POTENTIAL DEVELOPMENT OF COMMUNITY ORIENTED HIV OUTREACH AMONG DRUG INJECTORS IN THE UK

Given the current epidemiological and behavioural risk profile of HIV infection among injecting drug users in the UK, the main strategic tas k continues to be to develop interventions to prevent the spread of HI V infection. Outreach to drug injectors is an important part of the wi der UK HIV prevention strategy. This paper reviews critically and reas sesses practically the role of outreach interventions among drug injec tors in the UK. It is argued that despite the development of innovativ e outreach activity, the full potential of outreach has not been reali zed due to its theoretical orientation and inbuilt structural limitati ons. Outreach has predominantly operated with an 'individual' orientat ion, aiming to work with individual clients to help them to change the ir behaviour, gain access to services, or to become better users of se rvices. The main thesis of this paper is that current outreach provisi on needs to be complemented by 'community change' models which seek to engender changes in the social etiquette of drug use within communiti es of drug injectors. The paper argues that the social networks throug h which HIV may be transmitted are the same social networks that may b e coopted for HIV prevention. Future outreach services must turn to th ese networks as a way of targeting and encouraging changes among broad populations of drug injectors. Such models might use indigenous advoc ates, working within social networks, supported by community outreach facilitators.