perceptions are almost nonexistent. AIDS has created a qualitatively different risk of death associated with IV drug use, and previous beliefs about what does and does not encourage IV drug use cannot safety be generalized to the AIDS situation. The dilemma about preventing adverse health consequences of drug use versus "encouraging" drug use can be applied to any treatment of adverse health consequences of drug use (e.g., using naloxone to treat acute overdoses). AIDS, however, magnifies the scale of the dilemma on several dimensions -- it is specific to IV drug use rather than all forms of drug use; some successful prevention can probably be achieved without any overall reduction in drug injection (e.g., reducing the use of contaminated needles); the adverse consequences may occur after successful elimination of IV drug use, thus undermining the hope needed in drug-abuse treatment programs; and the fatal consequences are not limited to the drug user, but may also include sexual partners and children.
Specific approaches to these prevention policy questions will vary according to the different target groups for preventing AIDS among IV drug users, the extent to which HIV has spread among the local IV drug users, the feelings of individual prevention workers, the philosophy of the sponsoring organization, and the local political climate. The problem is certainly large enough to permit a wide variety of approaches, and there are not yet sufficient data to identify the single "best" prevention approach. Individuals working to prevent AIDS among IV drug users, their sexual partners, and their children need to believe in the validity of what they are personally doing, but will also need to be able to keep an open mind to forthcoming data showing the relative effectiveness of the different approaches. In the meantime, the AIDS problem is of sufficient urgency that we should be trying and assessing a wide variety of prevention programs.
Support for the preparation of this chapter was provided by grant DA 03574 from the National Institute on Drug Abuse. The chapter is based on an article in the Journal of Applied Social Psychology.
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