Review of Global Policy Architecture and Country Level Practice on HIV/AIDS and Drug Treatment

Abstract

This review, funded by the U.K Department for International Development, provides an understanding of the gaps and opportunities for improving access to drug treatment, in particular opioid substitution treatment (OST), for drug users affected and infected by HIV. OST is effective in treating opioid dependency, reducing its individual and social costs. For HIV-infected, opioid-dependent injecting drug users, consistent participation in OST is associated with a higher probability of antiretroviral treatment and, amongst antiretroviral users, more consistent use of antiretrovirals. At the global policy level, there are few barriers to the introduction and expansion of OST with both methadone and buprenorphine now on the WHO Essential Drugs List, and all relevant international organisations approving and encouraging the use of OST for HIV prevention, treatment, care and support in countries where injecting drug use and HIV are found. Unfortunately, there are huge disparities in access to drug treatment, with participation in treatment in Asia and Africa being disturbingly low. Country reports from Vietnam, Kyrgyzstan and Kenya provide examples of the barriers and successes on the ground. Recommendations for donors, international organizations and public health champions include:1. Strengthen leadership at global level for access to drug treatment and, in particular, opioid substitution therapy as a key intervention in HIV prevention, treatment and care among injecting drug users. 2. Develop audit tools for donors to ensure that consideration of harm reduction interventions, prioritizing OST and needle-syringe programmes, becomes a standard part of all development work related to HIV/AIDS. 3. Support the implementation of drug treatment and, in particular, OST in country. 4. Integrate drug treatment and, in particular, OST with HIV treatment. 5. Establish comparable drug treatment programs within correctional institutions to those in the community.