Options may include referral to treatment to stop injecting altogether, social strategies to avoid sharing injection equipment, and, for those who still share, instruction on how to clean injection equipment with bleach and water to reduce the risk of HIV transmission. Outreach workers carry supplies of bleach, water, cotton, condoms, and information pamphlets at all times and distribute materials as needed in all encounters.

  1. In repeated encounters with injection drug users, outreach workers support and reinforce behavioral change.

  2. The intervention's impact is further extended by promoting prevention advocacy within injection drug user social networks for HIV risk reduction.

Chicago's program represents the more intensive end of the range of NADR outreach programs in the frequency and duration of contacts that take place between street outreach workers and networks of injection drug users. As stated above, this program cannot be considered simply a bleach distribution program, although it uses bleach and other injection supplies as tools to facilitate interaction with street addicts and to reduce injection harm. It focuses on total risk awareness, education, and reduction, rather than solely on distributing bleach and providing instruction in bleach use.

To monitor trends in risk behavior and HIV incidence, a panel of injection drug users was recruited for study and followed over a 4-year period. The results of seven waves (baseline and six follow-ups) of interview and serologic data collection from 1988 through 1992 were analyzed.

The sample was recruited from the three Chicago neighborhoods in which the outreach was conducted: the mostly African American South Side, the ethnically mixed North Side, and the largely Puerto Rican Northwest Side. These neighborhoods were selected for their high concentration of injection drug activity, the variety of injectable drugs represented in the areas, and the broad demographic mix of user characteristics known to exist in Chicago. Recruitment targeted injectors in the three outreach areas in community settings such as street corners, copping (drug sales) areas, and shooting galleries. Injectors were identified on the basis of street outreach workers' knowledge of them and injectors' identification of others in their injection networks (targeted sampling).

Between March and August 1988, baseline interviews and blood specimens were collected from a cohort of 850 injection drug users. Of this initial cohort, 209 (24.6 percent) were HIV seropositive at their first serologic evaluation. Those injection drug users initially HIV seronegative and thus at risk for infection (n = 641) were the focus of the evaluation.

Subsequent to the 1988 baseline assessment, six waves of follow-up interviews and blood specimen collections were performed through fall 1992. The questionnaires used at the baseline and follow-up waves assessed the



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