levels of attendance and compliance with medical regimens,4 and similar compliance rates with IDUs have been achieved in general medical settings.5,6

REFERENCES

1 +
Becker MN, Joseph JG.  AIDS and behavioral changes to reduce risk: a review. Am J Public Health . 1988;;78:394-410.
2 +
Des Jarlais DC, Friedman SR.  The psychology of preventing AIDS among intravenous drug users: a social learning conceptualization. Am Psychol . 1988;;43:865-870.
3 +
Nace E, Davis C, Gaspari J.  Axis II comorbidity in substance abuse. Am J Psychiatry . 1991;;148:118-120.
4 +
Selwyn PA, Feingold AR, Iezza A, et al.  Primary care for patients with human immunodeficiency virus (HIV) infection in a methadone maintenance treatment program. Ann Intern Med . 1989;;111:761-763.
5 +
Samet JH, Libman H, Steger KA, et al.  Compliance with zidovudine therapy in patients infected with HIV type 1: a cross-sectional study in a municipal hospital clinic. Am J Med . 1992;;92:495-502.
6 +
O'Connor PG, Molde S, Henry S, Shockcor WT, Schottenfeld RJ.  Human immunodeficiency virus infection in intravenous drug users: a model for primary care. Am J Med . 1993;;93:382-385.
7 +
Stein MD, Samet JJ, O'Connor PG.  The linkage of primary care services with substance abuse treatment: new opportunities for academic generalists. J Gen Intern Med . 1993;;8:106-107.
8 +
Des Jarlais DC, Friedman SR, Sotheran JL, et al.  Continuity and change within an HIV epidemic: injecting drug users in New York City, 1984 through 1992. JAMA . 1994;;271:121-127.
9 +
Vlahov D, Anthony JC, Celentano D.  Trends of HIV-1 risk reduction among initiates into intravenous drug use, 1982-1987. Am J Drug Alcohol Abuse . 1991;;17:39-48.
10 +
Schottenfeld RS, O'Malley S, Abdul-Salaam K, O'Connor PG.  Decline in intravenous drug use among treatment-seeking opiate users. J Subst Abuse Treat . 1993;; 10:5-10.
11 +
Hartgers C, Buning EC, van Santen GW, et al.  The impact of the needle and syringe-exchange programme in Amsterdam in injecting risk behavior. AIDS . 1989;; 3:571-576.
12 +
Hart GJ, Carvell ALM, Woodward N, et al.  Evaluation of needle exchange in central London: behaviour change and anti-HIV status over one year. AIDS . 1989;; 3:261-265.
13 +
Ljunberg B, Christensson B, Tuning K, et al.  HIV prevention among injecting drug users: three years' experience from a syringe exchange program in Sweden. J Acquir Immune Defic Syndr . 1991;;4:890-895.
14 +
Anderson W.  The New York needle trial: the politics of public health in the age of AIDS. Am J Public Health . 1991;;81:1506-1517.
15 +
Watters JK, Estilo MJ, Clark GL, Lorvick J.  Syringe and needle-exchange as HIV/AIDS prevention for injection drug users. JAMA .1994;;271:115-120.
16 +
New York City Dept of Health Report. The Pilot Needle Exchange Study in New York City: A Bridge to Treatment: A Report on the First Ten Months of Operation . New York, NY: New York City Dept of Public Health; 1989;.
17 +
Purchase D, Hagan H, Des Jarlais DC, Reid T.  Historical account of the Tacoma syringe exchange.  In: Program and abstracts of the Fifth International Conference on AIDS ; June 4-9, 1989;; Montreal, Quebec. Abstract THDP74.
18 +
Kaplan EN, Heimer R.  HIV prevalence among intravenous drug users: model-based estimates from New Haven's legal needle exchange. J Acquir Immune Defic Syndr . 1992;;5:163-169.
19 +
Carvell AM, Hart GJ.  Help-seeking and referrals in a needle exchange: a comprehensive service to injecting drug users. Br J Addict . 1990;;85:235-240.
