title: Prevention of HIV infection among injection drug users in resource-limited settings.
abstract: Injection drug use contributes to considerable global morbidity and mortality associated with human immunodeficiency virus (HIV) infection and AIDS and other infections due to blood-borne pathogens through the direct sharing of needles, syringes, and other injection equipment. Of approximately 16 million injection drug users (IDUs) worldwide, an estimated 3 million are HIV infected. The prevalence of HIV infection among IDUs is high in many countries in Asia and eastern Europe and could exacerbate the HIV epidemic in sub-Saharan Africa. This review summarizes important components of a comprehensive program for prevention of HIV infection in IDUs, including unrestricted legal access to sterile syringes through needle exchange programs and enhanced pharmacy services, treatment for opioid dependence (ie, methadone and buprenorphine treatment), behavioral interventions, and identification and treatment of noninjection drug and alcohol use, which accounts for increased sexual transmission of HIV. Evidence supports the effectiveness of harm-reduction programs over punitive drug-control policies.
authors.affiliation: Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York 10029, USA. dVlahov@nyam.org
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
authors.forename: Angela M
authors.initials: AM
authors.lastname: Robertson
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D003140:Communicable Disease Control / Q000379:methods*; D055030:Drug Users; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D015819:Substance Abuse, Intravenous / Q000150:complications*
references.citation: AIDS Care. 2010 Mar;22(3):397
references.pmid: 26876272
references.citation: J Urban Health. 1999 Dec;76(4):448-60
references.pmid: 10609594
references.citation: J Subst Abuse Treat. 2006 Dec;31(4):319-28
references.pmid: 17084785
references.citation: J Subst Abuse Treat. 2008 Jul;35(1):87-92
references.pmid: 17933486
references.citation: J Infect Dis. 2003 Dec 15;188(12):1820-6
references.pmid: 14673760
references.citation: AIDS. 2001 Aug;15 Suppl 4:S109-16
references.pmid: 11686459
references.citation: J Urban Health. 2008 Nov;85(6):812-25
references.pmid: 18758964
references.citation: Soc Sci Med. 2009 Feb;68(4):740-8
references.pmid: 19070413
references.citation: Drug Alcohol Depend. 2003 Jul 20;71(1):17-24
references.pmid: 12821202
references.citation: Int J Health Plann Manage. 2005 Jul-Sep;20(3):239-52
references.pmid: 16138737
references.citation: J Acquir Immune Defic Syndr. 2000 Sep 1;25(1):63-70
references.pmid: 11064506
references.citation: Lancet. 2002 Jun 8;359(9322):2011-7
references.pmid: 12076570
references.citation: Int J Drug Policy. 2000 Mar 1;11(1-2):99-112
references.pmid: 10699547
references.citation: Addiction. 2003 Feb;98(2):153-8
references.pmid: 12534419
references.citation: Drug Alcohol Depend. 2000 Apr 1;59(1):17-31
references.pmid: 10706972
references.citation: AIDS. 1999 Apr 16;13(6):F45-51
references.pmid: 10397556
references.citation: Ann Behav Med. 2007 Nov-Dec;34(3):263-74
references.pmid: 18020936
references.citation: Drug Alcohol Depend. 2000 Jul 1;60(1):51-4
references.pmid: 10821989
references.citation: J Acquir Immune Defic Syndr. 2004 Oct 1;37 Suppl 2:S110-8
references.pmid: 15385907
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1999 Jan 1;20(1):73-80
references.pmid: 9928733
references.citation: Addiction. 2008 Sep;103(9):1484-92
references.pmid: 18636999
references.citation: Drug Alcohol Depend. 2005 Aug 1;79(2):137-43
references.pmid: 16002023
references.citation: Am J Drug Alcohol Abuse. 2002;28(2):231-41
references.pmid: 12014814
references.citation: Addiction. 2008 Jul;103(7):1187-97
references.pmid: 18494842
references.citation: Am J Psychiatry. 2005 Aug;162(8):1401-2
references.pmid: 16055760
references.citation: Proc R Soc Med. 1965 May;58:295-300
references.pmid: 14283879
references.citation: J Acquir Immune Defic Syndr. 2005 Aug 1;39(4):471-7
references.pmid: 16010172
references.citation: Health Technol Assess. 2009 Feb;13(14):iii, ix-x, 1-60
references.pmid: 19236820
