HIV Prevention among Injection Drug Users
April 7, 2010
In 2008, the United States agreed to extend and expand its historic global HIV/AIDS program, authorizing up to $48 billion over five years to combat global HIV/AIDS, tuberculosis, and malaria. In its first phase (2004–2008), the President’s Emergency Plan for AIDS Relief (PEPFAR) concentrated most of its resources and attention on countries in sub-Saharan Africa, with a priority focus on expanding access to treatment with antiretroviral therapy (ART). Among the primary accomplishments of the initiative in its first phase was to demonstrate the feasibility of mass provision of life-saving ART treatment in low-income African countries hardest hit by the HIV pandemic. But despite the major gains in ART access since 2003, it is estimated that for every two people starting HIV treatment today, another five are newly infected. PEPFAR’s second phase (2009–2013) continues and expands treatment scale-up and prevention with the intent of transitioning from an emergency program to a sustainable country-driven and -managed response. The program will be judged, in large part, on the progress it makes in halting the further spread of HIV.
This report offers recommendations on one aspect of the HIV pandemic that provides an opportunity for major gains in global HIV prevention: injecting drug use. In some regions of the world—Eastern Europe and Central Asia, for example—the ratio of new HIV infections among injecting drug users (IDUs) to those gaining access to ART exceeds the global five-to-two average. At the same time, there is overwhelming evidence that syringe exchange and medication-assisted drug treatment (MAT, that is, treatment of substance use disorders with either methadone or buprenorphine) are highly effective in preventing the spread of HIV among IDUs; yet these interventions continue to receive little attention and few resources, and they remain unavailable to the vast majority of people who inject drugs.