Abstract
Injecting drug use is one of the major risk factors for HIV infection due to the efficiency of parenteral transmission associated with the sharing of injecting equipment. As a result of this and the numbers of injecting drug users (IDUs) worldwide, approximately 5 /10% of global infections are estimated to be due to exposure via injecting drug use (Adler, 2001). The direct contribution of injecting drug use to the HIV epidemic varies considerably by geographic region: from virtually zero in many African and Caribbean countries (UNAIDS, 2002; PAHO, 2001), to 25% of cumulative AIDS cases in the USA (Centres for Disease Control and Prevention, 2001) and an estimated 34% of new infections in Canada (Geduld & Archibald, 2000), and to 61% of cumulative reported HIV cases in Vietnam (WHO, 2001) and 89% of reported HIV cases in 2001 in Eastern Europe (European Centre for the Epidemiological Monitoring of AIDS, 2002). In addition to the risks of sharing injecting equipment, IDUs are also at risk of spreading HIV among themselves via sexual transmission. As pointed out by Lowndes, Renton, Alary, Rhodes, Garnett and Stimson (2003) and others (Diaz, Vlahov, Greenberg, Cuevas & Garfein, 2001; Sabbatini, Carulli, Villa, Leite & Nicolosi, 2001), there is increasing evidence for the important role played by sexual transmission of HIV among IDUs, especially in situations where injecting risk behaviour is low or has been reduced by harm reduction efforts. Sexual HIV transmission among IDUs may also be more likely among cocaine users due to the association of cocaine injection with risky sexual behaviours (Kim, Marmor, Dubin & Wolfe, 1993; Hudgins, McCusker & Stoddard, 1995) and this may help explain situations where the association between cocaine injection and HIV infection is independent of injection frequency (Chaisson, Bacchetti, Osmond, Brodie, Sande & Moss, 1989; Anthony, Vlahov, Nelson, Cohn, Astemborski & Solomon, 1991).
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