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Strategies to Improve the Replicability, Sustainability, and Durability of
HIV Prevention Interventions for Drug Users
May 6-7, 2002
Sponsored by:
Center on AIDS and Other Medical Consequences of Drug Abuse, NIDA
Purpose
On May 6-7, 2002, NIDA's Center on AIDS and Other Medical Consequences of Drug
Abuse (CAMCODA) sponsored a Working Meeting on "Strategies to Improve the
Replicability, Sustainability, and Durability of HIV Prevention Interventions
for Drug Users" in Chevy Chase, Maryland. Dr. Wendee Wechsberg, of the Research
Triangle Institute in North Carolina, served as Chair of the meeting.
The immediate purpose of the meeting was to bring together multi-disciplinary
experts in the study of HIV prevention and drug abuse to present their research
findings, discuss and exchange emerging scientific data, and identify gaps and
future directions in research to improve behavioral prevention interventions that
target HIV/AIDS and other blood-borne diseases among drug users and their sexual
partners. In-depth discussion sessions were interspersed throughout the 2-day
meeting to focus on individual studies, to highlight emerging, new, and common
themes, and to identify key features and approaches for improving the replicability,
sustainability, and durability of behavioral interventions to prevent HIV/AIDS
and other infectious diseases in drug users
The Director of CAMCODA, Henry Francis, M.D., set the stage for the meeting
by underscoring the importance NIDA gives to prevention, and the need for new,
innovative approaches to improve long-lasting behavioral changes among drug users
to prevent HIV and other infections. Since no single intervention strategy will
work equally well for every drug user, it is important that multiple, complementary,
and coordinated behavioral interventions are available to reach diverse populations
of drug users, across different time periods and social contexts.
Dr. Wechsberg reviewed the objectives of the working meeting, namely to review
the current science of HIV prevention in drug-using populations, and to identify
innovative approaches for enhancing HIV interventions so that their outcomes -
positive behavioral change, HIV risk reduction, and the development and maintenance
of protective behaviors - become the norm. She also discussed the concepts of
replicability, sustainability, and durability, and their roles in the characterization
of effective HIV interventions, and added other important concepts for discussion,
including adaptability, maintainability, and "translatability."
A number of themes emerged during the meeting presentations and discussions,
of which five of the more salient ones are mentioned here. One was that, while
the medical model may be relevant for the development of HIV prevention interventions
among drug users in some situations, it is not relevant in others. Social, behavioral,
and biological experts must work together to distinguish appropriate intervention
models for given circumstances and populations, since HIV risks and drug use are
multidisciplinary problems.
A second theme concerned the questions that arise from the complexities of
drug abuse and addiction. HIV risk reduction interventions for drug users have
beneficial effects, but the effects may vary with, among other factors, the intervention
dose and its timing, and the type of drug user. Since drug addiction is a chronically
relapsing disease, there will never be complete elimination of risk. For this
reason, it is important to ask such questions as, what are reasonable expectations
to achieve risk elimination, or to sustain risk reduction? What is the most effective
way to allocate limited resources to maximize risk reduction? Is it more cost-effective
to avert risk in a high-risk population, in a young population, or in other special
populations?
Still another theme highlighted what research has shown about HIV interventions
that work at the individual level, including a cognitive approach and changing
norms. Less clear is what interventions work, for whom, and how long at the level
of couples and networks. Research is also needed to develop cost-effective approaches
for adapting and tailoring proven behavioral interventions to fit the needs and
characteristics of heterogeneous populations and situations, rather than to create
and test new interventions for each context.
A fourth theme spanned the discussions throughout the meeting: While research
on HIV prevention interventions for drug users is critically important, so also
is research to address the variety of co-occurring diseases and co-morbidity that
drug users often experience, including hepatitis B and hepatitis C, other sexually
transmitted infections, violence victimization, psychological stress and mental
illness, and alcoholism. Recognition of the need for linkages and collaborations
among multi-disciplinary experts who can address HIV as well as a range of potential
co-morbid conditions among drug users is important for developing durable, sustainable,
and replicable behavioral interventions.
A fifth theme concerned the need to develop and promote protective behaviors
- what drug users can do to protect themselves from HIV and other infections in
a positive, empowered way - in addition to reducing risk behaviors. Often, HIV
prevention interventions for drug users focus on behavioral risk reduction and
"don'ts" rather than on positive behavioral changes or "do's."
HIV interventions that promote pro-social, positive behavioral change among drug
users can also be empowering, and can thereby facilitate the diffusion of social
norms that are both reinforcing and self-sustaining.
Current data on the etiology and underlying pathophysiology of cardiovascular
complications of HIV/AIDS, substance abuse (cocaine, alcohol), and HIV infection,
Next Steps:
As a result of the Working Meeting, plans are now underway to publish a special issue of a journal or other publication on strategies for improving the replicability, sustainability, and durability of HIV prevention interventions for drug users. Meeting participants will work with CAMCODA staff in the development of manuscripts for such a publication. Future forums and science meetings on strategies to improve HIV behavioral prevention interventions are also likely to build on the results of this meeting, to promote new research and cross-disciplinary collaborations, and to disseminate widely information on emerging research findings and applications.
For additional information about NIDA send e-mail to information@nida.nih.gov
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