Only Way to Tame a Monster : Timely federal study emphasizes urgent need for AIDS education

An exhaustive national survey of intravenous drug users has confirmed the worst fears of public health officials concerning the role of addicts in the spread of the human immunodeficiency virus (HIV) that causes AIDS. Even more important, the study strengthens the call for improved education and drug rehabilitation programs.

Most intravenous drug users regularly share needles with others and generally take no precautions to protect sexual partners from the risk of sexually transmitted disease, including AIDS. In all, 78% said they shared needles. Only 20% reported using new needles and, while 63% said they cleaned their needles, only 14% used bleach (this is used as a cleansing agent and is recommended in outreach programs because of its easy availability and relative effectiveness.) More than half of those surveyed said that they did not use condoms or other protection while engaged in either heterosexual or homosexual relations.

The Centers for Disease Control conducted the study over a two-year period, surveying drug users not engaged in rehabilitation programs. Earlier studies had focused on those involved in therapy. This new sampling dramatized the failure of existing education and treatment programs to encourage behavior change that will minimize the risk of spreading HIV infection.

It’s true that the majority of AIDS cases nationwide still are among homosexual males. But most studies indicate a stabilization of the disease in that group, contrasted with a rapid increase among intravenous drug users and among children, particularly children born to drug-using infected women.

The rate of HIV infection among intravenous drug users in Southern California remains around 5%, but more than half of the drug users in New York City have tested positive for HIV, an indication of the risk of rapid spreading in other areas if prevention services fail. There is particular concern about the disproportionate rise in infection among blacks and Latinos, two groups for which educational programs have lagged.

There is no question that the new CDC study is a timely warning to expand educational efforts and to improve access to drug treatment programs. Education programs that are explicit--and presented in the jargon of the impacted communities--are one inarguably effective tool. Another is wider distribution of bleach and condoms to intravenous drug users as reminders of how they can limit the spread of the disease.

And, as the National Commission on AIDS has emphasized, all drug rehabilitation programs need to emphasize AIDS and, by ensuring quick access, provide help to those ready to try to end their drug dependency. But none of these useful remedies are now adequately funded, a brutal measure of the harsh risks of the continued spread of HIV.