REHABILITATION REFERRAL SERVICES
How can drug users reduce their risks for
Drug users should be advised that stopping all
drug use, including drug injection, is the most
effective way to reduce their risks for contracting
HIV/AIDS and other blood-borne diseases, including
hepatitis B and hepatitis C. However, not every drug
user is ready to stop using drugs, and many of those
who stop may relapse.
A variety of HIV/AIDS prevention strategies to
protect against becoming infected are available for
individuals who may be considering or already
injecting drugs. These are described in a hierarchy
of HIV/AIDS risk-reduction messages, beginning with
the most effective behavioral changes that drug
users can make:
- Stop using and injecting drugs.
- Enter and complete drug abuse treatment,
including relapse prevention.
- If you continue to inject drugs, take the
following steps to reduce personal and public
- Never re-use or "share"
syringes, water, or drug preparation
- Use only sterile syringes obtained from a
reliable source (e.g., a pharmacy or a
syringe access program).
- Always use a new, sterile syringe to
prepare and inject drugs.
- If possible, use sterile water to prepare
drugs; otherwise use clean water from a
reliable source (e.g., fresh tap water).
- Always use a new or disinfected container
("cooker") and a new filter
("cotton") to prepare drugs.
- Clean the injection site with a new
alcohol swab before injecting drugs.
- Safely dispose of syringes after one use.
As the hierarchy shows, drug injectors can best
reduce their risks by stopping all drug use. If they
inject drugs, they should always use sterile
supplies and never share them. When this is not
possible, cleaning and disinfecting techniques
should be considered. Full-strength bleach is the
most effective disinfectant when safer options are
not available. However, sterile, unused injection
equipment is safer than previously used injection
equipment disinfected with bleach.
Drug users should never share their other injection
equipment, such as cookers, cottons, rinse water,
and drug solutions prepared for injection. Sharing
these materials presents an important but often
overlooked HIV transmission risk.
In addition to learning how to make the
behavioral changes described in the hierarchy, drug
users and their sex partners should be counseled
about sexual risks for HIV and other STDs and the
importance of avoiding unprotected sex.
Community-based outreach workers, treatment
providers, and other public health professionals
should use any contact with a drug user as an
opportunity to convey these important HIV/AIDS
risk-reduction messages. The messages should be
delivered along with referrals for testing and
counseling services for HIV and other blood-borne
infections, drug abuse-treatment programs, and other
What is the best HIV/AIDS prevention strategy
for drug users?
Given the diversity of drug users and their sex
partners, no single HIV/AIDS prevention strategy
will work effectively for everyone. A comprehensive
approach is the most effective strategy for
preventing HIV/AIDS and other blood-borne infections
in drug-using populations and their communities. A
comprehensive approach readily adapts and responds
to changing patterns of drug use and HIV/AIDS risk
behaviors, to the characteristics of the local
setting, and to the varied service needs of drug
users and their sex partners. At every contact with
a drug user, outreach workers, interventionists, and
counselors deliver drug- and sex-related
risk-reduction messages and provide the means to
reduce or eliminate their risks for transmitting HIV
and other blood-borne infections.
comprehensive approach is the most effective
strategy for preventing HIV/AIDS and other
blood-borne infections in drug-using
populations and their communities.
What are the components of a comprehensive
HIV/AIDS prevention approach?
The comprehensive HIV/AIDS prevention approach
for drug users includes three complementary
approaches: community-based outreach, drug abuse
treatment, and sterile syringe access programs. Each
of these also includes HIV testing and counseling.
is an effective
approach for contacting drug users in their local
neighborhoods to provide them with the means to
change their risky drug- and sex-related behaviors.
This approach relies on outreach workers who
typically reside in the local community and are
familiar with its drug use subculture. As a result,
they are in a unique position to educate and
influence their peers to stop using drugs and reduce
their risks for HIV and other blood-borne
infections. Outreach workers distribute HIV/AIDS
educational information, bleach kits for
disinfecting injection equipment when sterile
equipment is not available, and condoms for safer
sex. They also provide drug users with referrals for
drug treatment, syringe access and exchange
programs, and HIV, HBV, and HCV testing and
Drug abuse treatment
is HIV prevention.
Drug users who enter and continue in treatment are
more likely than those who remain out of treatment
to reduce risky activities, such as sharing needles
and injection equipment or engaging in unprotected
sex. Drug abuse treatment can be conducted in a
variety of settings (e.g., inpatient, outpatient,
residential) and often involves various approaches,
including behavioral therapy, medications, or a
combination of both. The best treatment programs
offer their clients HIV testing and counseling and
referral to other services.
HIV prevention programs can help drug users
stop using drugs, change their risk
behaviors, and reduce their risks for
acquiring or transmitting the HIV infection.
Sterile syringe access programs
community-based outreach and drug abuse treatment by
providing drug users who will not or cannot seek
treatment, or who are in treatment but continue to
inject drugs, with access to sterile syringes and
other services. These programs help remove
potentially contaminated needles from circulation.
They also serve as a bridge to active and
out-of-treatment drug users by providing them with
HIV/AIDS information and materials (e.g., bleach
kits and condoms) to reduce their risks, by offering
opportunities for HIV testing and counseling, and by
providing referrals for drug abuse treatment and
other social services. Hence, it is important that
drug abuse treatment and other services are
available and accessible to drug users referred by
sterile syringe access programs.
Testing and Counseling Services for HIV and
Other Blood-Borne Infections
HIV testing and counseling services are an important
part of comprehensive HIV prevention programs. These
services are most effective when a range of
anonymous and confidential testing options are
available in diverse, accessible settings (e.g.,
mobile clinics) and at nontraditional times. The
most current, rapid testing technologies can be
especially useful. These allow drug users and others
at risk to learn their test results as soon as they
are available, plan a course of action to stop using
drugs and reduce their risk of transmitting HIV to
others, and get a referral to appropriate drug abuse
treatment and other health services.
HIV testing and counseling staff also can inform
drug users about their potential risks for
contracting HBV and HCV and explain why it is
important to be tested for these and other
blood-borne and sexually transmitted infections.
Staff are trained to help people who test positive
for HIV and/or other infections to inform their drug
use and sex partners about their potential risks for
infection and the importance of getting testing and
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