title: Barriers to HIV treatment among people who use injection drugs:  implications for 'treatment as prevention'.
abstract: OBJECTIVE
  Recent research has confirmed the efficacy of employing highly active antiretroviral therapy (HAART) to prevent the transmission of HIV. However, barriers to the use of HAART among people who use injection drugs (PWIDs) remain an international concern. We review recent findings regarding factors determining effective HIV treatment among PWIDs and describe their possible impact on efforts to curb HIV incidence using HAART.
  
  
  RESULTS
  Internationally, HIV-seropositive PWIDs continue to experience suboptimal HIV treatment outcomes compared with other risk groups. Recent findings have better elucidated the role of ongoing illicit drug use in limiting access and adherence to HAART. However, recent research has also increasingly demonstrated the important role that social, environmental and structural factors, resulting from the criminalization of PWIDs, have in placing barriers to optimal HAART use among this population.
  
  
  CONCLUSIONS
  Treatment as prevention strategies for PWIDs will only be maximally effective if structural barriers to effective addiction and HIV treatment, which stem from the ongoing criminalization of this population, are addressed.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada. mail: mjmilloy@cfenet.ubc.ca
authors.forename: Michael-John
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000635:transmission; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents