Controlling the HIV Epidemic Among Drug Injectors

Abstract

About 50% of iv drug users in Madrid Spain may be HIV infected. 52% are prisoners. HIV prevalence rates among iv drug users are also high in Barcelona and Bilbao. Many of these iv drug users do not use condoms likely resulting in sizable heterosexual transmission. The possibility of resurgent tuberculosis (TB) among HIV-infected iv drug users looms since most receive no treatment. HIV-infected persons with multidrug-resistant TB almost always die. It is also difficult and expensive to treat in HIV seronegatives. Faulty cost-benefit estimations leading to reduced TB-oriented care and prevention and programs that did not provide effective iv drug user-oriented harm reduction and medical care account for the spread of TB in New York City. Evidence suggests that HIV epidemics have stabilized in many cities. Yet mathematical models show that once epidemics reach 50% among iv drug users they spread quite quickly. Many people believe that iv drug users are unable to practice risk reduction behavior but research in Bangkok and Rio de Janeiro shows that they can indeed modify their behavior. Needle-syringe exchange programs result in risk behavior reduction and subsequent reduction of HIV seroconversion and of new infections with hepatitis B. They should include street-based outreach and fixed-site exchanges. They also effectively increase the number of iv drug users who seek drug abuse treatment. Some countries have legalized the sale of syringes thus reducing syringe sharing among iv drug users. Iv drug users must have access to confidential HIV counseling and testing and user-friendly medical treatment. Drug abuse treatment should be expanded with minimal documentation or bureaucratic procedure. Methadone treatment protects iv drug patients against HIV infection. Other programs need to emphasize abstinence from drug use. New iv drug users tend to be less likely to be HIV infected thus they are a prime target group but it is difficult to locate them.