CHANGES IN HIV RISK BEHAVIOR AMONG INJECTING DRUG-USERS - THE IMPACT OF 21 VERSUS 90 DAYS OF METHADONE DETOXIFICATION

Objective: To evaluate the hypothesis that long-term methadone detoxif ication would produce greater HIV risk reduction among injecting drug users (IDU) than short-term detoxification. Design: Random assignment to 21 or 90 days of free detoxification. Setting: Storefront offices i n two cities, with referrals to outpatient methadone detoxification. P articipants: Out-of-treatment IDU (n = 1803), recruited through street outreach and word of mouth, between April 1990 and March 1991. Of the se, 62.6% were successfully located for 6-month follow-up. Main outcom e measures: Self-reported drug injection and sexual practices at basel ine and follow-up. Results: Substantial reductions in risk behavior we re observed at follow-up. Substantial percentages of subjects reported less frequent drug injection (54%), use of shooting galleries (85%), needle-sharing (67%), and number of sex partners (73%), and more frequ ent use of bleach to disinfect needles (67%) and condom use (31%). The re were no significant differences in behavioral change between 21 and 90-day treatment, and subjects who entered treatment did not report s ignificantly greater risk reduction than untreated subjects. Discrimin ant analyses showed a marginal effect for duration of treatment on ris k reduction, although results were inconsistent. Conclusions: Large sc ale behavioral risk reduction appears to be occurring in this populati on regardless of treatment condition. In minimal service methadone det oxification, subjects treated under a longer-term detoxification proto col demonstrated no greater risk reduction than those receiving short- term detoxification.