HIV Prevention for People Who Inject Drugs: Time for a Global Change
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The controversy over drug policies reached a new height last summer at the 2010 International AIDS Conference, held in Vienna, Austria. For decades, most countries have criminalized illicit drug use while many healthcare professionals, researchers and community members have advocated a harm reduction approach, one that minimizes the harmful consequences of illicit drug use. The AIDS 2010 Conference marked the launch of the Vienna Declaration, which calls for a full re-orientation of drug policies. The Vienna Declaration points to the failure of the international "War on Drugs" to achieve its stated objectives and calls for drug policies based on scientific evidence. So, what does the evidence tell us about the links between illicit drug use and the prevention of HIV? What does it tell us about the effectiveness of drug prohibition vs. harm reduction?
Using a combination of strategies (including sterile needles or syringes, opioid substitution treatment and antiretroviral medications, among others) and treating illicit drug use as a public health issue rather than a criminal justice issue could significantly reduce the risks of HIV infection.
Front-line workers know, and Louisa Degenhardt and her colleagues concur in one of the Lancet articles, that a combination of strategies is needed to effectively prevent HIV transmission among injection drug users and that those strategies need to reach as many people as possible.2 The long list of strategies include HIV testing and counselling, counselling to reduce the risk behaviours of individuals and couples, peers promoting changes in risk behaviours among their social networks, needle exchange programs, condom distribution, opioid substitution therapy, cognitive behavioural therapy, treatment of sexually transmitted infections (STIs) and antiretroviral treatment. Current evidence shows that each of these interventions reduces the number of injections, the riskiness of injection, sexual risk behaviours and/or the infectiousness of people living with HIV. Three of these interventions have proven to be especially beneficial -- namely, opioid substitution treatment, needle and syringe programs and antiretroviral treatment (for HIV-positive people with CD4 counts lower than 350 cells).
Although providing drug users with opioid substitution treatment, clean needles and syringes, and antiretroviral treatment can cut HIV transmission in half, it is estimated that worldwide only 5% of drug injections involve a sterile needle or syringe; 8% of injection drug users have access to opioid substitution treatment; and 4% of HIV-positive injection drug users take antiretroviral medications.
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication Prevention in Focus: Spotlight on Programming and Research. Visit CATIE's Web site to find out more about their activities, publications and services.
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