Background:
With the new wave of addiction to methamphetamine, following the waves of addiction to heroin, cocaine, and crack it is important that staff members of STD clinics develop good working strategies with drug users to control STDs in this population. The fact that HIV transmission has been reduced to a greater extent among drug users than among other populations at risk for HIV infection indicates that it is possible to work with drug users to contain infectious epidemics.

Objective:
To review the strategies that HIV investigators and providers used in working with drug users to reduce HIV transmission among drug users.


Method:
We used various automatic and manual search strategies to locate the articles published between 1998 and 2005 with information on successful strategies used with drug users to contain infectious epidemics.


Result:
Many HIV investigators and providers demonstrated a public health understanding of the powerful forces of addiction and of the societal conditions that drive people to addiction. They worked with drug users in designing prevention and treatment interventions. Successful strategies included developing professional relationships that showed respect and avoided blame or judgment, educating drug users about the health care process and about their responsibilities, including drug users in the decision-making process, establishing realistic commitments to risk-reduction activities, reducing barriers to care, establishing multidisciplinary and case management teams, and learning about referral resources for drug users.


Conclusion:
The working relationships developed with drug users to control HIV infection can be used to control infection with other STDs.


Implications:
As health care providers and public health practitioners learn to feel comfortable in working with drug users and as drug users feel respected when they seek treatment in STD clinics, good progress can be made to control STDs in drug users.