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HIV Rises in Injecting Drug Users

Rick Lines, Harm Reduction International, said steps must be taken to reduce the spread of HIV among injecting drug users. Credit: Harm Reduction International

HIV infections are on the rise among people in Africa who inject illegal drugs. A new report recommends scaling-up programs designed to prevent the spread of the AIDS virus among drug users.

Rick Lines, head of Harm Reduction International, said unsafe injecting drug use is a major driver of HIV/AIDS worldwide.

“Traditionally, we’ve seen regions such as Eurasia and Asia and the Middle East and North Africa sort of be epicenters of a lot of injecting drug use and a lot of unsafe injecting drug use. And so we see very high rates of HIV amongst people who inject drugs in those countries. But in recent years, researchers and community health organizations in a number of sub-Saharan Africa countries have also begun to document an increase.”

He said there are “new and emerging patterns of injecting drug” use in such places as Tanzania, Zanzibar Uganda, Senegal and Kenya.

“Of course,” he said, “sub-Saharan Africa is a region of the world which has been disproportionally been affected by HIV across the board, as we’ve known since the beginning of the epidemic. That has largely been driven by sexual transmission. So, HIV transmission via injecting drug use in the region is something quite new. Our research would estimate that perhaps up to a million people are injecting drugs in various countries in that part of the world.”

Lines said the increase in injecting drug use in sub-Saharan Africa is connected to a change in drug trafficking routes. The drugs pass through the continent on their way to Western Europe.

The Global State of Harm Reduction 2014 report calls for an increase in programs to help drugs users. One such program is called OST or opioid substitution therapy.

“Most people would probably be familiar with a medicine called methadone. Opioid substitution therapy is essentially a medical intervention whereby people who are dependent upon illicit opioids -- most usually heroin, people who are injecting heroin, for example -- can switch to drugs such as methadone, which are pharmaceutical prescription drugs administered by physicians or health clinics,” lines said.

Methadone is taken orally. It’s been in wide use in the United States, Western Europe and Australia.

Another way to help stop the spread of HIV among injecting drug users is the needle or syringe exchange program or NSP. Lines said, it too, has been in use for decades.

“We know that the main risk of HIV transmission -- via injecting drug use – is people sharing syringes. So, one of the early interventions in, what we call, the harm reduction approach, or HIV prevention approach, was to set-up programs whereby we have outreach workers going out and working with people who inject drugs. And ensuring that – if they’re going to be injecting – that they’re actually injecting with sterile equipment rather than sharing equipment.”

He said needle exchange programs are widely credited with reducing HIV infection rates in Western Europe and Australia in the late 1980s. The Global State of Harm Reduction report says Malaysia, Iran and Australia have seen the “steepest increase” in needle and syringe exchange programs.

There’s been an increase in high-risk injecting practices reported in Tanzania and Zanzibar. One example is called flashblood. It’s when someone injects himself with blood taken from another person, who already has had an injection of heroin.

Nearly seven million people in sub-Saharan Africa are receiving antiretroviral therapy to either treat or prevent HIV infection. Lines said that few of them are injecting drug users.

“Unfortunately, it’s the case across the world that people, who are drug users, are largely left outside that otherwise successful approach. The estimates that are usually used in United Nations documents is that about four percent of people, who are drug users, who are living with HIV, are accessing antiretroviral therapy.”

Part of the reason for that, he said, is stigma.

“There’s a general assumption that people who are drug users are somehow not going to be compliant with the drug regime. But all the evidence that’s been done to date shows that that’s clearly not the case,” he said.

Lines added that the “harm reduction approach can be implemented in many different socio-economic, cultural and political environments.”

“In recent years,” he said, “we’ve seen very, very successful projects being established in parts of Eurasia, Central and Eastern Europe, certain countries in the Middle East, in North Africa. And now we’re starting to see very effective programs being developed in parts of sub-Saharan Africa.”

He said even though opioid substitution therapy and needle exchange programs are low cost, there’s a big funding gap. He says UNAIDS estimates more than $2.3 billion dollars is needed annually for HIV prevention among people who inject drugs. Lines said only about $200 million of that is actually provided.