HIV Among People Who Use Drugs: A Global Perspective of Populations at Risk

Abstract

This paper examines the epidemiology of HIV among selected subgroups of drug users around the world who are ‘most at risk’ - men who have sex with men (MSM), female sex workers (FSWs), prisoners, and mobile populations. The underlying determinants of HIV infection among these populations include stigma, physical and sexual violence, mental illness, social marginalization, and economic vulnerability. HIV interventions must reach beyond specific risk groups and individuals to address the micro- and macro- level determinants that shape their risk environments. Public health interventions that focus on the physical, social, and health policy environments that influence HIV risk-taking in various settings are significantly more likely to impact the incidence of HIV as well as other blood-borne and sexually transmitted infections across larger population groups.

Risk-taking behaviours and HIV infection among sex workers in Portugal: results from a cross-sectional survey

“…Among HIV-positive SW, 52.2% ever injected drugs. This is consistent with research demonstrating that HIV infection is driven largely by the overlap of injecting drug use and sex work 10 11 21. Our study also found a higher proportion of injecting drug users working outdoors which heightens vulnerability to HIV infection.…”

“…Increased risk of HIV infection can result from multiple exposures: large number and concurrency of sexual partners, inconsistent condom use,7 8 intersection with injecting drug use9 10 and presence of other sexually transmitted infections (STIs) 7 11. In addition, among SW, infection risk and the adoption of unsafe behaviours vary across economic strata, sociocultural context and work environments 12.…”

Prevalence and Correlates of Female Condom Use and Interest Among Injection Drug-Using Female Sex Workers in Two Mexico–US Border Cities

“…FSW-IDUs face a number of vulnerabilities including entrenched poverty, mental illness, violence from clients or intimate partners, and conflict with sex partners surrounding drug use. These factors may directly or indirectly impair FSWs’ ability to negotiate male condom use and thus increase their risk of STIs [27–29]. Furthermore, compared to non-IDU female sex workers, FSW-IDUs may also be more likely to acquiesce to clients’ demands for unprotected sex if they are suffering from drug-related withdrawal [24].…”

Prevention and Treatment of HIV/AIDS Among Drug-Using Populations: A Global Perspective

“…The articles by Beyrer et9 and by Stockman and Strathdee10 point to the rapidly changing epidemiology of HIV and drug abuse around the world. In Afghanistan, as in countries in Central Asia, the Commonwealth of Independent States, and in Africa, opium supplies are plentiful, leading to increases in heroin use, addiction, and the unsafe use of syringes and other equipment for drug injection.…”