The role of the satellite clinic in reaching intravenous drug users at risk from HIV

The arrival of HIV has challenged the traditional services for intravenous drug users providing the im petus to re-examine working practices. Only 10% of intravenous drug users attend hospital based treat ment centres offering out-patient programmes based on reducing doses of oral methadone with an ulti mate goal of abstinence (Hartnoll et al, 1985), yet for public health programmes designed to limit the spread of HIV it is important to increase the contact between high-risk groups and health professionals. Satellite clinics originally introduced to provide low cost help for drug users at a more local level may also be effective as a means of reaching intravenous drug users at high risk of HIV who would otherwise not be exposed to treatment and health education. Strang has described how a satellite clinic may be established with few resources, with staff who can be supervised by more senior workers at a central site (Strang & Creed, 1985). In this study the client groups of a satellite clinic and a conventional drug dependency unit were compared in order to charac terise the clientele of the satellite clinic and to dis cover whether it was indeed fulfilling a useful role in terms of attracting such high-risk individuals for treatment. Drug Indicators Project has already demonstrated that attcndcrs at the satellite clinic are more likely to abuse a variety of drugs and have more drug-related social problems than the drug dependency unit attendcrs (Daviaud, 1987), and Dolans has shown that these two factors are linked with an increased rate of needle-sharing among intravenous drug users (Dolans et al, 1987). Accordingly it might be expected that there would be more needle-sharing among the satellite clinic attenders, and so this and other risk factors for HIV infection were specifically investigated in the two clinic populations. Demo graphic and other variables were also investigated to aid comparison of the two samples with each other and with subjects of other studies.