• Coordinated among national, regional, and local public health, criminal justice, and community leaders to develop a framework for interventions that balance their respective missions;

  • Complementary to broader interventions in drug use and HIV, including primary prevention;

  • Built upon plans for fiscal and infrastructure sustainability;

  • Coupled with monitoring and evaluation.

CONCLUSION

Nations where the HIV pandemic is newly emerging can and should take effective action now to stem the tide of this tragic and preventable illness. In countries where injecting drug use is the primary source of HIV infection, national programs must address the challenges of both drug use and HIV. The Committee has reviewed the evidence regarding interventions for injecting drug use and HIV among IDUs, and hopes it has provided policymakers a knowledge base regarding what works. The Committee recognizes though that each country will pursue a different combination of interventions, reflecting its economic circumstances and legal, ethical, and cultural traditions. However, these policy decisions should not be based on erroneous understanding if scientific truth is available. The Committee believes that the evidence-based conclusions and recommendations in this report can provide an important foundation for governments and communities engaging in economic, legal, and ethical debates about these issues.

Evidence on effective interventions provides a solid basis for action now. The experiences of other nations with extensive HIV epidemics underscore the urgent need for an immediate response. As policy unfolds into programmatic action, nations should also evaluate their implementation, to inform the next generation of responses to drug dependence and HIV.

REFERENCES

Burris S, Strathdee S, Vernick J. 2003. Lethal injections: The law, science, and politics of syringe access for injection drug users. University of San Francisco Law Review. 37: 813–885.

Cabases J, Sanchez E. 2003. Costs and effectiveness of a syringe distribution and needle exchange program for HIV prevention in a regional setting. The European Journal of Health Economics. 4(3):203–208.

Doran C, Shanahan M, Mattick R, Ali R, White J, Bell J. 2003. Buprenorphine versus methadone maintenance: A cost-effectiveness analysis. Drug and Alcohol Dependence. 71: 295–302.

Farmer P, Leandre F, Mukherjee J, Gupta R, Tarter L, Kim JY. 2001. Community-based treatment of advanced HIV disease: Introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy). Bulletin of the World Health Organization. 79(12):1145–1151.



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