Drug use and HIV
Injecting drug use continues to drive the HIV epidemic in many countries around the world. It has been documented in 158 countries and territories, and in 2013 it was estimated that between 11.2 million and 22.0 million people inject drugs globally. And of those, 1.6 million (ranging between 1.2 million-3.9 million) were living with HIV, representing 11.5 per cent of global prevalence of HIV among people who inject drugs.
People who use drugs have multiple vulnerabilities to HIV, tuberculosis, hepatitis and other infectious diseases. For example:
• Sharing of drug injecting equipment can be three times more likely to transmit HIV than sexual intercourse.
• Stimulant drug use, both non-injecting and injecting, has been associated with sexual transmission of HIV in specific sub- groups of key populations such as sex workers and men who have sex with men.
• People who use drugs are highly stigmatized, including in health sector.
• People who use drugs are often unable or unwilling to access HIV services for fear of arrest.Given the magnitude of the HIV epidemic among people who inject drugs, and the impact it has on the health and well-being of people at the individual, familial, community and national levels, preventing HIV and other harms among people who inject drugs - and providing them with effective prevention, treatment, care and support - should be essential components of a sound and effective national HIV response.
An effective, evidence- and rights-based response for people who inject drugs requires the implementation of a comprehensive package of nine interventions as defined by WHO, UNODC and UNAIDS. Often referred to as harm reduction services for HIV, these nine interventions include:
- Needle and syringe programs (NSPs)
- Opioid substitution therapy (OST) and other evidence-based drug dependence treatment
- HIV testing and counselling (HTC)
- Antiretroviral therapy (ART)
- Prevention and treatment of sexually transmitted infections (STIs)
- Condom programmes for people who inject drugs and their sexual partners
- Targeted information, education and communication (IEC) for people who inject drugs and their sexual partners
- Prevention, vaccination, diagnosis and treatment of viral hepatitis
- Prevention, diagnosis and treatment of tuberculosis (TB)
The interventions should be delivered using a range of modalities, including community outreach and peer-to-peer work. Services for people who inject drugs are best delivered in community-based settings and in close collaboration with civil society and community based organizations.
More information on these interventions, as well as on related UNODC policies and research can be found in our publications here.
Towards reaching the UNGASS target of 50% reduction of HIV transmission among people who inject drugs by 2015:
Since 2013, UNODC, in collaboration with partners, has selected 24 High Priority Countries (HPCs) where it has focused its efforts for a greater impact on the epidemic. These countries are Argentina, Belarus, Brazil, China, Egypt, India, Indonesia, Iran, Kazakhstan, Kenya, Kyrgyzstan, Moldova, Morocco, Myanmar, Nigeria, Pakistan, Philippines, South Africa, Tajikistan, Tanzania (mainland and Zanzibar), Thailand, Ukraine, Uzbekistan, and Vietnam.
These countries were selected following an analysis of the epidemiological data on injecting drug use and HIV burden, including in prisons, and the country readiness regarding the policy and legislative environment allowing essential services such as needle and syringe programmes, opioid substitution therapy, VCT and antiretroviral therapy and regarding the resource environment.
In these HPCs, UNODC has intensified its technical assistance, based on its comparative advantage, to:
- Identify key bottle-necks/challenges in scaling up the 9 harm reduction interventions of the comprehensive package
- Engage key in-country stakeholders to develop prioritized work plans for each HPCs
- Advocate for inclusion of essential services such as NSP, OST, and ART in national/provincial health budgets
- Develop partnerships with the private sector, promoting low-cost generic production of opioid substitution medication, needles and syringes and condoms.
- Promote south-south cooperation
- Facilitate the engagement of national/local CSOs in relevant forums, including supporting networks of people who use drugs
- Generate strategic information on PWID and HIV
Read more - Visit the drug use and HIV publications page