Archival Content: 1999-2005

A Comprehensive Approach:
Preventing Blood-Borne Infections Among Injection Drug Users

Chapter 3: Key Ideas

• The problems associated with infection with blood-borne pathogens among IDUs require a comprehensive, multifaceted approach.

• A comprehensive approach rests on cross-cutting principles that guide the ways that interventions are planned and carried out.

• A comprehensive approach incorporates a range of strategies that take into account IDUs' differing life circumstances, cultures and languages, behaviors, and readiness to change.

• Assessing current services and programs, in light of the legal, social, and political environment and available resources, can help communities plan and carry out a comprehensive approach.

Prevention planners, program staff, policy makers, community-based organizations, and others who work with IDUs must deal with several significant and interrelated problems:

• the high risk of infection with HIV and other blood-borne pathogens, particularly hepatitis B and C;
• a range of sex and drug use behaviors that maintain the epidemics and facilitate their transmission to non-infected IDUs as well as to the larger population of sex partners, children, and other adults who do not inject drugs;
• attitudes of bias and stigma that marginalize and dehumanize IDUs and that limit options for prevention through their negative influence on laws, regulations, social policies, and access to services; and
• profound and deeply held differences of philosophy and orientation among providers and organizations, which cause polarization and fragmentation, hinder cooperative working relationships, and ultimately, limit the effectiveness of services and interventions for IDUs.

These problems are hard to solve. Their complexity, interconnectedness, and deep-rooted nature require a comprehensive and multifaceted approach. This chapter proposes and describes such a comprehensive approach.

Though many services and interventions can be used to help IDUs, this approach focuses on eight specific strategies and four underlying principles. Figure 1 illustrates the comprehensive approach and shows how its components are linked. The eight strategies, clustered around the concept of HIV prevention for IDUs, are supported and framed by the cross-cutting principles of collaboration, tailoring, overcoming stigma, and ensuring coverage, access, and quality.

A range of strategies are included because a single type of service or program (substance abuse treatment, HIV prevention education, access to sterile syringes) is not enough. Multiple services and programs delivered in multiple settings are needed. The supporting principles are included because if the strategies are to succeed, the providers, health departments, and community organizations who plan, deliver, and monitor them must consciously focus not only on "what" to pursue but also on "why" and "how" they will be pursued.

Each principle contains the seeds of positive action that will allow communities, agencies, and providers to come together and act more effectively. The remainder of this chapter defines and describes the four supporting principles and the eight key strategies for preventing blood-borne diseases among IDUs.

Accompanying these descriptions are vignettes about selected programs around the country that are working with IDUs. Although many of these programs provide similar types of services and all employ multiple components of the comprehensive approach, the vignettes are intended to highlight one or another strategy or principle and show the way in which each program's unique approach, content, or philosophy brings that particular principle or strategy to life. Many other exemplary programs throughout the country are incorporating these same approaches and philosophies in their work with IDUs. Readers also are encouraged to read Appendix A, which provides expanded discussions of the eight key strategies, including findings from research and programs and descriptions of issues and barriers facing providers and agencies as they seek to accomplish their goals.

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