Injecting drug use is estimated to

Injecting drug use is estimated to
account for just less than one-third of new
infections outside Sub-Saharan Africa.
In spite of the importance of preventing
HIV among injecting drug users, coverage
of HIV prevention for this population is
at best 5% across the globe2 .
Beyond the physical risks associated
with drug injection, drug users are
vulnerable to HIV because of their social
and legal status. Ironically, in many
countries this means that HIV
interventions are not legally available to
drug users, or that drug users are
unable or unwilling to access them for
fear of recrimination or arrest.
Prisoners
Prisons are sites for drug use, unsafe
injecting practices, tattooing with
contaminated equipment, violence, rape
and unprotected sex. Conditions in most
prisons make them extremely high-risk
environments for HIV transmission,
leading them to be called ‘incubators’ of
HIV, hepatitis C and tuberculosis. They
are often overcrowded and offer poor
nutrition with limited access to health
care. Both male and female prisoners
often come from marginalized populations,
such as injecting drug users or sex
workers, who are already at increased
risk of HIV infection.
HIV prevention and treatment efforts in
prisons should be important components
of national AIDS strategies not only
because of the undoubted benefits in
public health terms but also as a matter
of fundamental human rights.
Furthermore, most prisoners at some
point return to the community. People
retain the majority of their human rights
when they enter prison, losing only
those that are necessarily and explicitly
limited because of incarceration. They
retain such rights as freedom from cruel
and inhuman punishment, and the right
to the highest attainable standard of
health care.
Over 20 years into the HIV response
these populations remain key to the
dynamics of the epidemic and continue
to be disproportionately infected with
HIV and affected by it. Unfortunately the
political and institutional commitment
required to address the economic,
social, gender and other disparities
which fuel AIDS epidemics and
exacerbates its impact on people with
these behaviours or in some settings
remains unacceptably low.
Enhanced leadership, resources and
prevention and even treatment
programmes will prove inadequate
unless the capacity of individuals and
communities to decrease their
vulnerability to infection is improved.
What is needed is a radical reorientation
of existing responses to HIV prevention
and impact mitigation; a refocused
approach to prevention that moves from
rhetoric about vulnerability to making
vulnerability reduction a priority.