Stimson G V, Eaton G, Rhodes T, Power R
Department of Psychiatry, Charing Cross and Westminster Medical School, London, UK.
Addiction. 1994 Dec;89(12):1601-11. doi: 10.1111/j.1360-0443.1994.tb03761.x.
Given the current epidemiological and behavioural risk profile of HIV infection among injecting drug users in the UK, the main strategic task continues to be to develop interventions to prevent the spread of HIV infection. Outreach to drug injectors is an important part of the wider UK HIV prevention strategy. This paper reviews critically and reassesses practically the role of outreach interventions among drug injectors in the UK. It is argued that despite the development of innovative outreach activity, the full potential of outreach has not been realized due to its theoretical orientation and in-built structural limitations. Outreach has predominantly operated with an 'individual' orientation, aiming to work with individual clients to help them to change their behaviour, gain access to services, or to become better users of services. The main thesis of this paper is that current outreach provision needs to be complemented by 'community change' models which seek to engender changes in the social etiquette of drug use within communities of drug injectors. The paper argues that the social networks through which HIV may be transmitted are the same social networks that may be coopted for HIV prevention. Future outreach services must turn to these networks as a way of targeting and encouraging changes among broad populations of drug injectors. Such models might use indigenous advocates, working within social networks, supported by community outreach facilitators.
鉴于英国注射吸毒者中当前艾滋病毒感染的流行病学和行为风险状况，主要战略任务仍然是制定干预措施以防止艾滋病毒感染的传播。对吸毒者的外展服务是英国更广泛的艾滋病毒预防战略的重要组成部分。本文对英国吸毒者外展干预措施的作用进行了批判性回顾和实际重新评估。有人认为，尽管开展了创新的外展活动，但由于其理论导向和内在的结构限制，外展服务的全部潜力尚未实现。外展服务主要以“个体”为导向开展工作，旨在与个体客户合作，帮助他们改变行为、获得服务或更好地利用服务。本文的主要论点是，当前的外展服务需要辅以“社区变革”模式，这种模式旨在促使注射吸毒者社区内吸毒的社会规范发生变化。本文认为，艾滋病毒可能通过其传播的社交网络同样也可以被用于艾滋病毒预防。未来的外展服务必须转向这些网络，以此作为针对广大注射吸毒者群体并鼓励其改变的一种方式。此类模式可能会利用在社交网络中工作的本土倡导者，并由社区外展促进者提供支持。
