Reduction of HIV transmission Through Outreach: Evidence for Action on HIV/AIDS and Injecting Drug Use

The brief explains that in many countries, access to drug-dependence treatment and HIV/AIDS prevention and care services is limited for injecting drug users. Moreover, users of illicit drugs are commonly marginalised by communities and usually attempt to remain hidden from the authorities, especially law enforcement agencies. Drug users who could benefit most from HIV/AIDS prevention services and drug-dependence treatment are often the least likely to use these services. For this reason, HIV/AIDS prevention programmes have undergone significant change during the past two decades: instead of waiting for injecting drug users to enter health and social institutions they offer services to users where they are and where they use drugs. In order to accomplish such programmes a strong outreach component is necessary, involving various approaches.

Outreach aims to contact drug users in the communities where they live, use drugs and gather, and to provide them with information and the means to reduce the risks of acquiring HIV infection related to the sharing of injecting equipment and sexual contact. Outreach is also intended to prevent other health and social consequences
of drug use. Typically, outreach workers provide risk-reduction information and commodities such as clean needles and syringes, bleach and condoms. They also provide, where available, referral opportunities for drug-dependence treatment, including substitution treatment, and other services, such as the collection of used injecting equipment, abscess management, HIV testing and counselling and treatment of sexually transmitted infections. Outreach programmes vary in respect to the components adopted and the services provided.

The World Health Organisation (WHO) commissioned international literature and programme reviews on the effectiveness of HIV prevention for injecting drug users. The evidence obtained in more than 15 years of research and evaluation involving various types of research design in different country settings strongly indicates that outreach-based interventions are effective in contacting out-of-treatment injecting drug users and providing them with the means for effective behaviour change. The evidence supports the view that outreach and face-to-face contact between outreach workers and the target group is associated with reduced risk behaviour and reduced exposure to HIV.

Policy and programming implications:

• Community-based outreach as a means of HIV/AIDS prevention should be considered essential in countries or locations where injecting drug use is a significant route of HIV transmission.
• Existing outreach programmes should be expanded so as to reach a majority of out-of-treatment injecting drug users.
• Reaching out to injecting drug users and providing them with information, services and referral linkages, rather than waiting for them to access services, requires commitment by local and national governments to reorient drug and HIV/AIDS policies and to recruit skilled staff and peer educators or retrain existing staff.
• The implementation of effective outreach programmes requires the creation of an enabling environment for the establishment and maintenance of outreach services, including the review of paraphernalia and drug laws, law enforcement practices and the provision of a variety of health services.
• Finding the right mix of approaches and services appropriate for the group of injecting drug users to be reached in particular political, legal and socioeconomic
  circumstances often presents a challenge. The likelihood of effective programme implementation can be significantly increased by including injecting drug users and people living with HIV/AIDS in programme development and implementation.
• Central to effective outreach work are referrals to other services and the inclusion of outreach in other services, including drug-dependence treatment,
  abscess management, HIV testing and counselling, and treatment of sexually transmitted infections and HIV/AIDS, tuberculosis and hepatitis C. When outreach programmes are being established and expanded, such ancillary services should be appropriately included in programme development and implementation, and staff members must be trained accordingly.