Motivation and attitude are central to behaviors that are implicated in the spread of HIV infection: intravenous drug use and unprotected sex. It would be particularly valuable to explore how the underlying attitudes and motivations can be modified.
Social networks, especially among injection drug users, appear to exert large effects on recruitment to, and attrition from, needle exchange and bleach distribution programs. They are also implicated in needle-sharing behavior. Research in this area would contribute to better understanding of how social networks affect program participation (and nonparticipation).
The HIV epidemic in the United States is growing largely because of infection spread by contaminated needles in the population of injection drug users. Needle exchange and bleach distribution programs can help to retard this spread. And, to the extent that these programs can be made to be more effective, their retardant effect will be greater. To improve the effectiveness of needle exchange and bleach distribution programs calls for additional research, including arrangements for collecting findings across sites and coordinating studies at various locations. Good, up-to-date local measures of seroprevalence, not only of HIV but also of HBV and HCV, would help greatly to target program efforts and resources.
Finally, to make a difference, resources must flow to these research tasks. An infusion of funds, personnel, and training would all yield important returns. To live now with this epidemic without knowledgeably combatting it would be shortsighted. In the long-term control of HIV and AIDS, the kinds of research we propose would be thoroughly worthwhile.
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