At secondary level once⁽⁴⁾ experimentation of these risk behaviour have been initiated/ onset of social consequences(individual or community engages in drug use), strategies include creating positive user-health worker relationships, positive peer group support systems with the purpose to arrest drug abuse process. ⁽⁵⁾At this level we look at newly HIV positive individuals and intervention suggests prompt treatment such as the description of antiretroviral drugs/chemotherapy(ARV) as well as helping with coping strategies and increasing access to health care.

 At tertiary level these clinics intervene the ⁽⁴⁾establishment of this risk behaviour with the purpose to reduce addiction and its inducement of other health concerns. Once this level is reached we are already working with patients with established HIV/AIDS. ⁽⁵⁾Strategies here focus on providing a claim to a quality life thus ARV are still prescribed to battle opportunistic infections and also to HIV+ mothers to prevent transmission to their child during pregnancy(PMTCT). Support also plays a major role as to assist these individuals back into their workplace and communities.

Clinics like these use systems that make use of external and internal framework when assisting in the prevention of drug abuse and its relationship to diseases such HIV.

 

⁽⁴⁾Externally they focus on creating positive experiences between the patient and the people and clinic in their lives by focusing on these main points:

• Reinforcement- Addicts and people exposed to these conditions need support and assistance from friends, family and the community.

• Equipped-Patients should be empowered and given the opportunity to give back to their community.

• Trust-They should know their boundaries and what is expected of them, but be given the freedom to operate within their communities.

• Time consumption- teach member how to use time wisely in such a way to contribute to constructive personal growth.

⁽⁴⁾Internally the focus is more on the community in the sense that they should assist them in the teachings of qualities such as confidence, positive choices and decision making by focusing on these categories:

• Dedication to education- Develop of lifelong devotion to learning. 

• Worth- Development of values to guide decision making

• Capability- to be able to function efficiently and/or successfully

 

Globally it is estimated that⁽¹⁾255 million people used illicit drugs such as cannabis, opioids and amphetamines,⁽²⁾ it is estimated that 92% of drug users has shared needles in the past and there is currently 12 million drug users that inject drugs according to the world drug report of 2017. Drug abuse ⁽³⁾ increases the prevalence of HIV due to the use of needles that has been shared among peers. This occurs due to people unknowingly of the other users HIV status shares a needle contributing in reckless behaviour and by doing so the virus is spread, the virus spreads further especially when a person shares a needle with multiple friend groups.

2. United Nations P. WORLD DRUG REPORT 2017. [S.l.]: UNITED NATIONS PUBNS; 2017.

3. Homer JB, St. Clair CL. A Model of HIV Transmission through Needle Sharing. Interfaces [Internet]. 1991; 21(3):[26-49 pp.].

4. Owen S. Levels of Prevention Georgia: Georgia State University; 2000 [cited 2018 23 April]. Available from: http://www2.gsu.edu/~wwwche/Primary%20Secondary%20Tertiary%20Prevention.htm.

5. Sahasrabuddhe VV, Vermund SH. The future of HIV prevention: control of sexually transmitted infections and circumcision interventions. Infectious disease clinics of North America. 2007;21(1):241-57.

6. Mallin R, Porter M. Substance Use Disorders. In: South-Paul JE, Matheny SC, Lewis EL, editors. CURRENT Diagnosis & Treatment: Family Medicine, 4e. New York, NY: McGraw-Hill Education; 2015.

7. King TE, Jr., Wheeler MB. Medical management of vulnerable and underserved patients : principles, practice, and populations. New York :: McGraw Hill Education; 2016. Available from: AccessMedicine http://accessmedicine.mhmedical.com/book.aspx?bookid=1768.

8. Cucciare MA, Han X, Timko C, Zaller N, Kennedy KM, Booth BM. Longitudinal associations between outpatient medical care use and substance use among rural stimulant users. The American Journal of Drug and Alcohol Abuse. 2018;44(2):235-43.

9. Devil Bones: Cheap heroine grips SA's youth [Internet]. YouTube. 2018 [cited 23 April 2018]. Available from: https://www.youtube.com/watch?v=l8fDXSqE_ZM&feature=youtu.be&has_verified=1

10.The Nyaope 'Bluetooth' craze caught on camera [Internet]. YouTube. 2018 [cited 23 April 2018]. Available from: https://youtu.be/qD0w36VRkg8

 

⁽⁸⁾Drug abusers in rural settings are less likely to make use of formal in-patient clinics than their urban counterparts (24% in the past 3 years to 37% in the last year alone). A more practical and appealing alternative is outpatient medical care (OMC). Studies conducted in the USA that looked specifically at methamphetamine users in rural communities, showed a reduction in drug use with an increase in OMC by drug users with no medical insurance and a lower than high school education. Drug users without medical insurance but a higher level of education also showed a decrease in drug usage with more OMC. Contrary to this, people with a higher education and medical insurance increased their drug usage when they visited outpatient clinics three or more times in the 6-month period. Similar results were observed under cocaine users. The reason for this is unclear, but a possible explanation can be that the people who visited the clinics more often experience more severe substance abuse related health problems.

 

⁽⁸⁾ The study concluded that more visits to outpatient health clinics help to reduce and treat substance abuse in some cases but not in all, since drug-abuse is such a highly multi-causal disorder. 22% of the test subjects reported no visits to OMC facilities at baseline, but at the end of the study results showed conclusively that even just one visit reduces the total number of days that the drug is used. It is necessary to assign resources and focus on outpatient clinics in rural communities. However, care should be taken in the coordination of these resources, since data shows that this prevention is not the most effective method in all cases. Further research is necessary to determine a better course of action, bur for now these clinics are sufficient in reducing drug abuse and sequentially the prevalence of HIV.