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U.S. Department of Health and Human Services

Archival Content: 1999-2005

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

Chapter 2, Section 3: Conclusion

As seen in this chapter, the social, legal, and public policy climate surrounding drug use creates structural and environmental barriers that limit the ability of IDUs to stop their drug use and reduce their risks of acquiring or transmitting infection. For example, IDUs are advised to enter substance abuse treatment and, if they continue to inject, to use only sterile syringes. However, insufficient substance abuse treatment capacity and syringe laws that make it illegal to obtain or possess sterile injection equipment often make it difficult or impossible to carry out this public health advice.

This climate presents a multi-layered challenge for program staff, policy makers, and others in the public health community. Many types of services and interventions currently exist to serve the complex drug-related, medical, and social circumstances of IDUs and their families. More of these services and interventions are clearly needed, but if they are to be successful, public health program staff, service providers, and policy leaders need to design them with this existing social, legal, and policy climate in mind. This is because the social attitudes and structural factors described here often substantially limit program activities and contribute to a fragmented service delivery system that does not ensure the availability of a full range of high-quality services that IDUs can easily obtain. Services and programs need to be organized and delivered in such a way that prevention messages and public health strategies can be reinforced across IDUs' various circumstances, patterns of drug use, stages of change of risk behaviors, and across the many community and institutional settings where they are found. At the same time, individual services need to be supported by a philosophical framework that moves beyond the stigma surrounding IDUs, reduces the current polarization among different approaches to working with IDUs, and ensures that collaboration is integral to the provision of services. The next chapter provides further detail on this vision of a comprehensive approach to preventing HIV and other blood-borne pathogens among IDUs.

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