Solutions for IDU continued

AIDS Project Hartford’s needle exchange offers materials on prevention and transmission of HIV/AIDS, as well as about drug treatment services (39). While they do offer these educational materials, the high incidence of risky sexual behaviors associated with drug use would dictate that a better job of educating on the topics of safer sex practices among IDUs is something that needs to be considered. For example, one study demonstrated an inverse relationship between methamphetamine use and using condoms, and that methamphetamine users were twice as likely to have had sex with a prostitute, and four times as likely to receive money or drugs for sex (4). IDUs exhibit very low levels of condom use, especially with steady partners that also use drugs (6), feeling that condom use denotes distrust and lack of intimacy, and they themselves often have a low “perceived risk of HIV” (5). These studies should illustrate to public health officials that they should confront these issues and intervene if possible.

The van that already provides these intervention and counseling services should continue to do so, but more effectively. There is no need for a new headquarter, since the drug users would ideally be at these needle exchanges anyway, but if the range of coverage of the van can be expanded, a larger population can be aided. By handing out more specific pamphlets focused on promoting positive attitudes regarding condoms, as well as ways to “extol the pleasurable aspects of them [condoms], and show participants ways to eroticize their [condom] use” (5), IV drug abusers could become better educated about the risks of unprotected sex. Since free condoms are already distributed (35), it is more information, than actual materials that is needed.

The annual budget for running an NEP is $169,000 per year, and with an average cost of a syringe at $1.35, there is potential to serve over 100 clients per day (19). A van itself costs less than $100,000 (36). The average cost of care for a person alive for 16 years after becoming infected with HIV is $199,980 (18), and the value of avoiding morbidity associated with a single case of HIV/AIDS is $157,811 for the period beginning with transmission of HIV through late stage HIV and AIDS (17). There is no doubt that a van is cost effective, because alone it costs less than caring for two HIV-positive people.

There should also be periodic “booster” sessions, provided by AIDS Project Hartford, to ensure that behavior changes are being maintained, and to allow for a broader range of more in depth topics to be addressed (27). With a use of a small incentive, this could easily become a reality. In fact, at a three-month follow up session to a previous intervention, condom use increased from 26 to 56% (1). The effects of this could be significant.