NJ offers everything but needle exchange

State focuses on treatment, HIV testing

New Jersey health officials may have no programs to prevent HIV-infected drug users from sharing dirty needles, but the state does have an array of programs aimed at getting these users off drugs.

"We have 105 drug treatment programs in the state, and the division of addiction services now mandates those programs to provide HIV counseling and testing on the premises," says Larry Ganges, MSW, director of the intervention and care services unit of the New Jersey Department of Health and Senior Services in Trenton.

New Jersey had the nation’s fifth-highest number of AIDS cases reported between July 1997 and June 1998, according to the latest statistics from the Atlanta-based Centers for Disease Control and Prevention (CDC). (See most recent statistics on AIDS cases from the CDC, p. 64.) And the state’s HIV data show that women account for more than one-third of all HIV-infection cases.

Women who have been infected with HIV by men who inject drugs are one of the fastest-growing HIV populations, Ganges says. The state health department has attacked this problem with this two-pronged approach:

1. The state has developed a program specifically geared toward female sex partners of injecting drug users that teaches HIV prevention and offers counseling and testing. If a woman tests positive for HIV, she is guided to health care services for treatment. Moreover, the state health department offers women incentives to participate. These incentives include discount coupons for merchandise at local stores, vocational training, transportation services, and child care.

2. Together with the HIV Prevention Community Planning Group — a group consisting of community representatives, policy leaders, consumers, and others who address and identify HIV prevention needs and strategies — the state decided to focus on the injecting drug population, providing them with free drug treatment upon demand. The drug treatment program is called the Patient Incentive Program (PIP). To qualify for free treatment, a person must be an injecting drug user who is at risk for HIV and probably shares needles and must be eligible for admission to one of the state’s four high-volume methadone maintenance programs. PIP tests participants for HIV and gives them a timetable during which they can be admitted to the free drug treatment plus methadone, detox services, and maintenance.

All four treatment centers have medical directors, case managers, and other clinicians. The program also counsels drug users on risk prevention, and counselors work with participants by introducing them to vocational training and assisting them with locating affordable housing. "If they’re working, they can begin to pay for treatment on a sliding income scale, which goes to a maximum of $6 to $8 a week," Ganges says.

The program assists about 1,800 to 2,000 injection drug users each year. The funding includes $1.2 million from the state health department and additional money from the CDC.

The Eagleton Institute at Rutgers University in New Brunswick is conducting a study to assess how well the program has succeeded in keeping injection drug users off drugs and continuing with follow-up care.

"We’re trying to measure success over time to see what is the initial impact and the long-term impact of these programs, and to see whether there is a need for follow-up interventions," Ganges says.