Characteristics of Clients in Alcohol- and Drug-Treatment Centers -- South Carolina, 1989

The South Carolina Department of Health and Environmental Control (SCDHEC) recently evaluated characteristics of clients in detoxification programs of selected alcohol- and drug-treatment centers to determine 1) the human immunodeficiency virus (HIV), hepatitis B, and syphilis seropositivity of clients; 2) the proportion of clients with histories of intravenous (IV)-drug use; and 3) clients' drug-use and risk behaviors and attitudes. This report presents findings of the SCDHEC evaluation.

In 1989, the 37 public, community-based alcohol- and drug-treatment centers in South Carolina served 32,323 clients who had a primary diagnosis of alcohol or other drug use. In South Carolina, clients who are admitted to alcohol- and drug-treatment centers are charged for services on a sliding scale based on their ability to pay; no one is refused service. Clients are referred for treatment by themselves, state and local agencies, hospitals, and emergency rooms. Inpatient services are offered for a maximum of 28 days; outpatient services may continue indefinitely. In 1989, 86% of clients were treated on an outpatient basis.

From April 25 through June 23, 1989, the SCDHEC surveyed and tested all clients entering detoxification services at alcohol- and drug-treatment centers in three urban counties (approximate population of each county: 300,000). During this period, 632 clients entered the centers and were tested for HIV, hepatitis B surface antigen (HBsAg), and syphilis (rapid plasma reagin (RPR)); nine (1%) were HIV-antibody positive, 21 (3%) were HBsAg positive, and 22 (3%) had a reactive RPR.

Of the 632 clients, 478 (76%) completed an anonymous, self-administered questionnaire concerning drug use, HIV-transmission risk behaviors, and attitudes regarding HIV prevention. Of the clients who completed the questionnaire, 442 (92%) provided drug-use information. Of these, 182 (41%) indicated they had used IV drugs at some time in the past, and 129 (29%) indicated they had used IV drugs in the past year. The median age of the IV-drug users (IVDUs) was 31 years (range: 12-72 years), and their median education level was 12th grade (range: 4-16 years of school). Of the 174 for whom gender was known, 131 (75%) were male. Of the 169 for whom race was known, 103 (61%) were white, 63 (37%) were black, and three (2%) were other races. Sexual preference was known for 163 IVDUs: 150 (92%) were heterosexual and 13 (8%; nine males and four females) were homosexual/bisexual. Drug use was reported by the nine HIV-positive persons: seven indicated IV-drug use as their only risk behavior, one indicated a history of IV-drug use and bisexuality, and one indicated a history of non-IV cocaine use.

Of the 182 clients who had used IV drugs, 80 (44%) reported sharing needles or other drug-injection equipment. One hundred six (58%) indicated that they always rinsed their drug-injection equipment after use; however, only 16 (15%) of these used bleach when cleaning their drug-injection equipment. Of the 182 IVDUs, 28 (15%; 16 males, 10 females, two unknown) indicated that in the past year they had exchanged sex for money, drugs, or other gifts. The drugs most frequently injected were cocaine (62%), heroin (30%), and combinations of cocaine and heroin (22%).

Of 114 persons indicating how frequently they injected drugs, 43 (38%) reported injecting daily; 34 (30%), weekly; and 37 (32%), monthly. Of the 173 persons who answered questions on condom use, 88 (51%) reported never using condoms; 72 (42%), sometimes using condoms; and 13 (8%), always using condoms.

In regard to attitudes about HIV testing, 85% of the IVDUs indicated that all persons in a drug-treatment program should be offered testing and counseling at the site where drug treatment is received. Reported by: JL Jones, MD, P Rion, MSPH, H Dowda, PhD, L Kettinger, MPH, R Ball, MD, WB Gamble, Jr, MD, State Epidemiologist, South Carolina Dept of Health and Environmental Control. L Nalty, MHEd, D Nalty, PhD, South Carolina Commission on Alcohol and Drug Abuse.

Editorial Note

Editorial Note: The findings of this evaluation by the SCDHEC have played an important role in the development of new disease-prevention programs in South Carolina alcohol- and drug-treatment centers. These programs include client education on the prevention of HIV infection, hepatitis B, and sexually transmitted diseases; specific HIV-training sessions for substance-abuse counselors; training plans for the implementation of outreach programs; specific risk-reduction programs for female IVDUs; condom distribution programs; and a program for counselors to demonstrate one-on-one to clients how to clean drug-injection equipment with bleach.

This survey (which involved 76% of clients) found that 41% of the clients of these centers reported IV-drug use. Clients who attend alcohol- and drug-treatment centers may not be representative of the IV-drug-using population in a locality (1); however, they do represent a population that is accessible through public health programs that offer counseling and testing for HIV and other sexually transmitted diseases, partner notification, and other HIV-related services (e.g., free and confidential CD4 lymphocyte testing with referral to other health-care providers). These services can provide incentives for clients to return for follow-up counseling, which is important for behavioral change among IVDUs (2). Results of this evaluation also indicate that greater efforts in preventive education are needed to reduce risk factors associated with HIV transmission among IVDUs.

References

1. CDC. Coordinated community programs for HIV prevention among intravenous-drug users--California, Massachusetts. MMWR 1989;38:370-4.

2. van den Hoek JAR, van Haastrecht HJA, Coutinho RA. Risk reduction among intravenous-drug users in Amsterdam under the influence of AIDS. Am J Public Health 1989;79:1355-7.

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