HIV and risk environment for injecting drug users: the past, present, and future

Abstract

We systematically reviewed reports about determinants of HIV infection in injecting drug users from 2000 to 2009, classifying findings by type of environmental influence. We then modelled changes in risk environments in regions with severe HIV epidemics associated with injecting drug use. Of 94 studies identified, 25 intentionally examined risk environments. Modelling of HIV epidemics showed substantial heterogeneity in the number of HIV infections that are attributed to injecting drug use and unprotected sex. We estimate that, during 2010-15, HIV prevalence could be reduced by 41% in Odessa (Ukraine), 43% in Karachi (Pakistan), and 30% in Nairobi (Kenya) through a 60% reduction of the unmet need of programmes for opioid substitution, needle exchange, and antiretroviral therapy. Mitigation of patient transition to injecting drugs from non-injecting forms could avert a 98% increase in HIV infections in Karachi; whereas elimination of laws prohibiting opioid substitution with concomitant scale-up could prevent 14% of HIV infections in Nairobi. Optimisation of effectiveness and coverage of interventions is crucial for regions with rapidly growing epidemics. Delineation of environmental risk factors provides a crucial insight into HIV prevention. Evidence-informed, rights-based, combination interventions protecting IDUs' access to HIV prevention and treatment could substantially curtail HIV epidemics.

Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico

“…Consumption of drugs and alcohol in the context of a transactional sex encounter is known to be associated with unprotected sex, violence, and disease acquisition. 18,54,55 To the extent that police abuse facilitates this practice, this may represent another pathway for compounding sexual and risk behavior and health risk.…”

Scale-up of a comprehensive harm reduction programme for people injecting opioids: lessons from north-eastern India

“…The best way is through strategic advocacy to influence national and local policies; an enabling environment; community mobilization; innovative delivery models and practical approaches to enable rapid scale-up. 3,4 In 2004 the Bill & Melinda Gates Foundation, through its Avahan India AIDS initiative, funded Project ORCHID (acronym for "organized response for comprehensive HIV interventions in selected high-prevalence districts") in Manipur and Nagaland, two states of north-eastern India, to introduce and scale up a comprehensive harm reduction package for people injecting opioids. 5 This paper describes the approaches to achieving scale-up, the lessons learnt from this experience, and how these lessons have informed harm reduction programmes and policy in India.…”

The Prevalence of HIV, HBV, HCV, and HIV-Related Risk-Taking Behaviors among Palestinian Injecting Drug Users in the East Jerusalem Governorate

“…HIV vulnerability of IDUs is also structural-or socially produced-as it is related to a number of characteristics of the social environment. [13][14][15] The situation in the EJG is characterized by the persisting economic hardship, widespread unemployment (925% in the West Bank in 2008 16 ), and poverty. About 40-46% of the population in the West Bank was estimated to live below poverty line in 2007.…”