International Journal of Drug Policy - 2015

Volume 26 Supp 1 Feb 2015

Issue link: http://digitalreprints.elsevier.com/i/470203

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International Journal of Drug Policy 26 (2015) S1–S4 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Editorial State of the art science addressing injecting drug use, HIV and harm reduction Unsafe injecting drug use continues to drive the HIV epidemics in many countries around the world. The United Nations Office on Drugs and Crime (UNODC), Joint United Nations Programme on AIDS (UNAIDS), World Health Organization (WHO) and the World Bank estimate that there are 12.7 million (range: 8.9–22.4 mil- lion) people who inject drugs (PWID), globally. Among them, 13.1 per cent or 1.7 million people (range: 0.9–4.8 million) are living with HIV, with wide variations between regions and countries. The HIV situation is of particular concern in South-West Asia and in Eastern and South-Eastern Europe and Central Asia, where the prevalence of HIV among PWID is estimated to be between 23 and 29 percent, respectively. While HIV in sub-Saharan Africa is transmitted mainly via unprotected sexual intercourse, HIV trans- mission through unsafe injecting drug use has now also emerged as a significant concern in East Africa, and has also been reported in several countries in other parts of Africa (UNODC, 2014). In addition, high risk sexual practices linked to the use of stimu- lant drugs (e.g. amphetamine-type stimulants, cocaine) among key populations – for example, men having sex with men – are also contributing to the spread of HIV in certain parts of the world. To respond to HIV and associated epidemics among people who inject drugs, WHO, UNODC and UNAIDS have jointly recommended a package of nine interventions, commonly referred to as a 'harm reduction' approach to injecting drug use (WHO, UNODC & UNAIDS 2012), aimed at reducing the risk of acquiring and improving treat- ment and care of HIV, hepatitis and TB in PWID. The first four interventions: needle-syringe programmes (NSP), opioid substitu- tion therapy (OST), testing and counseling for HIV and provision of antiretroviral therapy (ART) are the most critical. There is com- pelling evidence that NSP and OST are effective in reducing the sharing of injecting equipment and averting HIV infections. In com- bination with ART, these interventions reduce HIV transmission, decrease mortality, reduce drug dependency, and improve quality of life. In March 2014, UNODC organized, in the context of the High- level Review of the 57th session of CND, a one-day Scientific Consultation in Vienna, entitled "Science addressing drugs and HIV: State of the Art", where it brought together leading scientists to dis- cuss the latest developments in prevention and treatment of HIV and AIDS as it relates to drug use. The presentations and discussions at the Scientific Consultation revolved around six thematic top- ics, pre-identified by UNODC, in consultation with its civil society partners. These were: The cost effectiveness of harm reduction; HIV, drugs and the legal environment; Women and drugs; Harm reduction in prisons; Compulsory detention as drug treatment and the impact on HIV outcomes; and Prevention, treatment and care of hepatitis C among people who inject drugs. The scientists were encouraged to reach out to a broader group of the relevant scientific com- munity and gather its inputs as they were to prepare for their individual thematic paper and related presentation at the Scientific Consultation.In their commentary, Wilson, Braedon, Shattock, and Fraser-Hurt (2015) demonstrate the cost-effectiveness of key harm reduction interventions for people who inject drugs, from both gov- ernment and societal perspectives, in terms of HIV outcomes and drug dependency. The commentary also provides a brief overview of current implementation levels of the various interventions by region. Access to comprehensive harm reduction services for PWID remains disproportionately low. As of 2010, globally, fewer than 8 in 100 PWID have access to OST, only 2 sterile needles are dis- tributed per month per PWID and only 4 in every 100 eligible people who inject drugs are receiving ART (Mathers et al., 2010). HIV services are typically not responsive to the specific needs of particularly vulnerable groups of PWID, in particular women, young people, and those living in prisons and other closed settings. In the commentary by Azim, Bontell, and Strathdee (2015) the authors discuss the reasons why women who use drugs are particularly vul- nerable to HIV infection, suggesting that interventions to optimize HIV prevention and care need to be sensitive to the needs of women and often, their children.A growing body of evidence indicates that the main factors behind the disproportionately low access to harm reduction services among PWID include: the lack of supporting drug policies and legislation in many countries; over-reliance of many national drug control systems on sanctions and over-use of incarceration of people who use drugs; compulsory detention for drug use and punitive practices in a number of countries in the name of treatment for drug dependence; and stigma and dis- crimination. In their commentary, Strathdee, Beletsky, and Kerr (2015) show how the legal environment, such as policing prac- tices, are directly or indirectly responsible for elevated HIV risks among PWID. They also present examples where police educa- tion programs and supportive policing practices can enhance harm reduction programs rather than undermining them. The commen- tary by Kamarulzaman and Mc Brayer (2015) provide an overview on the increased international attention and the evolving response to the human rights abuses and the denial of medical care that often exist within the compulsory drug detention centres. It also high- http://dx.doi.org/10.1016/j.drugpo.2014.11.008 0955-3959/© 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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