HIV PREVENTION IN HIV-POSITIVE DRUG-USERS - A METHADONE-BASED MODEL

In Switzerland, an estimated 15-25% of intravenous drug users (IVDUs) are infected with human immunodeficiency virus (HIV). It has been sugg ested that reduction of HIV-transmission-prone behavior could be achie ved in so-called ''early intervention programs''. Few public preventio n programs have so far been targeted to HIV-infected IVDUs. Socially m arginalized, jobless, street-based, HIV-infected IVDUs are those harde st to reach for education programs: it was the hypothesis that they ca n be motivated for HIV-prevention efforts by methadone-based comprehen sive social and medical care. The program was established by integrati ng one additional social worker in an outpatient clinic for infectious diseases in St. Gallen, a city with a population of 70,000 inhabitant s in eastern Switzerland. Access to the 29 clients of this study (10 w omen, 19 men) was facilitated by offering methadone treatment (follow- up 5 to 29 months). Abstinence from additional illegal drugs was not r equired. Methadone, plus social care and medical treatment was provide d by a small team consisting of a social worker, a physician and a nur se. A gradual approach was chosen to establish a working relationship with clients. The first attempt was to satisfy basic medical needs, ho using, and financial support as well as to strengthen relevant persona l relationships. Once trusting cooperation was established, reduction of transmission-prone behavior was targeted. The results show that soc ial performance can be greatly improved by integrated social, psycholo gical and medical assistance: for the 16 initially homeless housing wa s found, 14 found a job and for all but 2 basic financial support was eventually guaranteed. Self-reported drug abuse was markedly reduced, as was transmission-prone behavior by prostitution, unsafe sex practic es, needle sharing and improper disposal of used syringes. Breaking th e isolation of socially marginalized IVDUs seems to be the important m ove to enhance their social responsibility as carriers of HIV.