Time to act: a call for comprehensive responses to HIV in people who use drugs

Time to act: a call for comprehensive responses to HIV in people who use drugs

The published work on HIV in people who use drugs shows that the global burden of HIV infection in this group can be reduced. Concerted action by governments, multilateral organisations, health systems, and individuals could lead to enormous benefits for families, communities, and societies. The authors review the evidence and identify synergies between biomedical science, public health, and human rights. Cost-effective interventions, including needle and syringe exchange programmes, opioid substitution therapy, and expanded access to HIV treatment and care, are supported on public health and human rights grounds; however, only around 10% of people who use drugs worldwide are being reached, and far too many are imprisoned for minor offences or detained without trial. To change this situation will take commitment, advocacy, and political courage to advance the action agenda. Failure to do so will exacerbate the spread of HIV infection, undermine treatment programmes, and continue to expand prison populations with patients in need of care.

This article is a clarion call to action on HIV and drug use. It argues cogently for the evidence-informed, rights-based public health policies that are urgently needed to address continuing HIV transmission among people who inject drugs. Support for the concept of decriminalisation of drug users is found in a panel on the results of Portugal’s pragmatic, humanistic approach – Portugal decriminalised personal consumption and possession for the consumption of drugs in 2000. A second panel highlights the WHO/UNODC/UNAIDS comprehensive approach for HIV prevention, treatment, and care for people who inject drugs. Informative figures show HIV prevalence in people who inject drugs by region and the growth in opium production in Afghanistan from 1980 to 2009. A personal testimonial underscores why compulsory drug detention centres should be closed and replaced by evidence-informed, human-rights-based drug treatment centres. An assessment matrix compares HIV responses to people who inject drugs in China, Malaysia, Russia, Ukraine, Vietnam, and the USA. A further panel lays out clear points of action for each of 6 key stakeholders: governments, ministries of health, donors, providers, researchers, and people who use drugs. If you are short of time, read the panels, figures, and tables of this excellent paper. If you have more time, read the paper – it draws attention to the findings of each of the six overview articles in this Lancet series