ethics

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Part 2: Hepatitis C

This text is from: National Institute on Drug Abuse Notes (Volume 15, Number 1) found at: http://www.nida.nih.gov/NIDA_Notes/NNVol15N1/tearoff.html

 

What is Hepatitis C?

Hepatitis C, a viral disease that destroys liver cells, is the most common blood-borne infection in the United States. Approximately 36,000 new cases of acute hepatitis C infection occur each year in the United States, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. People with acute HCV infection may exhibit such symptoms as jaundice, abdominal pain, loss of appetite, nausea, and diarrhea. However, most infected people exhibit mild or no symptoms.

About 85 percent of people with acute hepatitis C develop a chronic infection. Chronic hepatitis is an insidious disease whose barely discernible symptoms can mask progressive injury to liver cells over 2 to 4 decades. An estimated 4 million Americans are infected with chronic hepatitis C, according to CDC.

Chronic hepatitis C often leads to cirrhosis of the liver and liver cancer and causes between 8,000 and 10,000 deaths a year in the United States. It is now the leading cause of liver cancer in this country and results in more liver transplants than any other disease.

How Is HCV Transmitted?

People become infected with the hepatitis C virus (HCV) through direct contact with an infected person's blood. Although this contact can occur in a number of ways, injection drug use now accounts for at least 60 percent of HCV transmission in the United States, according to CDC. This estimate may be conservative because about 10 percent of people newly diagnosed with HCV do not report an identifiable risk factor. Some of these cases may represent people who are reluctant to identify injection drug use as a risk factor. Because HCV is highly transmissible through the blood, anyone who has ever injected drugs is at risk for liver disease and should be tested for the virus.

Injecting drug users (IDUs) contract hepatitis C by sharing contaminated needles and other drug injection paraphernalia. One recent study found that 64.7 percent of IDUs who had been injecting for 1 year or less were already infected with the virus. Overall prevalence of HCV was 76.5 percent among IDUs who had been injecting drugs for 6 years or less.

Additional research indicates that rates of hepatitis C among past or current IDUs are extremely high in a number of cities in the United States. For example, last year a NIDA- and CDC-funded study detected HCV infection in approximately 85 percent of 3,000 IDUs in Seattle. Researchers in Texas reported similar percentages in several Texas cities and noted that many recovering IDUs who tested positive for HCV reportedly had not injected for 5 to 15 years.

Hepatitis C, HIV/AIDS, and hepatitis B share common risk factors for infection. IDUs have a high prevalence of co-infection with the viruses that cause these diseases. It is important to test IDUs for all three viruses.

Prior to the development of sophisticated HCV blood screening tests in the early 1990s, blood transfusions accounted for a substantial proportion of HCV infections. Now, there is only 1 chance in 100,000 that someone will get HCV from transfused blood or blood products. However, people who received blood transfusions prior to July 1992 should be tested for HCV.

The risk of perinatal transmission of hepatitis C is relatively low. About 5 of every 100 infants born to HCV-infected women become infected. However, about 17 out of every 100 infants born to HCV-infected women who are also infected with HIV become infected with HCV. HCV infection among women with HIV also is associated with increased maternal-infant transmission of HIV.

Can HCV Infection Be Prevented?

Although there are vaccines for other forms of hepatitis, none exists to protect against HCV. However, prevention of illegal drug injection would eliminate the greatest risk factor for HCV infection in the United States, according to CDC. Therefore, drug addiction treatment can play a major role in reducing HCV transmission. Research shows that drug users who enter and remain in treatment reduce high-risk activities, such as sharing needles and other drug injection paraphernalia, that are responsible for spreading HCV. AIDS outreach and HIV prevention programs for out-of-treatment drug users that reduce HIV risk also reduce the risk of HCV transmission.

How Can HCV Infection Be Treated?

Available antiviral drugs to eliminate the virus and reduce liver injury are not highly effective for patients with chronic hepatitis C. Side effects can be severe and the treatment is costly, lengthy, and effective for only 30 to 40 percent of those with the disease.

