30 Years on Selected Issues in the Prevention of HIV among Persons Who Inject Drugs

D C Des Jarlais,J Feelemyer,V Guardino,H Cooper,A Hatzatkis,H Hagan,A Uuskula,S Pinkerton

doi:10.1155/2013/346372

Abstract

After 30 years of extensive research on human immunodeficiency virus (HIV) among persons who inject drugs (PWID), we now have a good understanding of the critical issues involved. Following the discovery of HIV in 1981, epidemics among PWID were noted in many countries, and consensus recommendations for interventions for reducing injection related HIV transmission have been developed. While high-income countries have continued to develop and implement new Harm Reduction programs, most low-/middle-income countries have implemented Harm Reduction at very low levels. Modeling of combined prevention programming including needle exchange (NSP) and antiretroviral therapy (ARV) suggests that NSP be given the highest priority. Future HIV prevention programming should continue to provide Harm Reduction programs for PWID coupled with interventions aimed at reducing sexual transmission. As HIV continues to spread in low- and middle-income countries, it is important to achieve and maintain high coverage of Harm Reduction programs in these locations. As PWID almost always experience multiple health problems, it will be important to address these multiple problems within a comprehensive approach grounded in a human rights perspective.

Highlights

We have three decades of experience in human immunodeficiency virus (HIV) prevention for persons who inject drugs (PWID); a vast amount of data has been collected, and much is known
Large-scale implementation of HIV prevention programs, needle/syringe access programs, when HIV prevalence is very low in a population of PWID can keep the prevalence low indefinitely [10, 11, 17, 18]
Some types of HIV prevention programs, long-term drug treatment programs and antiretroviral treatment for HIV, are comparatively expensive, and it may not be possible to provide these on a public health scale in many low- and middle-income countries

Summary

Introduction

We have three decades of experience in HIV prevention for persons who inject drugs (PWID); a vast amount of data has been collected, and much is known. Undertake a systematic review of the epidemiology of HIV infection among PWID nor a review of the implementation of various interventions to prevent HIV infection among PWID. For those topics, we would refer readers to the Lancet series [1] and the most recent UNAIDS Annual Report [2]. Before discussing the selected topics, it will be useful to consider the historical circumstances under which research has been conducted on HIV and injecting drug use. The context in which the research has been conducted is in some ways as important as the actual outcomes of the research

Initial Historical Contexts

Doing HIV Prevention for PWID in Resource-Limited Settings

Modeling

Findings

15 No ART