Abstract
The epidemic of HIV/AIDS linked to injecting drug usage is one of the most explosive in recent years. After a historical epicentre in Europe, South and North America, at present it is clearly the main cause of dissemination of the epidemic in Eastern Europe and some key Asian countries. Recently, 10 African countries reported the spread of HIV through people who inject drugs (PWID), breaking one of the final geographical barriers to the globalization of the epidemic of HIV among and from PWID.Several countries of the Asia and Pacific Region have HIV epidemics that are driven by injecting drug usage. Harm reduction interventions have been implemented in many countries and potential barriers to implementation are being overcome. Harm reduction is no longer a marginal approach in the Region; instead, it is the core tool for responding to the HIV/AIDS epidemic among PWID. The development of a comprehensive response in the Region has been remarkable, including scaling up of needle and syringe programmes (NSPs), methadone maintenance treatment (MMT), and care, support and treatment for PWID. This development is being followed up by strong ongoing changes in policies and legislations. The main issue now is to enhance interventions to a level that can impact the epidemic.The World Health Organization (WHO) is one of the leading UN agencies promoting harm reduction. Since the establishment of the Global Programme on AIDS, WHO has been working towards an effective response to the HIV epidemic among PWID. WHO's work is organized into a number of components: establishing an evidence base; advocacy; development of normative standards, tools and guidelines; providing technical support to countries; ensuring access to essential medicines, diagnostics and commodities; and mobilizing resources.In this paper, we trace the course of development of the HIV/AIDS epidemic among and from PWID in the Western Pacific and Asia Region (WPRO) as well as WHO's role in supporting the response in some of the key countries: Cambodia, China, Lao PDR, Malaysia, the Philippines and Viet Nam.
Highlights
Worldwide, around 13 million people inject drugs [1]
The first cases of HIV related to injecting drug use were reported in the United States of America in 1982 in the MMWR bulletin from the Centers for Disease Control and Prevention (CDC), Atlanta [2]
By the late 1980s and 1990s, concentrated epidemics of HIV in people who inject drugs (PWID) were restricted to North and South America and Europe
Summary
Around 13 million people inject drugs [1]. The first cases of HIV related to injecting drug use were reported in the United States of America in 1982 in the MMWR bulletin from the Centers for Disease Control and Prevention (CDC), Atlanta [2]. It was based on assessment missions to countries with varied situations with regard to HIV and the use of drugs including China, Cambodia, Lao PDR, Malaysia and Viet Nam. Consultations were held with key partners in this area, including UNAIDS, UNODC, CDC-Global AIDS Program, Family Health International (FHI) and Burnet Center for Harm Reduction. The main objectives of the WPRO HIV/AIDS and STI Unit in the field of harm reduction are to harmonize (as much as possible) the response to the HIV/AIDS epidemics among PWID in different countries of the Region; help countries to develop better policies, legislations and practices to facilitate their response; increase the availability of advocacy tools; reinforce the main package of interventions comprising NSP, Drug Dependence Treatment (mostly but OST) and care, support and treatment (including ARV). While the progress made has been impressive, it is important to consolidate the advances and scale up interventions to better confront the epidemics driven by injecting drug use
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