Abstract

In the western world, intravenous drug users are the second most important risk group for AIDS after homosexual men with multiple partners. Because of the long incubation period of AIDS, research on the prevalence of HIV in risk groups can lead to a considerable gain in time with regard to the formulation of care and prevention policies. Until now in the Netherlands prevalence studies among drug users have almost exclusively been done in Amsterdam. Therefore, little is known about the spread of HIV among drug users across the country. This study was initiated to investigate the feasibility of (regularly repeated) prevalence studies among drug users. Of special importance was to ascertain to what extent drug users in general and hidden groups in particular could be reached using care facilities as an entrance. Apart from that the study generates data on prevalence of HIV infections and HIV-related risk factors in a population of drug users outside the urbanized Western part of the country. In this study a recently developed saliva test for antibodies against HIV is used. It was attempted to reach all hard-drug users, both injecting and non-injecting, in the population. This was done to be able to study selections, that occur when studying sub-populations, and to be able to study sexual risk behaviour independently of risk related to injection of drugs. Deventer, a provincial town in the Eastern part of the country, was selected as research site on the basis of population size, the number and type of care facilities, and comparability with a simultaneous project among drug users in Alkmaar. The most important findings are: 1 Given the fruitful collaboration prevalence research among drug users, using local care facilities as an entrance is well possible. 2. Prevalence research in collaboration with care facilities can offer advantages with respect to the acceptability for care givers and participants and repeatability. 3. Hidden groups, not reached by care facilities, can still be reached by this approach. Realistic estimates of the number and characteristics of the whole population are possible through nomination techniques. 4. The prevalence of HIV infections among drug users in Deventer is low: 0-2.6% in general and 0-5.3% among intravenous drug users. This low prevalence is probably representative of the prevalence among drug users outside the urbanized Western part of the country. 5. Sharing of needles and syringes is uncommon in Deventer. Sexual risk is more common among women, drug users with little education, and among drug users currently or ever under methadone treatment. Injecting drug users are older, more often have a history of prostitution and make more drug-related travels to other cities.