By the end of 1992, almost 250,000 cases of AIDS had been reported to the U.S. Centers for Disease Control (CDC). Injection drug use was the documented means of exposure for over 25% of these cases, with rates of HIV seropositivity as high as 60% among injection drug users (IDUs) in some areas of the northeast.
In 1987, the National Institute on Drug Abuse (NIDA) mounted a widescale effort to reduce high-risk behaviors among IDUs through the National AIDS Demonstration Research (NADR) project. NADR initiated community-based programs that provided risk-reduction education and HIV testing and counseling to out-of-treatment IDUs and their sex partners. The project, operating through 41 programs across the U.S., interviewed approximately 60,000 IDUs as research participants, and provided risk-reduction information and services to thousands more. Although the actual content of the interventions varied from site to site, a basic HIV prevention model was followed (e.g., discussion of HIV transmission and risk-reduction strategies, and provision of literature, bleach, condoms, and testing). Research participants were recruited through indigenous outreach efforts, emergency rooms, criminal justice files, and community service agencies. Using random assignments, alternative behavioral intervention strategies aimed at changing high-risk needle use and sex practices were implemented. Follow-up interviews assessed changes over time.
IBR served as an evaluation research resource center and provided scientific coordination for program sites located in the southwestern U.S. Researchers at IBR provided scientific and technical support, including research designs, designs for special studies, development of outcome criteria, and development of data collection instruments for measuring the effectiveness of interventions. Special efforts were focused on multisite studies to evaluate the impact of HIV/AIDS intervention strategies on follow-up outcomes. These evaluations showed that outreach and targeted interventions were associated with significant HIV risk-reduction indicators among IDUs, and work has continued in order to identify the most effective elements and applications for this hard-to-reach popluation.
Camacho, L. M., Williams, M. L., Vogtsberger, K. N., & Simpson, D. D. (1995). Cognitive readiness of drug injectors to reduce AIDS risk. The American Journal on Addictions, 4(1), 49-55. [Abstract]
Simpson, D. D., Camacho, L. M., Vogtsberger, K. N., Williams, M. L., Stephens, R. C., Jones, A., & Watson, D. D. (1994). Reducing AIDS risks through community outreach interventions for drug injectors. Psychology of Addictive Behaviors, 8(2), 86-101. [Abstract]
Joe, G. W., & Simpson, D. D. (1993). Needle use risks: Composite measures and comparisons. In B. S. Brown, G. M. Beschner, & the National AIDS Research Consortium (Eds.), Handbook on risk of AIDS: Injection drug users and sexual partners (pp. 137-154). Westport, CT: Greenwood Press.
Stephens, R. C., Simpson, D. D., Coyle, S. L., & McCoy, C. B. (1993). Comparative effectiveness of NADR intervention. In B. S. Brown, G. M. Beschner, and the National AIDS Research Consortium (Eds.), Handbook on risk of AIDS: Injection drug users and sexual partners (pp. 519-556). Westport, CT: Greenwood Press.