English Abstract In the western world, intravenous drug users are the
second most important risk group for AIDS after homosexual men with multiple
partners. Because of the long incubation period of AIDS, research on the
prevalence of HIV in risk groups can lead to a considerable gain in time
with regard to the formulation of care and prevention policies. Until now
in the Netherlands prevalence studies among drug users have almost
exclusively been done in Amsterdam. Therefore, little is known about the
spread of HIV among drug users across the country. This study was initiated
to investigate the feasibility of (regularly repeated) prevalence studies
among drug users. Of special importance was to ascertain to what extent
drug users in general and hidden groups in particular could be reached using
care facilities as an entrance. Apart from that the study generates data on
prevalence of HIV infections and HIV-related risk factors in a population of
drug users outside the urbanized Western part of the country. In this study
a recently developed saliva test for antibodies against HIV is used. It was
attempted to reach all hard-drug users, both injecting and non-injecting, in
the population. This was done to be able to study selections, that occur
when studying sub-populations, and to be able to study sexual risk behaviour
independently of risk related to injection of drugs. Deventer, a provincial
town in the Eastern part of the country, was selected as research site on
the basis of population size, the number and type of care facilities, and
comparability with a simultaneous project among drug users in Alkmaar. The
most important findings are: 1 Given the fruitful collaboration prevalence
research among drug users, using local care facilities as an entrance is
well possible. 2. Prevalence research in collaboration with care
facilities can offer advantages with respect to the acceptability for care
givers and participants and repeatability. 3. Hidden groups, not reached
by care facilities, can still be reached by this approach. Realistic
estimates of the number and characteristics of the whole population are
possible through nomination techniques. 4. The prevalence of HIV
infections among drug users in Deventer is low: 0-2.6% in general and
0-5.3% among intravenous drug users. This low prevalence is probably
representative of the prevalence among drug users outside the urbanized
Western part of the country. 5. Sharing of needles and syringes is
uncommon in Deventer. Sexual risk is more common among women, drug users
with little education, and among drug users currently or ever under
methadone treatment. Injecting drug users are older, more often have a
history of prostitution and make more drug-related travels to other
cities.
