30 Years on Selected Issues in the Prevention of HIV among Persons Who Inject Drugs

August 2013 - Structural Prevention

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Des Jarlais, D.C., Pinkerton, S., Hagan, H., et al. Advances in Preventative Medicine (June 2013), Vol. 2013.

The authors reviewed the history of and lessons learned from the past three decades in HIV prevention for people who inject drugs (PWID) and discussed critical issues for future research and public health programs. Despite successes in HIV prevention among PWID, including large-scale syringe access programs, combination prevention, and integrated health and social approaches (primarily in high-income countries), lack of resources and political will, stigmatization, and other factors, hinder effective HIV prevention for PWID in resource-limited countries. Long-term data for HIV prevention among PWID are inadequate because of stigmatization, friction between law enforcement and drug users, and political leaders’ belief that drug use is a “Western issue.” The authors described two modeling studies which indicated that combination programs would dramatically reduce HIV incidence among PWID in two countries. Current economic pressures point toward reducing programming for PWID, particularly in low-prevalence epidemics; the authors argued against scaling these programs down because other factors, e.g., sexual transmission, could increase HIV. Lastly, the authors described two opposing policy perspectives to injecting drug use: the proscriptive “war on drugs” and the pragmatic “harm reduction” approach, which focuses on public health and human rights. The authors concluded that the successes in HIV prevention among PWID have informed global goals for improving overall health (including HIV prevention and care) through a rights-based, politically supportive environment.

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