Injecting drug use
HIV epidemics among injecting drug users are characterized by notable regional and in-country variations. Once the virus is introduced into an injecting drug user community, prevalence can rise up to 90 per cent in less than two years. Injecting drug use is a global and spreading phenomenon.
According to conservative estimates made by the United Nations Injecting Drug User Reference Group, the number of countries where drug injecting is reported to occur has increased from 129 to 148 in the last decade and similarly, the number of countries where HIV was reported among injecting drug users increased from 103 to 120 countries.
Research shows that an HIV epidemic among injecting drug users can be prevented, halted and even reversed if responses are based on a sound assessment of the specific drug use situation, the socio-cultural and political context, and on scientific evidence. HIV epidemics among IDUs tend to manifest themselves very differently from situations where sexual transmission is the main driver. In fact the use of contaminated injection equipment is one of the more efficient modes of HIV transmission, and drug-related epidemics therefore spread more rapidly.
Experience has shown that halting the epidemic amongst injecting drug users requires a comprehensive strategy. HIV transmission and HIV impact associated with injecting drug use can best be contained by implementing a comprehensive package of interventions, which includes needle and syringe programmes; drug dependence treatment, particularly pharmacological treatment of opioid dependence; voluntary HIV counselling and testing; antiretroviral therapy; prevention and treatment of sexually transmitted infections; condom programmes for injecting drug users and their sexual partners; targeted information, education and communication for injecting drug users and their sexual partners; vaccination, diagnosis and treatment of viral hepatitis; prevention, diagnosis and treatment of tuberculosis. These nine interventions are included in the comprehensive package because they have the greatest impact on HIV prevention and treatment. While each of these separate interventions is useful in addressing HIV prevention and care among IDUs, it is important to recognize that they form part of a package and have the greatest beneficial impact when delivered together. In countries with limited resources, it is advised that at least the first four of the nine interventions - needle and syringe programmes, pharmacotherapy of opioid dependence, HIV testing and counselling and antiretroviral therapy - be implemented.