2006). In some cases, epidemics initially fueled by the sharing of contaminated injecting equipment are spreading through sexual transmission from IDUs to non-injecting populations, and through perinatal transmission to newborns. Reversing the rise of HIV infections among IDUs has thus become an urgent global public health challenge—one that remains largely unmet.


In response to this challenge, in 2005 the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Bill & Melinda Gates Foundation commissioned the Institute of Medicine to undertake an expedited review of the scientific evidence on strategies to prevent HIV transmission through contaminated injecting equipment, with a specific focus on high-risk2 countries—namely in Eastern Europe, the Commonwealth of Independent States, and significant parts of Asia—where injecting drug use is, or is on the verge of becoming, the primary driver of the HIV epidemic.

The charge to the Committee included five questions. They are listed here in the order in which they are addressed in the chapters. The Committee found it most helpful to first discuss the evidence on the intermediate outcomes of drug-related risk (question one) and sex-related risk (question two) prior to examining the impact on HIV transmission (question three).

  1. What impact do needle and syringe exchange, disinfection programs, drug substitution programs, drug treatment programs, and counseling and education have on the extent and frequency of drug injection?

  2. What evidence is there on the extent to which these prevention strategies help reduce HIV transmission from IDUs to their sex partners and through maternal-to-child transmission to their offspring?

  3. How effective are such programs in reducing HIV transmission among IDUs?

  4. To what extent do such programs also increase the use of health and social services and drug treatment?

  5. What evidence is there that programs aimed at reducing the risk of HIV transmission among IDUs are more effective when they are part of a comprehensive array of services, which include outreach, HIV prevention education, counseling, referral to drug substitution treatment, drug rehabilitation services, and medical and psychosocial support?


 In this report, such countries are labeled as “high-risk,” indicating that injecting drug use is, or is on the verge of becoming, the primary driver of the HIV epidemic.

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