CIRCUMSTANCES SURROUNDING NEEDLE USE TRANSITIONS AMONG INJECTION-DRUGUSERS - IMPLICATIONS FOR HIV INTERVENTION

Injection drug users (IDUs) are at increased risk of infection with th e human immunodeficiency virus (HIV). Intervention programs aimed at r educing the spread of HIV in this population typically incorporate a r ange of risk reduction strategies, including encouragement to move fro m injection to noninjection. However, very little is known about the f actors associated with needle use transitions, either spontaneous or i n response to intervention. We report a study in which a cohort of IDU s were asked about the reasons they stopped and restarted injection. O f 855 IDUs, 179 (21%) had had at least one 12-month period of noninjec tion since they first injected. Almost one-half of the reasons given f or stopping injecting related to personal crises, characterized by maj or shifts in attitude to drugs and/or life more generally, and often g enerated by pressures in significant relationships. Concerns about HIV were cited by only one respondent. Many of the factors associated wit h transition out of needle use in the study population are not readily amenable to intervention. The implications of this for HIV risk reduc tion programs are discussed.