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This paper analyses the relationship of history to two current and inter-related policy issues, AIDS and drugs. AIDS, in particular in its early years, was a disease surrounded by history; and historians and others actively brought the 'lesson of history' into the public debates. Cholera and the Black Death provided historical examples of reactions to past epidemic disease; and the record of voluntarism in Britain in the area of sexually transmitted diseases was used to justify a non-punitive response to AIDS. As the perception of AIDS has changed from epidemic to chronic disease, as reactions to the disease have become 'normalized; so the type of historical input has also altered. The 'lesson of history' approach has appeared less relevant, or has changed focus to encompass chronic--TB, multiple sclerosis--rather than epidemic disease. The concept of AIDS itself as an historic event, of the 'contemporary history' of AIDS has also come to the fore. The paper contrasts the relationship of AIDS and history with the ahistorical reaction to the particular impact of AIDS on drug policy. The policy reaction to illicit drugs has been historically conscious, in particular in the 1960's. But little of this historical perspective filtered into the reaction to AIDS on drug policy. Drugs, unlike AIDS, was not an open policy arena. The paper argues that overall drug policy objectives were already clear and it suited no policy interest to call on the historical record. The achievement of established policy objectives was better achieved by an emphasis on the newness of development, a response to potentially epidemic and unusual circumstances. [ABSTRACT FROM AUTHOR]

Recognition of changes in the nature and extent of problem drug taking in the early 1980s led to changes in service provision and to an increased interest in help-seeking. The advent of AIDS accelerated these changes. This paper introduces concepts from the wider field of help-seeking and compliance with preventive health measures. It reviews the major conclusions of studies of help-seeking by problem drug takers, and identifies areas for further research. These include the need to 'unpack' the concept of 'drug problems' and to differentiate dimensions of needs in different individuals and populations; to evaluate attempts to make services attractive and accessible and to contact out-of-treatment groups; to assess the role of 'significant others'; to understand the demands that changing service roles place on agency staff; and to give greater prominence to studies of the process of help-seeking in terms of drug users' perceptions of their drug use, of problems, of risks and of services within the wider context of their lifestyles. [ABSTRACT FROM AUTHOR]

Epidemiological data on HIV seroprevalence has been essential in assessing the (future) extent of the AIDS epidemic. By coupling these data with quantifiable variables related to injection drug use (frequency of injecting, number of needle sharing partners) specific 'risk behaviors' could be determined, accounting for the rapid spread of the virus in the injecting drug user (IDU) population. Yet, such data give little information on the social mechanisms and setting generating such risk behaviors. In order to understand the transmission of HIV among the IDU population one needs to study the micro settings and social context of drug use. This paper describes and explores certain patterns of drug use, sharing, and natural support systems found amongst IDUs in two very different cities, Rotterdam (The Netherlands) and the Bronx, New York City (USA). By specifying details of the micro-settings of everyday drug use in both locales, it is possible to identify certain common elements and consequences of personal and social behavior driven by drug use per se (e.g. drug preference), and to differentiate these from behaviors and consequences determined by drug policy and the social context in which drug use actually occurs. These policies and the social context they create can in turn be shown to relate to risks for HIV transmission, e.g. the increased likelihood of sharing injection equipment. A more careful ethnographic approach, taking advantage of natural experimental opportunities, comparisons and controls, may be utilized to examine drug-related behaviors in their social context and to better assess their relevance to public health--especially to AIDS. [ABSTRACT FROM AUTHOR]

The sharing of unsterile needles and syringes is a primary means by which drug users who inject put themselves at risk of HIV infection. This paper examines a sample of 127 regular illicit drug users (both in and out of treatment) in terms of injecting and needle sharing patterns, and investigates the impact of concern about AIDS upon these behaviours. Amongst those that had ever injected, it was found that 54% had substantially reduced their risk behaviour, in that they either no longer injected, or else no longer shared injecting equipment. A further 32% had to some extent reduced their risk behaviour, and only 14% stated that they had been unaffected by concern about AIDS. Those who were in contact with agencies were more likely to have substantially reduced their risk behaviour than those not in contact with agencies. Regarding the impact of HIV testing, the data suggest that it may be associated with reduced rather than increased risk behaviours, though the differences only approach significance. In two consecutive time periods, similar proportions reported that they were still sharing; but by the second time period almost all reported some attempt at change. In general, the results confirm other studies, from the USA and Britain, that have shown that drug users are not inherently irrational, and are capable of modifying their risk behaviour. Availability of clean injecting equipment was given as the prime reason for sharing, and the free supply of needles and syringes is advocated as a complement to effective health education. Aggressive outreach work is to be encouraged so as to reach those individuals unlikely to use established schemes. [ABSTRACT FROM AUTHOR]

