AIDS and the use of injected drugs.

Abstract

More than 50 countries have reported HIV infected persons who use illegal intravenous (IV) drugs. Another 30 countries have citizens using them. 33% of US AIDS cases acquired HIV by injecting illegal drugs. The political commitment to implement HIV prevention efforts in the IV drug community is wanting even though some health care providers in North America Europe and Australia have demonstrated that these efforts stem the epidemic in this community. Indeed lack of political commitment is the greatest obstacle to reducing the spread of HIV. AIDS manifests itself differently in IV drug users tend to experience more morbidity and mortality from bacterial infections. Many IV drug users travel often therefore transmitting HIV to other IV drug communities where it spreads very rapidly. Use of shooting galleries where needles and syringes are rented account for this rapid transmission. Contrary to popular opinion IV drug users are able to assimilate HIV prevention information received via the mass media and informal communication networks. For example 80% of IV drug users in New York City practice risk reduction behavior. Evidence shows that the most effective AIDS prevention programs are those that involve drug users in design and implementation. Such programs should provide the means for behavioral change however including treatment for users (e.g. methadone) and access to sterile injection equipment and condoms. They should offer IV drug users a choice on which way they want to reduce their risk. Once HIV infection becomes well established in a community however these programs face considerable difficulties in curbing HIV transmission. Few studies have been done on how to keep people from starting IV drug use.