Previous reviews have examined the existence of HIV prevention, treatment, and care
services for injecting drug users (IDUs) worldwide, but they did not quantify the
scale of coverage. We undertook a systematic review to estimate national, regional,
and global coverage of HIV services in IDUs.
We did a systematic search of peer-reviewed (Medline, BioMed Central), internet, and
grey-literature databases for data published in 2004 or later. A multistage process
of data requests and verification was undertaken, involving UN agencies and national
experts. National data were obtained for the extent of provision of the following
core interventions for IDUs: needle and syringe programmes (NSPs), opioid substitution
therapy (OST) and other drug treatment, HIV testing and counselling, antiretroviral
therapy (ART), and condom programmes. We calculated national, regional, and global
coverage of NSPs, OST, and ART on the basis of available estimates of IDU population
sizes.
By 2009, NSPs had been implemented in 82 countries and OST in 70 countries; both interventions
were available in 66 countries. Regional and national coverage varied substantially.
Australasia (202 needle-syringes per IDU per year) had by far the greatest rate of
needle-syringe distribution; Latin America and the Caribbean (0.3 needle-syringes
per IDU per year), Middle East and north Africa (0.5 needle-syringes per IDU per year),
and sub-Saharan Africa (0.1 needle-syringes per IDU per year) had the lowest rates.
OST coverage varied from less than or equal to one recipient per 100 IDUs in central
Asia, Latin America, and sub-Saharan Africa, to very high levels in western Europe
(61 recipients per 100 IDUs). The number of IDUs receiving ART varied from less than
one per 100 HIV-positive IDUs (Chile, Kenya, Pakistan, Russia, and Uzbekistan) to
more than 100 per 100 HIV-positive IDUs in six European countries. Worldwide, an estimated
two needle-syringes (range 1-4) were distributed per IDU per month, there were eight
recipients (6-12) of OST per 100 IDUs, and four IDUs (range 2-18) received ART per
100 HIV-positive IDUs.
Worldwide coverage of HIV prevention, treatment, and care services in IDU populations
is very low. There is an urgent need to improve coverage of these services in this
at-risk population.
UN Office on Drugs and Crime; Australian National Drug and Alcohol Research Centre,
University of New South Wales; and Australian National Health and Medical Research
Council.
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