The WHO/ UNODC/UNAIDS Technical Guide to reduce HIV infection among people who inject drugs (PWID) sets out nine interventions proven effective in reducing HIV transmission among this population. Universal access to the comprehensive package of nine interventions is a priority. Of these nine, the first four have been identified as the most effective in reducing the spread of HIV: when delivered at scale the four can contain and reverse the upward trend of HIV epidemics among PWID. The nine interventions are:

  1. Needle and syringe programmes (NSPs)
  2. Opioid substitution therapy (OST) and other evidence based drug dependence treatment
  3. HIV testing and counselling (HTC)
  4. Antiretroviral therapy (ART)
  5. Prevention and treatment of sexually transmitted infections (STIs)
  6. Condom programmes for people who inject drugs and their sexual partners
  7. Targeted information, education and communication (IEC) for people who inject drugs and their sexual partners
  8. Prevention, vaccination, diagnosis and treatment for viral hepatitis
  9. Prevention, diagnosis and treatment of tuberculosis (TB)

Situation

People who use drugs

Injecting drug use has been documented in at least 158 countries, where it continues to drive the AIDS epidemic globally.UNODC/WHO/UNAIDS/World Bank estimated that in 2013 the number of people who inject drugs worldwide was 12.19 million. Of these, an estimated 1.65 million were living with HIV. In the majority of countries, coverage of HIV prevention services for people who inject drugs is too low to have an impact on the HIV epidemic. People who inject drugs living with HIV have been found to be more than twice as likely to contract tuberculosis than people from other key populations living with HIV.

Among people who use stimulant drugs, the interaction of poverty, marginalization and sex work; the connection with historic injecting epidemics; the collective use of recreational drugs to enhance sexual experience; the use of stimulants to extend working hours; and the immunosuppressant qualities of stimulants, co-exist to create the conditions for the transmission of HIV.

HIV among women and young people who inject drugs

Women who inject drugs face a range of gender-specific barriers to accessing HIV-related services, and in many contexts remain a particularly hard-to reach population, even where harm reduction programmes are in place. Existing legal and policy-related barriers, including those indicating drug use as a criteria for loss of child custody and forced or coerced sterilization or abortion discourage women from accessing services.

Women who inject drugs experience high rates of intimate partner violence, which negatively affects their ability to practise safe sex and safer drug use. Many women who inject drugs are also engaged in sex work (regularly or occasionally), adding to their HIV transmission risk.

The stigma and discrimination women who inject drugs experience, as well as gender-based violence and abuse, increases their risk of contracting HIV, TB, viral hepatitis and sexually transmitted infections.

A significant proportion of people who inject drugs are under the age of 25. According to UNAIDS, young people under the age of 25 who inject drugs have a HIV prevalence of 5.2 per cent. Young people under the age of 18 face legal barriers based on the 'age of consent", creating an additional obstacle for those attempting to access needle syringe programmes and opioid substitution therapy.

HIV and people who inject drugs in humanitarian situations

During natural disasters, conflict or other emergency situations, access to HIV prevention, treatment, care and support services for people who inject drugs can be severely disrupted or interrupted altogether. When people who inject drugs are internally and externally displaced due to disasters, conflicts or emergency situations, they may face stigma and discrimination associated with drug taking and their displacement or refugee status.

Our Results

To increase availability and improved quality of information and capacity, UNODC and World Bank have implemented a project on population size estimation of people who inject drugs (PWID) in selected High Priority Countries to address the problem of low availability and quality of population size estimates of the number of PWID and their HIV prevalence. UNODC has supported the drafting and dissemination of a training manual for law enforcement officials on HIV service provision for PWID. Senior law enforcement officials from Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, Pakistan, Belarus, Moldova, Ukraine, Thailand and Vietnam held a three-day meeting to review and adapt the manual in to the national university curriculum. Belarus is one of the first countries that adopted the academic course for advanced training of law enforcement agencies on HIV prevention among people who use drugs (PWUD).

Through advocacy, workshops, trainings and study tours, UNODC has presented the evidence base for opioid substitution therapy (OST) and sought to dispel misconceptions. In 11 countries, UNODC has increased the capacity of key partners to advocate for and implement harm reduction with a specific focus on OST. In Kenya, OST was initiated March 2015 in Malindi, followed by two additional services points in Mombasa in September.  A new clinic is planned in Ukunda  in 2016. UNODC oversees the coordination of and technical support to five OST sites in India.

In prioritizing gender-responsive interventions, UNODC has worked with partners in eight countries to advance national dialogue and advocacy for gender-responsive HIV programmes and ensure equitable access to HIV prevention, treatment and care services for women who use drugs. In Nepal, the very first network of women who use drugs, the "Association of women who use drugs in Nepal" registered in 2014, has been a major success. Following UNODC technical assistance, HIV prevention services for female drug users are included in Afghanistan's national strategies and harm reduction policies are in place.

Enhanced and sustainable collaboration between law enforcement authorities and the civil society sector is critical for the HIV response among PWID. In order to create a space for law enforcement officials and CSOs to share respective positions, concerns and ideas, UNODC organised 33 workshops in 18 countries for police, CSOs and CBOs. In Indonesia, UNODC organized workshops for 320 police narcotics officers to increase their knowledge and understanding of HIV/AIDS, drug dependency, national policies on HIV/AIDS and harm reduction services and programming. In Kyrgyzstan, 149 law enforcement officers attended a training to decrease stigma and discrimination of key populations and improve collaboration with CSOs.

To strengthen and facilitate dialogue on HIV, drug policies and human rights, UNODC has engaged PWUD and other key partners to share best practices and identify how drug policies can be strengthened to ensure that the right to health, for PWUD is protected and respected. In Myanmar, upon request from the Ministry of Home Affairs, UNODC together with UNAIDS supported the organization of a three-day workshop on amending the Drug Law, held by the Central Committee for Drug Abuse Control in 2014.

In responding to the 2014 humanitarian situation in Crimea, when all OST programmes were discontinued, UNODC facilitated and took part in an experts' mission to assess the OST situation in Crimea and the eastern part of Ukraine and to provide assistance in developing an emergency plan aimed at supporting the continuation of OST.

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