references.citation: Subst Use Misuse. 2006;41(6-7):953-77
references.pmid: 16809181
references.citation: Arch Gen Psychiatry. 2006 Jan;63(1):102-9
references.pmid: 16389204
references.citation: Soc Sci Med. 2000 Dec;51(12):1771-82
references.pmid: 11128265
references.citation: Lancet. 2008 Nov 15;372(9651):1733-45
references.pmid: 18817968
references.citation: Drug Alcohol Rev. 2008 May;27(3):253-62
references.pmid: 18368606
references.citation: Arch Gen Psychiatry. 1978 Apr;35(4):501-16
references.pmid: 215096
references.citation: Drug Alcohol Depend. 2008 Sep 1;97(1-2):105-13
references.pmid: 18479840
references.citation: J Am Pharm Assoc (Wash). 2002 Nov-Dec;42(6 Suppl 2):S77-82
references.pmid: 12489621
references.citation: Am J Public Health. 2003 Jun;93(6):970-9
references.pmid: 12773364
references.citation: Lancet. 2005 Jul 23-29;366(9482):316-8
references.pmid: 16039335
references.citation: Lancet. 1993 Sep 18;342(8873):742-3
references.pmid: 8103844
references.citation: Ir Med J. 2000 Jul-Aug;93(5):143-6
references.pmid: 11072923
references.citation: Am J Addict. 2002 Winter;11(1):66-74
references.pmid: 11876585
references.citation: Am J Epidemiol. 1997 Dec 15;146(12):994-1002
references.pmid: 9420522
references.citation: Harm Reduct J. 2006 Feb 01;3:4
references.pmid: 16451717
references.citation: PLoS Med. 2008 Dec 9;5(12):e234
references.pmid: 19071954
references.citation: Clin Infect Dis. 2009 Mar 15;48(6):806-15
references.pmid: 19193111
references.citation: Soc Sci Med. 2003 Nov;57(9):1593-608
references.pmid: 12948569
references.citation: Drug Alcohol Depend. 2006 Jul 27;83(3):225-32
references.pmid: 16364566
references.citation: Harm Reduct J. 2009 May 04;6:7
references.pmid: 19413911
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Mar 1;11(3):301-6
references.pmid: 8603266
references.citation: AIDS. 2001 Jul 27;15(11):1329-41
references.pmid: 11504954
references.citation: Addict Behav. 2006 May;31(5):868-79
references.pmid: 16085366
references.citation: Am J Public Health. 2000 Jul;90(7):1100-11
references.pmid: 10897189
references.citation: Am J Epidemiol. 2005 Jun 1;161(11):999-1012
references.pmid: 15901620
references.citation: Addiction. 2003 Nov;98(11):1585-97
references.pmid: 14616185
references.citation: Can HIV AIDS Policy Law Rev. 2004 Apr;9(1):41-5
references.pmid: 15216827
references.citation: Am J Epidemiol. 2002 Jan 15;155(2):169-75
references.pmid: 11790681
references.citation: Harm Reduct J. 2008 Jun 24;5:23
references.pmid: 18577225
references.citation: AIDS Educ Prev. 2005 Feb;17(1 Suppl A):6-20
references.pmid: 15843114
references.citation: Drug Alcohol Depend. 2000 Feb 1;58(1-2):143-52
references.pmid: 10669065
references.citation: Drug Alcohol Depend. 2001 May 1;62(3):225-30
references.pmid: 11295327
references.citation: J Acquir Immune Defic Syndr. 2000 Jul 1;24(3):241-8
references.pmid: 10969348
references.citation: Am J Health Promot. 1997 Sep-Oct;12(1):38-48
references.pmid: 10170434
references.citation: J Acquir Immune Defic Syndr. 2008 Aug 15;48(5):581-9
references.pmid: 18645513
references.citation: Addiction. 2008 Dec;103(12):2017-23
references.pmid: 19469745
references.citation: Clin Psychol Rev. 2008 Jul;28(6):952-62
references.pmid: 18374464
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18 Suppl 1:S133-8
references.pmid: 9663636
references.citation: Drug Alcohol Depend. 2007 Jan 5;86(1):30-6
references.pmid: 16793221
references.citation: Subst Use Misuse. 2006;41(10-12):1349-78
references.pmid: 17002987
references.citation: Drug Alcohol Depend. 2009 Apr 1;101(1-2):92-100
references.pmid: 19101098
references.citation: Eur J Public Health. 2002 Sep;12(3):228-34
references.pmid: 12232964
references.citation: Addiction. 2008 Apr;103(4):660-1
references.pmid: 18339111
references.citation: Public Health Rep. 1999 Sep-Oct;114(5):439-47
references.pmid: 10590766
references.citation: J Subst Abuse Treat. 2003 Apr;24(3):233-9
references.pmid: 12810144
references.citation: JAMA. 2003 Aug 13;290(6):731-5
references.pmid: 12915410
references.citation: J Subst Abuse Treat. 2000 Oct;19(3):247-52
references.pmid: 11027894
references.citation: Addict Behav. 2003 Jun;28(4):785-93
references.pmid: 12726791
