dence, and pharmacotherapies for treating stimulant dependence (on cocaine or amphetamine-type drugs)—as well as psychosocial interventions. This chapter also examines the extent to which drug treatment provides IDUs with links to other health and social services.

The primary goal of drug abuse treatment is to reduce drug use. By doing so, it may also decrease injection drug use and other risk behaviors associated with drug use and provide a platform for providing other specific interventions directly targeting HIV transmission. Thus it may have direct, indirect, and facilitative effects on prevention of HIV transmission. As a result, the Committee first reviews the evidence regarding the effectiveness of drug treatment in reducing drug use and improving treatment-related outcomes, and then considers the impact of such treatment on HIV-related outcomes.

Efficacy refers to how well a treatment works under the best of circumstances, or in controlled clinical trials. Effectiveness refers to how well the treatment works in actual clinical practice. From a public health perspective, a particular treatment will have the greatest impact on HIV transmission if it is effective in reducing drug use and drug- and sex-related HIV risk behavior, and if it attracts and retains a large-enough proportion of drug-dependent individuals. Some treatments may be efficacious in controlled clinical trials but difficult to scale up for widespread, effective use in community settings. Other treatments may be efficacious but not attractive enough to patients to gain widespread acceptance. Although clinically efficacious treatments may reduce drug use and HIV transmission among drug-dependent patients who receive the treatment, unless these treatments are sufficiently widely disseminated, accessible, and attractive to the entire population of drug-dependent individuals, even the most efficacious treatment will not substantially reduce HIV transmission and other problems resulting from drug dependence in a country.

Social factors may also affect the willingness of drug-dependent patients to participate in efficacious treatments. Discrimination against patients receiving treatment for drug dependence and the stigma associated with drug dependence, as well as the monetary costs and other demands of treatment, can deter drug-dependent individuals from seeking or remaining

semisynthetic drug heroin that is produced from poppy compounds. The term ‘opioids’ refers to opiates and other semisynthetic and synthetic compounds with similar properties. Opioids are dependence producing substances, which elicit their effects by activating opioid receptors in the brain. Opioids are generally consumed by injection, oral ingestion or inhalation of the fumes produced by heating. Regular use of opioids can lead to opioid dependence” (WHO et al., 2004, p. 4).

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