Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed

HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community (by sexual transmission). Here, we summarise evidence on the effectiveness of individual-level approaches to prevention of HIV infection; rev...

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Veröffentlicht in:The Lancet (British edition) Jg. 376; H. 9737; S. 285 - 301
Hauptverfasser: Degenhardt, Louisa, Mathers, Bradley, Vickerman, Peter, Rhodes, Tim, Latkin, Carl, Hickman, Matt
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Kidlington Elsevier Ltd 2010
Elsevier
Schlagworte:
Antiviral agents
Biological and medical sciences
Harm Reduction
HIV Infections - etiology
HIV Infections - prevention & control
HIV Infections - therapy
Human immunodeficiency virus
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infectious diseases
Internal Medicine
Medical sciences
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Substance Abuse, Intravenous - complications
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Infection
Human
Prevention
Immunopathology
Drug addiction
Intravenous administration
Methodology
Viral disease
AIDS
Immune deficiency
ISSN:0140-6736, 1474-547X, 1474-547X
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Zusammenfassung:HIV can spread rapidly between people who inject drugs (through injections and sexual transmission), and potentially the virus can pass to the wider community (by sexual transmission). Here, we summarise evidence on the effectiveness of individual-level approaches to prevention of HIV infection; review global and regional coverage of opioid substitution treatment, needle and syringe programmes, and antiretroviral treatment; model the effect of increased coverage and a combination of these three approaches on HIV transmission and prevalence in injecting drug users; and discuss evidence for structural-level interventions. Each intervention alone will achieve modest reductions in HIV transmission, and prevention of HIV transmission necessitates high-coverage and combined approaches. Social and structural changes are potentially beneficial components in a combined-intervention strategy, especially when scale-up is difficult or reductions in HIV transmission and injection risk are difficult to achieve. Although further evidence is needed on how to optimise combinations of interventions in different settings and epidemics, we know enough now about which actions are effective: the challenge is to deliver these well and to scale.
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ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(10)60742-8