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Principles of HIV Prevention in Drug-Using Populations
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Introduction

In the mid-1980s, the National Institute on Drug Abuse (NIDA) launched an extensive research program to develop, implement, and evaluate the effectiveness of a range of intervention strategies to reduce risk behaviors and prevent the spread of HIV/AIDS, particularly among injection drug users (IDUs), their sex partners, and crack cocaine users. Cumulative findings from these efforts show that it is possible to prevent the transmission of HIV in drug-using populations.

These studies have shown that comprehensive HIV prevention strategies, in the absence of a vaccine or a cure for AIDS, are the most cost-effective and reliable approaches for preventing new HIV infections in diverse populations of drug users and their communities. Comprehensive HIV prevention includes a variety of complementary components — community-based outreach, drug abuse treatment, and sterile syringe access programs — to help drug-using populations increase their protective behaviors and reduce their risks for HIV/AIDS as well as other blood-borne infections, such as hepatitis B (HBV), hepatitis C (HCV), and other sexually transmitted diseases (STDs). In combination with HIV testing and counseling, each major component has proven somewhat effective in reducing HIV-related risk behaviors. However, no single strategy has proven sufficient by itself to prevent the further spread of HIV/AIDS.

In August 1997, after more than a decade of HIV prevention research, NIDA sponsored the "Research Synthesis Symposium on the Prevention of HIV in Drug Abusers" to review and translate research conducted by NIDA on HIV/AIDS prevention strategies for drug users and their sex partners. Less than a year later, NIDA published a special issue of Public Health Reports (1) that featured selected papers from the Symposium on the origins, current status, and future prospects of HIV prevention in drug-using populations. The special issue also provided an initial set of overarching principles to help guide HIV prevention planning efforts.

As a follow-up to both the Symposium and the special issue, NIDA held a workshop on "HIV Prevention in Drug-Using Populations: Research Outcomes and Principles of Effective Behavioral Interventions" in January 2000. The workshop sought to (a) review the scientific literature on the principles of effective behavioral interventions to prevent HIV/AIDS among drug users, (b) refine a set of prevention principles that is both comprehensive and representative of the best science available, and (c) translate the principles so that they could be widely applied and implemented in diverse community settings. The workshop coincided with NIDA's development of a manual on the NIDA Outreach Model, released in September 2000 (2). The manual discusses the principles of HIV prevention for drug users and their sex partners, includes step-by-step instructions for conducting community-based outreach, and provides information for program managers to use in designing outreach risk reduction programs in their communities (for more information, see "Resources").

Available resources, social and cultural factors, and local conditions and policies will influence how, when, where, and to what extent HIV/AIDS prevention programs can be implemented to ensure that even the most difficult-to-reach drug users have access to the services that they need. The research-based principles described in this publication can be a useful tool for communities to use in planning and implementing a comprehensive HIV/AIDS prevention program. Coordination and effectiveness of the various services called for in a comprehensive approach can be improved through partnerships among researchers, drug abuse and HIV/AIDS prevention and treatment providers, and local civic leaders. Once HIV/AIDS prevention programs are adapted to the individual community, they should be assessed continually to determine whether they are successfully achieving program objectives and whether they should be modified or adapted in response to other blood-borne diseases.

References

  1. NIDA. HIV Prevention With Drug-Using Populations: Current Status and Future Prospects. Public Health Reports 113 (Suppl. 1), 1998.

  2. NIDA. A Manual to Reduce the Risk of HIV and Other Blood-Borne Infections in Drug Users: The NIDA Community-Based Outreach Model. NIH Pub. No. 00-4812. Washington, DC: U.S. Govt. Print. Off., Sept. 2000.

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