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The continuing threat posed by HIV, HCV, drug overdose, and other injectionrelated health problems in both the United States and Canada indicates the need for further development of innovative interventions for drug injectors, for reducing disease and mortality rates, and for enrolling injectors into drug treatment and other health care programs. Governmentally sanctioned "safer injection facilities" (SIFs) are a service that many countries around the world have added to the array of public health programs they offer injectors. In addition to needle exchange programs, street-outreach and other services, SIFs are clearly additions to much larger comprehensive public health initiatives that municipalities pursue in many countries. A survey of the existing research literature, plus the authors' ethnographic observations of 18 SIFs operating in western Europe and one SIF that was recently opened in Sydney, Australia, suggest that SIFs target several problems that needle exchange, street-outreach, and other conventional services fall short in addressing:(1) reducing rates of drug injection and related-risks in public spaces; (2) placing injectors in more direct and timely contact with medical care, drug treatment, counseling, and other social services; (3) reducing the volume of injectors' discarded litter in, and expropriation of, public spaces. In light of the evidence, the time has come for more municipalities within North America to begin considering the place of SIFs in public policy and health initiatives, and to provide support for controlled field trials and demonstration projects of SIFs operating in injection drug-using communities. BROADHEAD, KERR, GRUND, ALTICE 330JOURNAL OF DRUG ISSUES

AIDS prevention efforts for injection drug users (IDUs) since 1988 in over 60 inner-city areas within the United States have been based on a “provider-client” model called “street-based outreach.” We document the research showing that these traditional outreach projects operate under conditions that cause hierarchy and supervision to break down easily. The result is an array of organizational problems that push outreach projects toward inertia, and invite high levels of mal- and nonperformance by outreach workers (OWs) as rational adaptations to their work conditions. Nevertheless, research has also documented that IDUs responded very impressively to the outreach services they received. Based on IDUs' responsiveness, we outline the operational features of a “Peer-Driven Intervention” (PDI) that relies on an active collaboration with IDUs in place of a “provider-client” model. Based on a comparative study in eastern Connecticut, we present preliminary impact data comparing the effectiveness of a PDI with a traditional outreach intervention in terms of recruitment power, educational effectiveness of IDUs in the community, and comparative intervention costs.

Whereas many infectious diseases are spread through casual contact and contagion,HIV transmission results from risk behaviors that involve close and often intimate contact. As a result, the transmission of HIV is structured by the social relationships within which these contacts are embedded. Hence, social network analysis is especially suitable for understanding the AIDS epidemic. This paper reports the results of a field experiment that compares a network-based HIV prevention intervention, termed a "Peer-Driven Intervention" (PDl), with the standard form of streetbased outreach intervention.The results suggest that the network intervention outperforms the standard approach with respect to number of people accessed, reductions in self-reported levels of HIV risk behavior and cost. Finally, the analysis focuses on the network structure of drug injectors and discusses the implications of these structures for understanding both the spread of HIV through social networks and the design of HIV-prevention interventions.The results show that certain network features, including geographically extensive networks and an abundance of ties across ethnic boundaries, genders, ages and drug preferences, can further the spread of HIV.Ironically, these are also the network features that increase the effectiveness of network-based HIV-prevention interventions.Thus, we show that network interventions work best precisely when they are most needed, that is, when network structures facilitate the spread of HIV.

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A dilemma arises for researchers who sample hidden populations, such as injection drug users (/DUs), and use financial incentives to recruit respondents. To prevent respondent duplication (a subject participates in a study multiple times by using different identities) and respondent impersonation (a subject assumes the identity of other respondents), researchers must confirm their subjects' identities. Documentation, however, introduces sampling bias against those who lack such identification, or who wish to remain anonymous. Definitive forms of identification like photography and fingerprints introduce a bias against the more distrustful members ofthe population, and scanner-based biometrics can be expensive. Most research projects therefore rely on staff to recognize former respondents, but staff turnover and a large number of respondents compromise accuracy. We describe and assess quantitatively the accuracy ofa method for subject identification based on a statistical principle, the interchangeabilityofindicators, in which multiple weak indicators combine to form a stronger aggregate measure. The analysis shows that observable indicators ofidentity (scars, birthmarks, tattoos, eye color, ethnicity, and gender) and five biometric measures (height, forearm lengths, and wrist widths) provide the basis for a reliable and easily administered method for subject identification.

JOURNAL OF DRUG ISSUES 0022-0426/06/04 953-974 __________Stephen Ostertag is a Ph.D. student at the University of Connecticut. His interests include crime, deviance and social control, mass media and culture. This paper is an adaptation of his master's thesis. Brad Wright, Ph.D., is an associate professor in the Department of Sociology at the University of Connecticut where he studies the social psychology of crime and deviance. Robert S. Broadhead, Ph.D., is a professor of sociology at the University of Connecticut and the principal investigator of the NIDA-funded study (RO1 DA12112) from which this analysis derived. Frederick Altice, M.D., is an associate professor of medicine with the Yale University School of Medicine and the Yale AIDS Program and the co-principal investigator of the project from which this analysis is derived.