Langendam M, Van Brussel G, Coutinho R, Van Ameijden E; International Conference on AIDS.

Int Conf AIDS. 2000 Jul 9-14; 13: abstract no. TuPpC1249.

M. Langendam, Municipal Health Service, Div. of Public Health, Nieuwe Achtergracht 100, 1018 WT Amsterdam, Netherlands, Tel.: +31 20 555 5231, Fax: +31 20 555 5533, E-mail: mlangendam@gggd.amsterdam.nl

International studies suggest that methadone treatment can reduce the spread of HIV. These studies, however, were mainly based on drug-free programs. In Amsterdam, The Netherlands, methadone programs are implemented according to the harm reduction (HR) approach. In this approach, the use of illicit drugs is tolerated and there are no waiting lists. We summarise the results of 4 studies that evaluate the Amsterdam HR-based methadone programs as a preventive intervention. Data of the Central Methadone Register were linked to the Amsterdam AIDS cohort study among drug users (n = 1058). In the 4 studies, methadone dosage, frequency of program attendance and type of program were correlated to borrowing needles/syringes and inconsistent condom use among female prostitutes, cessation of injecting drug use, HIV incidence and mortality from natural causes. Compared to dosages >40 mg/day, lower methadone dosages were related to a higher rate of borrowing (OR 1.4, 95%CI 1.1-1.7) and inconsistent condom use (OR 1.7, 95%CI 1.2ndash;2.5). An individual increase in methadone dosage, often prescribed on the drug user's own request, was related to a higher rate of cessation of injecting (OR 4.2, 95%CI 1.5ndash;11.5, ref:no change) and lower HIV-incidence (RRper 10mg 0.8, 95%CI 0.6ndash;1.0). Drug users with unstable frequency of program attendance became more often infected with HIV (RR 2.0, 95%CI 1.1ndash;3.5, ref:stable). Compared to drug users in treatment, those who left treatment were at increased risk for mortality from natural causes (mainly AIDS, RR 2.4, 95%CI 1.3ndash;4.6). The Amsterdam HR-based methadone programs reach a large group of drug users. In these 4 observational studies we found some positive effects of methadone dosage and treatment retention. These effects are not enough to prevent HIV-infection in the total population of drug users, but may be effective among sub-populations. The impact of the HR-based methadone programs on mortality is considerable.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Cohort Studies
• Female
• HIV Infections
• HIV Seropositivity
• Harm Reduction
• Incidence
• Methadone
• Netherlands
• Substance-Related Disorders
• Syringes
• mortality

Other ID:

• GWAIDS0001772

UI: 102239265

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