A Comprehensive Approach:
Preventing Blood-Borne Infections Among Injection Drug Users
Chapter
3, Section 2: Key Strategies
COMMUNITY OUTREACH
Many IDUs are not engaged by conventional service
systems that provide treatment and prevention services or medical, mental
health, or social welfare services. This is due partly to funding and
capacity limitations on the part of the service systems. It is also
due to IDUs' own attitudes and life circumstances. The overwhelming
priorities of obtaining and using drugs often prevent IDUs from seeking
out services, such as HIV prevention, that may seem abstract or unimportant
in comparison. In addition, the stigma and negative attitudes experienced
by many IDUs when they have worked with service providers leads them
to mistrust government agencies and conventional service systems and
be reluctant to obtain services. Thus, to effectively provide prevention,
treatment, and care services to IDUs, it is essential to bring the services
to IDUs in the settings in which they live and socialize.
Community outreach programs can make a valuable
contribution to preventing blood-borne infections (Wiebel et al., 1996).
These practical and relatively low-cost approaches are designed to reach
high-risk IDUs and present and reinforce prevention messages in a community
setting. They can be the first step in developing a relationship with
drug users and ultimately linking them with services. Because they are
both an individual- and community-level intervention, they help create
a culture of risk reduction among drug users, their families, friends,
and neighbors. This culture of risk reduction also
helps to support recovering drug users returning from substance abuse
treatment and those returning to the community after time spent in prison
or jail.
Community Outreach is typically carried out in
settings where drug users gather-on the street, in homes, in shooting
galleries and crack houses, and in housing projects, emergency rooms,
laundromats, and parks. Ideally, the messages and services are delivered
by people with whom the drug user is familiar and likely to trust, such
as peers who live in the community. Many community outreach workers
are recovering IDUs themselves. A typical outreach encounter involves
face-to-face communication that is intended to assist IDUs in changing
their high-risk drug use and sexual behaviors. Outreach workers may
give out literature on HIV and how to prevent it or provide information
on available services. They also distribute condoms and bleach kits
for decontaminating injection equipment and they help IDUs obtain other
services in the community, such as housing assistance or mental health
treatment. Outreach also involves working with drug users' social and
drug-using networks to diffuse prevention messages and build risk reduction
skills. Outreach can also be used to recruit drug users to other activities,
such as confidential risk assessments, HIV testing and counseling, and
substance abuse treatment, and to distribute sharps containers for safe
disposal of used syringes.
TAKING
IT TO THE STREETS
A Science-based
Community Outreach Program
Located in the heart of Detroit's Empowerment
Zone, Taking It to the Streets' target population is low-income, underserved,
at-risk and HIV-infected African American substance users. It provides
health education, HIV risk reduction counseling and testing, and syringe
exchange services, and collaborates closely with six of the area's largest
chemical dependency treatment centers.
Taking It to the Streets was based in part on a National
AIDS Demonstration Research Project supported by NIDA that looked at effective
outreach to injecting drug users. The program has pioneered the indigenous
leader outreach approach. It operates on the diffusion model, which focuses
on the spread of ideas and practices throughout a social system from person
to person. Harry Simpson, former executive director of the Community Health
Awareness Group that oversees the program, describes the staff as "individuals
who share the demographic characteristics as well as the life experiences"
of the people they serve. They walk the walk, and they talk the talk.
Because they are often in recovery themselves, they are seen as credible
role models." Simpson says also that community involvement is the "central
theme in our program's design, development and implementation, and monitoring
and evaluation."
Taking It to the Streets is research-based, incorporating
approaches and specific strategies that have been shown to work. For example,
it was one of the first programs in the state to use OraSure for HIV testing,
a quick, relatively noninvasive technology with proven reliable results.
Project Respect is the counseling model employed by the program because,
according to Simpson, "The results of their research showed that people
who had gone through a two-session contact had pretty much the same outcome
as those in longer sessions. After we implemented the Project Respect
Model, our return rate increased from 40 percent to more than 80 percent."
Simpson stresses that the mobility of the program
is also key to its success. His staff work out of specially outfitted
vans that some have called "prevention on wheels." Simpson says, "These
vans let us take the service to those who need it most, rather than waiting
for them to come to us."
For more information: Taking It to the Streets,
Detroit, MI, 313/872-2424
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