IDUs. The committee has grouped these interventions into three broad categories: drug dependence treatment (including both pharmacotherapies and psychosocial interventions), sterile needle and syringe access, and outreach and education. Other important HIV prevention and treatment strategies that are not specific to IDUs, such as voluntary counseling and testing, antiretroviral treatment, and prevention and treatment of sexually transmitted diseases, are also briefly discussed, but are not part of the committee’s evidence review. The chapter ends with a brief discussion of the global coverage of HIV prevention services for IDUs.

EPIDEMIOLOGY OF HIV IN INJECTING DRUG USERS

Data on the size of the IDU population and HIV prevalence among IDUs are scarce. Estimating the size of the IDU population is difficult because drug use is an illegal and stigmatized activity. IDUs are often hidden and avoid settings where researchers might obtain data for fear of arrest or stigmatization (Magnani et al., 2005; Des Jarlais et al., 2001). HIV prevalence is difficult to estimate because many areas also lack the capacity to systematically monitor HIV infections among IDUs (Des Jarlais et al., 2001). Areas with routine HIV surveillance collect most of the data at institutions such as prisons, jails, and drug abuse treatment and outreach centers, which do not necessarily represent the IDU population at large (Dehne et al., 2002).

The United Nations Reference Group on HIV/AIDS Prevention and Care among IDUs recently developed estimates of the prevalence of injecting drug use, prevalence of HIV infection among IDUs, and the availability of prevention services worldwide, with a focus on developing and transitional countries (Aceijas et al., 2004). These estimates were compiled from a comprehensive review of published and unpublished documents for the period 1998–2003. Estimates were based on information available for 130 countries and territories.2 The authors assigned a strength of evidence rating to each source based on the type of information and methods used in calculating the estimate. The strength of evidence supporting estimates of both IDU prevalence and HIV prevalence among IDUs was generally poor. Approximately 95 percent of the estimates of IDU prevalence and 64 percent of HIV prevalence estimates received a rating of “low,” meaning that estimates lacked any supporting technical information (Aceijas et al., 2004). As a result of these limitations, estimates of IDU population size and HIV

2

Data were missing for 119 countries and territories (Aceijas et al., 2004).



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