HIV transmission in this setting is related to the sexual behavior associated with cocaine use, especially drug-related prostitution activities. The seroprevalence rate in IDUs varies by community. The social interactions make intervention difficult and dependent on an understanding of the driving forces for the risk behaviors and the underlying social environment which promotes and supports the risk behaviors. Interventions - Risk Reduction Primary prevention of HIV through cessation of drug use or through drug treatment is clearly the most preferable policy option. However, the number of active IDUs currently overwhelms the availability of drug treatment, and the medical model of substance abuse recognizes this disorder as a chronic condition which is prone to relapse and exacerbation in many individuals.
Drug treatment is extremely cost-effective.
Needle Exchange Needle Exchange Needle exchange as a means of risk reduction has gained increasing popularity and has been subject to considerable political controversy. In some areas, these have become legitimatized and are operated by health departments or community groups. The underlying hypothesis of the needle exchange programs is that access to and provision of clean injection equipment is attractive to IDUs and will result in decreased sharing practices. The opposing arguments include the potential for increasing initiation of drug use and increased occupational risk to medical and law-enforcement personnel 103. In addition, senior law enforcement officials and many legislators have opposed needle exchange for legal and moral grounds.