Publications
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.
To view the detailed country reports of this paper click here
To view the full article online go to The Lancet website: www.thelancet.com
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To view the appendices of this paper click here
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
To view press release click here
The Benefits and risks of pharmaceutical opioids: Essential treatment and diverted medication. A global review of availability, extra-medical use, injection and the association with HIV
- Louisa Degenhardt, Briony Larance, Bradley Mathers, Tasnim Azim,Adeeba Kamarulzaman, Richard Mattick, Samiran Panda, Abdalla Toufik,Mark Tyndall, Lucas Wiessing and Alex Wodak
Forthcoming Papers
Mortality among people who inject drugs: Results of a systematic review and meta-analysis
This paper is currently underreview
Women who inject drugs: A review of their risks, experiences and needs
Women who inject drugs are an important but highly stigmatized population. Compared to male injectors, women who inject drugs are more likely to become infected with HIV. They also face higher rates of violence, move from drug use to drug dependence faster, face higher levels of social stigma and are more likely to die. These risks are due in part to women’s higher levels of risky injecting behaviours such as injecting with used equipment contaminated with other injectors’ blood and their higher likelihood of having injection related problems. Risks also come from their higher levels of risky sexual behaviours such as having unsafe sex and exchanging sex for money. Because of these different risks and outcomes, women who inject have different needs than men from service providers and treatment facilities, however, most of these services are provided in a gender-blind fashion which may not sufficiently address the needs of these women.
This paper will be released in the third quarter of 2010.
To receive a copy of this paper on its release please email the Reference Group Secretariat: IDUreferencegroup@med.unsw.edu.au
2002-2006 Reference Group Publications