Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries An Assessment of the Evidence (2007) / Chapter Skim
Currently Skimming:
1 HIV/AIDS in Injecting Drug Users
1 HIV/AIDS in Injecting Drug Users
Pages 33-73
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 33... ...
Examples of structural-level factors include proximity to overland trafficking routes, drug laws and enforcement practices, injecting environment and culture, and stigma and discrimination. The chapter then describes specific interventions to prevent HIV among 1In this report, such countries are labeled as "high-risk," indicating that injecting drug use is, or is on the verge of becoming, the primary driver of the HIV epidemic.
|
From page 34... ...
. The United Nations Reference Group on HIV/AIDS Prevention and Care among IDUs recently developed estimates of the prevalence of injecting drug use, prevalence of HIV infection among IDUs, and the availability of prevention services worldwide, with a focus on developing and transitional countries (Aceijas et al., 2004)
|
From page 35... ...
Worldwide, an estimated 10 percent of all HIV infections are related to injecting drug use, although that proportion is estimated to be much higher in certain regions of the world (UNODC, 2005; WHO, 2005a; Aceijas et al., 2004)
|
From page 36... ...
36 on Group Reference UN the and 2004 2004. Crime, and Countries, Drugs 19982003.
|
From page 37... ...
. Canada's small HIV epidemic is driven by unprotected sex between men although HIV infection among women is rising, mostly due to unprotected sex and unsafe injecting drug use (UNAIDS, 2006)
|
From page 38... ...
. Increases in ATS use are being reported in many areas of the world, with the most rapid expansions occurring in countries of Southeast Asia, including Hong Kong SAR, Indonesia, Thailand, Myanmar, Malaysia, Singapore, the Philippines, China, Lao People's Democratic Republic, Cambodia, and Vietnam.
|
From page 39... ...
. ROUTES OF HIV TRANSMISSION The sharing of contaminated injecting equipment is the primary mode of HIV transmission among IDUs, accounting for up to 80 percent of all HIV infections among IDUs in Eastern Europe and Central Asia (UNAIDS, 2006; UNODC, 2005)
|
From page 40... ...
. National survey data also reveal a link between injecting drug use and high-risk sexual activity among commercial sex workers.
|
From page 41... ...
. FACTORS INFLUENCING HIV RISK AMONG IDUS A range of individual and structural factors can affect an IDU's risk of contracting HIV.
|
From page 42... ...
. Examples discussed in the following section include proximity to drug trafficking routes, drug laws and law enforcement practices, socioeconomic and political stability, injecting environment and culture, and stigma and discrimination.4 Individual and structural factors converge to affect the likelihood that an IDU will engage in high-risk behavior, such as sharing of injecting equipment, more frequent injecting, commercial sex work, unprotected sex, and multiple sex partners.
|
From page 43... ...
. Other studies in Montreal, Vancouver, and Toronto also found that cocaine use was positively associated with HIV infection (Bruneau et al., 2001; Strathdee et al., 2001, Lamothe et al., 1993)
|
From page 44... ...
. Structural-Level Risk Factors Proximity to Drug Trafficking Routes Drug trafficking routes are also tightly linked with injecting drug use and HIV epidemics (Beyrer et al., 2000; Beyrer, 2002; Quan et al., 2000; Yu et al., 1999)
|
From page 45... ...
; and (4) people's understanding of the laws (in this case the knowledge, attitudes, and beliefs of injecting drug users regarding laws)
|
From page 46... ...
. If drug users do not have a sterile syringe when purchasing or injecting drugs, they are more likely to share injecting equipment (Gostin et al., 1997)
|
From page 47... ...
This tension also points to the need to identify common ground and overlapping goals between these two approaches. Reconciling these roles can be difficult, but it is critical if HIV prevention efforts for IDUs are to succeed (Hammett et al., 2005)
|
From page 48... ...
. Although coverage of HIV prevention interventions in prisons is limited, some prisons distribute condoms, bleach, and needles and syringes, or offer drug dependence treatment, risk reduction education, and voluntary counseling and testing (WHO, 2004b)
|
From page 49... ...
The vast majority of HIV prevention efforts target the risk behavior of individual drug users, attempting to get them to: stop using drugs (through drug treatment) ; stop injecting (through drug treatment or education)
|
From page 50... ...
