Out medical treatments can be viewed as an input, and through

Out medical treatments can be viewed as an input, and through research studies to test the program’s efficacy or impact, an output of SIFs. SIFs are shaped by various, potentially conflicting sources of influence and control. In addition to reducing morbidity and mortality among drug users, a goal of SIFs is to change social norms through informal social influence. SIFs legitimize the treatment of injection drug use as a medical concern and the involvement of health care workers in the process of injection of illegal drugs. However, controversies over the appropriate interactions with drug users in the community are likely to generate a backlash despite efforts to change popular opinion. Establishing SIFs also requires formal systems of influence, including community support and a political system that allows for public health concerns to influence a socially sanctioned behavior, which is usually viewed as the purview of the law enforcement system. Contextual factors are highly relevant to the success of a SIF. An important goal of SIFs is to change the social relationships in the injection process. Health professionals or paraprofessionals become involved in the injection process, and the social norms of these settings foster HIV prevention. Potential consequences of SIFs may be to alter the drug network structure or the social norms of drug networks to discourage the sharing of injection equipment. The physical locations of SIFs are also critical. To be effective, SIFs need to be located in geographic areas near a large number of injection drug users. However, areas that can provide drug users with easy access may encounter resistance if they are perceived to be too visible. Beginning in 2003, the regional health authority in Vancouver, Canada was granted by the federal government a legal exemption to pilot a SIF program. The Vancouver SIF survived because the Supreme Court of the Province of British Columbia granted the SIF in Vancouver constitutional immunity from Canada’s drug laws. As a condition of the initial approval of the Vancouver SIF, an innovative scientific evaluation was integrated into the program. Mixed methods were used, including qualitative and quantitative interviews of drug users (some of whom used the SIFs and some of whom did not) and analyses of community data sets on crime and drug overdoses. The Urban Health Research Initiative of the British Columbia Centre for Excellence in HIV/AIDS produced over 30 peer-reviewed studies on the SIF. These studies document the benefits to the users.69-74 Moreover, several of the research studies document the absence of significant negative consequences for theAIDS Behav. Author manuscript; available in PMC 2011 December 1.Latkin et al.PageSIF participants or the GGTI298 structure adjacent community members. The investigators even documented how the local police have played an important role in referring drug users to the SIFs, and have shown how continued public injections are due in part to the lack of access to the SIF among some drug users.74 The strong scientific data researchers generated by studying the Vancouver SIFs created a order Alvocidib feedback loop. After the pilot program was established, the results of the empirical studies provided political power to advocate at the meso and macro levels to maintain the SIFs because of their benefits at multiple social levels. Voluntary Counseling and Testing It is estimated that 21 of the people living with HIV (PLWH) in the United States are unaware of b.Out medical treatments can be viewed as an input, and through research studies to test the program’s efficacy or impact, an output of SIFs. SIFs are shaped by various, potentially conflicting sources of influence and control. In addition to reducing morbidity and mortality among drug users, a goal of SIFs is to change social norms through informal social influence. SIFs legitimize the treatment of injection drug use as a medical concern and the involvement of health care workers in the process of injection of illegal drugs. However, controversies over the appropriate interactions with drug users in the community are likely to generate a backlash despite efforts to change popular opinion. Establishing SIFs also requires formal systems of influence, including community support and a political system that allows for public health concerns to influence a socially sanctioned behavior, which is usually viewed as the purview of the law enforcement system. Contextual factors are highly relevant to the success of a SIF. An important goal of SIFs is to change the social relationships in the injection process. Health professionals or paraprofessionals become involved in the injection process, and the social norms of these settings foster HIV prevention. Potential consequences of SIFs may be to alter the drug network structure or the social norms of drug networks to discourage the sharing of injection equipment. The physical locations of SIFs are also critical. To be effective, SIFs need to be located in geographic areas near a large number of injection drug users. However, areas that can provide drug users with easy access may encounter resistance if they are perceived to be too visible. Beginning in 2003, the regional health authority in Vancouver, Canada was granted by the federal government a legal exemption to pilot a SIF program. The Vancouver SIF survived because the Supreme Court of the Province of British Columbia granted the SIF in Vancouver constitutional immunity from Canada’s drug laws. As a condition of the initial approval of the Vancouver SIF, an innovative scientific evaluation was integrated into the program. Mixed methods were used, including qualitative and quantitative interviews of drug users (some of whom used the SIFs and some of whom did not) and analyses of community data sets on crime and drug overdoses. The Urban Health Research Initiative of the British Columbia Centre for Excellence in HIV/AIDS produced over 30 peer-reviewed studies on the SIF. These studies document the benefits to the users.69-74 Moreover, several of the research studies document the absence of significant negative consequences for theAIDS Behav. Author manuscript; available in PMC 2011 December 1.Latkin et al.PageSIF participants or the adjacent community members. The investigators even documented how the local police have played an important role in referring drug users to the SIFs, and have shown how continued public injections are due in part to the lack of access to the SIF among some drug users.74 The strong scientific data researchers generated by studying the Vancouver SIFs created a feedback loop. After the pilot program was established, the results of the empirical studies provided political power to advocate at the meso and macro levels to maintain the SIFs because of their benefits at multiple social levels. Voluntary Counseling and Testing It is estimated that 21 of the people living with HIV (PLWH) in the United States are unaware of b.