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      Improving the effectiveness and delivery of pre-exposure prophylaxis (PrEP) to people who inject drugs : Commentaries

      1 , 2 , 3
      Addiction
      Wiley

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          Abstract

          <p class="first" id="P1">Given evidence to date, pre-exposure prophylaxis (PrEP) for people who inject drugs should be implemented alongside efforts to improve access to existing evidence-based HIV prevention interventions, including antiretroviral therapy and opioid agonist treatments. The criminalization and marginalization of people who inject drugs has and will continue to limit the effectiveness of HIV prevention strategies, including PrEP. </p>

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          Most cited references9

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          Acceptability of HIV Pre-exposure Prophylaxis (PrEP) Among People Who Inject Drugs (PWID) in a Canadian Setting

          A recent clinical trial provided evidence that pre-exposure prophylaxis (PrEP) has the potential to prevent HIV infection among people who inject drugs (PWID). We examined willingness to use PrEP among HIV-negative PWID in Vancouver, Canada (n = 543) to inform PrEP implementation efforts. One third (35.4 %) expressed willingness to use PrEP, with adjusted models indicating that younger age, no regular employment, requiring help injecting, engaging in sex work, and reporting multiple recent sexual partners were positively associated with willingness to use PrEP. Although willingness to use PrEP was low, PrEP was acceptable to some PWID at heightened risk for HIV infection.
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            How well do international drug conventions protect public health?

            The Single Convention on Narcotic Drugs in 1961 aimed to eliminate the illicit production and non-medical use of cannabis, cocaine, and opioids, an aim later extended to many pharmaceutical drugs. Over the past 50 years international drug treaties have neither prevented the globalisation of the illicit production and non-medical use of these drugs, nor, outside of developed countries, made these drugs adequately available for medical use. The system has also arguably worsened the human health and wellbeing of drug users by increasing the number of drug users imprisoned, discouraging effective countermeasures to the spread of HIV by injecting drug users, and creating an environment conducive to the violation of drug users' human rights. The international system has belatedly accepted measures to reduce the harm from injecting drug use, but national attempts to reduce penalties for drug use while complying with the treaties have often increased the number of drug users involved with the criminal justice system. The international treaties have also constrained national policy experimentation because they require nation states to criminalise drug use. The adoption of national policies that are more aligned with the risks of different drugs and the effectiveness of controls will require the amendment of existing treaties, the formulation of new treaties, or withdrawal of states from existing treaties and re-accession with reservations. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Willingness to use HIV pre-exposure prophylaxis among opiate users.

              Few studies of pre-exposure prophylaxis (PrEP) to prevent HIV infection have focused on drug users. Between February to September 2013, we asked 351 opiate injectors entering detoxification treatment about HIV risk, knowledge about PrEP, and willingness to use a once daily PrEP pill under one of two randomly assigned effectiveness scenarios-40 % (low) or 90 % (high) effective in reducing HIV risk. Participants were 70 % male and 87 % non-Hispanic White. Only 7 % had heard of a drug to reduce HIV risk, yet once informed, 47 % would be willing to take such a pill [35 % of those in the low effectiveness scenario and 58 % in the high group (p < 0.001)]. Higher perceived HIV risk was associated with greater willingness to take medication. Increasing knowledge of PrEP and the rate of HIV reduction-effectiveness promised will influence its use among targeted high-risk drug users.
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                Author and article information

                Journal
                Addiction
                Addiction
                Wiley
                09652140
                April 2017
                April 2017
                October 12 2016
                : 112
                : 4
                : 580-582
                Affiliations
                [1 ]Department of Epidemiology; Brown School of Public Health; Providence RI USA
                [2 ]Urban Health Research Initiative; British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital; Vancouver BC Canada
                [3 ]Division of AIDS, Department of Medicine; University of British Columbia, St Paul's Hospital; Vancouver BC Canada
                Article
                10.1111/add.13597
                6659115
                27730702
                ad75cd7c-e7d4-4fe8-9b46-1811551de904
                © 2016

                http://doi.wiley.com/10.1002/tdm_license_1

                http://onlinelibrary.wiley.com/termsAndConditions

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