The effectiveness of harm reduction in preventing HIV among injecting drug users

Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst NSW.
New South Wales Public Health Bulletin 01/2010; 21(3-4):69-73. DOI: 10.1071/NB10007
Source: PubMed


There is now compelling evidence that harm reduction approaches to HIV prevention among injecting drug users are effective, safe and cost-effective. The evidence of effectiveness is strongest for needle and syringe programs and opioid substitution treatment. There is no convincing evidence that needle and syringe programs increase injecting drug use. The low prevalence approximately 1%) of HIV among injecting drug users reflects the early adoption and rapid expansion of harm reduction in Australia. Countries that have provided extensive needle and syringe programs and opioid substitution treatment appear to have averted an epidemic, stabilised or substantially reduced the prevalence of HIV among injecting drug users. However, despite decades of vigorous advocacy and scientific evidence, the global coverage of needle and syringe programs and opioid substitution treatment falls well short of the levels required to achieve international HIV control.

Download full-text


Available from: Lisa Maher,
  • Source
    • "Given their relatively low costs and evidence of effectiveness , NSPs are recognized as one of the most cost-effective public health interventions ever funded (International, 2012). Studies in numerous countries have repeatedly provided compelling evidence that NSPs are cost-effective both from societal and health sector perspectives (Vickerman, Miners, & Williams, 2008; Wodak & Maher, 2010). A systematic review found that all 12 included studies that examined the impact of NSPs on HIV infection found that NSPs were cost-effective according to the studies' defined willingness-to-pay thresholds (Jones, Pickering, Sumnall, McVeigh, & Bellis, 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
    International Journal of Drug Policy 02/2015; 26 Suppl 1:S5-S11. DOI:10.1016/j.drugpo.2014.11.007 · 2.40 Impact Factor
  • Source
    • "Third, we know that it is possible to avert HIV epidemics among PWID. Large-scale implementation of HIV prevention programs, particularly needle/syringe access programs, when HIV prevalence is very low in a population of PWID can keep the prevalence low (under 5%) indefinitely [10] [11] [17] [18]. It is important to note, however, that there have been instances of outbreaks of HIV when it appeared that HIV was under control in the local PWID population. "
    [Show abstract] [Hide abstract]
    ABSTRACT: After 30 years of extensive research on human immunodeficiency virus (HIV) among persons who inject drugs (PWID), we now have a good understanding of the critical issues involved. Following the discovery of HIV in 1981, epidemics among PWID were noted in many countries, and consensus recommendations for interventions for reducing injection related HIV transmission have been developed. While high-income countries have continued to develop and implement new Harm Reduction programs, most low-/middle-income countries have implemented Harm Reduction at very low levels. Modeling of combined prevention programming including needle exchange (NSP) and antiretroviral therapy (ARV) suggests that NSP be given the highest priority. Future HIV prevention programming should continue to provide Harm Reduction programs for PWID coupled with interventions aimed at reducing sexual transmission. As HIV continues to spread in low- and middle-income countries, it is important to achieve and maintain high coverage of Harm Reduction programs in these locations. As PWID almost always experience multiple health problems, it will be important to address these multiple problems within a comprehensive approach grounded in a human rights perspective.
    06/2013; 2013:346372. DOI:10.1155/2013/346372
  • Source
    • "Implementation of NSP should be highly successful in controlling the HIV epidemic among IDUs as demonstrated in a recent publication from Australia [11]. However, drug use remains illegal in Indonesia and subsequent law enforcement is conflicting with implementation and support for NSP. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The HIV prevalence among injecting drug users (IDUs) in Indonesia reached 50% in 2005. While drug use remains illegal in Indonesia, a needle and syringe program (NSP) was implemented in 2006. Methods In 2007, an integrated behavioural and biological surveillance survey was conducted among IDUs in six cities. IDUs were selected via time-location sampling and respondent-driven sampling. A questionnaire was administered face-to-face. IDUs from four cities were tested for HIV, syphilis, gonorrhoea and chlamydia. Factors associated with HIV were assessed using generalized estimating equations. Risk for sexual transmission of HIV was assessed among HIV-positive IDUs. Results Among 1,404 IDUs, 70% were daily injectors and 31% reported sharing needles in the past week. Most (76%) IDUs received injecting equipment from NSP in the prior week; 26% always carried a needle and those who didn’t, feared police arrest. STI prevalence was low (8%). HIV prevalence was 52%; 27% among IDUs injecting less than 1 year, 35% among those injecting for 1–3 years compared to 61% in long term injectors (p < 0.001). IDUs injecting for less than 3 years were more likely to have used clean needles in the past week compared to long term injectors (p < 0.001). HIV-positive status was associated with duration of injecting, ever been imprisoned and injecting in public parks. Among HIV-infected IDUs, consistent condom use last week with steady, casual and commercial sex partners was reported by 13%, 24% and 32%, respectively. Conclusions Although NSP uptake has possibly reduced HIV transmission among injectors with shorter injection history, the prevalence of HIV among IDUs in Indonesia remains unacceptably high. Condom use is insufficient, which advocates for strengthening prevention of sexual transmission alongside harm reduction programs.
    Harm Reduction Journal 09/2012; 9(1):37. DOI:10.1186/1477-7517-9-37 · 1.26 Impact Factor
Show more