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 response to this charge, the Committee convened a public workshop in Geneva in December 2005 to gather information from experts on IDU-driven HIV epidemics in the most affected regions of the world, including Eastern Europe, the Commonwealth of Independent States, and significant parts of Asia. Experts from other regions also provided information on their experiences in preventing HIV infection among IDUs (see Appendix A for the agenda of this meeting).

The Committee further conducted a comprehensive search of the English language peer-reviewed scientific literature, and evaluated previous systematic reviews and reports on these issues (see Appendix B for an overview of the Committee’s literature searches and review methods). While the Committee sought evidence from high-risk countries, the literature review and evaluation included evidence from all over the world. In reviewing the evidence, the Committee grouped the range of HIV prevention strategies for IDUs it was asked to address in the charge into three categories: (1) drug dependence treatment programs, which include both pharmacotherapies and psychosocial interventions; (2) sterile needle and syringe access programs; and (3) outreach and education programs (see Chapter 1 for descriptions of these interventions). The Committee then assessed the evidence it had gathered at a closed meeting in Washington, DC, in March 2006, and during later conference calls.

This report focuses on programs that are designed to prevent the transmission of HIV among injecting drug users. These programs range from efforts to curtail non-medical drug use to those that encourage reduction in high-risk behavior among drug users. The term “harm reduction” is often used to describe programs such as sterile needle and syringe access because their primary aim is to reduce the harms related to drug use among those who are unable or unwilling to stop using drugs. However, because the term has a wide range of interpretations, the Committee refers to all interventions in this report as HIV prevention programs for IDUs.

Several issues are beyond the Committee’s charge and are not addressed in this report. First, the committee did not evaluate various drug control policies, such as supply and demand reduction strategies. While a large number of drug users interface with the criminal justice system, the committee did not evaluate the impact of criminal justice programs on drug use, HIV risk behaviors, or HIV transmission. An evaluation of programs such as mandatory drug treatment or diversion of drug users from the criminal justice system into treatment settings was also outside the scope of this study. Similarly, the committee did not evaluate interventions



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