DRUG REHABILITATION REFERRAL SERVICES

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. 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.