Document 2271
 DOCN  M94A2271
 TI    Evaluation dilemma: serotesting in needle-exchange programs, helpful or
       counterproductive?
 DT    9412
 AU    Schepp-Beelen JC; de Jongh-Wieth FE; de Wildt GR; Beaumont WJ; City
       Health Department, Hague, Netherlands.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):342 (abstract no. PC0307). Unique
       Identifier : AIDSLINE ICA10/94370304
 AB    PROBLEM DEFINITION: In The Hague in the Netherlands, the programme aimed
       at controlling HIV and its consequences in intravenous drug users (IDUs)
       involves health education, emotional support, needle-exchange, and the
       provision of condoms. It focuses on visits by outreach workers to the
       privacy of IDUs' homes and to places where high-risk behaviour takes
       place, e.g. sites where soliciting takes place by commercial sex
       workers, including IDU's. Outreach workers are covered by medical
       confidentiality. Many recipients are not in contact with other health
       services. Interviews showed that IDU's, especially those with high-risk
       behaviour, were reluctant to get involved for fear of being tested. To
       gain the trust of IDU's, deliberately no effort was made to collect
       quantitative data on IDU's behaviour or seroprevalence of HIV. Trust was
       established, which is also of benefit to TB control and other aspects of
       public health. Output measures suggest that the programme has a large
       coverage while HIV-prevalence in IDU's may be low. Thus, an evaluation
       problem exists: While reticence with regard to serotesting and other
       research is likely to have facilitated the building of trust and the
       establishment of conditions which favour safe behaviour, the absence of
       hard quantitative indicators poses a hurdle when it comes to evaluating
       the outcome and impact of the programme and its replicability.
       CONCLUSION: There is a need for the development of alternative methods
       and indicators for evaluation which can be used in situations where
       serosurveillance and other quantitative research efforts are not deemed
       appropriate.
 DE    *AIDS Serodiagnosis  Comprehensive Health Care  Condoms  Human  HIV
       Infections/EPIDEMIOLOGY/*PREVENTION & CONTROL/TRANSMISSION  HIV
       Seroprevalence  Knowledge, Attitudes, Practice  Needle Sharing/*ADVERSE
       EFFECTS  Netherlands/EPIDEMIOLOGY  Program Evaluation  Substance Abuse,
       Intravenous/*COMPLICATIONS/REHABILITATION  MEETING ABSTRACT

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