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AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Preventing HIV infection among injecting drug users in high-risk countries: an assessment of the evidence Jonathan Dewhurst
a
a
Kensington & Chelsea Drug Treatment Centre , CNWL NHS Foundation Trust , London, UK Published online: 26 Mar 2010.
To cite this article: Jonathan Dewhurst (2010) Preventing HIV infection among injecting drug users in high-risk countries: an assessment of the evidence, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 22:3, 397-397, DOI: 10.1080/09540120903193757 To link to this article: http://dx.doi.org/10.1080/09540120903193757
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
AIDS Care Vol. 22, No. 3, March 2010, 397398
BOOK REVIEWS
Downloaded by [University of Boras] at 20:53 05 October 2014
Preventing HIV infection among injecting drug users in high-risk countries: an assessment of the evidence, by Committee on the Prevention of HIV Infection among Injecting Drug Users in High-risk Countries and National Academy of Sciences, Washington, DC, The National Academies Press, 2006, 282 pp., £41.00 (paperback), ISBN-10 0 309102804, $61.25 (paperback), ISBN-13 978-0309102804 It is apparent from the first page that the study for this book was funded by the National Academy of Sciences and the Bill & Melinda Gates Foundation but it continues to state that ‘‘any opinions, findings, conclusions, or recommendations . . . are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project’’. Not exactly a ringing endorsement for the text ahead, although, with an open mind, I felt this may reflect the objective independence of the writers. However, with no clear author for this book, it is difficult to know who to direct any praise or criticism towards. Instead, we are given a list of the committee tackling the purpose of the book, who are experts mainly based in America, with one from Thailand and one from India. This is followed by a list of reviewers with a similar mix of backgrounds. It later becomes apparent that the book was born from an international meeting in Geneva over two days in December 2005. One of the main difficulties I had with negotiating the book was its layout. The content page was buried between acknowledgements, acronyms and abbreviations, and there was a summary before the introduction. Notably, both of these latter chapters started with exactly the same text for the first two pages. Both chapters list the five original study questions but, having read the book, I cannot help feeling they could have been left out as it is the four chapters in the middle of the book that give the most relevant information for the reader. The first chapter gives clear and current statistics of HIV worldwide, specifying on routes of transmission and focussing on factors influencing HIV risk among intra-venous drug users. The chapter helpfully distinguishes between ‘‘individual-level factors’’, like co-morbid mental health issues and severity of dependence, and ‘‘structural-level factors’’, like law enforcement practices, showing they both affect a drug user’s risk. The second chapter reviews treatment for drug dependence. The argument for opioid agonist ISSN 0954-0121 print/ISSN 1360-0451 online DOI: 10.1080/09540120903193757 http://www.informaworld.com
maintenance treatment for opioid injectors is strong and the chapter reviews psychosocial interventions. The conclusion pushes for further research in this area. In the third chapter, strategies including needle exchange programmes, community outreach projects and public education are reviewed. Difficulties in analysing these complex programmes arise as multiple components are difficult to separate out in looking for causes of reductions in transmission. ‘‘Taking Action’’ is the title of the fourth chapter, which summarises the evidence whilst considering costs, infrastructure and sustainability for public health. In countries with emerging HIV pandemics from drug use, it urges policy makers to act now. The book ends with appendices running through unnecessary conference agendas, literature search strategies and tables of evidence already listed. Appendix E gives motivating reflection for a community randomised trial and it would have been most sensible to include this in chapter four. This book is well referenced and the information is clearly led by world experts in this complex medical field. The findings are not groundbreaking but the information gives a sound basis for future research. It is not clear who this book is aimed at. Most of the contributors specialise in public health and infectious diseases, with only one health economist and one psychiatrist on the committee. The book does give a broader perspective than individual case management. I would argue it would have most impact for government officials looking for ways to combat HIV rates in drug users, although any clinician dealing with infectious diseases and drug dependence would find it a useful reference. However, as the study focusses on high-risk countries, it is doubtful that local clinicians will access the information. Unfortunately, this text has been set out in a clumsy way. Use of tables and boxes could have easily enhanced the book’s understanding of this multifaceted and complex world problem. Instead, the ones used here add to the confusion of the layout. I think that if someone had taken responsibility to edit more effectively, the result would be a more concise, easy to follow book reaching a wider audience. Jonathan Dewhurst Kensington & Chelsea Drug Treatment Centre CNWL NHS Foundation Trust, London, UK [email protected] # 2010, Jonathan Dewhurst
AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Preventing HIV infection among injecting drug users in high-risk countries: an assessment of the evidence Jonathan Dewhurst
a
a
Kensington & Chelsea Drug Treatment Centre , CNWL NHS Foundation Trust , London, UK Published online: 26 Mar 2010.
