the hiv epidemic among people who inject drugs

The HIV Epidemic among People who Inject Drugs

Thomas KerrDirector, Urban Health Research Initiative,

BC Centre for Excellence in HIV/AIDSSt. Paul’s Hospital, Providence Health Care

Associate Professor, Division of AIDSDepartment of Medicine, University of British Columbia

People who Inject Drugs: The Global Situation

• 11 - 21 million PWID in 151 countries

• 0.8 – 6.6 million PWID living with HIV/AIDS

• Growing epidemics in former Soviet Union/Eastern Europe & Southeast Asia driven primarily by PWID and transmission to their partners

Mathers et al., Lancet 2008; Mathers et al., Lancet 2010; UNAIDS, 2012

49 countries with HIV prevalence among PWID 22-50% greater than the in general population (UNAIDS, 2012)

Injection Drug Use & HIV/AIDS

Mathers et al., The Lancet, 2008

Access to Evidence-based HIV Prevention & Treatment

• 57 countries reporting: 37% of PWID receiving an HIV test annually

• NEP in 82 countries: 5% of injections covered by sterile syringes

• OST in 71 countries: 8 per 100 PWID covered with OST

Mathers et al., Lancet, 2010Degenhardt et al., 2010; UNAIDS, 2012

Access to Evidence-based HIV Prevention & Treatment

• 57 countries reporting: 37% of PWID receiving an HIV test annually

• NEP in 82 countries: 5% of injections covered by sterile syringes

• OST in 71 countries: 8 per 100 PWID covered with OST

• 47 countries reporting ART for PWID: 4 per 100 PWID receiving ART

Mathers et al., Lancet, 2010Degenhardt et al., 2010; UNAIDS, 2012

AIDS & Behavior, in press

The Lancet, 2010

Journal of Infectious Diseases, 2011

Global heroin supply increased by 380% from 1980-2010Price of heroin in Europe decreased by 79%

Conclusions

• PWID suffer from high rates of preventable HIV infection

• Evidence-based interventions exist but access remains low

• Enforcement and incarceration have failed to reduce the use and supply of drugs and have contributed to the spread of HIV infection and treatment failure

• The barriers to scale-up of prevention and treatment programs are social and structural in nature