Solutions for IDU
The final aspect of the AIDS problem that needs to be addressed in Erie County is the high rate of transmission, 21%, through IDU. A 2003 meta-analysis by Ksobiech reveals the association between needle exchange programs, in which IDUs receive sterile needles in exchange for contaminated needles at little or no cost, and reductions in risky needle behaviors. The weighted correlations for “pure” needle sharing, in which effects were related to a dependent variable identified only as needle/syringe sharing (-0.189), combined needle sharing, which comprised sharing with 2 or more people or with a sexual partner (-0.161), and combined borrowing/lending (-0.194) all reveal a decrease in risky needle acts due to the needle exchange programs when comparing program attendees with non-attendees or frequent with infrequent attendees. In the analyzed studies, race was distributed widely among the subjects; 45% were white, 32% black, and 13% Hispanic (Ksobiech 2003). This study is therefore relevant to a variety of races and resembles the moderate racial diversity among zipcodes of the AIDS clinics in Erie County. In corroboration with the results of the Ksobiech analysis, in order to reduce needle sharing and borrowing that facilitates the spread of HIV through IDU, 2 needle exchange programs should be established on site of the AIDS clinics. The clinics are located in areas where a large percentage of the population is below the poverty level; 14201 has 71.59% of the population below the poverty level, proximitious 14203 has 84.24% below the poverty level, and 14209 has 45.09% below the poverty level. Impoverished areas most likely possess the greatest need for clean needles at no cost; therefore, having the needle exchange programs at the same location as the clinics would be most necessary and effective.
In addition to establishment of needle exchange programs, peer HIV prevention outreach represents a possible effective strategy for reducing transmission through IDUs. In Latkin’s 2004 analysis of 156 peer outreach educators 6 months after their 10-session training, a large percentage of the educators distributed general information about HIV and discussed HIV prevention. Peer educators received cognitive-behavioral risk reduction and communication skills training and tests on knowledge of HIV to assure accurate and consistent distribution of information. 72% of educators discussed general information about HIV/AIDS to others, 68% discussed HIV prevention, and 76% provided network members with condoms. Although Latkin’s study does not assess the behavioral effects of peer outreach on individuals, the study demonstrates the importance of peer education on informing people with HIV knowledge, which may impact sexual behavior. AIDS clinics in Erie County can establish training sessions for individuals to become peer educators and provide small stipends for people who recruit individuals to the clinics. Such training has a double advantage; it provides the peer educators with a form of employment, which Myers associated with a 24% decrease in risky sexual behavior, and may facilitate spread of HIV knowledge by introducing people to the clinics (Myers, 2003). Furthermore, peer outreach is also advantageous because it is less expensive than individual interventions, reaches those who do not visit health care facilities, and utilizes people familiar with the local population. Peer intervention has proven more effective in regard to “recruitment power and ethnic and geographic representativeness” than traditional clinic-based, paid staff models (Latkin, 2004).
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