Report on the Global HIV/AIDS epidemic

Prevention: daunting challenges ahead

The Belarus campaign was bolstered by a change in the law, which made it legal to
carry syringes. A legislative change that facilitated the funding and implementation
of AIDS education and needle exchange among drug users has also been brought
about in Brazil.
Drug treatment is another approach to preventing HIV infection among injecting drug
users. This includes helping users to switch to substances that do not need to be
injected. Methadone treatment, which involves giving oral doses of methadone as a
substitute for the injection of heroin, has been associated with reduced risk behaviour and lower HIV infection rates. In an 18-month study of 255 drug users in
Philadelphia (USA) in the early 1990s, only 3.5% of the drug users on stable
methadone treatment became infected with HIV, compared with 22% of those who
were not being treated.
Clearly, greater efforts are needed to reduce both injecting drug use and the risk of
HIV infection among drug users, especially in the many countries where drug injection is a major driving force for the spread of HIV. Like other marginalized groups,
drug users can often be reached more easily by nongovernmental organizations.
National AIDS programmes in some countries, including several in central and eastern Europe and a few in Latin America and Asia, are actively supporting such organizations in their efforts to prevent HIV infection among injecting drug users and transmission from them to their sex partners. Their prevention efforts should be
applauded, but above all they must be expanded.

77