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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 1: Guiding Principles


IDUs have diverse languages, cultures, sexual orientations, life circumstances, behaviors, and requirements for services. One size does not fit all. In planning and delivering interventions, providers must take into account the factors that differentiate IDUs-who they are, where they are, what they do, what motivates them, who they socialize with. Programs and providers must also account for the fact that the behaviors or occupations of certain groups of IDUs, such as the mentally ill, the homeless, commercial sex workers, and those in prisons and jails, put them at particularly high risk of acquiring and transmitting infection. Tailoring interventions to the particular characteristics and service needs of recipients will increase their effectiveness. Involving IDUs in planning, delivering, and evaluating services and interventions is one important way to make sure that they are appropriately tailored.


Tailoring Interventions for a Specific Population of IDUs

Well-Being Institute is a drop-in day treatment center located in Detroit's inner city. It works primarily with HIV-infected, substance-abusing women who are mentally ill. These women tend to fall between the cracks of the existing health care delivery system, which is not well suited for creating and maintaining long-term relationships with such a high-risk population. The program locates eligible women through street outreach, nursing staff contacts with case managers in Detroit's HIV care network, and referrals. Through its own model of individualized nursing care, Well-Being staff help clients achieve three primary objectives: access-overcoming barriers to obtaining care for their HIV disease, substance abuse problem, or mental illness; retention-maintaining relationships with care providers over the long-term; and adherence-sticking with treatment regimens over time.

To illustrate the specific and broader pay-offs of tailoring interventions to the needs and circumstances of particular IDUs, Geoffrey Smereck, Well Being's director, tells the story of a mentally ill woman who was also homeless, an IDU, a victim of domestic violence, and had an HIV-related cancer:

"In the course of 9 months, we got her housing, got her primary health care needs met, and made sure she kept going to her health care appointments. We got her into a substance abuse treatment program so she was getting herself off drugs. We made sure she took her HIV meds and her meds to reduce her mental illness symptoms. I ran into her 3-4 months ago and she looked great. For public policy purposes, notice how she is no longer really an infection risk to any other person. She is a thousand-fold less drain on public resources. No one will have to pick her body out of an alley somewhere. Simply getting her to take her meds and getting her to show up for regular health care appointments is a far more cost-effective way of dealing with her health problems than her showing up in an ER somewhere with her problems like an out-of-control train wreck. The kind of interventions that can prevent the train wrecks can save the public health care systems enormous amounts of money, not to mention preventing a lot of human suffering. When I talked to her, the client wanted to get into community college and into the workplace. If we can get someone to stop soaking up resources, let alone to start contributing..."

For more information: The Well-Being Institute, Detroit, MI, 734/913-4300.

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