The effectiveness of harm reduction in preventing HIV among injecting drug users

Alex Wodak; Lisa Maher

doi:10.1071/NB10007

RESEARCH ARTICLE

Previous Next Contents Vol 21(4)

The effectiveness of harm reduction in preventing HIV among injecting drug users

Alex Wodak ^A ^C and Lisa Maher ^B

+ Author Affiliations

- Author Affiliations

^A Alcohol and Drug Service, St Vincent’s Hospital, Darlinghurst NSW

^B National Centre in HIV Epidemiology and Clinical Research, Darlinghurst NSW

^C Corresponding author. Email: awodak@stvincents.com.au

NSW Public Health Bulletin 21(4) 69-73 https://doi.org/10.1071/NB10007
Published: 27 May 2010

Abstract

There is now compelling evidence that harm reduction approaches to HIV prevention among injecting drug users are effective, safe and cost-effective. The evidence of effectiveness is strongest for needle and syringe programs and opioid substitution treatment. There is no convincing evidence that needle and syringe programs increase injecting drug use. The low prevalence (∼1%) of HIV among injecting drug users reflects the early adoption and rapid expansion of harm reduction in Australia. Countries that have provided extensive needle and syringe programs and opioid substitution treatment appear to have averted an epidemic, stabilised or substantially reduced the prevalence of HIV among injecting drug users. However, despite decades of vigorous advocacy and scientific evidence, the global coverage of needle and syringe programs and opioid substitution treatment falls well short of the levels required to achieve international HIV control.

Acknowledgments

The authors would like to thank Ms Leah McLeod for her assistance with the manuscript. Lisa Maher is supported by an NHMRC Senior Research Fellowship and the National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, The University of New South Wales.

References

[1] Stimson GV. Syringe-exchange programmes for injecting drug users (Editorial review). AIDS 1989; 3 253–60.
| Crossref | GoogleScholarGoogle Scholar | PubMed | CAS | (Cited 4 March 2010.)

[3] World Health Organization (SEARO & WPRO), United Nations Office on Drugs and Crime. HIV/AIDS care and treatment for people who inject drugs in Asia and the Pacific: an essential practice guide. Geneva: WHO Press; 2008. Available at: http://www.who.int/hiv/pub/idu/idu_searo_wpro_treatment.pdf (Cited 4 March 2010.)

[4] World Health Organization, United Nations Office on Drugs and Crime, Joint United Nations Program on HIV/AIDS. Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users. Geneva: World Health Organization; 2009. Available at: http://www.who.int/hiv/pub/idu/idu_target_setting_guide.pdf (Cited 4 March 2010.)

[5] Wodak A, Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse 2006; 41(6–7): 777–813.
| Crossref | GoogleScholarGoogle Scholar | PubMed | (Cited 4 March 2010.)

[14] Thomas DL, Astemborski J, Rai RM, Anania FA, Schaeffer M, Galai N, et al. The natural history of hepatitis C virus infection: host, viral, and environmental factors. JAMA 2000; 284 450–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed | CAS | (Accessed 4 March 2010.)

[46] Kwon JA, Iversen J, Maher L, Law M, Wilson D. The impact of needle and syringe programs on HIV and HCV transmissions in injecting drug users in Australia: A model-based analysis. J Acquir Immune Defic Syndr 2009; 51 462–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |

[47] Higgs P, Yohannes K, Hellard M, Maher L. Factors influencing a self limiting HIV outbreak among ethnic Vietnamese injecting drug users in Melbourne, Australia. Qual Health Res 2009; 19 1690–701.
| Crossref | GoogleScholarGoogle Scholar | PubMed |

[48] Butler T, Milner L. The 2001 New South Wales Inmate Health Survey. Sydney: Corrections Health Service; 2003.

[49] Jürgens R, Ball A, Verster A. Interventions to reduce HIV transmission related to injecting drug use in prison. Lancet Infect Dis 2009; 9 57–66.
| Crossref | GoogleScholarGoogle Scholar | PubMed |

[50] Stimson GV, O’Hare P. Harm reduction: moving through the third decade. [editorial] Int J Drug Policy 2010; 21(2): 91–3. Pubmed Abstract

[51] Maher L, Coupland H, Musson R. Scaling up HIV treatment, care and support for injecting drug users in Vietnam. Int J Drug Policy 2007; 18 296–305.
| Crossref | GoogleScholarGoogle Scholar | PubMed |