Archival Content: 1999-2005
A Comprehensive Approach:
Introduction and Overview
These blood-borne infections are transmitted primarily through two routes-sharing contaminated syringes, needles, and other drug injection equipment, and having unprotected sex with infected individuals. Through both types of risk behaviors, injection drug users (IDUs) are an important factor in the continuing evolution of these epidemics. Women who become infected with HIV through sharing needles or having sex with an infected IDU can also transmit the virus to their babies before or during birth or through breastfeeding.
To address this critical public health issue, program managers and staff, policy makers, HIV prevention community planners, and others in the public health community must focus attention on ways in which they can more effectively reach and influence IDUs and must intensify efforts to develop and carry out prevention and treatment strategies directed to IDUs and their sex partners and children. This technical assistance document is designed to help staff, planners, and policy makers accomplish this goal. It first describes the complex problems facing programs and professionals who work with the issue of preventing blood-borne infections in IDUs and then proposes a comprehensive approach to ameliorating these problems. We recognize that other drugs besides injection drugs are also important in the transmission of blood-borne infections. However, we focus on injection drugs in this document because of the key role they play in the intersection of addiction and infection and because of the myriad ways in which communities and providers can work with injection drug users to reduce their risk and burden of infection.
The core of the comprehensive approach is a group of pragmatic strategies. These strategies recognize that services and interventions for IDUs must be organized so that prevention and behavior change messages can be delivered and reinforced across various settings, populations, life circumstances, patterns of drug use, and stages of behavior change. Though many kinds of services and interventions can be directed toward IDUs and the issues of drug use and disease, eight strategies are included here. They are:
These eight strategies are supported by four cross-cutting principles:
This document describes in more detail the need for and characteristics of the comprehensive approach. It is divided into three chapters:
Chapter 1: Injection Drug Users Play a Key Role in the Transmission of HIV and Other Blood-borne Infections. This chapter provides epidemiologic detail on the importance of injection drug use in the epidemics of HIV and other blood-borne infections and describes the drug use and sexual behaviors that place IDUs at risk of infection.
Chapter 2: The Legal, Social, and Policy Climate Limits Prevention Options for IDUs. This chapter describes the context within which prevention programs with IDUs must work-the existing stigmas and biases that characterize many public and provider attitudes toward IDUs, even in the face of current knowledge about the nature of addiction, and the policy, legal, and service provision climate that has emerged from these attitudes.
Chapter 3: A Comprehensive Approach is a More Effective Approach. This chapter briefly describes the component strategies and principles of the comprehensive approach. Vignettes about selected programs are included throughout this chapter to illustrate the ways in which the strategies and principles are being applied in diverse communities and settings.
This document also includes two
Appendixes. Appendix A provides greater detail on each of the eight key strategies, including findings from programs and research and discussions of issues and barriers faced by agencies and providers in each of these areas. Appendix B is a matrix of the many research studies and reports cited in Appendix A, organized by strategy so that readers have easy access to this rich literature.
More effective and comprehensive prevention approaches for IDUs will clearly benefit injection drug-using men and women and their partners and children. The benefits have important implications for society as a whole as well, for reducing the transmission of HIV and other blood-borne infections in this population means reducing transmission in the broader population. The results will be a smaller impact on and costs for health and social services, reduced crime, and a more productive society. Many individuals, organizations, and agencies have recognized the importance of the issue of HIV and other blood-borne infections among IDUs and are acting in innovative ways to address them. We hope this document provides the vision and impetus for other program staff and policy makers to take the steps necessary to effectively address the prevention and care needs of injection drug users.
This CDC Web site is no longer being reviewed or updated and thus is no longer kept current. This site remains to assist researchers or others needing historical content.