Reaching the unreached: An outreach model for ‘on the spot’ AIDS prevention among active, out-ot-treatment drug addicts

Around 1985 the spread of HIV among drug addicts in the Netherlands became a serious concern to policy makers, drug service agencies and users themselves, organized in so-called Junkie Unions. The first AIDS prevention initiatives, aimed at Injecting Drug Users (IDUs) were established by these pressure or interest groups of drug addicts. In Amsterdam the AIDS-inspired syringe exchange was initiated by the MDHG, a user-based organization, in 1984. The earliest AIDS prevention leaflet for drug users in the Netherlands was produced by the Rotterdam Junkie Union. In 1981 this union was already distributing clean syringes at places in the drug scene where IDUs gathered to prevent the spread of hepatitis. When it became apparent that HIV would also mean a menace to Dutch IDUs, the Rotterdam Junkie Union immediately started a syringe exchange. This was long before the municipal syringe exchanges opened. At first, these activities were exposed to firm opposition from the police, the treatment agencies and the municipal authorities. Insight into the magnitude of the AIDS epidemic was yet to come about at these levels. In Rotterdam, where this research was conducted, the municipal syringe exchange system was established in the first half of 1987. This rather late start was due to. resistance in some parts of the treatment system. Among other arguments, it was felt that syringe exchange would encourage injecting and undermine drug-free treatment (van Heiningen, 1988). Nowadays, these arguments are generally seen as obsolete and, more important, it has been proved that they have no scientific basis (Buning, 1988). At the end of 1986 HADON, at that time a small and experimental outreach and drug information programme, took the initiative and set up a syringe exchange. Soon the rest of the city was to follow.

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