UNODC is cosponsor of the Joint United Nations Programme on HIV/AIDS - UNAIDS
Background: Inter- Country Consultation on HIV Prevention among Injecting Drug Users
Worldwide, more than 55 million people use opiates, cocaine and amphetamine-type stimulants, and an estimated 13.2 million people inject these drugs. Injecting drug use is one of the main drivers of HIV transmission in South Asia where needle and syringe sharing is common and injection by "professional injectors" (who often use the same needle or syringe repeatedly, thus multiplying the chance of HIV transmission) is widespread.
Many of the countries in South Asia are experiencing dual epidemics of drug use and HIV. Once HIV enters a community of injecting drug users, it can spread with alarming speed due to the efficiency with which HIV can be transmitted through the use of contaminated injection equipment. HIV infection levels in a community of IDUs can rise from zero to 50-60 percent within 1-2 years. In Manipur, India, for example, HIV prevalence among IDUs increased from close to zero to 56 percent within six months when the epidemic started some years ago.
In addition to the danger posed by sharing contaminated injecting equipment, pharmaceuticals that are not injected can also increase HIV transmission due to their impact on sexual risk-taking behavior which may further fuel HIV transmission and contribute to its spread into the general population. Yet, in spite of the importance of drug users in the response to HIV, coverage of HIV prevention interventions for this key population remains limited at about five percent worldwide.
Unfortunately, due to a range of political, social, and legal obstacles, the response has been slow and insufficient in most countries and many programs that have tried to tackle the issues have been suboptimal and challenging and without the benefit of community involvement. Emerging data suggest that easily available over-the-counter pharmaceutical preparations such as buprenorphine and diazepam are being injected more frequently than illicit opiods in some parts of South Asia. In addition, little is known about how the widespread and growing use of amphetamine-type stimulants (ATS) in South Asia will impact the HIV situation in the region.
More than two decades of international research and experience confirm that HIV epidemics among IDU can be prevented, stabilized and even reversed using a comprehensive package including demand reduction and HIV prevention and care activities for IDU and their sexual partners. However, the marginalization of most drug users makes them difficult to reach and negative attitudes towards drug users can make it difficult to mobilize financial, political and community support required for effective programs. In addition, local laws and regulations may prohibit the implementation of specific interventions. As a result, many governments and policy makers struggle to adopt pragmatic approaches to preventing HIV among IDUs.
