Archival Content: 1999-2005
A Comprehensive Approach:
Chapter 3, Section 3: Next Steps for Communities
This chapter has described the elements of a comprehensive approach to preventing the continued transmission of blood-borne pathogens among IDUs-eight strategies supported by four essential principles. Health departments, community planning groups, community-based organizations, health care and social service providers, correctional facilities, policy makers, and others who work with IDUs are already carrying out many of these elements and working in creative ways to enhance the impact and reach of their efforts.
At the same time, communities and community planning groups must deal with various realities that hamper their ability to bring individual efforts together into a truly comprehensive approach. These realities can include limited funding; restrictive laws and regulations; community opposition; a lack of trained staff; insufficient knowledge about the extent and nature of the community's HIV, hepatitis, and injection drug use problems; a limited understanding of the community's IDU populations; or polarized political and philosophical viewpoints among different organizations and providers. What can communities do to adjust their programs to overcome these realities?
One important step that communities can take is to assess existing IDU-related prevention needs, services, interventions, and barriers in light of the comprehensive approach. The process of gathering this information does not have to involve a formal or lengthy needs assessment. Health department staff, service providers, and other interested local groups may already know much of this information or have ongoing working relationships with those who do. An important group to include in this process is IDUs themselves, for they have a unique perspective on the programs and services that are designed for them. Various reports have been written that also provide valuable back ground information and expert consensus on effective interventions (NIH, 1997b).
The following questions, organized around the four principles that guide the comprehensive approach, provide a framework for communities to generate the information necessary for this assessment.
ENSURE COORDINATION AND COLLABORATION
Successfully reaching IDUs must involve arange of services and interventions. By definition, this means that different agencies, health and social services providers, health professionals, and others active in the community must work together to plan, carry out, manage, and monitor these efforts. Understanding ongoing efforts as well as the attitudes of key players toward coordination is an essential first step to building and maintaining effective collaborations.
ENSURE COVERAGE, ACCESS, AND QUALITY
Assessing services and programs from these three perspectives will provide valuable insight into the strengths of existing programs and services and the ways in which communities can build on these strengths. This exercise can also shed light on the barriers that individuals face as they attempt to obtain or participate in them and reveal gaps or weaknesses in programs that must be addressed.
RECOGNIZE AND OVER COME STIGMA
In addition to collecting facts about services, programs, and interventions, it will be important for those participating in the assessment to examine the community's attitudes toward IDUs, including the attitudes of the general public, providers, and policy makers. An important element of this task will be to explore the community's legal, policy, and social environment and how it affects the services and programs available to IDUs. For example, one community may have laws that penalize IDUs for carrying syringes and an outspoken citizen group that opposes syringe exchange programs. These clearly are barriers to IDUs in their attempts to obtain sterile syringes and reduce transmission risks. Another community may have laws allowing possession of a certain number of sterile syringes and a strong outreach initiative with active peer-led education groups that are successful in helping IDUs change their behaviors. Learning about attitudes and environments and how they inhibit or encourage successful implementation of programs and services is critical.
TAILOR SERVICES AND PROGRAMS
To effectively plan and deliver prevention and care services, providers and organizations need to understand the particular characteristics and risk pro files of the various IDU populations in the community. Generating this information will help providers to more effectively reach those at highest risk.
Because it may not be financially possible or organizationally feasible for a community to implement all eight of the strategies described in this chapter, agencies, organizations, and providers will need to make choices and trade-offs. The information that emerges from answering the questions listed above can help communities, community planning groups, and health departments set priorities and plan programs because it will reveal gaps in services, needs for expanded or new services, and existing duplication of services and interventions. The assessment also can be useful in helping organizations match high priority needs with potential areas of collaboration as they plan activities and determine how funding, staff, and other resources are to be allocated.
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