EDUCATION DOES NOT STOP NEEDLE SHARING, STUDY SHOWS

Most young injection drug users infected with hepatitis C continue to share
needles and other drug paraphernalia, even after being given risk
counseling and referred to needle-exchange programs, a new report has found.

The study, published in the Oct. 1 issue of the journal Clinical Infectious
Diseases, concludes that routine risk-reduction counseling, advocated by
the federal Centers for Disease Control and Prevention, "is of limited
benefit" for drug addicts who use needles.

Researchers at the Johns Hopkins University, Columbia University, and the
New York Academy of Medicine, who conducted the study in Baltimore,
determined that a "more comprehensive approach is needed" to wean injection
drug users (IDUs) from sharing needles and drug equipment and thus to
reduce the risk of contracting or transmitting hepatitis C.

The findings "don't surprise me one bit," said Kevin Krueger, co-founder of
the National Hepatitis C Coalition, based in Hemet, Calif.

"We always thought needle-exchange programs just meant putting more tools
on the street to harm people," said Mr. Krueger, who continues to battle
the hepatitis C that he contracted in 1994. "A person addicted to drugs
isn't thinking about anyone's health. That person's primary concern is when
he'll get his next fix."

According to Dr. Miriam Alter, associate director of science in the CDC's
Division of Viral Hepatitis C, an estimated 3.9 million Americans are
infected with hepatitis C.

Like Mr. Krueger, three-quarters of hepatitis C patients are chronically
afflicted. Although discovered less than 15 years ago, the potentially
deadly disease today is the leading cause of liver transplants. It's also a
major cause of cirrhosis and a liver cancer known as heptacellular
carcinoma in the United States.

"About 60 percent of those with hepatitis C are injection drug users. It's
the major risk factor for the disease," Dr. Alter said in a telephone
interview.

Like the better known hepatitis B and HIV, hepatitis C can be transmitted
by blood and sexual contact. But Mr. Krueger said cases of sexual
transmission he has heard about involved a tearing of tissue and bleeding.

In the report in Clinical Infectious Diseases, a publication of the
Infectious Disease Society of America, lead author Danielle C. Ompad noted
that contracting hepatitis C virus (HCV) infection has been associated both
with "direct sharing of needles and syringes and indirect sharing of
paraphernalia, such as drug cookers and cotton filters."

"We aimed to investigate changes in the frequencies of high-risk behaviors
associated with HCV transmission after disclosure of a positive HCV
antibody test result among young, recently initiated IDUs," wrote Ms.
Ompad, a graduate assistant in Hopkins' Bloomberg School of Public Health.

Study participants were all between the ages of 15 and 30 and had injected
illicit drugs at least once in the previous six months. Participants
underwent semiannual interviews about high-risk behavior; antibody testing
for HCV; and pre-test and post-test counseling.

Forty-six subjects who tested positive for HCV were compared with 60 others
who were either HCV-negative or were HCV-positive but were not diagnosed at
least three months prior to a six-month follow-up visit.

The study found that, overall, 17 percent of participants reported reducing
the frequency of sharing needles, while 15.1 percent reported a decrease in
"backloading." That term refers to a procedure in which drugs are injected
from one syringe to the barrel of another.

The researchers concluded that such proportions indicated "routine
risk-reduction counseling" has limited benefits for the injection
drug-using population. Some IDUs do not seem to understand the risk posed
by sharing of needles and drug paraphernalia.

Nearly 35 percent of participants infected with HCV reported increasing or
not changing their frequency of needle-sharing, while better than
three-quarters of those who were hepatitis C-positive increased or did not
change their frequency of backloading.

A synopsis of the study said between 23 percent and 29 percent of study
participants cut their frequency of sharing drug paraphernalia. But more
than 50 percent of the hepatitis C group did not change their frequency of
sharing cookers and rinse water.

"This virus doesn't die when it hits air, so you have to bake utensils that
come in contact with it," Mr. Krueger said.

Dr. Steffanie Strathdee, a Hopkins researcher who was an investigator in
this newly published study, was the lead author in another recent study
that found that injection drug users were more likely to acquire HIV, the
AIDS virus, through unsafe sex than through sharing dirty needles.