A Comprehensive Approach:
Preventing Blood-Borne Infections Among Injection Drug Users
Chapter 3, Section 1: Guiding Principles
RECOGNIZE AND OVERCOME STIGMA
If IDUs are to be successfully engaged in prevention
efforts and if public policy is to move forward, the negative attitudes,
stereotypes, and stigma attached to injection drug users and their addiction
must be recognized and overcome. It is all too easy for IDUs to be dehumanized,
to become "them," not "us." In fact, IDUs are "us"-they are family members,
neighbors, friends, colleagues, patients. A willingness to put a human
face on the problem, to attempt to understand the disease of drug addiction,
and to consider IDUs as full human beings is a critical step to moving
beyond the stigma. Overcoming stigma is also, fundamentally, a pragmatic
necessity, for without it, the job of helping IDUs overcome their addiction
and prevent disease will not be accomplished.
to Change Attitudes on a National Scale
Stigma toward IDUs and other drug users
results from individual experiences with drug use or drug users, but it
is also generated in large measure from broader societal attitudes toward
drug use. Changing social attitudes is one way to affect change on an
individual level. The National Institute on Drug Abuse (NIDA), a component
of the National Institutes of Health (NIH), supports over 85 percent of
the world's research on the health aspects of substance abuse and addiction
and it is working on a number of fronts to disseminate the results of
its research. This dissemination effort is helping to improve the nation's
understanding of addiction and, as a result, change attitudes about drug
addiction and people who use drugs.
These various activities include:
Being clear on the terminology. NIDA
carefully crafts the language it uses to talk about addiction and individuals
who use drugs so that it reflects current scientific knowledge and is
clearly understandable. These words and phrases-"addiction is a brain
disease," for example-are used repeatedly and in multiple contexts so
that, eventually, they can become a permanent part of the way that society
talks about this issue.
Fostering dialogue with communities.
Since 1996, NIDA has hosted a series of 1-day Town Meetings in communities
across the country to help bridge "the great disconnect"-the dichotomy
between the public's perception of drug addiction and the scientific
facts. These meetings, which are tailored to meet local interests and
needs, give NIDA the chance to provide communities with the latest findings
from drug abuse prevention and treatment research. They also give communities-local
civic leaders, health care providers, parents, teachers, concerned citizens-a
chance to tell NIDA what kind of information they need to better deal
with drug problems in their community."
Taking information to the people.
If research findings and scientific facts are to have an impact and
be useful, they need to be used. A big focus of NIDA's information dissemination
effort, therefore, is creating a wide range of publications and other
materials that are appealing, user-friendly, and pragmatic. For example,
NIDA's recent publication, Principles of Drug Abuse Treatment: A
Research-based Guide synthesizes 25 years of research into a series
of practical principles that communities can use to develop effective
substance abuse treatment programs. NIDA has also produced numerous
educational booklets, slide shows, and other materials for parents,
youth, and teachers.
Harnessing the power of partnerships. NIDA
has developed collaborative relationships with many different organizations
and agencies, from Hollywood's Entertainment Industries Council, to
the American Medical Association and other professional associations,
to other federal agencies such as the Department of Justice and the
Office of National Drug Control Policy (ONDCP), to community coalitions
such as Join Together and Community Anti-Drug Coalitions of America
(CADCA). NIDA works through these partnerships to promote wide distribution
of information, ensure that depictions of drug use and addiction are
accurate, and create a better and more thorough understanding of drugs
and their effects on the brain and body.
For more information: National Institute on Drug
Abuse (NIDA), Bethesda, MD, www.nida.nih.gov.
The ARRIVE Program of Exponents, Inc.
is designed to improve the quality of life of traditionally underserved
minorities affected by drugs, HIV/AIDS, incarceration, and poverty. Serving
clients from the entire New York City area, Exponents' programs intervene
with detainees, recently released inmates, people living with HIV/AIDS,
and substance users and their families. The ARRIVE curriculum covers harm
reduction, relapse issues, HIV care and prevention strategies, health
education, infection control, and nutrition. HIV counseling, referrals
to much-needed services, and peer-led support groups reinforce classroom
information and help clients amplify their strengths and resources to
meet their health and social challenges.
Communications and presentation classes help clients
transform personal experience into marketable skills.
ARRIVE is based on a "corporate social work model,"
says deputy executive director, Maria (Sam) Josepher. "It was begun by
people who were corporately aware as well as people who had been in the
substance abuse field for more than 30 years. We used a lot of what we
learned from the business world to teach addicts-the importance of information,
communication skills, respect, cleanliness-all of this is given to the
client. On the social work side, the clients receive a lot of therapeutic
peer support. We acknowledge the incremental steps that people make. We
notice when people are dressing better, acting better, making more out
of their lives."
Started in 1988, ARRIVE now trains over 900 substance
users a year, 60 percent of whom are HIV-positive. It has maintained an
83 percent retention rate over the last decade. As Ms. Josepher explains,
the program is based on the premise that investing in human capital not
only works, but is cost-effective. "We see people go through a transformation
within 2 months," she says. ARRIVE costs about $1,000 per person for more
than 60 hours of education, support groups, and counseling. For $1,000
you have a person who is literally transformed, motivated, and renewed."
Ms. Josepher illustrates this with the following
story: "One of my staff is a woman who was in and out of prison for prostitution,
for drugs, for burglary. She would get off drugs but couldn't stay off.
She didn't have that ability. She was a heroin IDU for 20 years and on
methadone for two. She came into the ARRIVE program. She saw people like
herself training, counseling, and becoming part of the solution. Then
we put her on a computer. She just started soaking it up like a sponge.
She became a volunteer, our first part-time employee. She never went back
to drugs. The last time she was in prison was about 9 years ago. Two years
ago she bought a house. When she announced this at a staff meeting, there
wasn't a dry eye in the place."
For more information: The ARRIVE Program of Exponents,
Inc., New York, NY, 212/243-3434 www.exponents.org.