Reports on HIV/AIDS: 1990

AUGUST 10, 1990, MMWR, Vol. 39, No. 31, pp. 529, 535-538
Update: Reducing HIV Transmission
in Intravenous-Drug Users Not in Drug Treatment - United States
In 1987, the National Institute on Drug Abuse (NIDA) initiated ongoing demonstration projects to study and change the high-risk behaviors of both intravenous-drug
users (IVDUs) who were not enrolled in drug treatment and their sex partners (1 ). The
goal of the projects is to eliminate or reduce the likelihood of human immunodeficiency virus (HIV) transmission from these two high-risk groups. As of July 1, 1990,
the projects included >30,000 IVDUs and their sex partners in 41 community-based
programs. This report describes preliminary data (as of January 1990) based on
follow-up interviews of 1584 primarily <40-year-old, black, male IVDUs recruited from
1987 through 1989 in Chicago, Houston, Miami, Philadelphia, and San Francisco
(Table 1, page 535).
In these projects, IVDUs were recruited through community-based outreach
workers who were familiar with the neighborhoods in which the programs operate,
were often former drug users, and had access to neighborhoods in which drugs were
used. Eligibility criteria for participants included intravenous (IV)-drug use during the
6 months before recruitment and no enrollment in a drug-treatment program during
the 30 days before recruitment. Clients were paid for their participation. The return
rates for participants from initial to follow-up interviews were >65% in four citiesranging from 45% (Houston) to 78% (Philadelphia).
The specific interventions to reduce risk behaviors varied by city but included one
or more of the following: 1) individual and group counseling, 2) efforts to build peer
support for behavior change, and/or 3) demonstration and practice of behaviors that
reduce risk. All interventions emphasized termination of IV-drug use. IVDUs were
urged to start drug treatment as soon as it became available to them. In all cities, the
programs strongly encouraged those who did not stop IV-drug use to 1) stop sharing
drug-injection equipment (e.g., needles and syringes, drug-cooking implements, and
rinse water); 2) use only sterile needles and syringes from unopened packages;
and/or 3) disinfect drug-injection equipment with bleach or other appropriate agents.
The interventions related to sexual activity advocated celibacy and, for persons who
were sexually active, safer sexual practices, including use of condoms and reduction
of the number of sex partners.
Fourteen percent to 35% of IVDUs participating in the first follow-up interview had
entered a drug-treatment program during the approximately 6 months after enrollment (Table 1). Forty-nine percent to 75% of IVDUs reported stopping or decreasing
their frequency of drug injection during the approximately 6 months between the
initial intervention and follow-up interview (Table 1)-including 16%-47% who
reported stopping all use of IV drugs.
In all five cities, the percentage of IVDUs who reported not sharing drug-injection
equipment with friends increased in the approximately 6 months between initial and
follow-up interviews, as did the percentage of IVDUs who reported not borrowing
previously used drug-injection equipment (Table 1). Thirty-four percent (Houston) to
59% (Chicago) of IVDUs reported decreased sharing of drug-injection equipment;
22% (San Francisco) to 37% (Chicago) of IVDUs reported decreased borrowing of
drug-injection equipment.

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