Nearly half of heroin addicts in Baltimore's drug treatment programs are unaware that they suffer from chronic blood infections such as HIV and hepatitis, according to a study by the Johns Hopkins School of Public Health. Despite the disturbing picture of health problems associated with addiction, the researchers said the city has an excellent chance to reduce the toll through its methadone maintenance centers. Officials with the Open Society Institute, the foundation that paid for the study, said the methadone centers should screen clients for blood-borne infections and refer those who need care to clinics.

"You want to break down the barriers between drug treatment and the health care system," said Dr. Robert Schwartz, an addictions specialist with OSI.

Researchers found that nearly two out of three addicts were infected with hepatitis C, a chronic infection that can eventually trigger liver failure and cancer. Only one-third of those infected knew it. Meanwhile, one in five addicts were infected with HIV. Eighty percent were aware they were infected, presumably because HIV testing is widely available and encouraged by public health campaigns. Only 3 percent were infected with syphilis. Researchers credited the city Health Department's campaign in the mid-1990s with curbing what was then a serious syphilis epidemic.

In the two-year study, OSI paid for case managers at the clinics who referred infected addicts for medical care. About 2,000 addicts were vaccinated against hepatitis B.

The researchers and OSI recommended that the treatment centers offer free testing for HIV, syphilis, and hepatitis B and C, using state laboratory services. They also urged treatment centers to seek federal funding for hepatitis B vaccines. The clinics should refer patients to federally funded community health centers and the city clinics that treat STDs, the study said. An unanswered question, however, is how to pay for the services -- particularly hepatitis C treatment, which can cost as much as $35,000. Federal funding is fragmented and scarce.

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