20 +
Cooper JR.  Methadone treatment and acquired immunodeficiency syndrome. JAMA . 1989;;262:1664-1668.
21 +
Novick DM, Joseph H, Croxson TS, et al.  Absence of antibody to human immunodeficiency virus in long-term, socially rehabilitated methadone maintenance patients. Arch Intern Med . 1990;;150:98-99.
22 +
Newman RG.  Advocacy for methadone treatment. Ann Intern Med . 1990;;113: 819-820.
23 +
Dans PE, Matricciani RM, Otter SE, Reuland DS.  Intravenous drug abuse and one academic health center. JAMA . 263;3173-3176.
24 +
Stein MD, O'Sullivan PS, Ellis P, Perrin H, Wartenberg A.  Utilization of medical services by drug abusers in detoxification. J Subst Abuse . 1993;;5:187-193.
25 +
Northfelt DW, Hayward RA, Shapiro MF.  The acquired immunodeficiency syndrome is a primary care disease. Ann Intern Med . 1989;;109:773-774.
26 +
Wartenberg AA, Liepman MR.  Medical complications of substance abuse.  In: Lerner WD, Barr MA, eds. Handbook of Hospital Based Substance Abuse Treatment . New York, NY: Pergamon Press; 1990;:45-65.
27 +
Stein MD.  Medical complications of intravenous drug use. J Gen Intern Med . 1990;;5:249-257.
28 +
Wartenberg AA.  HIV disease in the intravenous drug user: role of the primary care physician. J Gen Intern Med . 1991;;6( (suppl) ):35-40.
29 +
Wartenberg AA.  The drug using patient.  In: Libman J, Witzburg RA, eds. HIV Infection: A Clinical Manual . 2nd ed. Boston, Mass: Little Brown & Co Inc; 1992;: 455-466.
30 +
Edelstein L. The Hippocratic Oath: Text Translation and Interpretation by Ludwig Edelstein . Baltimore, Md: The Johns Hopkins Press; 1943;.

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1 +
Becker MN, Joseph JG.  AIDS and behavioral changes to reduce risk: a review. Am J Public Health . 1988;;78:394-410.
2 +
Des Jarlais DC, Friedman SR.  The psychology of preventing AIDS among intravenous drug users: a social learning conceptualization. Am Psychol . 1988;;43:865-870.
3 +
Nace E, Davis C, Gaspari J.  Axis II comorbidity in substance abuse. Am J Psychiatry . 1991;;148:118-120.
4 +
Selwyn PA, Feingold AR, Iezza A, et al.  Primary care for patients with human immunodeficiency virus (HIV) infection in a methadone maintenance treatment program. Ann Intern Med . 1989;;111:761-763.
5 +
Samet JH, Libman H, Steger KA, et al.  Compliance with zidovudine therapy in patients infected with HIV type 1: a cross-sectional study in a municipal hospital clinic. Am J Med . 1992;;92:495-502.
6 +
O'Connor PG, Molde S, Henry S, Shockcor WT, Schottenfeld RJ.  Human immunodeficiency virus infection in intravenous drug users: a model for primary care. Am J Med . 1993;;93:382-385.
7 +
Stein MD, Samet JJ, O'Connor PG.  The linkage of primary care services with substance abuse treatment: new opportunities for academic generalists. J Gen Intern Med . 1993;;8:106-107.
8 +
Des Jarlais DC, Friedman SR, Sotheran JL, et al.  Continuity and change within an HIV epidemic: injecting drug users in New York City, 1984 through 1992. JAMA . 1994;;271:121-127.
9 +
Vlahov D, Anthony JC, Celentano D.  Trends of HIV-1 risk reduction among initiates into intravenous drug use, 1982-1987. Am J Drug Alcohol Abuse . 1991;;17:39-48.
