HIV and risk environment for injecting drug users: the past, present, and future

We systematically reviewed reports about determinants of HIV infection in injecting drug users from 2000 to 2009, classifying findings by type of environmental influence. We then modelled changes in risk environments in regions with severe HIV epidemics associated with injecting drug use. Of 94 stud...

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Bibliographic Details
Published in:The Lancet (British edition) Vol. 376; no. 9737; pp. 268 - 284
Main Authors: Strathdee, Steffanie A, Hallett, Timothy B, Bobrova, Natalia, Rhodes, Tim, Booth, Robert, Abdool, Reychad, Hankins, Catherine A
Format: Journal Article
Language:English
Published: Kidlington Elsevier Ltd 24.07.2010
Elsevier
Subjects:
Addictive behaviors
Adult and adolescent clinical studies
Biological and medical sciences
Drug abuse
Drug addiction
Female
General aspects
Harm Reduction
Health Services Needs and Demand
HIV Infections - epidemiology
HIV Infections - etiology
Human viral diseases
Humans
Infectious diseases
Internal Medicine
Kenya - epidemiology
Male
Medical sciences
Models, Theoretical
Pakistan - epidemiology
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Risk Factors
Socioeconomic Factors
Substance Abuse, Intravenous - complications
Ukraine - epidemiology
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Kenya
Pakistan
Ukraine
Kenya, Nairobi
Human
Immunopathology
Drug addiction
Retroviridae
Risk
AIDS
Immune deficiency
Lentivirus
Infection
Virus
Medicine
Viral disease
Risk factor
Environment
Human immunodeficiency virus
ISSN:0140-6736, 1474-547X, 1474-547X
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Summary:We systematically reviewed reports about determinants of HIV infection in injecting drug users from 2000 to 2009, classifying findings by type of environmental influence. We then modelled changes in risk environments in regions with severe HIV epidemics associated with injecting drug use. Of 94 studies identified, 25 intentionally examined risk environments. Modelling of HIV epidemics showed substantial heterogeneity in the number of HIV infections that are attributed to injecting drug use and unprotected sex. We estimate that, during 2010–15, HIV prevalence could be reduced by 41% in Odessa (Ukraine), 43% in Karachi (Pakistan), and 30% in Nairobi (Kenya) through a 60% reduction of the unmet need of programmes for opioid substitution, needle exchange, and antiretroviral therapy. Mitigation of patient transition to injecting drugs from non-injecting forms could avert a 98% increase in HIV infections in Karachi; whereas elimination of laws prohibiting opioid substitution with concomitant scale-up could prevent 14% of HIV infections in Nairobi. Optimisation of effectiveness and coverage of interventions is crucial for regions with rapidly growing epidemics. Delineation of environmental risk factors provides a crucial insight into HIV prevention. Evidence-informed, rights-based, combination interventions protecting IDUs' access to HIV prevention and treatment could substantially curtail HIV epidemics.
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SAS devised the topic for systematic review and modelling, was lead author of the report, and oversaw the review process. TBH devised and carried out the modelling scenarios and wrote corresponding methods, results, and interpretation sections. CAH, TR, and NB extracted and categorised data for systematic review, assisted with collection of secondary data for the modelling scenarios, and helped to write the report and interpret results. RB and RA provided primary data for modelling scenarios, and assisted with interpretation of results and report revision.
Contributors
ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(10)60743-X