Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries An Assessment of the Evidence (2007) / Chapter Skim
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4 Taking Action
4 Taking Action
Pages 187-198
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From page 187... ...
Based on these considerations, the Committee offers recommendations for countries implementing such programs. SUMMARY OF THE EVIDENCE Eastern Europe, the Commonwealth of Independent States, and significant parts of Asia are experiencing explosive growth in new HIV infections, driven largely by injecting drug use (UNAIDS, 2006)
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Those seeking effective interventions for non-opioid users should consider these behavioral or psychosocial interventions, but funders and policymakers are urged to collect rigorous evaluation data if they are selected. For injecting drug users who cannot gain access to treatment or are not ready to consider it, multi-component HIV prevention programs that include sterile needle and syringe access reduce drug-related HIV risk behav 1Refer to Chapters 2 and 3 for a detailed and properly referenced discussion of the evidence related to HIV prevention for IDUs.
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From page 189... ...
or the legal, accessible, and economical sale of needles and syringes through pharmacies, voucher schemes, and physician prescription programs. Other components of multi-component HIV prevention programs may include outreach, education in risk reduction, HIV voluntary counseling and testing, condom distribution, distribution of bleach and education on needle disinfection, and referrals to substance abuse treatment and other health and social services.
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And while multi-component prevention programs that include needle and syringe exchange have been shown to reduce drug-related HIV risks, questions remain about the specific contribution of individual elements to reductions in risk behavior and HIV incidence. Elements of these multi-component prevention programs can be resource intensive.
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Economic Trade-Offs Many high-risk countries face severe resource constraints. In these circumstances, HIV prevention programs for IDUs will run up against competing demands from other compelling interventions, both within the health sector and outside it.
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Infrastructure Needs As discussed in Chapter 1, for effective HIV prevention efforts to exert a public health impact, they must be scaled up to provide adequate coverage of the target populations. Scaling up prevention programs, particularly opioid agonist maintenance treatment, imposes certain infrastructure requirements.
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The recent scale-up of antiretroviral treatment of HIV/AIDS in developing countries has highlighted some of the infrastructural challenges that may occur when expanding HIV prevention programs for IDUs (IOM, 2005)
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The care of injecting drug users in hard-to-reach areas may benefit from some of the systems for providing outreach and acquiring and transporting commodities created for the global scale-up of HIV/AIDS. Public Perceptions Public perception also helps shape the choice of strategies to prevent HIV transmission and reduce illicit drug use.
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illustrates the inherent tension -- in this case in the United States but which may also occur in other countries -- surrounding certain interventions: "Needle exchange programs cannot proceed without the cooperation of the very groups that traditionally oppose them-law enforcers and community leaders. The conflict between public health and criminal justice is illustrated by the dilemmas inherent in needle exchange: public health officials in some of the highest seroprevalence cities cannot establish exchange programs without first obtaining authorization from the state under needle prescription laws; the police must agree not to arrest, and the district attorney not to prosecute, people using drug paraphernalia distributed under the public health program; and community leaders must agree to the location of needle distribution centers which, if they are to be effective, need to be situated in poor urban areas." (p.
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RECOMMENDATIONS In making decisions regarding implementation, policymakers and other stakeholders should consider several recommendations: Recommendation 4-1: Because a variety of interventions have been shown to be effective, high-risk countries should act now to pre vent the growing problem of HIV among IDUs, their partners, and children. Recommendation 4-2: To increase their acceptability and likeli hood of success, HIV prevention interventions for IDUs should be: · Tailored to local circumstances and implemented in a cultur ally appropriate manner; · Coupled with cost-effectiveness evaluations to improve re source-allocation decisions; · Scaled-up to provide adequate coverage of the interventions to the target populations in order for programs to have a public health impact; · Integrated with strategies to combat stigma and discrimina tion among drug users and HIV-infected people;
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2003. Costs and effectiveness of a syringe distribution and needle exchange program for HIV prevention in a regional setting.
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1995. Operating needle exchange programmes in the hills of Thailand.
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