10 +
Schottenfeld RS, O'Malley S, Abdul-Salaam K, O'Connor PG.  Decline in intravenous drug use among treatment-seeking opiate users. J Subst Abuse Treat . 1993;; 10:5-10.
11 +
Hartgers C, Buning EC, van Santen GW, et al.  The impact of the needle and syringe-exchange programme in Amsterdam in injecting risk behavior. AIDS . 1989;; 3:571-576.
12 +
Hart GJ, Carvell ALM, Woodward N, et al.  Evaluation of needle exchange in central London: behaviour change and anti-HIV status over one year. AIDS . 1989;; 3:261-265.
13 +
Ljunberg B, Christensson B, Tuning K, et al.  HIV prevention among injecting drug users: three years' experience from a syringe exchange program in Sweden. J Acquir Immune Defic Syndr . 1991;;4:890-895.
14 +
Anderson W.  The New York needle trial: the politics of public health in the age of AIDS. Am J Public Health . 1991;;81:1506-1517.
15 +
Watters JK, Estilo MJ, Clark GL, Lorvick J.  Syringe and needle-exchange as HIV/AIDS prevention for injection drug users. JAMA .1994;;271:115-120.
16 +
New York City Dept of Health Report. The Pilot Needle Exchange Study in New York City: A Bridge to Treatment: A Report on the First Ten Months of Operation . New York, NY: New York City Dept of Public Health; 1989;.
17 +
Purchase D, Hagan H, Des Jarlais DC, Reid T.  Historical account of the Tacoma syringe exchange.  In: Program and abstracts of the Fifth International Conference on AIDS ; June 4-9, 1989;; Montreal, Quebec. Abstract THDP74.
18 +
Kaplan EN, Heimer R.  HIV prevalence among intravenous drug users: model-based estimates from New Haven's legal needle exchange. J Acquir Immune Defic Syndr . 1992;;5:163-169.
19 +
Carvell AM, Hart GJ.  Help-seeking and referrals in a needle exchange: a comprehensive service to injecting drug users. Br J Addict . 1990;;85:235-240.
20 +
Cooper JR.  Methadone treatment and acquired immunodeficiency syndrome. JAMA . 1989;;262:1664-1668.
21 +
Novick DM, Joseph H, Croxson TS, et al.  Absence of antibody to human immunodeficiency virus in long-term, socially rehabilitated methadone maintenance patients. Arch Intern Med . 1990;;150:98-99.
22 +
Newman RG.  Advocacy for methadone treatment. Ann Intern Med . 1990;;113: 819-820.
23 +
Dans PE, Matricciani RM, Otter SE, Reuland DS.  Intravenous drug abuse and one academic health center. JAMA . 263;3173-3176.
24 +
Stein MD, O'Sullivan PS, Ellis P, Perrin H, Wartenberg A.  Utilization of medical services by drug abusers in detoxification. J Subst Abuse . 1993;;5:187-193.
25 +
Northfelt DW, Hayward RA, Shapiro MF.  The acquired immunodeficiency syndrome is a primary care disease. Ann Intern Med . 1989;;109:773-774.
26 +
Wartenberg AA, Liepman MR.  Medical complications of substance abuse.  In: Lerner WD, Barr MA, eds. Handbook of Hospital Based Substance Abuse Treatment . New York, NY: Pergamon Press; 1990;:45-65.
27 +
Stein MD.  Medical complications of intravenous drug use. J Gen Intern Med . 1990;;5:249-257.
28 +
Wartenberg AA.  HIV disease in the intravenous drug user: role of the primary care physician. J Gen Intern Med . 1991;;6( (suppl) ):35-40.
29 +
Wartenberg AA.  The drug using patient.  In: Libman J, Witzburg RA, eds. HIV Infection: A Clinical Manual . 2nd ed. Boston, Mass: Little Brown & Co Inc; 1992;: 455-466.
30 +
Edelstein L. The Hippocratic Oath: Text Translation and Interpretation by Ludwig Edelstein . Baltimore, Md: The Johns Hopkins Press; 1943;.

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