America Living With AIDS

AM E R I C A Living Wit

of young people have not heeded such
advice, regardless of how forcefully this
message has been delivered. In view of
this stark and dangerous reality, advice
concerning abstinence must be supplemented by frank talk
about AIDS, and about
how to avoid sexually
you go transmitted diseases and
'y people unintended pregnancies.
t of an In addition, it must reach
vill say, children at a young age.
Ind then A similar set of probin our lems has existed in disding of cussions and attitudes
about drug use as it
relates to HIV transmis-, M.D., sion. The predominant
policy approach has char0 acterized drug use as a
criminal rather than a
public health problem.
Here too the approach
must be more than "just say no." A
more realistic strategy is crucial to the
prevention of HIV transmission related to drug use. Some of those at risk
will be able to stop using drugs on
their own, or will stop with the help of
formal treatment, self-help, or
"twelve-step" programs modeled on
Alcoholics Anonymous. Access to
drug treatment is an absolutely fundamental element of prevention in those
populations. Those who find it
impossible to stop using drugs, or who
relapse following a period of abstinence from drugs, must be encouraged to practice safer sex and safer
drug use and must be taught how to
do so.
The Commission reiterates the recommendations made in its fifth inter
im report to the President and the
Congress concerning the twin epidemics of HIV disease and substance
use. The federal government should
expand drug treatment so that all who
apply for treatment can be accepted
into treatment programs. The federal
government should also continually
work to improve the quality and effectiveness of drug use treatment. In
addition, legal barriers to the purchase
and possession of injection equipment
should be removed. Legal barriers do
not reduce illicit drug injection. They
do, however, limit the availability of
new, clean injection equipment, thereby encouraging the sharing of injection equipment, and the increase in
HIV transmission.
Cultural Sensitivity
and Cultural Competence
As part of the need to deal realistically
with issues about sex and drugs, it is
critical that these subjects be
addressed in a manner that is not only
culturally sensitive but also culturally
competent. Especially since sex and
drugs are sensitive topics, it is clear
that the best prevention messages will
be those developed by and for the people the messages are intended to reach,
through community-based efforts at
the local level. It is essential to include
people living with HIV disease in HIV
prevention efforts. For many communities, seeing people in education and
prevention efforts who are directly
affected by HIV will bring home the

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