Injecting Drug Users
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. This represents 11.9 million injecting drug users in countries comprising 77% of the world's population aged 15-64 years.
However, 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. There are worldwide examples of massive HIV outbreaks amongst injecting drug users and from these we can conclude that the size of the drug-related HIV epidemics that result largely depends on the number of people in a given location that regularly or occasionally inject drugs and their unsafe behaviour.
Although the main driver of the HIV pandemic in Southern Africa is multiple concurrent partners along with a low level of condom use, once again there is mounting evidence of increasing injection drug use in a number of Southern African countries. The risk of HIV infection amongst injecting drug users manifesting itself within Southern African countries and the subsequent further spread to the wider community via unsafe sexual practices represents a potentially explosive situation for the region.
Tackling the Epidemic
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 outreach to injecting drug users; drug dependence treatment, particularly Opioid Substitution Therapy; Needle and syringe programmes; Voluntary HIV Counselling and Testing; Anti-Retroviral Therapy; Sexually Transmitted Infections prevention and treatment; condom programming for injecting drug users and partners; Targeted Information, Education and Communication; Hepatitis diagnosis, treatment (Hepatitis A, B and C) and vaccination of Hepatitis A&B; Tuberculosis prevention, diagnosis and treatment.
In spite of increasing injecting drug use and what we do know from experience in other parts of the world HIV/AIDS among users remains for the most part, a neglected issue in the Southern African region. As a result, in most of these countries there is limited institutional and technical capacity to deal with the issue in an effective and comprehensive manner.