This text is from The National Institute on Drug Abuse Notes (Volume 16, Number 3) found at: http://www.nida.nih.gov/NIDA_Notes/NNVol16N3/Drug.html

 

Drug Injectors Sharing Cookers and Cotton Increase Their Risk
of Hepatitis C

By Josephine Thomas, NIDA NOTES Contributing Writer

The hepatitis C virus (HCV) is extremely common among injection drug users (IDUs); some regions of the United States have reported prevalence rates as high as 90 percent in their IDU populations. Previous research has shown that sharing contaminated needles is responsible for many of these infections. NIDA research now has shown that IDUs can contract hepatitis C not only from sharing needles but also through sharing other drug injection equipment, especially cookers and filtration cotton.

The research team, led by Dr. Holly Hagan of the Seattle-King County Public Health Department, evaluated risk factors for HCV by analyzing data from their Risk Activity Variables, Epidemiology and Networks (RAVEN) study. The RAVEN study collected information and blood samples between June 1994 and May 1997 from 2,879 IDUs in Seattle area programs that provided them with clean needles in exchange for used ones.

"As needle sharing declined throughout the 1980s and 1990s," says Dr. Hagan, "it became possible to consider other risk factors for the transmission of blood-borne diseases among IDUs. This was one of the principal goals of the RAVEN study. We knew that the IDUs who participated in that study were less likely to share needles after they received counseling, but that sharing of drug cookers and filtration cotton was commonplace."

Of the initial 2,879 IDUs, only 507 (17.6 percent) tested negative for HCV at the conclusion of the RAVEN study. After a year, researchers were able to collect blood samples and administer a questionnaire to 317 of these 507 participants. Of these, 259 reported having injected drugs during the follow up period, and of this group, 53 (16 percent) had become HCV-positive during the 1-year follow up period. The questionnaire also asked participants if they had shared needles at any time during the previous year and if they shared cookers and cotton.

 

Hepatitis C Is America's Most Common Blood-Borne Infection

Approximately 36,000 new cases of acute hepatitis C infection are reported each year in the United States, according to the Centers for Disease Control and Prevention (CDC). The number of Americans with chronic hepatitis is unknown-although CDC estimates the number at 4 million-because the symptoms of the disease can be minimal. In chronic hepatitis C, progressive injury to liver cells over 2 to 4 decades often leads to cirrhosis of the liver and liver cancer. Hepatitis C-related liver failure is now the leading indication for liver transplants in the United States. The disease also is the leading cause of liver cancer and is responsible for 8,000 to 10,000 deaths a year in this country.

 

Syringe sharing was associated with a three-fold higher risk of HCV infection as opposed to IDUs who did not share syringes, according to Dr. Hagan. Among the much smaller group that did not share syringes, "The risk of HCV infection was also three-fold higher among those who did not share syringes but did share a cooker and cotton." Dr. Hagan notes that the study's ability to evaluate the risk of sharing equipment other than syringes was reduced by the limited number of HCV-negative IDUs who did not share syringes but who did test positive over the course of the study. This group numbered only 11 out of the 53 who became positive over the course of the study.

With respect to frequency of sharing equipment, the study confirmed the link between more syringe sharing and higher risk of HCV-the rate of infection was relatively higher among those who reported sharing syringes sometimes, usually, or always than among those who reported rare syringe sharing. However, the risk elevation associated with cookers and cotton appeared to be the same for individuals who shared this equipment regardless of the frequency of sharing."

"Prevention education has been successful in a large portion of the IDU population, but over time, some high-risk groups will become more identifiable," says Dr. Peter Hartsock of NIDA's Center on AIDS and Other Medical Consequences of Drug Abuse. "This research should lead to the development of interventions that will have a greater impact than previous interventions on populations at risk of developing HCV and other blood-borne diseases. With this new data, we can better adjust interventions and programming to meet the needs of these populations," he says. Dr. Hagan notes that Seattle-King County Public Health Department staff have already revised their prevention messages to include the risks of sharing equipment such as cookers and cotton, as well as sharing needles, but adds that many IDUs are not yet aware that these are high-risk practices.

"I think it will be increasingly feasible to study each step of the injection process in terms of blood-borne viral transmission," Dr. Hagan says. "Once we understand the powerful risk factors, such as sharing needles and equipment, it will be possible to move on to other factors that perhaps do not carry as strong a risk but nonetheless are responsible for a significant number of infections. Studies to measure the risk of transmission through less common routes of exposure are important because they enable us to extrapolate general epidemiologic information that will have direct implications for the prevention of all types of blood-borne viruses in the population as a whole."

