has already created a public health crisis. Countries where the level of HIV infection is still relatively low have the chance—if they act now—to slow the spread of HIV.

A variety of HIV prevention programs targeting IDUs have been shown to be effective in reducing HIV-related risks.1 For injecting opioid users seeking treatment, opioid agonist maintenance treatment is the only consistently effective treatment for opioid dependence. Studies show that methadone and buprenorphine reduce illicit opioid use, injection-related HIV risk behavior, and risk of HIV seroconversion among people with opioid dependence. Opioid antagonist medication is another pharmacological treatment option for opioid-dependent individuals who will not accept or cannot gain access to opioid agonist maintenance therapy. Despite strong pharmacological evidence and theoretical potential for naltrexone, evidence regarding its efficacy in controlled clinical trials is inconclusive. Naltrexone is likely to be most successful for patients whose adherence to medication and retention in treatment can be closely monitored and facilitated. Psychosocial interventions alone have not been shown to be consistently effective in treating opioid dependence.

For injecting non-opioid users seeking treatment, no pharmacotherapies have been found to be consistently efficacious in treating stimulant dependence. Contingency management, a behavioral intervention, is an efficacious treatment for stimulant dependence, but additional research is needed on the feasibility of its application outside of research settings. There is modest evidence of efficacy of several other behavioral or psychotherapeutic approaches in addressing stimulant abuse, including individual drug counseling and intensive group drug counseling, cognitive behavioral therapy, and community reinforcement combined with contingency management. While there is weak evidence regarding the effectiveness of therapeutic communities, drug anonymous groups, and abstinence-based outpatient treatments, these are important treatment options for opioid-dependent individuals who will not accept or cannot gain access to opioid agonist maintenance treatment, or for individuals dependent on other classes of drugs. Those seeking effective interventions for non-opioid users should consider these behavioral or psychosocial interventions, but funders and policymakers are urged to collect rigorous evaluation data if they are selected.

For injecting drug users who cannot gain access to treatment or are not ready to consider it, multi-component HIV prevention programs that include sterile needle and syringe access reduce drug-related HIV risk behav-

1

Refer to Chapters 2 and 3 for a detailed and properly referenced discussion of the evidence related to HIV prevention for IDUs.



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