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    Dangerous Intersection of Drug Use and Sexual HIV Transmission Points to Critical Need for Comprehensive HIV Prevention

    Drug abuse treatment is HIV prevention, but drug treatment slots are scarce.

    In the United States, drug use and dependence are widespread in the general population. Experts generally agree that there are about 1 million active IDUs in this country, as well as many others who use noninjection drugs or abuse alcohol. Clearly, the need for substance abuse treatment vastly outstrips our capacity to provide it. Effective substance abuse treatment that helps people stop using drugs not only eliminates the risk of HIV transmission from sharing contaminated syringes, but, for many, reduces the risk of engaging in risky behaviors that might result in sexual transmission.

    For injection drug users who cannot or will not stop injecting drugs, using sterile needles and syringes only once remains the safest, most effective approach for limiting HIV transmission.

    To minimize the risk of HIV transmission, IDUs must have access to interventions that can help them protect their health. They must be advised to always use sterile injection equipment; warned never to reuse needles, syringes, and other injection equipment; and told that using syringes that have been cleaned with bleach or other disinfectants is not as safe as using new, sterile syringes.

    Having access to sterile injection equipment is important, but it is not enough.

    Preventing the spread of HIV through injection drug use requires a wide range of approaches, including:

    • preventing initiation of drug injection
    • using community outreach programs to reach drug users on the streets
    • improving access to high quality substance abuse treatment programs
    • instituting HIV prevention programs in jails and prisons
    • providing health care for HIV-infected IDUs
    • making available HIV risk-reduction counseling and testing for IDUs and their sex partners

    Better integration of all prevention and treatment services is critically needed.

    HIV prevention and treatment, substance abuse prevention, and sexually transmitted disease treatment and prevention services must be better integrated to take advantage of the multiple opportunities for intervention -- first, to help the uninfected stay that way; second, to help infected people stay healthy; and third, to help infected individuals initiate and sustain behaviors that will keep themselves safe and prevent transmission to others.

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