references.citation: AIDS. 2000 Mar 31;14(5):605-11
references.pmid: 10780722
references.citation: Cochrane Database Syst Rev. 2003;(2):CD002207
references.pmid: 12804429
references.citation: Cochrane Database Syst Rev. 2003;(2):CD002209
references.pmid: 12804430
references.citation: Addiction. 2006 Apr;101(4):491-503
references.pmid: 16548929
references.citation: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD002025
references.pmid: 15495026
references.citation: J Acquir Immune Defic Syndr. 2002 Oct 1;31(2):237-42
references.pmid: 12394803
references.citation: Lancet. 1998 Jun 13;351(9118):1819-20
references.pmid: 9635989
references.citation: J Epidemiol Community Health. 2009 Mar;63(3):191-6
references.pmid: 19218258
references.citation: Lancet. 2009 Mar 21;373(9668):989-90
references.pmid: 19282025
references.citation: Addiction. 2008 Nov;103(11):1828-36
references.pmid: 18778390
references.citation: J Subst Abuse Treat. 2009 Oct;37(3):277-85
references.pmid: 19339140
references.citation: AIDS. 1997 Jul;11(8):F59-65
references.pmid: 9223727
references.citation: Harm Reduct J. 2005 Aug 25;2:12
references.pmid: 16122382
references.citation: J Acquir Immune Defic Syndr (1988). 1994 Jul;7(7):760-6
references.pmid: 8207660
references.citation: Drug Alcohol Depend. 2000 Feb 1;58(1-2):153-7
references.pmid: 10669066
references.citation: N Engl J Med. 2000 Nov 2;343(18):1290-7
references.pmid: 11058673
references.citation: Drug Alcohol Depend. 1988 Oct;22(1-2):1-7
references.pmid: 2906863
references.citation: Health Place. 2009 Dec;15(4):999-1005
references.pmid: 19464228
references.citation: Am J Public Health. 2000 Mar;90(3):352-9
references.pmid: 10705851
references.citation: Am J Public Health. 1989 Oct;79(10):1355-7
references.pmid: 2782501
references.citation: Drug Alcohol Rev. 2004 Jun;23(2):203-11
references.pmid: 15370027
references.citation: J Clin Psychopharmacol. 1996 Feb;16(1):58-67
references.pmid: 8834420
references.citation: Drug Alcohol Depend. 2006 Oct 15;85(1):12-8
references.pmid: 16621339
references.citation: Eur Addict Res. 2001 Mar;7(1):40-5
references.pmid: 11316925
references.citation: Drug Alcohol Depend. 2007 Mar 16;87(2-3):249-57
references.pmid: 17182196
references.citation: Drug Alcohol Depend. 2009 Jan 1;99(1-3):222-30
references.pmid: 18930603
references.citation: J Subst Abuse Treat. 2000 Jul;19(1):15-22
references.pmid: 10867296
references.citation: J Subst Abuse Treat. 2006 Sep;31(2):163-71
references.pmid: 16919744
references.citation: Peptides. 2000 Jul;21(7):1141-6
references.pmid: 10998549
references.citation: AIDS. 1998 Jan 1;12(1):121-3
references.pmid: 9456269
references.citation: Am J Psychiatry. 1999 Jan;156(1):27-33
references.pmid: 9892294
references.citation: Addiction. 2005 Feb;100(2):150-8
references.pmid: 15679744
references.citation: J Pharmacol Exp Ther. 2002 Nov;303(2):695-703
references.pmid: 12388653
references.citation: AIDS. 2002 Jan 25;16(2):303-4
references.pmid: 11807323
references.citation: Clin Infect Dis. 2004 Mar 15;38(6):890-4
references.pmid: 14999636
references.citation: AIDS. 2008 Aug;22 Suppl 2:S81-92
references.pmid: 18641473
references.citation: Public Health Rep. 1998 Jun;113 Suppl 1:19-30
references.pmid: 9722807
references.citation: AIDS. 2006 Jan 2;20(1):73-83
references.pmid: 16327322
references.citation: AIDS. 2004 Nov 19;18(17):2295-303
references.pmid: 15577542
references.citation: J Acquir Immune Defic Syndr. 2001 Apr 15;26(5):483-9
references.pmid: 11391170
references.citation: Clin Infect Dis. 2003 Dec 15;37 Suppl 5:S451-6
references.pmid: 14648463
references.citation: J Appl Behav Anal. 2008 Winter;41(4):471-80
references.pmid: 19192853
references.citation: J Health Serv Res Policy. 2003 Jul;8(3):134-41
references.pmid: 12869338
references.citation: Subst Use Misuse. 2009;44(5):663-71
references.pmid: 19360539
references.citation: Psychosom Med. 2008 Jun;70(5):606-11
references.pmid: 18519886
references.citation: Lancet. 2004 Nov 27-Dec 3;364(9449):1918-9
references.pmid: 15566992
references.citation: Subst Use Misuse. 2006;41(6-7):777-813
references.pmid: 16809167
references.citation: Drug Alcohol Depend. 2006 Apr;82 Suppl 1:S49-55
references.pmid: 16769446