Break the Cycle in America: Preventing HIV transmission and acquisition by reducing initiation into injection drug use

Initiation into intravenous drug use is a major threat to the successful prevention of HIV and other blood-borne diseases. New injectors are at the highest risk of becoming infected with HIV, making it critical to prevent initiation of those at risk of IV drug use. This can potentially be done through modifying the behavior of active injection drug users (IDU) in social networks where NIDU (non-injection drug users) are present. Intervening at the point of initiation creates far-reaching behavior change beyond the individual level and into the community level. Social networks have been successfully utilized in other interventions aimed at influencing IDU behaviors. Social networks influence individual behavior through direct communication or, indirectly through exposure to and comparison with network members who engage in the behavior. An intervention that impacts injection initiation through active IDU social networks has the potential to strike at the core of HIV transmission risk. Break the Cycle (BTC) is an innovative intervention that works to prevent HIV and other blood borne infection risk by reducing actual injection initiation rates. Originally developed by Neil Hunt, the BTC intervention made its debut within the United States three years ago in Denver, Colorado. This presentation discusses the administration and evaluation of the American BTC intervention. Findings from the evaluation has helped to determine whether BTC is relevant for older adult IDU, the potential for changing initiation and modeling behaviors when adapted to a group-level intervention model, and BTC's potential for widespread adoption in the United States.