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Preventing HIV Transmission: The Role of Sterile Needles and Bleach
As some have suggested (Anglin et al., 1993), accurate estimates of injection drug use may be less important to policy makers than a constellation of data that helps to assess need and allocate limited resources. If this is the case, then more systematic efforts need to be directed toward monitoring patterns and trends in injection drug use, including improvements in recording the route of administration in secondary drug abuse indicator reporting systems. NIDA's Community Epidemiology Work Group provides one mechanism that may prove useful, particularly if expanded to incorporate more specific data on route of administration in its monitoring purview. This would provide policy planners with periodic updates as to whether the pool of injector drug users is likely to increase or decrease and whether there are any substantial shifts in the composition of the pool, including the emergence of injection as a route of drug administration among any previously unafflicted subpopulations.
The panel recommends that:
The Assistant Secretary for Health should charge appropriate agencies (i.e., the National Institutes of Health and the Centers for Disease Control and Prevention), in consultation with academic departments of epidemiology, to develop more effective surveillance of drug use, particularly for local areas. The data collected should move beyond gross prevalence estimation of drug use and toward detailed information about users. This should include data on behavioral dynamics (e.g., pattern of drug use, sharing of drugs and drug paraphernalia, social context of drug use) by drugs of choice, routes of administration for each, and the flow of injection drug users into and out of drug treatment programs.
The logic is that there are relatively fewer injection drug users in less populated rural areas. Note also that population centers that may sometimes be thought of as rather small are included within MSAs of more than 500,000 inhabitants. For example, the city of Ann Arbor, Michigan, with a population of about 110,000 is included because it is located within a metropolitan area that includes over 500,000 persons; similarly, Tacoma, Washington, Bridgeport, Connecticut, and Nashua, New Hampshire, are all represented within these 96 MSAs.
These data were made available to the panel by Joseph Gfroerer, who performed special analyses of the NHSDA.