CDC gives communities prevention strategies

Many AIDS cases involve drug use

More than one-third of all reported AIDS cases in the Unites States involve injection drug users, their sexual partners, and their children, a statistic that government officials say indicates the need for widespread prevention efforts targeting those populations. While critics claim needle-exchange programs are among the most effective means of preventing the spread of HIV through injection drug use, political opponents of such programs have succeeded in limiting their growth and effectiveness.

The Atlanta-based Centers for Disease Control and Prevention (CDC) has supported various prevention efforts aimed at stopping HIV’s spread through injection drug use and has issued community guidelines that outline various strategies. Here is an excerpt from the CDC’s 1997 guidelines:

• Changing community laws: In July 1992, Connecticut changed its state laws to permit purchasing up to 10 syringes without a prescription and possessing up to the same number. The CDC worked with the state health department to evaluate the effects of the new law, and found that 83% of Connecticut pharmacists sold syringes without prescriptions following the change. Also, injection drug users used the pharmacies instead of the street to obtain syringes, and users reported a substantial decrease in sharing needles. The total number of injection drug users and their age, duration of drug use, and frequency of injection did not change.

• Substance abuse interventions must provide education: Comprehensive programs must provide the information, skills, and support necessary to reduce risks from both drug-related and sexual behavior. According to research, many interventions aimed at reducing sexual risk behaviors among drug users have significantly increased the practice of safer sex among participants.

• Clean needle is safest approach: The CDC states that for injection drug users who cannot or will not stop injecting drugs, the once-over use of sterile needles and syringes remains the safest, most effective approach for limiting HIV transmission. Also, drug users must be advised to use sterile injection equipment, warned never to reuse needles or other injection equipment, and told that using syringes cleaned with bleach isn’t as safe as using new sterile needles. Extensive scientific evidence has shown that needle-exchange programs can be an effective part of a comprehensive strategy to reduce HIV transmission, and these programs do not encourage the use of illegal drugs, the CDC says.

• Communities should offer array of programs: Programs targeting injection drug users should include efforts to prevent people from first using drugs, high-quality substance abuse treatment options, outreach services to drug users and their sex partners, and prevention services in jails and prisons.

• The government should commit to drug treatment programs: The CDC cites statistics showing that only 500,000 drug treatment slots are available at any given time, and yet the nation has an estimated 1.5 million active injection drug users. The need for substance abuse treatment outstrips the nation’s capacity to provide it at a time when drug treatment could help eliminate the risk of HIV transmission from sharing contaminated syringes.