WASHINGTON — A pilot project using street outreach and other methods to try to reduce AIDS transmission among drug addicts has helped many to stop or decrease their use of intravenous drugs, according to preliminary data released Thursday by the Centers for Disease Control.
The early findings are based on interviews with 1,584 drug users in five cities. They are among more than 30,000 addicts and their sex partners from across the country who are participating in a program begun in 1987 by the National Institute on Drug Abuse.
The results varied from city to city, with 49% to 75% of the drug users reporting that they had either discontinued or reduced their use of drugs, the CDC said in its weekly Morbidity and Mortality Report. Of these, 16% to 47% said they had stopped all use of drugs.
"We're both surprised and pleased with the numbers," said Dr. Barry Brown, chief of NIDA's community research branch. "There has been a myth--which we hope these data explode--that drug abusers are much slower to change their risk-taking behaviors than other populations. These data put a lie to that myth."
The five cities included in the preliminary data are Chicago, Houston, Miami, Philadelphia and San Francisco. The entire program involves participants in 41 community-based programs across the country.
If results from other study sites are similar, they will provide even "stronger evidence of the considerable impact that this approach could have," the CDC said.
The sharing of hypodermic needles has been a primary route of transmission of the human immunodeficiency virus since the disease was identified nearly a decade ago. Of the cumulative total of 139,765 cases of AIDS, 29,487 have been reported among drug abusers. The number does not include drug users' sexual partners, who also may have contracted the virus.
The results from all five cities also reflected significant declines in the common practice among addicts of sharing drug-injection equipment with friends, and increases in the use of bleach to clean hypodermic needles to destroy the AIDS virus, the CDC said.
The outreach approaches differed among cities, but generally included individual and group counseling, efforts to "build peer support" for changing behavior and demonstrations of practices that reduce the risk of AIDS transmission, the CDC said.
All of the projects urged entry into drug treatment programs, and 14% to 35% of the drug users had entered such programs by the time of the first follow-up interviews, the CDC said.
Brown said that one effective technique involved former addicts "who go out into the streets and work on the streets with drug users. In a real sense, they become a part of the group of users but they become an influential non-using member of the group."
Intravenous drug users "are difficult to reach and influence with traditional public health education and other prevention interventions," the CDC said. "Although drug treatment centers can serve the dual purpose of drug treatment and HIV prevention, an estimated 80% of active intravenous drug users are not in treatment."
With that in mind, Brown said: "We've always thought of such treatment as involving four-walled institutions. The idea of going out in the streets is both a new and--given the nature of the problem we face with AIDS--terribly important initiative."
The figures are based on interviews with young black male addicts, most younger than 40, who had never entered drug treatment programs.
In Miami, 47% of the participants reported at their follow-up interviews that they had stopped using drugs altogether, the highest percentage among the five cities. The figures were 32% in Houston, 26% in Philadelphia, 17% in San Francisco and 23% in Chicago.
Chicago reported the highest percentage of participants who reduced needle-sharing, or 59%, while Houston reported the lowest figure, 39%. Chicago also reported that 37% of drug users reported a decrease in borrowing drug-using equipment, while San Francisco reported that 22% had done so.