Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries

Zaino Petersen,Bronwyn Myers,Marie-Claire Van Hout,Charles Parry,Andreas Plüddemann

doi:10.1186/1477-7517-10-13

Abstract

BackgroundAbout a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries.MethodsA data collection form was designed to cover questions on rates of IDU, prevalence and incidence of HIV and information on HIV treatment and harm reduction services available to people who inject drugs (PWID). National and regional data on HIV infection, IDU in the form of reports and journal articles were sought from key informants in conjunction with a systematic search of the literature.ResultsCompleted data collection forms were received for 11 countries. Additional country-specific information was sourced via the literature search. The overall proportion of HIV positive PWID in the selected countries ranged from 3% in Kazakhstan to 58% in Vietnam. While IDU is relatively rare in sub-Saharan Africa, it is the main driver of HIV in Mauritius and Kenya, with roughly 47% and 36% of PWID respectively being HIV positive. All countries had antiretroviral treatment (ART) available to PWID, but data on service coverage were mainly missing. By the end of 2010, uptake of needle and syringe programmes (NSP) in Bangladesh, India and Slovakia reached the internationally recommended target of 200 syringes per person, while uptake in Kazakhstan, Vietnam and Tajikistan reached between 100-200 syringes per person. The proportion of PWID receiving opioid substitution therapy (OST) ranged from 0.1% in Kazakhstan to 32.8% in Mauritius, with coverage of less than 3% for most countries.ConclusionsIn order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.

Highlights

About a third of the global Human Immunodeficiency Virus (HIV) infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV
Prevalence of IDU and HIV among people who inject drugs (PWID) Of the 21 participating countries, the Russian Federation and the Ukraine were countries identified with the highest rates of reported IDU, with roughly 2 million (2% of adult the population) and 425000 (1.3% of the adult population) injecting drugs respectively (Table 1)
A recent UNAIDS publication reported HIV prevalence in St Petersburg, Russia, to have doubled in the past five years, with approximately 60% of PWID in this city living with HIV [6]

Summary

Introduction

About a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. The continued high prevalence of injection drug use (IDU) is cause for concern because of the strong association between IDU and risk for Human Immunodeficiency Virus (HIV) transmission This association is largely due to the sharing of drug paraphernalia with other PWID, with needle sharing accounting for about one tenth of new HIV infections globally and almost a third of all new HIV infections outside sub-Saharan Africa [2]. There has been a decline in HIV incidence in the USA and Western Europe [4] This decline has been spurred on by behaviour changes among at-risk populations (including PWID) as well as improved access to HIV treatment and harm reduction services for these populations [5,6,7]. Limited availability of antiretroviral therapy (ART) and harm reduction services (such as needle and syringe programmes (NSP) and opioid substitution therapy (OST)) is a major barrier to efforts to limit HIV transmission amongst PWID and their injecting and sexual partners [10,11,12]

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Conclusion