HIV Prevention with Injecting Drug Users

Injection Drug Use and HIV/AIDS

As injection drug use rises, so do HIV infection rates. In the former Soviet Union, for example, where the epidemic has grown exponentially since 1999, HIV/AIDS epidemics have been discovered in more than 30 cities and in 86 of the country's 89 regions. Currently, up to 90% of registered infections in the country have been attributed to injection drug use. Likewise, social and economic upheavals in Indonesia have spawned sharp increases in injection drug use and HIV prevalence in the past decade. National estimates indicate that approximately 43,000 injecting drug users are already infected with HIV. Before 1990, injection drug use was virtually unknown in Indonesia (UNAIDS/WHO, 2002).

HIV/AIDS Risk

HIV infection spreads among injectors who share syringes or needles and other injection equipment. Sharing syringes involves significant HIV risk, because the HIV virus remains viable on even invisible traces of blood within a syringe or needle up to several days under certain conditions. Injection practices can be risky even when they do not involve the direct sharing of a syringe, however. Virological studies have indicated that HIV can survive in tap water for extended periods of time. Therefore, indirect sharing practices, such as rinsing previously used syringes in a shared container prior to drug preparation, also represent significant HIV transmission risks (Koester, 1996).

Targeted Prevention

Targeted prevention of HIV among injection drug users began in the early 1980s as part of a broader public health movement: harm reduction. Harm reduction is a philosophy that seeks to compassionately and pragmatically minimize the adverse consequences of drug use without condemning drug users or demanding abstinence from drugs. Harm reduction approaches to HIV prevention with drug injectors include syringe exchange (drug users exchange used syringes for sterile ones, as well as acquire clean water, bleach, alcohol, containers for drug mixing, and condoms); pharmacy access to syringes without a prescription; street outreach (peer-led prevention education and bleach distribution to sterilize syringes between uses); preventive case management; drug treatment; access to health care; and anti-retroviral treatment.

The best HIV prevention practice for active drug users involves using a sterile, unused needle for each injection, but primarily because of legal restrictions on access to needles, drug injectors are forced to reuse or share needles as well as other injection equipment. Many countries have made legal access to sterile injection equipment via needle exchange and/or pharmacy access a key component of AIDS prevention, although opposition has been common. While needle exchange is now legal in many states in the United States, prohibitions continue to disallow the use of federal monies to operate these programs.

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