To the Editor.
—Dr Des Jarlais and colleagues1 have concluded that as a result of establishing HIV prevention measures (needle exchange, outreach) for drug users, some cities have escaped from epidemic levels of HIV in IDUs and that simply the continued existence of such facilities will avert a future epidemic. Their conclusion is based on the observation that those cities with established HIV prevention measures currently have low HIV rates in the IDU population. The authors, how ever, assume rather than test any relationship between establishing HIV prevention measures and low-risk behavior in the associated drug-using community. In effect, their report has failed to include important performance indicators and outcome measures of health care provision to IDU populations by concentrating on the HIV infection incidence alone; a more relevant and predictive indicator would be to measure sharing risk. Health policy in England has recognized this and has set targets
Morrison CL, Ruben SM. Maintaining Low HIV Seroprevalence Among Injecting Drug Users. JAMA. 1996;275(8):596-597. doi:10.1001/jama.1996.03530320020025