A Comprehensive Approach to
Preventing Blood-Borne Infections
Drug Users are Important in the Transmission of HIV and Other
Since 1981, 753,907 cases of AIDS have
been reported to the Centers for Disease Control and
Prevention (CDC). It is estimated that 650,000 to 900,000
Americans are now living with HIV and that about 40,000 new
infections occur every year.
figures on hepatitis are equally impressive: Between 1 and 1
1/4 million Americans have active hepatitis B; 130,000 to
320,000 new infections occur every year. Nearly 3 million
Americans have active hepatitis C.
Injection drug users (IDUs) are an
important force in the continuing epidemics of these
devastating diseases. IDUs become infected and transmit the
viruses to others in two, often interconnected, ways:
- high-risk drug use—sharing blood-contaminated
syringes and injection paraphernalia such as water,
cookers, and cottons
- high-risk sex—unprotected sex, sex with many
partners, failure to treat STDs
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.
effective prevention approaches will help IDUs. Society as a
whole will benefit as well, because reduced transmission among
IDUs means reduced transmission among their sex partners,
their children, and ultimately, among the general population.
The Legal, Social, and Policy Environment Limits Options for IDUs
health departments, community-based organizations, agencies,
and providers are working hard to reach and work with IDUs to
help them change their behaviors and reduce or eliminate their
risk of acquiring or transmitting infection.
problem of injection drug use and transmission of blood-borne
disease persists, however. Solutions are hampered by society's
pervasive negative attitudes toward IDUs, a lack of
understanding of drug addiction as a treatable biomedical and
psychological disease, limited funding for prevention and
treatment, restrictive laws and regulations, and polarized
philosophical viewpoints among various organizations and
Solution: A Comprehensive Approach to Working with IDUs
organizations and providers, public health staff, and
prevention planners are to succeed in effectively reducing the
transmission of HIV and other blood-borne infections, they
must consider a comprehensive approach to working with IDUs.
Such a comprehensive approach, now being advocated by the
Centers for Disease Control and Prevention (CDC), incorporates
a range of pragmatic strategies that take into account IDUs'
various life circumstances, cultures and languages, behaviors,
and readiness to change. It also incorporates several basic
principles that serve as a framework for action.
coordination and collaboration. No single provider or
institution can or does deliver all required services to IDUs,
their sex partners, and their children. Coordination and
collaboration are essential. Providers must work together,
sharing their various expertise and outlooks, recognizing and
overcoming their philosophical differences, building on
existing relationships, and reaching out to groups with whom
they may not have worked before.
coverage, access, and quality. Interventions will not be
effective if they do not reach a critical mass of people, if
IDUs cannot or will not use them, or if they are of poor
quality. If they hope to truly reach and work with IDUs,
agencies and providers must consider ways to effectively deal
with these issues as they plan, deliver, and monitor programs
and overcome stigma. Injection drug use is regarded with
disapproval and fear, and a user's addiction is considered to
be a moral failing. To successfully engage IDUs in prevention
efforts and to advance public policy, these negative attitudes
and misconceptions must be addressed. Addiction is now
understood to be a treatable brain disease. This concept
should be more widely known and accepted.
services and programs. IDUs are diverse populations with
different languages, cultures, sexual preferences, life
circumstances, behaviors, and requirements for services. Many,
though not all, are poor and live high-risk lives on the
margins of society. In planning and delivering interventions,
programs and providers must take into account the factors that
characterize IDUs - who they are, where they are, what they
do, what motivates them, and with whom they socialize.
Tailoring services and programs and involving IDUs in their
planning, implementation, and monitoring will make them more
Abuse Treatment — Why include it?
- most drug users cannot stop using without it
- treatment prevents transmission because it helps users
reduce drug- and sex-related risk behaviors
- it has major positive effects on a user's life
- treatment is cost effective
- providers can reach IDUs with other messages and
interventions during treatment
- society benefits from reduced drug use and associated
Outreach — Why include it?
- it reaches IDUs who don't participate in conventional
- it provides services in settings that are familiar to
- outreach interventions help create a culture of risk
reduction in the community, which helps to reinforce
- peers, who are often used in community outreach, are
likely to be trusted by IDUs
- it's relatively low cost
to Sterile Syringes — Why include it?
- the U.S. Public Health Service and other agencies and
institutions recommend consistent, one-time only use of
sterile syringes obtained from a reliable source as a
central risk reduction strategy for IDUs who cannot or
will not stop injecting
- the use of a sterile syringe every time helps ensure
that IDUs who continue to inject will not acquire or
- existing laws, regulations, and public and
pharmacists' attitudes hamper IDUs' ability to obtain and
safely dispose of syringes and therefore promote multi
person use of syringes
- access to sterile syringes does not increase drug use
or attract new people to drug use
- ensuring access to sterile syringes involves working
with pharmacists; addressing existing syringe laws and
regulations; and syringe exchange programs
in the Criminal Justice System — Why include them?
- many IDUs are in jail or prison because of their drug
- inmates have disproportionately high rates of HIV
infection, STDs, and hepatitis
- high-risk sex and drug-use behavior occurs in jails
- interventions benefit inmates and the communities to
which almost all will return
to Prevent Sexual Transmission — Why include them?
- IDUs are an important source of sexual transmission of
HIV and hepatitis B
- high-risk drug use and sex behaviors are often linked
and Testing Services, Partner Counseling and Referral
Services, and Prevention Case Management — Why include them?
- they allow IDUs to find out whether they are infected
- they allow infected IDUs access to counseling and
medical care and other services
- they help infected IDUs inform sex and drug-use
- they help public health officials follow the chains of
transmission and reach those at high risk
- they help uninfected but high-risk IDUs reduce their
for IDUs Living with HIV/AIDS — Why include them?
- they can help infected IDUs reduce high-risk drug and
- IDUs should have access to comprehensive and quality
- HIV disease management is complex and long-term,
requiring close monitoring
- infected IDUs who receive substance abuse treatment
and other health services are more likely to comply with
Drug Prevention — Why include it?
- preventing first use of alcohol, marijuana, inhalants,
and other drugs among youth can reduce the risk that they
will go on to use injection drugs
- preventing injection drug use eliminates
injection-related blood-borne virus transmission
- preventing alcohol and drug use and associated crime
and injuries benefits society