A situation update on HIV epidemics among people who inject

A situation update on HIV epidemics among people who inject drugs and national responses in South-East Asia Region.

The authors explore the magnitude of and current trends in HIV infection among people who inject drugs and estimate the reach of harm reduction interventions among them in seven high-burden countries of the South-East Asia Region. Their data are drawn from the published and unpublished literature, routine national HIV serological and behavioural surveillance surveys and information from key informants. Six countries ( Thailand, Myanmar, Nepal, Indonesia, India, and Bangladesh) had significant epidemics of HIV among people who inject drugs. In Thailand, Indonesia, Bangladesh, Myanmar and India, there is no significant decline in the prevalence of HIV epidemics in this population. In Nepal, north-east India, and some cities in Myanmar, there is some evidence of decline in risk behaviours and a concomitant decline in HIV prevalence. This is countered by the rapid emergence of epidemics in new geographical pockets. Available programme data suggest that less than 12 000 of the estimated 800 000 (1.5%) people who inject drugs have access to opioid substitution therapy, and 20-25% were reached by needle-syringe programmes at least once during the past 12 months. A mapping of harm reduction interventions suggests a lack of congruence between the location of established and emerging epidemics and the availability of scaled-up prevention services. Harm reduction interventions in closed settings are almost nonexistent. To achieve significant impact on the HIV epidemics among this population, governments, specifically national AIDS programmes, urgently need to scale up needle-syringe programmes and opioid substitution therapy and make these widely available both in community and closed settings.

This broad mapping, across 7 high drug use burden South East Asian countries with significant, longstanding HIV epidemics among people who inject drugs, draws from a variety of data sources to paint a picture of national prevention responses. In addition to the strikingly inadequate reach of harm reduction programmes, current surveillance systems are not designed to pick up new epidemics. Indonesia is the only country with a national strategy (2005-2009) to guide HIV prevention, treatment, and care in prison settings – the very settings that are known to be high-risk environments worldwide for HIV transmission. Methadone and buprenorphine are unavailable and too expensive in most countries. Tensions between supply/demand reduction and harm reduction approaches call out now for enlightened leadership at all levels to implement effective HIV prevention programmes to cover at least 50-60% of people who inject drugs.