New PEPFAR Guidance on HIV Prevention Intervention for Injection Drug Users

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The regional HIV/AIDS epidemics in Russia, Eastern Europe and Southeast Asia are concentrated in part among injection drug users (IDU) and their partners. This population is highly stigmatized, making it difficult to successfully launch appropriate prevention campaigns.

In an effort to recognize that the use of syringe exchange programs and medication-assisted therapy can help reduce HIV transmission among injection drug users (IDU), PEPFAR recently released revised IDU harm reduction guidelines. The guidelines state, “There are approximately 16 million IDUs worldwide, with an estimated 3 million living with HIV; of those infected with HIV, 32% live in Eastern Europe, and 22% reside in East and Southeast Asia.”

According to the guidelines, PEPFAR supports a comprehensive HIV prevention package for IDUs which includes the following elements:

  • community-based outreach programs
  • sterile needle and syringe programs,  and
  • drug dependence treatment, including medication assisted treatment (MAT)5 with methadone or buprenorphine and/or other effective medications as appropriate, based on the country context.

Previous guidance from PEPFAR failed to address harm reduction strategies and supported interventions only for IDUs who were already infected with HIV.  The Center for Global Health Policy and other organizations focused on the needs of this marginalized subpopulation welcomed this evidence-based comprehensive guidance.

Research released at the 18th International AIDS Conference in Vienna showed that fewer than ten percent of IDUs get practical help to prevent the spread of HIV. Researchers also claimed that the number of IDUs worldwide that have HIV could be as high as 6.6 million. The studies presented at IAS 2012 appear in the July 24 issue of The Lancet.

During a forum at Kaiser Family Foundation Thursday, Lisa Carty of the Center for Strategic and International Studies made the comment that even though the location of this year’s International AIDS Conference was strategically chosen due to its proximity to Eastern Europe, there was almost no high-level Eastern European government presence at the meeting.  “The countries that are most affected by this facet of the epidemic are in denial of the problem,” she said, and that specifically needs to be addressed.

Carty also noted that there were only two African health ministers at IAS 2010, and no African sitting heads of state. “We need more active participation, leadership and financial commitment from other countries,” she said.

Prior to Vienna, the IAS released the Vienna Declaration, which calls for improving community health and safety by incorporating scientific evidence into illicit drug policies. In particular, it aims to address current international drug control policies and the need for a public health approach that focuses on reducing stigma associated with drug abuse while ensuring that policies do not encourage drug abuse or create social problems of their own.

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