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Principles of HIV Prevention in Drug-Using Populations
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Principles of HIV Prevention

  1. Reducing the risk of HIV/AIDS in drug users is an achievable goal. To prevent the spread of HIV and other blood-borne infections, drug users must reduce or eliminate those behaviors that place them and others at risk. Research has shown that appropriately designed prevention programs can reduce transmission of not only HIV but of other blood-borne diseases (e.g., hepatitis B [HBV], hepatitis C [HCV], and other sexually transmitted diseases [STDs]) as well.
  2. A community must start HIV/AIDS prevention programs as soon as possible. Even when HIV/AIDS is well established in a community, prevention programs can significantly limit the further spread of HIV/AIDS.
  3. Effective prevention programs require a comprehensive range of coordinated services. Given the diversity of drug users and their sexual partners, no single prevention strategy will work for everyone. A comprehensive approach that can readily adapt to changing needs and circumstances is the most effective approach for preventing HIV/AIDS and other blood-borne infections in drug users, their sexual partners, and their communities. This approach should include such services as community outreach, HIV testing and counseling, drug abuse treatment, access to sterile syringes, and services delivered through community health and social service providers. Services must be carefully coordinated within a community.
  4. Prevention programs should work with the community to plan and implement interventions and services. Involving the local community increases the likelihood of developing and implementing culturally appropriate HIV/AIDS prevention strategies that the community accepts and that can effectively reach drug users and their sexual partners in their natural environments.
  5. Prevention programs must be based on a thorough, continuing assessment of local community needs, and the effectiveness and impact of these programs must be continually assessed. Because the nature and extent of drug abuse and the HIV/AIDS epidemic vary widely, prevention strategies must be adapted to local community needs and resources. Local drug use and HIV/AIDS risk-behavior patterns must be tracked to refine program approaches over time and to evaluate program outcomes.
  6. Prevention services can most effectively reach drug-using populations when they are available in a variety of locations and at a range of operating times. Drug users are dispersed throughout communities and have varying lifestyles. Thus, reaching them requires providing HIV/AIDS prevention services in a wide range of settings, including community health and social service agencies, hospitals and clinics, and drug abuse treatment and correctional facilities. Coordinating these services in various community settings and at a range of operating times enhances the impact of interventions and reduces the unnecessary duplication of services.
  7. Prevention and treatment efforts should target drug users who already have the HIV infection, as well as their sex partners. People who have the HIV infection may need help gaining access to services and adhering to treatments that can prevent HIV from progressing to AIDS. Research has demonstrated that HIV-positive drug users are able to make major behavioral changes to protect their injecting and sex partners from contracting the infection.
  8. Prevention efforts must target not only individuals, but also couples, social networks, and the broader community of drug users and their sex partners. Risky behaviors typically occur in the context of social groups. Community-based outreach interventions that engage these groups can be highly effective in reducing risks and preventing the spread of infection. Behavioral norms that permit drug users to share injection equipment also need to be modified within the community. Relying on opinion leaders within these groups can be an effective strategy to influence the drug-using behaviors of individuals and their social networks.
  9. Community-based outreach is an essential component of HIV/AIDS prevention and must be directed to drug users in their own neighborhoods. Drug abuse is usually a covert activity, making it difficult to contact drug users and their sex partners through traditional health and social service agencies. Indigenous outreach workers who are familiar with the drug use subcultures and local neighborhoods in their communities have been shown to be effective agents of behavioral change and referral sources to service agencies and drug abuse treatment facilities.
  10. Prevention interventions must be personalized for each person at risk. Effective prevention entails discussing the many behavioral changes a drug user must make to reduce his or her risks for HIV/AIDS. It may require showing drug users and their sex partners how to assess their own risk behaviors. It may also require helping people identify barriers that keep them from changing their behavior, informing them about available resources to help them make those changes, encouraging them to seek voluntary HIV testing and counseling, and teaching them how to develop specific, achievable strategies to protect themselves and others from contracting HIV and other infections.
  11. Drug users and their sex partners must be treated with dignity and respect and with sensitivity to cultural, racial/ethnic, age, and gender-based characteristics. To successfully engage drug-using populations in interventions, it is important that outreach workers and service providers show that their concern for drug users is genuine and that they believe that drug users are capable of changing their HIV-related risk behaviors. Outreach workers and service providers should use socially and culturally appropriate, non-judgmental approaches to engage drug users and their sex partners.
  12. As part of a comprehensive HIV prevention program, injection drug users should have ready access to sterile injection equipment to reduce their use of previously used injection equipment. Individuals who inject drugs are at high risk for HIV and other infections if they share or reuse someone else's syringe and other injection equipment, including cookers, cottons, and rinse water. Research has shown that access to sterile syringes, one component of a comprehensive HIV prevention approach, effectively reduces syringe sharing and prevents the spread of HIV.
  13. In a comprehensive program, interventions that target injection risk must address sharing other injection equipment in addition to syringes. Sharing other injection equipment, including cookers, cottons, and rinse water, and drug solutions that have been prepared for injection, presents another potential route of infection for HIV and other blood-borne diseases. Sharing drug solutions (drugs mixed with water in preparation for injection) is a significant, but frequently overlooked, HIV transmission risk. Targeted interventions can help drug users reduce these associated risks.
  14. While necessary, risk reduction information alone cannot help drug users and their sex partners make lasting behavioral changes. In addition to offering accurate and up-to-date information on risky behaviors, effective HIV/AIDS prevention programs focus on enhancing individuals' motivation to change their behavioral patterns, teaching concrete strategies and behavioral skills to reduce risk, providing tools for risk reduction, and reinforcing positive behavior change.
  15. Prevention efforts must address the risks of transmitting HIV and other infections sexually as well as through drug injection. Drug and alcohol use may reduce inhibitions and increase the likelihood of engaging in unsafe sexual behaviors. Injecting and non-injecting drug users, their sexual partners, and people who exchange sex for drugs or money are at risk for sexually transmitting HIV, STDs, and other infections.
  16. HIV/AIDS risk-reduction interventions must be sustained over time. Although research has shown that brief interventions have significantly reduced risks for HIV and other infections among substantial numbers of drug users and their sex partners, brief interventions are typically not sufficient. Sustained and repeated interventions are usually needed.
  17. Community-based prevention is cost-effective. Sustained, well-designed prevention programs are cost-effective and can substantially reduce health care and social service costs associated with treating and caring for people with HIV/AIDS and other infectious diseases.

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