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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 3, Section 2: Key Strategies


Because HIV disease is a chronic and complex condition with frequently changing recommendations for treatment regimens, infected IDUs and their families require close monitoring and a constantly changing array of services in their homes, in the hospital or health care facility, and in the community (Keenan, 1990). With appropriate and high-quality services and medications, IDUs living with HIV can lead fulfilling, productive lives.

Many IDUs continue to engage in high-risk behaviors after they learn they are infected with HIV and, thus, place others at risk of HIV infection and themselves at risk for collateral health problems (CDC, 1996; HRSA, 1994; Kwiatkowski et al., 1998; Metsch et al., 1998). When HIV-infected IDUs are actively engaged in health care, however, they can be followed to identify renewed high-risk sex or drug use and counseled about the effects of these behaviors on themselves and others. HIV- infected drug users who are in substance abuse treatment and are receiving other health services are more likely to comply with HIV/AIDS drug treatment regimens and to reduce their sex and drug risk-related behaviors (Booth et al., 1999).

As a marginalized population, IDUs can be less connected to the AIDS service delivery system than are other infected individuals. Like non-IDU consumers, many IDUs do not know where to go to obtain services or what services are appropriate for different people at different stages of the disease. The service delivery system can be too complex and fragmented for them to navigate and often too remote geographically, socially, and culturally. Some programs prohibit services to active drug users, which presents formidable barriers for IDUs. Negative attitudes by staff toward IDUs' behaviors and life circumstances further exacerbate the situation. IDUs living with HIV/AIDS therefore need a full complement of services, delivered in a setting geared to attract IDUs from the community and retain them. Case managers and prevention case managers should offer risk reduction counseling and prevention services to these individuals and assist them with managing their chronic and acute health care needs, including taking anti-HIV medication and opportunistic infection prophylaxis as recommended. In addition, a full range of complementary, affordable, and accessible services should be made available, including substance abuse treatment services, mental health services, and help with other basic needs such as food, housing, child care, and job training.


Coordinated Services Improve the Health and Quality of Life of IDUs Living with HIV

Working in upper Manhattan and the South Bronx, Health Bridge's goal is to engage, link, and provide continuous care to HIV-infected men and women who have fallen through the cracks and are lost to follow-up within the traditional medical care delivery system. According to Debbie Indyk, director of Health Bridge, the key is to "identify strategic sites for reaching people who are not reached elsewhere, and engage them for whatever they need to be engaged for. We have lots of people with HIV who know their status but aren't in care and lots of people who don't even know their status. But we can reach these people if we think strategically about where to find them and establish linkages and infrastructure. Through outreach you find crises, but subsequently, you can also deal with stabilization and growth and development."

Working closely with the Mount Sinai Jack Martin Fund Clinic and other New York City programs for IDUs, Health Bridge staff provide holistic care to HIV-infected individuals who live in single room occupancy (SRO) hotels. Through their "home visiting" approach and consistent presence in the hotels, Health Bridge staff are able to successfully engage clients and provide various services, including wound care, urgent care, entry into substance abuse treatment, and stage-based links to primary care. For those clients who are not ready to come into the clinic for care, a Health Bridge team consisting of a physician assistant, a part-time attending physician, a medical assistant, and two case managers provide care, support, and referrals to housing, case management, and other services at the SRO hotels.

A fundamental element of the Health Bridge model is recognizing that disenfranchised individuals, such as HIV-infected IDUs, need support through various phases of engagement and retention in care. For example, clients may be willing to meet with Health Bridge staff but not come to the clinic for care; they may be ready to take AZT to reduce the risk of perinatal transmission, but not want to begin treatment for their own HIV disease. Through a model derived from the stages of change theory and using sustained outreach to reach individuals "where they are," Health Bridge staff have built a safety net that can quickly identify people in crisis as well as those ready to be engaged in medical care, substance abuse treatment, and other care and support services.

Since its inception in 1998, Health Bridge has reached well over 100 people living in three SRO hotels. Over one-half are African American and about two-thirds are men. Recognizing the very great need in this part of New York, Health Bridge is actively trying to expand its capacity and linkages so that it can serve increased numbers of infected and at-risk individuals.

For more information: Health Bridge, New York, NY 212/241-7863.

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