title: Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward.
abstract: We review evidence for effectiveness, cost-effectiveness, and coverage of antiretroviral therapy (ART) for injecting drug users (IDUs) infected with HIV, with particular attention to low-income and middle-income countries. In these countries, nearly half (47%) of all IDUs infected with HIV are in five nations--China, Vietnam, Russia, Ukraine, and Malaysia. In all five countries, IDU access to ART is disproportionately low, and systemic and structural obstacles restrict treatment access. IDUs are 67% of cumulative HIV cases in these countries, but only 25% of those receiving ART. Integration of ART with opioid substitution and tuberculosis treatment, increased peer engagement in treatment delivery, and reform of harmful policies--including police use of drug-user registries, detention of drug users in centres offering no evidence-based treatment, and imprisonment for possession of drugs for personal use--are needed to improve ART coverage of IDUs.
authors.affiliation: Open Society Institute, International Harm Reduction Development Program, New York, NY 10019, USA. dwolfe@sorosny.org
authors.forename: Daniel
authors.initials: D
authors.lastname: Wolfe
authors.forename: M Patrizia
authors.initials: MP
authors.lastname: Carrieri
authors.forename: Donald
authors.initials: D
authors.lastname: Shepard
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use; D002681:China; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D016527:Drug Costs; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D008296:Malaysia; D008691:Methadone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use*; D009294:Narcotics / Q000191:economics / Q000627:therapeutic use*; D033262:Narration; D011329:Prisoners; D011330:Prisons; D012426:Russia; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D014455:Ukraine; D014744:Vietnam
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D009292:Narcotic Antagonists; D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone