Missteps on Drug Abuse?

HIV prevention and treatment service coverage for injection-drug users is too low in many countries to prevent transmission, a discrepancy that affects infection rates at the local level, new research shows.

"Governments that have not made needle and syringe programs and opioid substitution available need to be convinced that these interventions are the most effective ways to stop HIV spreading among [IDUs], and to the wider community," said lead author Dr. Bradley Mathers of the University of New South Wales National Drug and Alcohol Research Center.

Australian health authorities distribute 213 clean needles per IDU each year, compared with 188 for the United Kingdom, 46 in Canada and 22 in the United States. In Russia, which has the second-largest IDU population after China, there is no methadone substitution. Other prevention measures among Russian IDUs are, similarly, virtually non-existent. HIV prevalence among Russian IDUs is 40 percent, versus just 1.5 percent among IDUs in Australia.

"Our high level of prevention in Australia has paid off with low levels of HIV infection among [IDUs] compared with countries with a similar level of injecting drug use," Mathers said.

Globally, just 8% of IDUs had access to a syringe exchange program last year, Mathers said. Coverage ranged from 100% in the Czech Republic and Ireland to less than 3% in China, Malaysia and Thailand. Opioid substitution therapy was available in only 70 of 151 countries with known IDU populations.

Only one of every 25 HIV-positive IDUs globally is receiving antiretroviral treatment. The worst treatment coverage was found in Kenya, Pakistan, and Russia.

The full report, "HIV Prevention, Treatment, and Care Services for People Who Inject Drugs: A Systematic Review of Global, Regional, and National Coverage," was published in The Lancet.