October 3, 2002
Since 1981, 753,907 cases of AIDS have been reported to the Centers for Disease Control and Prevention (CDC). It is estimated that 650,000 to 900,000 Americans are now living with HIV and that about 40,000 new infections occur every year.
The figures on hepatitis are equally impressive: Between 1 and 1 1/4 million Americans have active hepatitis B; 130,000 to 320,000 new infections occur every year. Nearly 3 million Americans have active hepatitis C.
Injection drug users (IDUs) are an important force in the continuing epidemics of these devastating diseases. IDUs become infected and transmit the viruses to others in two, often interconnected, ways:
Women who become infected with HIV through sharing needles or having sex with an infected IDU can also transmit the virus to their babies before or during birth or through breastfeeding.
More effective prevention approaches will help IDUs. Society as a whole will benefit as well, because reduced transmission among IDUs means reduced transmission among their sex partners, their children, and ultimately, among the general population.
Many health departments, community-based organizations, agencies, and providers are working hard to reach and work with IDUs to help them change their behaviors and reduce or eliminate their risk of acquiring or transmitting infection.
The problem of injection drug use and transmission of blood-borne disease persists, however. Solutions are hampered by society's pervasive negative attitudes toward IDUs, a lack of understanding of drug addiction as a treatable biomedical and psychological disease, limited funding for prevention and treatment, restrictive laws and regulations, and polarized philosophical viewpoints among various organizations and providers.
If organizations and providers, public health staff, and prevention planners are to succeed in effectively reducing the transmission of HIV and other blood-borne infections, they must consider a comprehensive approach to working with IDUs. Such a comprehensive approach, now being advocated by the Centers for Disease Control and Prevention (CDC), incorporates a range of pragmatic strategies that take into account IDUs' various life circumstances, cultures and languages, behaviors, and readiness to change. It also incorporates several basic principles that serve as a framework for action.
Ensure coordination and collaboration. No single provider or institution can or does deliver all required services to IDUs, their sex partners, and their children. Coordination and collaboration are essential. Providers must work together, sharing their various expertise and outlooks, recognizing and overcoming their philosophical differences, building on existing relationships, and reaching out to groups with whom they may not have worked before.
Ensure coverage, access, and quality. Interventions will not be effective if they do not reach a critical mass of people, if IDUs cannot or will not use them, or if they are of poor quality. If they hope to truly reach and work with IDUs, agencies and providers must consider ways to effectively deal with these issues as they plan, deliver, and monitor programs and services.
Recognize and overcome stigma. Injection drug use is regarded with disapproval and fear, and a user's addiction is considered to be a moral failing. To successfully engage IDUs in prevention efforts and to advance public policy, these negative attitudes and misconceptions must be addressed. Addiction is now understood to be a treatable brain disease. This concept should be more widely known and accepted.
Tailor services and programs. IDUs are diverse populations with different languages, cultures, sexual preferences, life circumstances, behaviors, and requirements for services. Many, though not all, are poor and live high-risk lives on the margins of society. In planning and delivering interventions, programs and providers must take into account the factors that characterize IDUs -- who they are, where they are, what they do, what motivates them, and with whom they socialize. Tailoring services and programs and involving IDUs in their planning, implementation, and monitoring will make them more effective.
Substance Abuse Treatment -- Why Include It?
Community Outreach -- Why Include It?
Access to Sterile Syringes -- Why Include It?
Services in the Criminal Justice System -- Why Include Them?
Strategies to Prevent Sexual Transmission -- Why Include Them?
Counseling and Testing Services, Partner Counseling and Referral Services, and Prevention Case Management -- Why Include Them?
Services for IDUs Living with HIV/AIDS -- Why Include Them?
Primary Drug Prevention -- Why Include It?
Get a copy of Preventing Blood-Borne Infections Among Injection Drug Users: A Comprehensive Approach (PDF), which provides extensive background information on HIV and viral hepatitis infection in IDUs and the legal, social, and policy environment. It also provides more detail on the strategies and principles listed here and suggests steps that communities can take in considering and carrying out a comprehensive approach.
You can get A Comprehensive Approach and other related information, including fact sheets on issues such as access to sterile syringes, from CDC's IDU web site or from a web site of the Academy for Educational Development.