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Injecting Drug Users and HIV/AIDS

December 2001

I care . . . Do you?

"I care . . . Do you?" is the slogan for the second year of a two-year campaign intended to create a sustained focus on the role of men in the AIDS epidemic.

Key Messages

HIV epidemics among injecting drug users (IDUs) can be prevented, stopped and even reversed by implementing programs that:


Facts

The sharing of contaminated drug injecting equipment and drug preparations is a highly efficient means of spreading HIV. Usually, small amounts of blood enter the needle and syringe when drugs are injected. In addition, the blood can then be transferred to other drug injecting equipment such as "cookers," filters and drug containers, as well as water used for mixing and rinsing. Only a small amount of infected blood is needed to pass on the virus from one drug user to another, so any type of equipment sharing poses a high risk of HIV transmission.

Injecting drug use is a rapidly expanding issue affecting over 135 countries. Worldwide, there may be as many as 2-3 million IDUs infected with HIV. Epidemics in Eastern Europe, the former Soviet Union and parts of Asia are being driven by injecting drug use. Injecting drug use is also a major factor in HIV epidemics in North America, Western Europe and parts of Latin America and the Middle East.

In all regions, 60-90% of all IDUs are men -- particularly young men. Often IDUs first inject drugs before the age of 20, with many users being under the age of 25. Young IDUs are at higher risk of HIV infection than older IDUs because they:


Issues

Rapid Spread of Injecting Drug Use

Countries should not become complacent as levels of drug use can quickly and dramatically change. For example, injecting drug use has rapidly spread throughout Eastern Europe; there has been a trend of injecting amphetamine-type stimulants in Southeast Asia; and heroin injecting is replacing opium smoking in many parts of Asia. Injecting drug use is also emerging in the Middle East and Africa.


Sexual Transmission of HIV

IDUs are at risk of HIV infection through sexual transmission, particularly when they have unsafe sex while intoxicated; in such situations, safer sex is less likely to occur. Also the trading of sex for drugs is common in many drug-using communities. Whereas IDUs are often able to change their drug-using behavior to reduce HIV risks, they may be less able to modify their sexual behavior.


Occasional Drug Users Are Also at Risk

Many people who inject drugs do not inject regularly or do not identify with being IDUs. Young, new and occasional injecting drug users are particularly at risk of HIV infection. Often it can be difficult to reach them and convince them that they are at risk.


HIV Prevention and Drug Control

Often communities and politicians are concerned about the effects of HIV prevention strategies on illicit drug use. However, well-managed prevention programs can reduce HIV transmission and actually strengthen drug control efforts, by effectively reaching and educating drug users about HIV and other risks, and putting them in contact with drug treatment services.


Marginalization

Because IDUs are often marginalized and therefore have less access to information services, HIV prevention services are best delivered to IDUs in their community through outreach programs whereby trusting relationships are established between IDUs and outreach workers. Outreach may include provision of HIV information, sterile injecting equipment and condoms, peer education, primary health care and referral to other services, including drug treatment.


Criminalization of IDUs

In most countries, injecting drug use is an illegal and covert activity, which adds to the marginalization of IDUs and increases their risk of imprisonment. This, in turn, makes it more difficult for them to access HIV prevention and treatment services. There is a need to look at existing legislation and community policing to make sure laws and practices facilitate (rather than hinder) access to drug users in order to reduce HIV transmission.  There are examples of laws that allow HIV prevention programs among drug users to be funded by government budgets.


Ideas for Action

For injecting drug users:




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