AEGiS-14IAC: Community acceptance of controversial HIV prevention programs for IDUs.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Community acceptance of controversial HIV prevention programs for IDUs.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no.. WeOrE1358)

Jarlais DC, Downing M, Vernon K, Riess TH, Mulia N, McKnight C, Edlin BR
Beth Israel Medical Center, New York, United States

BACKGROUND: Interventions such as syringe exchange and methadone maintenance have been shown to be highly effective in reducing HIV transmission among injecting drug users (IDUs). Despite this evidence, there is continuing opposition to implementation of these programs in many countries throughout the world, including countries experiencing HIV epidemics among IDUs.

METHODS: 43 qualitative interviews were conducted with key informants in 6 U.S. cities. Informants included AIDS prevention providers, political leaders, activists, substance abuse and AIDS researchers, and health department directors. Key informant interviews and documentary sources were then obtained for HIV prevention projects in 12 different developing and transitional countries (including projects in Asia, South America, Eastern Europe, and Africa).

RESULTS: Four different general strategies were identified for implementation of potentially controversial HIV prevention programs:(1) Broad coalition building, (2) Implementation by public health leaders, (3) Implementation by community activists, and (4) Implementation through research projects. Successful implementation generally occurred in two steps:(1) Activities to start programs, and (2) Consolidation and expansion to a public health scale. In the consolidation/expansion phase, community consultation was often critical, and leadership from politicians, public health officials, and program directors provided legitimacy and access to resources. Research supported the safety and effectiveness of the programs. Outside funding and pilot project/research was often used to initiate programs in developing/transitional countries, but consolidation and expansion to scale were often problematic in these countries.

CONCLUSION: Research, coalition building, activism, political leadership can all be important tools for implementing controversial HIV prevention programs, but better planning for large scale implementation is clearly needed.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Infections, Syringes, Substance-Related Disorders, Health Services Needs and Demand, Disease Outbreaks, Pilot Projects, United States, Africa, Asia, Europe, Eastern, South America, prevention & control

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