Yolande Obadia

Study objective: This study examined the impact of highly active antiretroviral therapies (HAART) on sexual risk behaviours of HIV infected injecting drug users (IDUs) included in the French MANIF 2000 cohort study. Design: Longitudinal analysis including baseline and last follow up characteristics using generalised estimating equations (GEE). Setting: Hospital departments for specialist AIDS care in south eastern France and inner suburbs of Paris. Patients: All patients antiretrovial treatment naive, who reported being sexually active at enrolment, and who had at least one follow up visit in the cohort between October 1996 and May 1998 (n=188). Main results: Of the 188 HIV infected IDUs who were antiretroviral treatment naive at enrolment, 34 were prescribed HAART during follow up. Proportion of patients who reported at least one episode of unprotected sexual intercourse in the previous six months only significantly decreased in the HAART treated group (from 47.1% to 23.5%, p=0.008, compared with 43.5% to 35.7% in the rest of the sample, p=0.10). GEE multivariate model confirmed that prescription of HAART was associated with reduced sexual risk. Conclusions: The concern that HAART might result in clinical improvement leading to resumption of high risk activities that could inadvertently result in HIV transmission was not supported by these data. Reasons for further reductions in HIV risk with taking HAART remain to be clarified.

Aims. To evaluate the extent to which the introduction (February 1996) of ambulatory prescriptions of buprenorphine for drug maintenance treatment (DMT) has been associated with its intravenous illicit use by French injecting drug users (IDUs). Design. Cross‐sectional survey (September 1997), using self‐administered questionnaires, in a sample of IDUs recruited at 32 pharmacies, four needle exchange programmes and three syringe vending machines. Setting. Thirty‐nine sites where IDUs have access to sterile syringes in the city of Marseille (South‐Eastern France). Participants. Sample of IDUs attending community pharmacies, vending machines and needle exchange programs to obtain equipment. Measurement. To compare characteristics of IDUs who declared that they only injected buprenorphine in the prior 6 months versus the rest of the sample. Findings. Among the 343 respondents (response rate = 70.7%), 33.8% were polydrug users who occasionally injected buprenorphine in parallel to heroin and/or cocaine, while 23.9% only injected buprenorphine in the previous 6 months. IDUs in this latter group were younger, injected more frequently, and were more frequently on buprenorphine DMT, but they were less likely to be HIV‐infected and to declare HIV‐related injecting risky behaviours. Conclusions. Substantial risk of injecting misuse is associated with large‐scale diffusion of buprenorphine DMT. A more stringent regulation for medical dispensation of buprenorphine than the current French general freedom of prescription for all physicians, including general practicioners in ambulatory care, may be necessary in other countries which are considering the diffusion of buprenorphine DMT.