This text is from: National Institute of Allergy and Infectious Diseases (An Introduction to Sexually Transmitted Diseases, Updated November 21, 2003).
Found at: http://www.crystalinks.com/std.html

 

Sexually Transmitted Diseases

Sexually transmitted infections (STIs), once called venereal diseases, are among the most common infectious diseases in the United States today. More than 20 STIs have now been identified, and they affect more than 13 million men and women in this country each year. The annual comprehensive cost of STIs in the United States is estimated to be well in excess of $10 billion.

Understanding the basic facts about STIs – the ways in which they are spread, their common symptoms, and how they can be treated– is the first step toward prevention. The National Institute of Allergy and Infectious Diseases (NIAID), a part of the National Institutes of Health, has prepared a series of fact sheets about STIs to provide this important information. Research investigators supported by NIAID are looking for better methods of diagnosis and more effective treatments, as well as for vaccines and topical microbicides to prevent STIs. It is important to understand at least five key points about all STDs in this country today:

  1. A complete history is needed if medical and treatment staff are to adequately assess the patient's risk for infectious disease. During the initial intake or assessment interview with the patient, the counselor can help solicit sensitive drug-taking and sexual practice information (see "The Initial Patient Contact").
  2. STIs affect men and women of all backgrounds and economic levels. They are most prevalent among teenagers and young adults. Nearly two-thirds of all STIs occur in people younger than 25 years of age.
  3. The incidence of STIs is rising, in part because in the last few decades, young people have become sexually active earlier yet are marrying later. In addition, divorce is more common. The net result is that sexually active people today are more likely to have multiple sex partners during their lives and are potentially at risk for developing STIs.
  4. Most of the time, STIs cause no symptoms, particularly in women. When and if symptoms develop, they may be confused with those of other diseases not transmitted through sexual contact. Even when an STI causes no symptoms, however, a person who is infected may be able to pass the disease on to a sex partner. That is why many doctors recommend periodic testing or screening for people who have more than one sex partner.
    5. Health problems caused by STIs tend to be more severe and more frequent for women than for men, in part because the frequency of asymptomatic infection means that many women do not seek care until serious problems have developed.
      • Some STIs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which in turn is a major cause of both infertility and ectopic (tubal) pregnancy. The latter can be fatal.
      • STIs in women also may be associated with cervical cancer. One STI, human papillomavirus infection (HPV), causes genital warts and cervical and other genital cancers.
      • STIs can be passed from a mother to her baby before, during, or immediately after birth; some of these infections of the newborn can be cured easily, but others may cause a baby to be permanently disabled or even die.
  5. When diagnosed and treated early, many STIs can be treated effectively. Some infections have become resistant to the drugs used to treat them and now require newer types of antibiotics. Experts believe that having STIs other than AIDS increases one's risk for becoming infected with the AIDS virus.

HIV Infection and AIDS

AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981. It is caused by the human immunodeficiency virus (HIV), a virus that destroys the body's ability to fight off infection. An estimated 900,000 people in the United States are currently infected with HIV. People who have AIDS are very susceptible to many life-threatening diseases, called opportunistic infections, and to certain forms of cancer. Transmission of the virus primarily occurs during sexual activity and by sharing needles used to inject intravenous drugs. If you have any questions about HIV infection or AIDS, you can call the AIDS Hotline confidential toll-free number: 1-800-342-AIDS.

Chlamydial Infection

This infection is now the most common of all bacterial STIs, with an estimated 4 to 8 million new cases occurring each year. In both men and women, chlamydial infection may cause an abnormal genital discharge and burning with urination. In women, untreated chlamydial infection may lead to pelvic inflammatory disease, one of the most common causes of ectopic pregnancy and infertility in women. Many people with chlamydial infection, however, have few or no symptoms of infection. Once diagnosed with chlamydial infection, a person can be treated with an antibiotic.