To cite this article: Jonathan Dewhurst (2010) Preventing HIV infection among injecting drug users in high-risk countries: an assessment of the evidence, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 22:3, 397-397, DOI: 10.1080/09540120903193757 To link to this article: http://dx.doi.org/10.1080/09540120903193757
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
AIDS Care Vol. 22, No. 3, March 2010, 397398
BOOK REVIEWS
Downloaded by [University of Boras] at 20:53 05 October 2014
Preventing HIV infection among injecting drug users in high-risk countries: an assessment of the evidence, by Committee on the Prevention of HIV Infection among Injecting Drug Users in High-risk Countries and National Academy of Sciences, Washington, DC, The National Academies Press, 2006, 282 pp., £41.00 (paperback), ISBN-10 0 309102804, $61.25 (paperback), ISBN-13 978-0309102804 It is apparent from the first page that the study for this book was funded by the National Academy of Sciences and the Bill & Melinda Gates Foundation but it continues to state that ‘‘any opinions, findings, conclusions, or recommendations . . . are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project’’. Not exactly a ringing endorsement for the text ahead, although, with an open mind, I felt this may reflect the objective independence of the writers. However, with no clear author for this book, it is difficult to know who to direct any praise or criticism towards. Instead, we are given a list of the committee tackling the purpose of the book, who are experts mainly based in America, with one from Thailand and one from India. This is followed by a list of reviewers with a similar mix of backgrounds. It later becomes apparent that the book was born from an international meeting in Geneva over two days in December 2005. One of the main difficulties I had with negotiating the book was its layout. The content page was buried between acknowledgements, acronyms and abbreviations, and there was a summary before the introduction. Notably, both of these latter chapters started with exactly the same text for the first two pages. Both chapters list the five original study questions but, having read the book, I cannot help feeling they could have been left out as it is the four chapters in the middle of the book that give the most relevant information for the reader. The first chapter gives clear and current statistics of HIV worldwide, specifying on routes of transmission and focussing on factors influencing HIV risk among intra-venous drug users. The chapter helpfully distinguishes between ‘‘individual-level factors’’, like co-morbid mental health issues and severity of dependence, and ‘‘structural-level factors’’, like law enforcement practices, showing they both affect a drug user’s risk. The second chapter reviews treatment for drug dependence. The argument for opioid agonist ISSN 0954-0121 print/ISSN 1360-0451 online DOI: 10.1080/09540120903193757 http://www.informaworld.com
maintenance treatment for opioid injectors is strong and the chapter reviews psychosocial interventions. The conclusion pushes for further research in this area. In the third chapter, strategies including needle exchange programmes, community outreach projects and public education are reviewed. Difficulties in analysing these complex programmes arise as multiple components are difficult to separate out in looking for causes of reductions in transmission. ‘‘Taking Action’’ is the title of the fourth chapter, which summarises the evidence whilst considering costs, infrastructure and sustainability for public health. In countries with emerging HIV pandemics from drug use, it urges policy makers to act now. The book ends with appendices running through unnecessary conference agendas, literature search strategies and tables of evidence already listed. Appendix E gives motivating reflection for a community randomised trial and it would have been most sensible to include this in chapter four. This book is well referenced and the information is clearly led by world experts in this complex medical field. The findings are not groundbreaking but the information gives a sound basis for future research. It is not clear who this book is aimed at. Most of the contributors specialise in public health and infectious diseases, with only one health economist and one psychiatrist on the committee. The book does give a broader perspective than individual case management. I would argue it would have most impact for government officials looking for ways to combat HIV rates in drug users, although any clinician dealing with infectious diseases and drug dependence would find it a useful reference. However, as the study focusses on high-risk countries, it is doubtful that local clinicians will access the information. Unfortunately, this text has been set out in a clumsy way. Use of tables and boxes could have easily enhanced the book’s understanding of this multifaceted and complex world problem. Instead, the ones used here add to the confusion of the layout. I think that if someone had taken responsibility to edit more effectively, the result would be a more concise, easy to follow book reaching a wider audience. Jonathan Dewhurst Kensington & Chelsea Drug Treatment Centre CNWL NHS Foundation Trust, London, UK [email protected] # 2010, Jonathan Dewhurst
