Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries

Abstract

BackgroundAbout a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries.MethodsA data collection form was designed to cover questions on rates of IDU, prevalence and incidence of HIV and information on HIV treatment and harm reduction services available to people who inject drugs (PWID). National and regional data on HIV infection, IDU in the form of reports and journal articles were sought from key informants in conjunction with a systematic search of the literature.ResultsCompleted data collection forms were received for 11 countries. Additional country-specific information was sourced via the literature search. The overall proportion of HIV positive PWID in the selected countries ranged from 3% in Kazakhstan to 58% in Vietnam. While IDU is relatively rare in sub-Saharan Africa, it is the main driver of HIV in Mauritius and Kenya, with roughly 47% and 36% of PWID respectively being HIV positive. All countries had antiretroviral treatment (ART) available to PWID, but data on service coverage were mainly missing. By the end of 2010, uptake of needle and syringe programmes (NSP) in Bangladesh, India and Slovakia reached the internationally recommended target of 200 syringes per person, while uptake in Kazakhstan, Vietnam and Tajikistan reached between 100-200 syringes per person. The proportion of PWID receiving opioid substitution therapy (OST) ranged from 0.1% in Kazakhstan to 32.8% in Mauritius, with coverage of less than 3% for most countries.ConclusionsIn order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.

Morbidity and mortality of black HIV-positive patients with end-stage kidney disease receiving chronic haemodialysis in South Africa

“…The HIV prevalence in this group was 19.4%. [20,21] There are no data from SA on injecting drug use in chronic dialysis populations, but based on the national prevalence rates it is possible to infer that the prevalence in dialysis units is low, and the impact of injecting drug use on outcomes in this patient group would be minimal.…”

Improving antiretroviral therapy scale-up and effectiveness through service integration and decentralization

“…In many settings with a large number of people who inject drugs, there remains limited access to OST, with provision often being led by community-based and nongovernmental organizations [11]. Therefore, HIV programmes may need to collaborate with these organizations when integrating services.…”

“…Provider-initiated testing and counselling should also be considered in primary health facilities where epidemiologically appropriate [7]. Despite these recommendations, in 2012, 57% of people with HIV and active TB received ART [9], 59% of eligible pregnant women received ART [1], and the available data suggest that 1-22% of people with HIV who inject drugs in high-burden countries received ART [10,11]. Coverage in all three of these populations remained lower than the coverage achieved among all adults with HIV [1].…”

Barriers and Strategies to Prevent HIV/AIDS among Pacific Countries: A Systematic Review Study

“…In Africa, some of the barriers are economic barriers, social and cultural barriers and legal barriers [7]. While in China, stigma and punitive barriers are barriers which prevent HIV identification [8]. In comparison to Europe, perceptions of patients and attitude of health care providers are barriers [9].…”