Genital Herpes

Genital herpes affects an estimated 60 million Americans. Approximately 500,000 new cases of this incurable viral infection develop annually. Herpes infections are caused by herpes simplex virus (HSV). The major symptoms of herpes infection are painful blisters or open sores in the genital area. These may be preceded by a tingling or burning sensation in the legs, buttocks, or genital region. The herpes sores usually disappear within two to three weeks, but the virus remains in the body for life and the lesions may recur from time to time. Severe or frequently recurrent genital herpes is treated with one of several antiviral drugs that are available by prescription. These drugs help control the symptoms but do not eliminate the herpes virus from the body. Suppressive antiviral therapy can be used to prevent occurrences and perhaps transmission. Women who acquire genital herpes during pregnancy can transmit the virus to their babies. Untreated HSV infection in newborns can result in mental retardation and death.

Genital Warts

Genital warts (also called venereal warts or condylomata acuminata) are caused by human papillomavirus, a virus related to the virus that causes common skin warts. Genital warts usually first appear as small, hard painless bumps in the vaginal area, on the penis, or around the anus. If untreated, they may grow and develop a fleshy, cauliflower-like appearance. Genital warts infect an estimated 1 million Americans each year. In addition to genital warts, certain high-risk types of HPV cause cervical cancer and other genital cancers. Genital warts are treated with a topical drug (applied to the skin), by freezing, or if they recur, with injections of a type of interferon. If the warts are very large, they can be removed by surgery.

Gonorrhea

Approximately 400,000 cases of gonorrhea are reported to the U.S. Centers for Disease Control and Prevention (CDC) each year in this country. The most common symptoms of gonorrhea are a discharge from the vagina or penis and painful or difficult urination. The most common and serious complications occur in women and, as with chlamydial infection, these complications include PID, ectopic pregnancy, and infertility. Historically, penicillin has been used to treat gonorrhea, but in the last decade, four types of antibiotic resistance have emerged. New antibiotics or combinations of drugs must be used to treat these resistant strains.

Syphilis

The incidence of syphilis has increased and decreased dramatically in recent years, with more than 11,000 cases reported in 1996. The first symptoms of syphilis may go undetected because they are very mild and disappear spontaneously. The initial symptom is a chancre; it is usually a painless open sore that usually appears on the penis or around or in the vagina. It can also occur near the mouth, anus, or on the hands. If untreated, syphilis may go on to more advanced stages, including a transient rash and, eventually, serious involvement of the heart and central nervous system. The full course of the disease can take years. Penicillin remains the most effective drug to treat people with syphilis.

Other diseases that may be sexually transmitted include trichomoniasis, bacterial vaginosis, cytomegalovirus infections, scabies, and pubic lice.

STDs in pregnant women are associated with a number of adverse outcomes, including spontaneous abortion and infection in the newborn. Low birth weight and prematurity appear to be associated with STDs, including chlamydial infection and trichomoniasis. Congenital or perinatal infection (infection that occurs around the time of birth) occurs in 30 to 70 percent of infants born to infected mothers, and complications may include pneumonia, eye infections, and permanent neurologic damage.

What Can Clients Do to Prevent STIs?

The best way to prevent STDs is to avoid sexual contact with others. If you decide to be sexually active, there are things that you can do to reduce your risk of developing an STD.

  • Correctly and consistently use a male condom.
  • Use clean needles if injecting intravenous drugs.
  • Prevent and control other STDs to decrease susceptibility to HIV infection and to reduce your infectiousness if you are HIV-infected.
  • Delay having sexual relations as long as possible. The younger people are when having sex for the first time, the more susceptible they become to developing an STD. The risk of acquiring an STD also increases with the number of partners over a lifetime.

Clients who are sexually active should:

  • Have regular checkups for STIs even in the absence of symptoms, and especially if having sex with a new partner. These tests can be done during a routine visit to the doctor's office.
  • Learn the common symptoms of STIs. Seek medical help immediately if any suspicious symptoms develop, even if they are mild.
  • Avoid having sex during menstruation. HIV-infected women are probably more infectious, and HIV-uninfected women are probably more susceptible to becoming infected during that time.
  • Avoid anal intercourse, but if practiced, use a male condom.
  • Avoid douching because it removes some of the normal protective bacteria in the vagina and increases the risk of getting some STIs.

Clients diagnosed as having an STI should:

  • Be treated to reduce the risk of transmitting an STI to an infant.
  • Discuss with a doctor the possible risk of transmission in breast milk and whether commercial formula should be substituted.
  • Notify all recent sex partners and urge them to get a checkup.
  • Follow the doctor's orders and complete the full course of medication prescribed. A follow-up test to ensure that the infection has been cured is often an important step in treatment.
  • Avoid all sexual activity while being treated for an STI.

