Coates says that HIV prevention among IDUs is especially effective when rates of HIV are still low. For example, in Tacoma, Wash., where prevention efforts for IDUs were begun in 1988, the prevalence of HIV among IDUs has remained steady at 3 to 4 percent, compared to New York City, where prevalence of IDUs increased from 10 percent to more than 50 percent in five years. The federal government bans the use of federal funds for needle exchange programs, although six government-sponsored reports have shown that those programs help stop the spread of HIV and do not lead to increased drug use, according to Coates. A CDC study in Connecticut found that repealing prescription laws led to a 50 percent reduction in the sharing of needles by IDUs, a primary route of HIV infection. Half of all new HIV infections occur in people under the age of 25, and many become infected as adolescents.
Programs are especially effective if they recognize gender equality and sexual diversity.
Coates says programs are needed for runaway shelters, halfway houses, and on the streets aimed at high-risk youth who are not in school. Although Coates says the popular belief is that teaching kids about sex will lead to promiscuity, the opposite is true. In Oakland, Calif., and Atlanta, successful sex education programs for seventh and eighth-graders helped abstinent students postpone sexual activity and increased condom use among sexually active students. Almost 75 percent of Americans favor making condoms and birth control information available through school clinics, yet 19 states prohibit or restrict the distribution of condoms or other contraceptives at schools or through school clinics. In recent years, Coates says many states have passed laws that restrict sexuality education.