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Prevention Among Injection Drug Users

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HIV Prevention Among Injection Drug Users

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Archival Content: 1999-2005

Training Doing the Work

NIDA Principles of HIV Prevention Outreach (more details)

The NIDA Community-based Outreach Model: A Manual to Reduce the Risk of HIV and Other Blood-borne Infections in Drug UsersLink to a non-CDC site lays out several principles of HIV outreach with IDUs that bring the provision of HIV prevention services to life:

  • Prevention efforts must work with individuals, and couples, risk networks, and the broader community of drug users and their sex partners. Risk behaviors typically occur within small or large groups, and community-based outreach interventions that engage small and larger groups can be effective.

  • Community-based outreach is an essential HIV prevention component and must be directed to drug users in their natural environments. Outreach workers who are familiar with the drug use subcultures and local neighborhoods in their communities have been shown to be particularly effective agents of behavior change. Peer outreach workers can act as referral sources to service agencies and drug treatment facilities, distribute HIV/AIDS information and risk-reduction technologies, and provide skills-building demonstrations. They serve as opinion leaders who educate and influence their peers to reduce risks for HIV and increase behavioral self-efficacy.

  • Prevention interventions must be personalized for each person at risk. Effective prevention requires more than simply passing out information and risk-reduction supplies. Persons at risk must be engaged in a personalized assessment of their own risk behaviors, assisted in identifying barriers to and resources available to help them change their behavior, and helped to formulate specific and achievable strategies to protect themselves and others.

  • 05/14/2007t be treated with dignity and respect and with sensitivity to cultural, racial/ethnic, and gender characteristics. Successful engagement of at-risk populations in interventions requires that they recognize that concern for them is genuine and that they are seen as capable of undertaking behavioral change. Outreach approaches must be socially and culturally appropriate.

  • Interventions must address not only the sharing of syringes, but also of other injection equipment (including cookers, cotton, water, and drug solutions that have been prepared for injection). Although sharing of other injection equipment is less risky for transmitting HIV than sharing syringes, it presents a potential additional route of infection for HIV and other diseases (e.g., hepatitis B and C) and must be addressed. Sharing drug solutions (drugs mixed with water in preparation for injection) is a significant, but frequently overlooked, HIV transmission risk. Targeted interventions can enable drug users to reduce the risks associated with sharing injection equipment and drug solutions.

  • Risk-reduction information is necessary, but alone not sufficient, to achieve and maintain behavior change. In addition to offering accurate and up-to-date information on risky behaviors, effective programs focus on enhancing motivation to change behavior patterns, teach concrete strategies and behavioral skills for reducing risk, provide tools for risk reduction, and offer reinforcements for initial behavior change.

  • Prevention efforts must address sexual transmission risks as well as risks associated with drug injection. Many non-injecting drug users and their partners are at risk for HIV infection and its transmission because of unsafe behaviors associated with their drug use, such as engaging in unprotected sex. For all sexually active individuals, drug and alcohol use may reduce inhibitions and increase the likelihood of unsafe sexual behaviors.

  • HIV intervention programs must be sustained over time. Although brief interventions have been shown to significantly reduce HIV risk among substantial numbers of drug users, brief interventions are seldom sufficient. Sustained and repeated interventions are usually needed.

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