Sometimes clients are too embarrassed or frightened to ask for help or information. Most STIs are readily treated, and the earlier a person seeks treatment and warns sex partners about the disease, the less likely the disease will do irreparable physical damage, be spread to others or, in the case of a woman, be passed on to a newborn baby.

Private doctors, local health departments, and STD and family planning clinics have information about STIs. In addition, the American Social Health Association (ASHA) provides free information and keeps lists of clinics and private doctors who provide treatment for people with STIs.

This text is from NIDA, Principles of HIV/AIDS and Other infections in Drug-Using Populations.
Found at: http://www.nida.nih.gov/POHP/research.html

 

Research on Preventing HIV/AIDS and Other Infections in Drug-Using

Epidemiology of Risk Behaviors

Reusing and sharing syringes, needles, and other drug injection equipment exposes injecting drug users (IDUs) to the risk of contracting or transmitting HIV and other blood-borne infections (e.g., hepatitis B (HBV) and hepatitis C (HCV). In addition to injecting drug use, unprotected sexual contact with infected individuals is a major way that these and other sexually transmitted diseases (STDs) are transmitted.

During the course of the HIV/AIDS epidemic, the major groups at risk for HIV in the United States have been men who have had sex with men, IDUs, the sexual partners of IDUs, and people who have blood transfusions. Today, however, the boundaries between the major risk groups are less distinct. Considerable mixing occurs among different at-risk populations who engage in multiple types of drug use, high-risk needle practices, and unsafe sex. A disproportionate number of HIV/AIDS cases, most of which are associated with injecting drug use, have occurred among racial and ethnic minority populations of both genders. These changes reflect the dynamic interactions of the epidemic and simultaneous risk-taking behaviors, including injecting and non-injecting drug use, unprotected sex with multiple partners, and the exchange of sex for drugs or money (1).

 

Prevalence rates have been reported as high as 50 percent for hepatitis B virus and 65 percent for hepatitis C virus among people who have injected drugs for less than a year.

 

IDUs have one of the highest HBV incidence rates among all risk groups, and at least half of all new HCV cases occur among IDUs. Studies have shown that infection with HBV and HCV frequently occurs soon after an individual begins injecting drugs. Prevalence rates vary considerably, but have been reported as high as 50 percent for HBV and 65 percent for HCV among people who have injected drugs for less than a year. Co-infections of HBV, HCV, and HIV have been found to cluster in IDUs and, in some geographic regions, are endemic among long-term IDUs. HCV is now considered an opportunistic infection in HIV-positive people, according to the U.S. Public Health Service and the Infectious Diseases Society of America (2). Although a vaccine is not yet available for HIV or HCV, data on the HBV vaccine indicate that it is possible to immunize injecting and non-injecting drug users successfully.

The strong epidemiologic association between HIV and other STDs also has been recognized since the HIV/AIDS epidemic began. Some studies have reported a two- to five-fold increased risk for HIV among people who have other STDs (3). Shifts in the HIV/AIDS epidemic in the United States highlight the important cofactor effects of STDs. The notable increase in heterosexual HIV transmission among young women, especially young African-American women, has been linked in part to the disproportionate rate of other STDs in this group (3), as well as to the mixing of drugs (including the non-injecting use of heroin, crack cocaine, amphetamines, and other substances), alcohol, and unprotected sex. Moreover, pregnant women who use drugs or are the sex partners of IDUs risk transmitting one or more infections to their infants. Because the proportion of asymptomatic STDs is higher among women than among men, many women are unaware that they have an infection and do not seek routine screening examinations. Therefore, testing and counseling for HIV and other blood-borne and sexually transmitted infections, including routine screening for asymptomatic STDs, are critically important for controlling, preventing, and treating these infections.

From NIDA, Principles of HIV Prevention in Drug-Using Populations.
Found at: http://www.nida.nih.gov/POHP/FAQ_1.html

 

How can drug users reduce their risks for HIV/AIDS?

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 health risks:
    • Never re-use or "share" syringes, water, or drug preparation equipment.
    • 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 (1). 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 services.

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.

 

A 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.

Community-based outreach 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 counseling.

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.

 

Comprehensive 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 complement 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 counseling.

 

End of Part 2, now go to Part 3