Sustained AIDS education campaigns and behavioural changes in Italian drug abusers

In the area of Padua, northern Italy, fear of AIDS along with AIDS educational campaigns had reduced risk behaviours for HIV among intravenous drug abusers (IVDA) as early as 1987, although at that time 38% of seropositive cases still shared needles and only 22% of subjects used condoms. The present study has been conducted in the same area and with similar criteria to evaluate the effectiveness and limits of a sustained education campaign. Drug related and sexual risk behaviours and motivations preventing behavioural changes were investigated by direct interview in 190 IVDA. Fourteen percent of the participants, including 16% of the seropositive, were still sharing needles, mainly because they did not have works available at the time they were needed. Demographic features, drug-related characteristics and anti-HIV seroprevalence did not differ significantly between needlesharers and other drug abusers. Condom use was reported by 46% of subjects, but encouragingly enough this figure included 80% of the seropositives. While knowledge of seropositivity seemed to encourage condom use, a higher selectivity about partners and a negative attitude towards condoms were the most frequent motivations preventing safer sex. These results suggest that sustained AIDS education campaigns are being successful in maintaining and reinforcing the trend to risk reduction previously observed among drug abusers in this area. Nevertheless the persistence of risk behaviours in a consistent proportion of participants emphasizes the urgency of additional prevention strategies, such as syringe exchange or supply to the limited number of sharers and counselling to encourage safer sex.