A review is presented of the association between the sex industry and the use and misuse of alcohol and illicit drugs. It is concluded that both the tatter are associated with 'high risk' sexual activities and that heavy drinking and illicit drug use are commonplace amongst prostitutes and their clients, Outside Africa evidence suggests that in some, though by no means all, areas prostitutes have low or zero levels of HIV seropositivity. It is concluded that far more information is needed on the patterns of AIDS-related knowledge, beliefs, attitudes and behaviours amongst male and female prostitutes and their clients. Vigorous policies are needed to increase levels of knowledge about AIDS risks amongst prostitutes and their clients and to foster the adoption of 'safer sex' practices. [ABSTRACT FROM AUTHOR]

To date, no cure has been found for HIV/AIDS. Prevention has therefore been the immediate principal aim and a didactic approach has been given a primary role. Studies from the USA indicate that knowledge level may be dictated by membership of particular subcultural groups and the perceived relevance of HIV/AIDS to these groups. This study investigates knowledge among four groups: homosexual; single heterosexual; IV drug users; and a 'married' group. Results indicate some gaps in knowledge and a greater knowledge base among one of the high risk groups, the homosexual group. [ABSTRACT FROM AUTHOR]

We used data from different sources to estimate the extent and the trend of the epidemic of drug use in Italy in the second half of the '80s. During the study, period, the number of subjects attending drug dependency units increased from 13 905 to 61 689. Mortality and morbidity indicators showed an increase in both drug related deaths (mainly from overdose) and AIDS cases reported in injecting drug users, particularly among older subjects. However, the number of young adults detected as drug users at the army recruitment remained virtually stable from 1986 on. These findings suggest that both demand and availability of treatment increased through the years 1985-89, and that clinical consequences of drug use related behaviour have become an important public health priority. [ABSTRACT FROM AUTHOR]

Elements of a systems approach to analysing service delivery are outlined. A specific example--St George's Hospital Addiction Behaviour Department--is detailed. Dynamics of the system--from the client's perspective and the workers viewpoint--demonstrate some of the ways in which emotional conflict surrounding the task is handled. The conclusions focus on what might constitute adaptive resolution of systems dilemmas as well as highlighting the public-health concerns relating to AIDS which, we argue, compromise the primary task of an addiction service at the present time. [ABSTRACT FROM AUTHOR]

The advent of HIV/AIDS has presented a major ideological challenge to established drug treatment agencies, where the incorporation of HIV-prevention strategies has proved problematic. This case study analyses the response to the HIV/AIDS epidemic by the drug misuse services of one Inner London district health authority (Bloomsbury) during the period 1985-89. While innovation and enthusiasm were much in evidence, a number of special problems prevented an effective and coherent strategic response. Key factors in the management of change in drugs/HIV services are identified which may be of special importance to clinicians, managers and funders and a number of key organizational and managerial competencies are suggested. [ABSTRACT FROM AUTHOR]

Despite the increase in social research into drug misuse that has occurred in the wake of the AIDS pandemic, the focus of the research has tended to be overly restricted in terms of the populations studied. Younger, nonopiate, non-agency samples are more representative of national patterns of illicit drug use but have been relatively neglected in favour of older, opiate users receiving treatment from drug agencies. Amphetamine misuse illustrates the dangers of such sampling bias. In comparing the HIV-related risk behaviour of amphetamine injectors with that of heroin injectors, the data suggest that amphetamine misuse is associated with patterns of behaviour that have serious implications for the transmission of HIV infection. [ABSTRACT FROM AUTHOR]

Many drug injectors continue to engage in behaviors that lead them to become infected with HIV in spite of a wide variety of public health programs. In addition, many persons have begun to inject drugs in spite of knowing the risks of AIDS. The inadequacy of current efforts to prevent these behaviors suggests that additional forms of intervention should be attempted. We suggest that social interventions be tried to complement current programs (almost all of which have an individual focus). Evidence that social factors such as peer pressure and the social relations of race affect risk behavior is presented. Social interventions that are discussed include organizing drug injectors against AIDS in ways analogous to those in which gays organized against the epidemic, and finding ways to change large-scale social relationships that predispose people to inject drugs. [ABSTRACT FROM AUTHOR]

British drug policies are undergoing a major reassessment and reformulation in response to problems raised by HIV disease and AIDS. The years from 1986 to 1989 are one of the key periods of crisis and transformation in the history of the British response to drug problems, with the emergence in current debate of a new public health paradigm of drug use. Drug policies can be analysed by examining their assumptions about the nature of (a) the problem (3) the drug user and (c) the task facing policy makers and practitioners; and their assumption about (d) the appropriate people to deal with the problem and (e) their relationships with clients. The emergent public health paradigm assumes that (a) the main problem with drug use is the injection of drugs (3) drug injectors are concerned about their health (c) the task is to promote change in health and risk behaviours (d) people dealing with the problem must be broadly skilled 'poly-drug workers' and (e) relationships with clients must be non-judgemental and 'user-friendly'. [ABSTRACT FROM AUTHOR]

Presents information on three videos produced by the British Medical Association foundation for AIDS as of June 1989. Topics of the three videos; Description of the two vignettes shown at the third video; Prices.

Presents news and information related to addiction. Symposium on early detection and intervention for persons with harmful alcohol and drug use; Debate on the availability of condoms and syringes for drug users to prevent the spread of AIDS; Description of the New South Wales Medical Education Project.