The Science of Prevention:
CDC's Role in Reducing HIV Infection Among Injection Drug Users


To date, more than a third of all reported AIDS cases in the United States are among injection drug users (IDUs), their heterosexual sex partners, and children whose mothers were IDUs or sex partners of IDUs. This disturbing trend continues: In 1995, 35% of reported AIDS cases were IDU-associated. And as a percentage of cases among heterosexuals, IDU-associated AIDS cuts a wide swath, accounting for 66% of AIDS cases among women and 85% of cases among straight men in 1995. In contrast, only 10% of MSM (men who have sex with men) reported a history of injection drug use.

CDC is the lead federal government agency responsible for tracking and preventing HIV/AIDS. In cooperation with other federal agencies and offices responsible for addressing drug use -- for example, the Center for Substance Abuse Prevention (CSAP), the Center for Substance Abuse Treatment (CSAT), the National Institute for Drug Abuse (NIDA), and the White House Office of National Drug Control Policy (ONDCP) -- CDC works to address the HIV/AIDS risks presented by illicit drug use. CDC also works directly with communities to give them the tools they need to address the unique prevention needs of IDUs, their sex partners, and their children.

Translating Science Into Practical Community-Level Prevention

Nationwide, approximately 475,000 drug treatment slots are available at any given time. There is an estimated 1.5 million active drug users. Clearly, Americans' need for drug treatment outstrips capacity to provide it. And, clearly, treating people's addiction reduces and, in many instances, eliminates their risk for HIV infection. What to do, then, to keep people safe from HIV until they can get into treatment?

As communities across America grapple with this question, CDC continues to provide them the science they need to make sound local decisions. Both biomedical and behavioral science information is vital to developing sound prevention programs.

For example, in 19XX, CDC, CSAP, CSAP, and NIDA issued a "bleach bulletin" alerting state and community prevention programs to the benefits of IDUs cleaning their syringes with bleach and water. But continuing research into the mechanisms of HIV transmission has shown that syringes are not the sole reservoir for HIV. Water used to rinse syringes, cottons used to filter drugs as they are drawn into needles, and even the shared drug itself -- not the shared syringe -- can harbor human immunodeficiency virus and serve as pools for transmission.

CDC has provided this information to communities, along with behavioral recommendations for users who continue to inject to use a sterile syringe for each injection and not to share water or cottons.

Users in Communities with NEPs Less Likely To Be HIV+

Research presented in Vancouver shows that IDUs want to use sterile syringes, when they're available.

Changing Community Laws Is Another Prevention Avenue

In July 1992, Connecticut changed its state laws to permit purchasing up to 10 syringes without a prescription and possessing up to the same number. CDC worked with the state health department to evaluate the effects of the law changes. Highlights of two studies include:

Many Tools Are Needed To Combat Two Complex Epidemics

Communities use the biomedical and behavioral science CDC provides to design, develop, deliver, and evaluate HIV prevention programming for IDUs. Research shows there are a variety of prevention tools -- drug prevention and treatment, NEPs, removing legal restrictions to sterile syringes -- that could help prevent HIV transmission. CDC will continue to provide communities with the information they need to tailor local solutions to local problems.


IDU Presentations in Vancouver

Oral

The AIDS Community Demonstration Projects(ACDP): A Successful Multi-Site Community-Level Behavioral Intervention, Martin Fishbein. (Oral)

Needle/Syringe Sources, Reuse, and Opinions Toward "One Set One Shot" Among Active Injection Drug Users (IDUs) in Six U.S. Cities, Alice Gleghorn. (Oral)

Condom Carrying and its Relationship to Condom Use among High Risk Populations, Carolyn Guenther-Grey. (Oral)

New Partners in HIV Prevention: The Role of Pharmacists in Increasing Drug Users' Access to Sterile Syringes, Linda Wright-De Agero. (Oral)

Poster

The Impact of Street Outreach for HIV Prevention in 5 High Risk Populations, John E. Anderson. (Poster)

Injection and Syringe Sharing among HIV-Infected Injectors: Implications for Prevention of HIV Transmission, Theresa Diaz. (Poster)

Can Enough Syringes be Provided to Allow Drug Injectors to Use New Syringe for Every Injection? Steve L. Jones. (poster)

AIDS among Heterosexual Injection Drug Users in the United States; Regional Diversity in an Ongoing National Epidemic, J. Stan Lehman. (Poster)

HIV Seroincidence, Needle Acquisition, and Predictors of Needle Sharing Among Injection Drug Users Entering Drug Treatment, Martha S. Miller. (Poster)

Access to Sterile Needles in the Collaborative Injection Drug Users Studies (CIDUS), Edgar Monterroso. (Poster)

Trends in AIDS Associated with Injecting Drug Use, United States, 1985-1995, Allyn K. Nakashima. (Poster)

Trends in AIDS Incidence among Women in the United States: a Birth Cohort Analysis, Pascale Wortley. (Poster)