In response to this charge, the Committee convened a public workshop in Geneva, Switzerland, in December 2005 to gather information from experts on IDU-driven HIV epidemics in the world’s most affected regions (see Appendix A for the meeting agenda). The Committee also conducted a comprehensive search of the English language peer-reviewed scientific literature, and evaluated previous systematic reviews and reports prepared by international organizations (see Appendix B for further detail on the Committee’s review methods). To assess this evidence, the Committee held a closed meeting in Washington, DC, in March 2006, and also conducted numerous conference calls.

Although the report focuses on HIV prevention for IDUs in high-risk countries, the Committee considered evidence from countries around the world. The findings and recommendations of this report are also applicable to countries where injecting drug use is not the primary driver, but in which injection drug use is nevertheless associated with significant HIV transmission.


This report focuses on programs designed to prevent the transmission of HIV among IDUs. 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.

The Committee grouped the wide range of HIV prevention strategies for IDUs into three categories: (1) drug dependence treatment, which include both pharmacotherapies and psychosocial interventions; (2) sterile needle and syringe access; and (3) outreach and education programs (see Box S-1). Other HIV prevention strategies, such as voluntary counseling and testing, antiretroviral therapy, and prevention and treatment of sexually transmitted infections, are important for IDUs but also apply to broader populations. While there is a large body of evidence evaluating the effectiveness of these interventions, the Committee’s review was limited to those prevention interventions specific to IDUs. Therefore, Chapter 1 includes only a brief overview of these broader interventions.

The most effective way to reduce the risks of HIV transmission among injecting drug users is to stop drug use. However, not all drug users are ready or able to take this step. An individual IDU’s risk of HIV infection is mediated by both individual-level factors (such as severity of dependence

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