• The use of
drugs—legal or illicit—is a universal phenomenon with sometimes-deadly
consequences. Now there is increasing evidence that drug use is playing
a major role in the spread of HIV/AIDS.
• Those most
at risk are injecting drug users who share needles and other contaminated
equipment, which is a highly effective way of transmitting the virus
from one person to another.
• Whether injected
or not, mind-altering drugs are also associated with behaviour that
can increase the risk of HIV infection. For example, the lack of inhibition
associated with some drugs may result in unprotected sex, while intoxication
can complicate condom use or the ability to negotiate safer sex. Rape
and coerced sex are also associated with drug use.
of the most widely used drugs in the world—is associated with risky
sexual behaviour and the spread of HIV.
• In some countries,
drug users are disproportionately likely to be involved in the sex industry,
increasing their risk of infection and the chances of the virus spreading
to the wider community.
• Drug use can
also arise from HIV infection. Occasionally, people living with the
virus resort to drugs to cope with psychological and social problems.
• Injecting drug
users rank among the groups most vulnerable to HIV/AIDS, because they
are often also poor and marginalized.
A growing factor
in the epidemic
• Injecting drug
use is a rapidly growing phenomenon in all regions (including, most
recently, Africa). It is estimated that about 10% of HIV infections
globally result from injecting drug use. In some European and Asian
countries, more than half of HIV infections are attributed to injecting
• In 1992, only
80 countries reported injecting drug use within their borders, compared
with 136 in 2000.
• In Central
and Eastern Europe, HIV prevalence rates were low until 1995, when evidence
emerged that the virus was spreading rapidly among injecting drug users
in several cities. The first outbreaks were reported in 1995 in the
Ukrainian cities of Odessa and Nikolayev.
Cutting the links
• Countries need
ideally to implement a comprehensive package of care for HIV prevention
among drug users. Such a package should offer a variety of service options,
include detoxification programmes, support therapeutic communities,
ensure access to clean needles and syringes, and provide substitution
therapy (for example, methadone treatment), as well as condoms and HIV
counselling. The services should have a wide reach and safeguard users’
• Outreach services
are crucial. Because they operate outside conventional channels, working
hours and settings, they are much more effective at reaching people
who might be living on the margins of society. These services tend to
focus on HIV prevention activities that can protect drug users and their
families against infection, and encourage them to take advantage of
abuse treatment and medical care.
• A project to
prevent drug use and HIV infection has been operating successfully in
Brazil since 1994. It targets at-risk teenagers, as well as injecting
drug users, and has reached more than 100,000 students, while providing
preventative education and care to about 8,000 drug users.
• Treatment and
rehabilitation services for drug users are equally important. By identifying
drug users early on and providing them with prompt treatment, programmes
can reduce the odds of them shifting to more dangerous practices such
as injecting drugs. The same programmes can offer drug users (injecting
or otherwise) additional services that reduce their risk of infection.
social support and welfare services are another facet of an effective
response. In view of the many social and welfare problems that drug
users experience, long-term measures are needed to improve their quality
of life. Those measures should aim at reducing poverty, improving education
and employment opportunities, extending access to essential legal and
social services, and offering psychosocial support.
• Efforts aimed
at preventing drug use in the first place are central to HIV/AIDS prevention,
since they help protect vulnerable groups (especially young people)
from dependencies that could increase their risk of infection. Strategies
include projects that help build life skills and promote healthier lifestyles.
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