The Committee identified four specific instances in which the social and political barriers described above have led to public policies that run counter to the scientific evidence regarding the effectiveness of HIV prevention interventions. These instances involve access to drug abuse treatment, access to sterile drug injection equipment, comprehensive sex education and condom availability in schools, and HIV prevention in correctional settings. These examples fall into two categories: (1) those in which policies impede implementation of effective HIV prevention efforts, and (2) those in which policies encourage funding for programs with no evidence of effectiveness. We believe that continuing to support such policies will result in unnecessary new HIV infections, lives lost, and wasted expenditures.

Access to Drug Abuse Treatment and Sterile Injection Equipment

Injection drug use is a major factor in the spread of HIV in the United States, accounting for 22 percent of new AIDS cases in 1999 (CDC, 2000a). Although the primary route of transmission among IDUs is through sharing of contaminated injection equipment, sexual partners and children of IDUs are also at high risk for infection (NRC and IOM, 1995). Non-injection drug use (e.g., use of alcohol, methamphetamines, crack cocaine, inhalants) also increases the likelihood of HIV infection and transmission through increasing high-risk sexual behaviors (IOM, 1997b).

Two of the most effective strategies for preventing HIV infection among IDUs include eliminating or reducing the frequency of drug use and associated risk behaviors through drug abuse treatment, and reducing the frequency of sharing injection equipment through expanded access to sterile injection equipment. However, legal, regulatory, and funding barriers prevent widespread implementation of these interventions.

Access to Drug Abuse Treatment

Drug abuse treatment can be provided in a variety of care settings (e.g., outpatient, residential, inpatient) using two primary types of interventions: pharmacotherapy or psychosocial/behavioral therapy. Pharmacotherapy, such as methadone maintenance treatment for opiate addiction, relies on medication to block the euphoria of the drug and the cravings and withdrawal symptoms associated with drug dependency. Psychosocial/behavioral therapies include skills training or a variety of counseling approaches. Some programs combine elements of the two approaches; for instance, many methadone maintenance programs also utilize some form of counseling or psychotherapy (GAO, 1998).

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