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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


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 Program

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.


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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