Doing the possible: harm reduction, injecting drug use and blood borne viral infections in Australia

Abstract

Most surveys show that, other than among men who inject drugs and have a history of homosexual contact, the prevalence of HIV infection among injecting drug users (IDUs) in Australia is about 2%. Rates of needle sharing have also declined greatly in the last decade, although the high prevalence and incidence of hepatitis C infection suggest that existing strategies have not yet brought this epidemic under control.Harm reduction has been the major Australian approach to the reduction of blood borne viral infections (BBVIs) in IDUs. Harm reduction strategies include needle distribution schemes, drug substitution therapies and education about safe administration practices. Importantly, with IDUs as with gay men, the infected and affected communities have been brought into partnership with health educators, researchers and policy makers. This paper will review Australia's approach to the prevention of BBVI in IDUs and the effectiveness of current strategies. I will argue that while HIV/AIDS among heterosexual IDUs appears to have been successfully prevented, international experiences of rapidly emerging epidemics demonstrate there is little room for complacency. Moreover, reducing the incidence of hepatitis C and hepatitis B among IDUs remains a major challenge.

Hazardous alcohol consumption and other barriers to antiviral treatment among hepatitis C positive people receiving opioid maintenance treatment

“…Recent research by Anderson et al (2000) reported that just 7% of IDUs attending a Sydney sexual health clinic had been vaccinated against HBV [32]. Loxley reported that only half of IDUs surveyed in Perth were aware of the existence of HBV vaccination [33].…”

Thailand's Response to the HIV Epidemic: Yesterday, Today, and Tomorrow

“…Thus, they are again becoming a reservoir for transmitting HIV to other segments of the population. Scientific studies have demonstrated the effectiveness of harm minimization programs (Loxley, 2000). Nevertheless, the pragmatic approach that effectively curbed heterosexual transmission via commercial sex, which is also illegal in Thailand, has not yet been adopted.…”

Drug-related HIV in South and South-East Asia

“…In spite of successful demonstrations of HIV interventions for drtig users in Asia, current interventions are unlikely to be effective due to several factors. Implementation of effective policies and strategies early on in the epidemic can keep HIV at significantly low levels even in presence of injecting practices (Loxley 2000), and the incidence of HIV can be reduced (Peters et al 1998), showing thereby that prevention of drug-related HIV is feasible. Characteristics of effective HIV prevention interventions include early introduction of intervention (ideally before HIV is reported among the IDU population), availability of needle and syringe exchange programmes (NSP), and drug treatment programmes such as methadone substitution and outreach with active partnership by the drug user community.…”