VENDING MACHINES ENLISTED IN AIDS FIGHT

In Marseille, France, some vending machines dispense neither soda nor candy
but free sterile needles for drug users. In Vancouver, British Columbia, a
stack of colorful coupons sits next to the register at a local drugstore,
offering 10 percent off on condoms.

The two endeavors aim to block the spread of infectious diseases, especially
AIDS, by making preventive tools available to people who might be reluctant
to seek them out in clinics or doctors' offices. And two studies in the
December issue of The American Journal of Public Health suggest that they
are working.

Researchers at Inserm, the French equivalent of the National Institutes of
Health, and Johns Hopkins University looked at where drug users in Marseille
got needles. The local government makes sterile needles available at
drugstores, needle exchanges and vending machines. In the survey, conducted
in 1997, questionnaires were handed out to 486 people getting needles at all
three kinds of sites, and 343 were completed.

The researchers found that people who used the vending machines tended to be
younger drug users who were less likely than others to be infected with
H.I.V. or hepatitis, making them an important group to catch before becoming
infected. Needle exchanges drew in more experienced users, while pharmacies
served older users, but neither tended to attract the youngest group with
the highest risk.

"I think younger people are more comfortable with vending machines," said
David Vlahov, a professor at Johns Hopkins, who was an author of the study.
"Why? Because they're not being preached at or to. They don't have to stand
in line. There's more anonymity possible with this type of program. That's
typically more attractive to young adults."

Dr. Vlahov explained that when people started to inject drugs, they did not
know how to do it themselves and tended to rely on others for supplies. "As
they're developing the experience, the likelihood of getting a contaminated
needle is high," he said. "The vending machines may be helpful in averting
that.

"Of course, the idea is to identify individuals early to get them not to use
drugs. If they're not injecting, then we'd like to get in there and tell
them injection is dangerous. For those who have started, we want them to
stop. Those who won't or can't stop, well, we want to reduce the risk of
transmission of these infections."

The study's lead author, Dr. Yolande Obadia, director of the Regional Center
for Disease Control of Southeastern France, said vending machines seemed to
attract a "hidden part of the injection-drug-user population."

The second study, in Vancouver, looked at ways to use marketing techniques
to get people to buy condoms. While health organizations sometimes
distribute condoms, the process can be expensive and sporadic.

Researchers at the University of Manitoba used two different condom coupon
strategies. In the first, a widespread distribution strategy, the
researchers distributed coupons offering discounts to people at nightclubs,
fitness centers and special events. In the second, more focused approach,
the investigators made discount coupons available inside drugstores for use
that day only. Researchers also observed the behavior of customers who
received the coupons while they were in the drugstores.

The use of the coupons was negligible in the more widespread distribution
method. But in the more focused method, the rates of redemption were
significantly higher than might otherwise be expected. The focused
distribution was more effective, researchers said, because buyers had the
occasion and limited time in which to make the purchase.

"Making safety more available is a viable strategy," said Dr. Darren W.
Dahl, the lead author and a professor of marketing in the Management School
at the University of Manitoba. "Abstinence is the safest approach, but it's
not for everyone. Those who don't choose that route to safety need other
options."