Featured news from NHIVNA
HIV-related news from NAM
Which interventions are best to reduce HIV infections among drug users?
Mara Kardas-Nelson, 2012-08-01 08:40:00
HIV infections among drug users currently make up 30% of new infections globally. Their social marginalisation makes them an especially difficult group to target for public health and HIV interventions. Yet researchers, civil society, and drug user organisations are considering innovative strategies to reduce the risk of HIV infection.
Presenting at a panel entitled "Evidence-Based Prevention for Injecting Drug Users: It Works!," which took place last week at the 19th International AIDS Conference (AIDS 2012), David Wilson of the University of New South Wales said that needle-syringe exchange programmes were cost-effective, resulting in either stable or reduced prevalence of both HIV and hepatitis C.
Looking at eight countries in Europe and Asia, Wilson did a "post-op" retrospective analysis of data from 2005 to 2010. Citing the example of Tajikistan, Wilson said that the onset of needle-syringe exchange programmes resulted in a reduction in self-reported sharing of syringes; while hepatitis C prevalence dropped significantly, HIV prevalence remained stable. But Wilson estimates that the epidemics would have boomed were it not for these programmes: he expects that prevalence of both would have been 20 to 30% higher among drug users in the country. Wilson says this reduction will result in future financial savings, given a reduction in new infections, treatment and death.
Noting variance, overall Wilson said that considering reduction in prevalence, "[needle-syringe exchange programmes] are exceptional…in terms of their value for money." As of 2010, the average cost per syringe distributed was US$0.32; the average cost of reaching an additional drug user was $60.
But more could be done. Wilson noted that while average spending on programmes increased by 300%, overall per capita distribution was still low, with the average of only a few dozen syringes given per drug user per year. Kazakhstan is the only exception, having "saturated" the population.
Despite successes, harm reduction programmes are battling to keep people enrolled. Xiaobin Cao of the Chinese Centers for Disease Control and Prevention presented on loss-to-follow-up in China's methadone maintenance treatment programme, which has been widely congratulated for its massive - and fast - scale-up, with 749 clinics opening up in 28 provinces in under a decade. But while 145,000 drug users are served monthly, "the high drop out is one challenge that we are facing,” said Cao.
In a study considering 1511 drug users from 2004 to 2010, two-thirds of subjects dropped out over a period of six years. Cao noted that most participants who did leave left soon after their enrolment, primarily because of arrest or immigration; the drop-out rate remained stable after the first year and a half of the study period. Cao said that strong support from family members was key to ensuring continued participation; he also noted that long distance between the participant and clinic hindered long-term participation, as did relatively low daily dosage of methadone, and the presence of a drug user in the participant's life.
Source:1
