Publications

Meth/amphetamine use and associated HIV: Implications for global policy and public health
Degenhardt, L. Mathers, B. Guarinieri, M. Panda, S. Phillips, B. Strathdee, S. Tyndall, M. Wiessing, L. Wodak, A. Howard, J. and the Reference Group to the United Nations on HIV and injecting drug use.
International Journal of Drug Policy 2010, Volume 21 published online, 25 August 2010

Amphetamine type stimulants (ATS) have become the focus of increasing attention worldwide. There are understandable concerns over potential harms including the transmission of HIV. However, there have been no previous global reviews of the extent to which these drugs are injected or levels of HIV among users. A comprehensive search of the international peer-reviewed and grey literature was undertaken. Multiple electronic databases were searched and documents and datasets were provided by UN agencies and key experts from around the world in response to requests for information on the epidemiology of use. Amphetamine or methamphetamine (meth/amphetamine, M/A) use was documented in 110 countries, and injection in 60 of those. Use may be more prevalent in East and South East Asia, North America, South Africa, New Zealand, Australia and a number of European countries. In countries where the crystalline form is available, evidence suggests users are more likely to smoke or inject the drug; in such countries, higher levels of dependence may be occurring. Equivocal evidence exists as to whether people who inject M/A are at differing risk of HIV infection than other drug injectors; few countries document HIV prevalence/incidence among M/A injectors. High risk sexual behaviour among M/A users may contribute to increased risk of HIV infection, but available evidence is not sufficient to determine if the association is causal. A range of possible responses to M/A use and harm are discussed, ranging from supply and precursor control, to demand and harm reduction. Evidence suggests that complex issues surround M/A, requiring novel and sophisticated approaches, which have not yet been met with sufficient investment of time or resources to address them. Significant levels of M/A in many countries require a response to reduce harms that in many cases remain poorly understood. More active models of engagement with M/A users and provision of services that meet their specific needs are required.

To view the full article online go to the Internal Journal of Drug Policy website: www.elsevier.com




HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage
Mathers, B. Degenhardt, L. Ali, H. Wiessing, L. Hickman, M. Mattick, R. P. Myers, B. Ambekar, A. Strathdee, S. A. for the 2009 Reference Group to the UN on HIV and Injecting Drug Use.
The Lancet 2010, published online, 1 March 2010.

Background:
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.

Methods:
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.

Findings:
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.

Interpretation:
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.

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To view the full article online go to The Lancet website: www.thelancet.com

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The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review
Mathers, B. Degenhardt, L. Phillips, B. Wiessing, L. Hickman, M. Strathdee, S. Wodak, A. Panda, S. Tyndall, M. Toufik, A. Mattick, R. P. and the Reference Group to the United Nations on HIV and injecting drug use.
The Lancet 2008, Volume 372 published online, 24 September 2008

Background:
Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide. Our aim was to determine the prevalence of injecting drug use among individuals aged 15–64 years, and of HIV among people who inject drugs.

Methods:
We did a systematic search of peer-reviewed (Medline, EMBASE, and PubMed/BioMed Central), internet, and grey literature databases; and data requests were made to UN agencies and international experts. 11 022 documents were reviewed, graded, and catalogued by the Reference Group to the UN on HIV and Injecting Drug Use.

Findings:
Injecting drug use was identified in 148 countries; data for the extent of injecting drug use was absent for many countries in Africa, the Middle East, and Latin America. The presence of HIV infection among injectors had been reported in 120 of these countries. Prevalence estimates of injecting drug use could be ascertained for 61 countries, containing 77% of the world’s total population aged 15–64 years. Extrapolated estimates suggest that 15·9 million (range 11·0–21·2 million) people might inject drugs worldwide; the largest numbers of injectors were found in China, the USA, and Russia, where mid-estimates of HIV prevalence among injectors were 12%, 16%, and 37%, respectively. HIV prevalence among injecting drug users was 20–40% in five countries and over 40% in nine. We estimate that, worldwide, about 3·0 million (range 0·8–6·6 million) people who inject drugs might be HIV positive.

Interpretation:
The number of countries in which the injection of drugs has been reported has increased over the last decade. The high prevalence of HIV among many populations of injecting drug users represents a substantial global health challenge. However, existing data are far from adequate, in both quality and quantity, particularly in view of the increasing importance of injecting drug use as a mode of HIV transmission in many regions.

To view the full article online go to The Lancet website: www.thelancet.com

To view a Word.doc version of the paper click here

To view the appendces of this paper click here


PRESS RELEASE: UN Report shows increased spread of HIV through drug injection
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