Almost three decades after the discovery of HIV, a new Lancet Series highlights the threat of a largely unpublicised and growing HIV epidemic—in people who use drugs. While large gains have been made in fighting the epidemic in the general population, socially marginalised populations such as people who use drugs, continue to suffer great stigma and lack of access to treatments that can save both their own lives and prevent HIV transmission to others. "Complacency about the HIV /AIDS epidemic now would be a terrible mistake," says Lancet Editor, Dr Richard Horton.
- There are some 16 million injecting drug users in the world, of which around 3 million are HIV positive. Add to this the uncounted numbers of people with HIV who use other drugs, and it's clear that the HIV epidemic is still raging in this community.
- The Lancet's Series dispels many of the myths about HIV/AIDs and people using drugs, including that rates of drug use are not higher in minorities in rich countries, and that needle exchanges do not encourage more drug use.
- The double risk of HIV in women who use drugs—through unprotected sex and injecting drugs—is a growing problem in Asia and Eastern Europe, as well as among crack-cocaine users in the USA. A drug that has a massive but hidden effect on HIV transmission is alcohol. Use of alcohol is associated with HIV infection and the behaviours that lead to infection, including unprotected sex, multiple partners, and commercial sex. Drinking venues themselves are associated with risk of HIV infection.
- There is a rapidly growing problem of HIV infection in users of non-injected drugs such as amphetamines. Amphetamine substitution therapies are sorely lacking, since they could help mitigate risk of HIV infection, as could intensive behavioural interventions. A further hidden catastrophe is the group of other diseases that hit people with HIV who use drugs, such as tuberculosis (especially within prisons), hepatitis, and mental illness.
- The interaction of sexual and drug related HIV-infection adds a further impetus to this growing epidemic particularly as new outbreaks of drug use and HIV are emerging in Africa, which the series explores.
- There are no single solutions for people who use drugs. Each country needs a response tailored to its own epidemic. But the Series demonstrates that a combination of interventions, including massive, simultaneous scale-up of access to antiretroviral treatment for HIV, opioid substitution therapy, and needle and syringe programmes could contain this epidemic over the next 5 years, since their effects are synergistic. The evidence is already available, and it calls for IMMEDIATE, combined implementation before new epidemics take hold. This requires concerted action from multinational and governmental agencies and people who use drugs themselves.
- All of these existing interventions, even if scaled-up, will be blunted without a further change in strategy. Traditional biomedical and health solutions are insufficient. An approach that tackles stigma, discrimination, and human rights abuses is essential. The Series concludes that action is needed on all fronts to reverse the HIV epidemic in drug users.
Below is a quote from the final paper in the Series:
"If drug control sectors and law enforcement are not a part of new approaches, then harm-reduction programmes will be closed, substitution clinics will stay sparsely attended, and antiretroviral and preventive interventions will have a low uptake by drug users."
To interview Lancet Editor-in-Chief Dr Richard Horton or Executive Editor Dr Pamela Das, please call +44 (0) 20 7424 4949 E) tony.kirby@lancet.com
Journal
The Lancet