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For decades, infectious diseases have posed a serious and avoidable threat to the health and survival of injection drug users (IDUs). The most deadly threat currently arises from the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS). Yet less visible infectious diseases are also significant. Data from local and population-based surveys indicate that the great majority of IDUs in the United States of America are infected with hepatitis B or hepatitis C virus [1, 2]. A smaller but still significant proportion is infected with endocarditis, bone and joint infections [3], tuberculosis [4] and other infectious ailments. As the average age of IDUs increases, the prevalence of infectious disease may increase [3].
What can be done to address those threats? Can epidemiological models play a useful role in public health prevention efforts? Can treatment for substance abuse slow the spread of disease, and is treatment cost-effective when compared with other public health efforts? Can hepatitus C virus or other highly infectious diseases be controlled within drug-using populations? How can clinicians and policy makers target IDUs at greatest risk of getting and spreading blood-borne disease? The present paper offers five tentative principles to help answer those difficult questions.
