The effectiveness of harm reduction in preventing HIV among injecting drug users.
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.
Wodak
Alex
A
Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst NSW. awodak@stvincents.com.au
Maher
Lisa
L
D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D040261:Harm Reduction; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects* / Q000191:economics; D007267:Injections / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D008691:Methadone / Q000191:economics; D018671:Needle-Exchange Programs / Q000191:economics; D009517:New South Wales / Q000453:epidemiology; D011314:Preventive Health Services / Q000191:economics; D016730:Program Development; D015397:Program Evaluation
D013287:Illicit Drugs; D008691:Methadone