Addressing Injecting Drug Use in Asia and Eastern Europe
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While the global HIV incidence dropped about 20 % in the past 10 years, HIV incidences among people who inject drugs (PWID) in Asia and Europe continue to increase and to account for high proportions of new HIV infections among PWID globally. Great changes have been observed in this region, such as progressing from rejection to acceptance of harm reduction strategies in Asian countries, but no such change has occurred in Eastern European countries. China has quickly scaled up harm reduction activities nationwide, resulting in the decline of HIV incidence and HIV prevalence among PWID since 2006. However, insufficient scaling up of harm reduction programs in other countries has failed to slow down their HIV epidemics. In Eastern European countries where the spread of HIV among PWID is the most severe, only about 15 % of funding for harm reduction programs are from domestic sources. Strong political and financial commitment from countries in this region is urgently needed to quickly scale up evidence-based harm reduction strategies in order to prevent the HIV epidemic from spreading rapidly from PWID to the heterosexual general population.
KeywordsInjecting drug use HIV/AIDS Harm reduction Antiretroviral treatment Asia Eastern Europe People who inject drugs (PWID) HIV infection among PWID
Conflict of Interest
Zunyou Wu declares that he has no conflict of interest.
Cynthia X. Shi declares that she has no conflict of interest.
Roger Detels declares that he has no conflict of interest.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.UNODC. World drug report 2012. Vienna: UNODC; 2012.Google Scholar
- 4.•• UNAIDS. Global report 2012: UNAIDS report on the global AIDS epidemic. Geneva: UNAIDS; 2012. The annual UNAIDS reports on the HIV/AIDS epidemic provide comprehensive overviews on the global epidemiology of HIV, including testing, treatment, and risk behaviors of the most-at-risk populations. The 2012 report is based on data from 186 reporting countries and summarizes the current progress in reaching the 2015 targets outlined in the 2011 United Nations Political Declaration on HIV and AIDS.Google Scholar
- 10.Solomon SS, Celentano DD, Srikrishnan AK, Vasudevan CK, Murugavel KG, Iqbal SH, et al. Low incidences of human immunodeficiency virus and hepatitis C virus infection and declining risk behaviors in a cohort of injection drug users in Chennai, India. Am J Epidemiol. 2010;172(11):1259–67.PubMedCrossRefGoogle Scholar
- 12.World Health Organization. Russian Federation: Summary country profile for HIV/AIDS treatment scale-up. http://www.who.int/hiv/HIVCP_RUS.pdf. 2005. Accessed December 29 2012.
- 22.Ministry of Health of the People’s Republic of China. 2012 China AIDS response progress report. Beijing: Ministry of Health; 2012.Google Scholar
- 23.Vuong T, Ali R, Baldwin S, Mills S. Drug policy in Vietnam: a decade of change? Int J Infect Dis. 2012;23(4):319–26.Google Scholar
- 25.Ding Y, Detels R, He N. Circumstances of initiation into new-type drug use among adults in Shanghai: Are there differences by types of first new-type drug used? Drug Alcohol Depend. 2013; doi: 10.1016/j.drugalcdep.2012.12.019.
- 32.• Hammett TM, Des Jarlais DC, Kling R, Kieu BT, McNicholl JM, Wasinrapee P, et al. Controlling HIV Epidemics among injection drug users: eight years of cross-border HIV prevention interventions in Vietnam and China. PLoS One. 2012;7(8):e43141-e. This article reports on one of the longest studies of HIV prevention among PWID in Asia. The research found that a peer-based needle/syringe exchange intervention was strongly correlated with significant reductions in HIV incidence through 96 months.CrossRefGoogle Scholar
- 33.•• MacArthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, et al. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ. 2012;345:e5945. This article provides a systematic review and meta-analysis of studies that assessed the impact of OST in relation to HIV incidence. OST was associated with a 54 % reduction in risk of HIV infection among PWID.PubMedCrossRefGoogle Scholar
- 34.World Health Organization. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Geneva: World Health Organization; 2004.Google Scholar
- 37.Liu E. Factors influencing client retention in methadone maintenance treatment clinics in China [dissertation]. Los Angeles: University of California, Los Angeles; 2008.Google Scholar
- 38.Hsieh J. Perceived barriers to post-release participation in methadone maintenance treatment: Perspectives of compulsory drug detoxification center detainees in Yunnan, China [dissertation]. Los Angeles: University of California, Los Angeles; 2013.Google Scholar
- 39.• Jolley E, Rhodes T, Platt L, Hope V, Latypov A, Donoghoe M, et al. HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy. BMJ Open. 2012;2:e001465. This article provides a systematic review of the risk factors associated with HIV prevalence among PWID in Central and Eastern Europe and Central Asia and a discussion of the response to HIV and the policy environments in these regions.PubMedCrossRefGoogle Scholar
- 45.Zhao Y, Shi CX, McGoogan JM, Rou K, Zhang F, Wu Z. Methadone maintenance treatment and mortality in HIV-positive people who inject opioids in China. Bull World Health Organ. 2013;91:93–101.Google Scholar
- 52.Malta M, Bastos FI, Silva CMFP, Pereira GFM, Lucena FFA, Fonseca MGP, et al. Differential survival benefit of universal HAART access in Brazil: a nation-wide comparison of injecting drug users versus men who have sex with men. J Acquir Immune Defic Syndr. 2009;52(5):629–35.PubMedCrossRefGoogle Scholar
- 58.Smith K, Bartlett N, Wang N. A harm reduction paradox: comparing China's policies on needle and syringe exchange and methadone maintenance. Int J Infect Dis. 2012;23(4):327–32.Google Scholar