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,
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
improving access to high quality substance abuse treatment
instituting HIV prevention programs in jails and
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