We monitored trends in HIV risk behaviors and seroconversion among out-of-treatment injection drug users (IDUs) receiving street-based outreach intervention. Beginning in 1988, 641 HIV-seronegative IDUs were recruited by targeted sampling methods to reflect broader IDU populations and were followed for 4 years (1988-1992). All were active injectors not in treatment when recruited. Cohort members were targets of HIV-prevention outreach. The intervention was guided by the Indigenous Leader Outreach Model: Exaddicts deliver HIV-prevention services targeting IDU social networks in community settings. Primary outcome measures were HIV seroconversion and HIV risk behaviors. Observed incidence of HIV infection decreased, from 8.4 to 2.4 per 100 person-years. Prevalence of drug risk behaviors also decreased, from 100 to 14%. Seroconversion was associated with injection risk behavior [risk ratio (RR) = 9.8]. Sex risk behavior also decreased, but less dramatically, from 71 to 45%. Out-of-treatment IDUs in Chicago have reduced their rates of new HIV infection by reducing their injection risk behavior. New infections were strongly associated with injection risk behavior but not with sex risk behavior.

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Three types of shooting galleries—places where people inject illicit drugs—are identified, based on the authority relations that organize them. Shooting gallery distribution within Chicago is linked to variations in neighborhood political economies. Risk for the transmission of human immunodeficiency virus (HIV) and the potential for risk reduction vary according to gallery type.

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TB treatment completion and adherence among substance users was improved by the enhanced intervention; the familiarity of enhanced-arm DOT workers with the patients' social norms due to their own previous substance use may have made them more effective. Successful DOT in hard-to-reach populations may require strategies that directly address the population's circumstances and utilize DOT workers who are intimately familiar with patients' life situations.

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This study assesses the efficacy of an intervention model designed to reduce the behaviors that place injection drug users (IDUs) at risk for contracting the human immunodeficiency virus. The authors obtained pre‐ and postintervention interviews of 566 subjects from three cities where the intervention was tested. By use of indigenous outreach workers who targeted their activities within the social networks of IDUs, the intervention model was conducted simultaneously, but not identically, in each site. Although risk was reduced in the three locations, major differences were observed between cities. The results of this study suggest that although behavioral changes were significant and could endure, providing prevention and educational materials without the reinforcing presence of indigenous outreach workers in the community was insufficient.

Street outreach workers in HIV prevention have expanded their role to include referring injection drug users to medical services. However, little is known about whether drug users act on these referrals. The study discussed in this article examined the level of exposure to street outreach reported by injection drug users, the most common medical referrals acted on as a result of such contacts, and the predictors of acting on these referrals. Findings indicate that injection drug users with four or more contacts with street outreach workers during the preceding six months were more likely to report acting on referrals. To maximize the relevance of outreach for encouraging medical treatment, both street outreach workers and social workers in health care could benefit from cross training that focuses on strengthening the referral process.