America Living With AIDS

AM E R I C A Living With AIDS

mission, the evidence suggests otherwise. Drug users know a great deal
about how HIV is transmitted and are
willing to make the changes necessary
to reduce risk of transmission when
encouraged to do so. There is evidence

What do we
do now? We do what many
cities have been doing for
several years now. We take it
to the street. We take
treatment to the user. We take
intervention to the user.
We take education to the user.
We take prevention to the
children and families.
Prevention is all of the above.
We take hope to people who
have no hope. We become
advocates. We become
transportation. We bring food
and clothing to those who have
no food and clothing.
We let the user, the addict, and
the persons living with HIV
and AIDS know that we truly
care. We open doors for
them that previously were
shut-treatment doors,
emergency care doors, medical
care doors, and whatever
doors remain locked.
EDMUND BACA
January 1991

that HIV prevention
strategies targeting injection drug users can result
in decreased needle sharing, increased needle
cleaning, increased demand
for sterile needles on the
street, and stable or declining seroprevalence rates
among drug users. In addition, when such HIV-related interventions are
offered, there is often an
increased demand both for
treatment for addiction
and for primary care.
Some consistent messages have emerged from
studies of the impact of
HIV on drug use behaviors. Most drug users
report changing their
behavior in response to
AIDS. There is no single
method of reducing HIV
risks that will work for all
drug users; prevention
strategies must encourage
both cessation of use and
the adoption of safer
injection practices for
those who continue use.
Finally, more drug users
have reported changes in

drug use practices than changes in sexual behaviors, and yet, of course, both
are essential. Thus, renewed efforts to
encourage behavioral changes related
to both sex and drug use are necessary.
HIV associated with drug use has
potential for extremely rapid spread.
Some cities have already experienced
this, with up to 50 percent of intravenous drug users HIV seropositive. In
other cities with large populations of
intravenous drug users, HIV seroprevalence remains at much lower levels.
The geographic variation in HIV seroprevalence among intravenous drug
users underscores the opportunities for
heading off the spread of HIV disease.
HIV prevention strategies targeting
injection drug users now include clinicbased interventions, street outreach
projects, community-based information and awareness campaigns, and
both publicly supported and unsanctioned needle exchange programs.
As the Commission noted in its
recent report, The Twin Epidemics of
Substance Use and HIV, the unmet
need for treatment on demand is critical. In cities hard hit by both drug use
and HIV disease the situation is
extremely serious. New York City, for
example, has an estimated 200,000
intravenous drug users, approximately
half of whom are HIV positive. Yet
New York has only 38,000 publicly
funded drug treatment slots. Outreach efforts have had the positive side
effect of referring individuals to treatment programs, but these gains will be
lost if there are not enough treatment
slots available.
Among the most important AIDS
prevention efforts are those aimed at

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