Report on the Global HIV/AIDS epidemic

Report on the global HIV/AIDS epidemic - June 2000

ing drug users in Quebec City, Canada, the prevalence of HIV infection was close to
30% among users who were also sex workers and just under 10% among men who
did not report sex work.
Despite the great uncertainties about the number of injecting drug users and the proIportion already infected with HIV, enough is known to move ahead quickly with comprehensive programming that can help reduce the high risk of new infections. This
must include the primary prevention of drug use, especially among young people,
and HIV prevention activities among drug users.
Reducing HIV transmission among drug users: interventions are
effective but not politically popular
If large-scale, comprehensive HIV prevention programmes can be implemented
among injecting drug users before the prevalence rate exceeds 5%, infections can
be contained at a low level. Such programmes should include AIDS education, condom promotion, needle exchange and drug treatment. These comprehensive programmes are sometimes referred to as "harm reduction". Yet the term "harm reduction" is politically sensitive, and some aspects of the approach are also politically
sensitive in most countries. For example, at least six government-funded studies of
HIV infection among drug users in the United States concluded that needle
exchange programmes significantly reduce new HIV infections among drug users,
without encouraging drug use. Despite these results, however, federal funding of
needle-exchange programmes is still prohibited because of political opposition. In
one study it was estimated that failure to implement widespread needle-exchange
programmes in the United States between 1987 and 1995 will cost the country at
least US$ 244 million in medical care for HIV cases that could have been prevented.
Harm reduction programmes, especially those aimed at preventing HIV infection,
have been shown to work in transitional economies as well as in high-income countries. In Belarus, an HIV prevention programme among drug users in Svetlogorsk,
which included education about safe injecting and safe sex and which provided
clean syringes, seems to have led to far safer behaviour among drug users. In 1997,
before the prevention programme began, 92% of those surveyed said they shared
syringes. By 1999, this percentage had dropped precipitously to 35%. While some
people did continue to reuse syringes, the proportion who cleaned them before
using them again rose to 55%, from just 16% before the prevention campaign. The
prevention project also included distribution of condoms to help reduce HIV transmission from infected drug users to their sex partners. And the users appear to be
taking advantage of them: by 1999 nearly two-thirds said they sometimes or always
used condoms, twice as many as two years earlier. The programme, which cost
around US$ 0.36 per disposable syringe distributed, is estimated to have prevented
over 2000 cases of HIV infection by its second year of operation, at a cost of around
US$ 29 per infection prevented - far below the cost of an AIDS case to a family or
a health system.

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