ENGLISH :
'Outreach' has taken on increasing importance in our nation's service delivery system as a way of reaching isolated, difficult-to-reach populations. It is now recognized as a necessary and critical component of programs designed to provide Acquired Immunodeficiency Syndrome (AIDS) prevention, education, and intervention to injection drug users (IDUs) and their sexual partners as the virus spreads among these vulnerable populations. While the drug abuse treatment system has taken many heroic measures to help interrupt the spread of the epidemic among injection drug users, the well-known fact is that for every drug user in the treatment system there are another six to seven outside the treatment system. It is critical that IDUs not in treatment be identified, located, and engaged in risk reduction measures, and that AIDS prevention/intervention efforts be extended to their sexual partners and children. This Manual describes an outreach program - The Community Health Outreach Worker (CHOW) Model - developed and tested by the YES Project on behalf of the Mid-City Consortium in San Francisco during the period from May, 1986 to December, 1990. It is essentially a strategy for utilizing applied ethnography in developing public health intervention with injection drug users at risk for HIV infection. At YES, professional ethnographers carried out the beginning research, and these "short" studies became the basis for developing the CHOW interventions. Later, CHOWs provided ongoing ethnographic feedback so that the Model could be shaped and reshaped according to updated information. In this Model, CHOWs learned how to make conscious field observations and to record them. These observations became the intelligence for conducting prevention efforts with specific subpopulations as well as identifying new, unserved, at-risk groups in a manner that allowed for ongoing revision of the Model in keeping with the changing nature of the HIV epidemic in San Francisco. The Manual is designed to convey the critical elements that accounted for the success of CHOW staff in reaching approximately 75% of the estimated 12,000 injection drug users in San Francisco and engaging them in AIDS education, risk reduction strategies and other program interventions. Our primary purpose is to provide information that will assist public and private health planning organizations, drug treatment programs and other agencies in planning and implementing outreach efforts to help prevent the spread of AIDS among hard-to-reach, but vulnerable groups in our nation.