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HIV/AIDS |
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Reducing HIV in Injecting Drug Users (IDUs) |
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HIV incidence continues to rise among injecting drug users (IDUs). Injecting drug use accounts for only 5 percent to 10 percent of cumulative HIV infections globally, but in some parts of the world it is the major mode of HIV transmission. For example, it is estimated that in China, Malaysia, and Vietnam at least half of HIV infections are associated with drug injection. In parts of Central and Eastern Europe and the newly independent states of the former Soviet Union, the rapid spread of HIV through shared use of contaminated injection equipment has been observed. In some cities, such as Svetlogorsk in Belarus, HIV prevalence among IDUs rose to more than 55 percent within one year of identifying HIV among the city's IDU population. HIV epidemics among IDUs are distinguished from those of other populations by their potential for rapid spread of the virus within the IDU community and outward into the general population. A public health strategy that promotes behavior change through comprehensive HIV prevention and care programs for injecting drug users is essential to HIV programming. Using lessons learned internationally, this strategy aims to keep HIV prevalence low in IDU populations by emphasizing that sharing contaminated drug equipment — not drug use itself or even drug injecting — carries the greatest risk of HIV infection. A comprehensive approach also addresses issues surrounding sexual transmission. This approach is compatible with proven public health principles, which view drug use or abuse as a public health issue rather than only as a law-and-order issue. It gives drug users options to reduce their risk at various levels and focuses on supportive rather than punitive strategies. It recognizes that while stopping drug use altogether is the ideal goal, intermediate steps (such as drug substitution and safer injecting techniques) are frequently just as effective in countering the spread of HIV. These five steps can help implement a comprehensive approach:
Lessons Learned Evidence indicates that the HIV epidemic associated with injecting drug use can be slowed, stopped or even reversed. At least three essential prevention components have been associated with containing the epidemic: implementing prevention initiatives early, while HIV prevalence is less than 5 percent; engaging in community outreach that provides IDUs with HIV information and helps them trust health care providers; and distributing sterile injection equipment widely. Specific lessons that arise from experiences with IDU programming initiatives include: Law enforcement policies. Police in some countries have devised an approach known as "responsible demand enforcement" in which law enforcement officials work with health care providers to help drug users access services rather than face incarceration. These efforts have helped steer drug users from crime and possible imprisonment. These policies create an environment in which individual drug users can reduce their risk behaviors over the long term. Syringe exchange and availability. The rationale behind syringe exchange is that because many IDUs are unable or unwilling to stop injecting, intervention strategies must be used to reduce their risk of HIV infection and transmission. Providing sterile needles and syringes is a simple, inexpensive way to achieve this goal, and also helps establish contact with drug users through outreach services. Education and outreach programs. Drug education materials with a focus on comprehensive HIV prevention and care programs are already available in numerous countries. These materials advise drug users about ways to inject more safely and how to otherwise reduce the risks associated with injecting. They do not promote drug use. Methadone programs. Methadone is a synthetic opiate substitute whose long-lasting effects reduce the user's need to resort to street drugs. Numerous studies have shown that methadone can reduce deaths, reduce the drug user's involvement in crime, curb the spread of HIV and hepatitis and help drug users regain control of their lives. Resources
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In Bangkok, New York and Odessa, experience has shown that once HIV prevalence reaches a threshold of about 10 percent, it can surpass 40 to 50 percent within one to four years. Most of these infections result from sharing or reusing contaminated equipment (mainly needles and syringes) or from injecting tainted drug preparations.