, a comprehensive HIV prevention program for IDUs includes outreach, information, education and communication, risk reduction counseling, HIV testing and counseling, disinfection programs, sterile needle and syringe access programs, disposal of used injecting equipment, drug treatment services, agonist pharmacotherapy programs, HIV/AIDS treatment and care, primary health care, and peer education (WHO, 2005a)
|
From page 51... ...
There are two primary types of opioid pharmacotherapies: agonist and antagonist medications. Opioid agonist medications: These medications work by preventing withdrawal symptoms and reducing opiate cravings -- and therefore the need to use illicit drugs -- and also by diminishing the effects of opioid use by creating cross-tolerance to their effects (IOM, 1995)
|
From page 52... ...
. Opioid antagonist medications: An alternative to opioid agonists are antagonist agents which block the effects of opiates.
|
From page 53... ...
. Sterile Needle and Syringe Access Several HIV prevention approaches provide IDUs with access to sterile needle and syringes, including needle and syringe exchange (NSE)
|
From page 54... ...
Outreach and Education Outreach relies on peers and local health workers to identify IDUs, provide education on preventing HIV infection, and serve as guides to health and social services (WHO, 2004c)
|
From page 55... ...
. Factors limiting access to VCT include the stigma associated with HIV/AIDS and drug use, fear of prosecution for illicit drug use, low awareness of the risks of HIV infection and thus the relevance of VCT, and the distance, time, and cost required to engage in VCT.
|
From page 56... ...
. Treating IDUs with ART poses unique treatment challenges due to the high rate of co-occurring medical and psychiatric conditions, limited access to HIV care, increased likelihood of medication side effects and toxicities, and interactions between ART and opioid agonist maintenance treatments (DHHS, 2006)
|
From page 57... ...
. HIV infection has also been associated with reactivation of herpes simplex virus type 2.
|
From page 58... ...
Several studies have attempted to quantify the coverage of HIV prevention services for IDUs. According to a recent study of coverage of HIV/ AIDS prevention, care, and support programs in low- and middle-income countries, an estimated 4.3 percent of the estimated 910 million IDUs living in these countries had access to HIV prevention programs (USAID et al., 2004)
|
From page 59... ...
. More than 19 developing and transitional countries have approved opioid agonist maintenance treatment (Hankins, 2005)
|
From page 60... ...
60 the by Otherwise, IDUs 79,000 170,000 900,000 eighted Estimated Number of 2,500,000 1,250,000 4,300,000 9,200,000 w ided. are prov of values when Region by 4 2 6 3 4 5 used, Number Countries 24 country were The 2003, IDUs in of users Agonist data.
|
From page 61... ...
. On the other side of the spectrum, federal law in Russia prohibits the treatment of drug dependence with opioid agonist agents such as methadone.
|
From page 62... ...
Three major categories of HIV prevention interventions for IDUs that are reviewed in this report include: drug dependence treatment programs, which include both pharmacotherapies and psychosocial interventions; sterile needle and syringe access programs; and outreach and education programs. Data on the coverage of these interventions are quite limited, but in general, estimates suggest that coverage is inadequate in many areas.
|
From page 63... ...
2004. Global overview of injecting drug use and HIV infection among injecting drug users.
|
From page 64... ...
1998. Injecting drug use and HIV infection in Asia: The Asian Harm Reduction Network.
|
From page 65... ...
Presentation at the Institute of Medicine Workshop on the Prevention of HIV Among Injecting Drug Users in High-Risk Countries, Geneva, Switzerland. Institute of Medicine Committee on the Prevention of HIV Infection Among Injecting Drug Users in High-Risk Countries.
|
From page 66... ...
2001. Risk factors of HIV infection and needle sharing among injecting drug users in Ho Chi Minh City, Vietnam.
|
From page 67... ...
1989. Prejudice and AIDS: The views and experience of people with HIV infection.
|
From page 68... ...
1998. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users.
|
From page 69... ...
1995. Preventing HIV Transmission: The Role of Sterile Needles and Bleach.
|
From page 70... ...
2005. The social structural production of HIV risk among injecting drug users.
|
From page 71... ...
2006. Marked ethnic differences in HIV prevalence and risk behaviors among injection drug users in Dushanbe, Tajikistan, 2004.
|
From page 72... ...
2005b. Evidence for Action: Effectiveness of Drug Dependence Treatment in Prevent ing HIV among Injecting Drug Users.
|
From page 73... ...
2006. High prevalence of HIV infection associated with incarcera tion among community-based injecting drug users in Tehran, Iran.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.