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Towards combination HIV prevention for injection drug users: addressing addictophobia, apathy and inattention

Strathdee, Steffanie A.a; Shoptaw, Stevenb; Dyer, Typhanye Pennimanc; Quan, Vu Minhd; Aramrattana, Apinunefor the Substance Use Scientific Committee of the HIV Prevention Trials Network

Current Opinion in HIV and AIDS: July 2012 - Volume 7 - Issue 4 - p 320–325
doi: 10.1097/COH.0b013e32835369ad
INJECTING DRUG USE AND HIV: Edited by Lisa Maher and Nick Walsh

Purpose of review Recent breakthroughs in HIV-prevention science led us to evaluate the current state of combination HIV prevention for injection drug users (IDUs). We review the recent literature focusing on possible reasons why coverage of prevention interventions for HIV, hepatitis C virus (HCV) and tuberculosis among IDUs remains dismal. We make recommendations for future HIV research and policy.

Recent findings IDUs disproportionately under-utilize voluntary HIV counseling and testing (VCT), primary care and antiretroviral therapy (ART), especially in countries that have the largest burden of HIV among IDUs. IDUs present later in the course of HIV infection and experience greater morbidity and mortality. Why are IDUs under-represented in HIV-prevention research, access to treatment for both HIV and addiction, and access to HIV combination prevention? Possible explanations include addictophobia, apathy, and inattention, which we describe in the context of recent literature and events.

Summary This commentary discusses the current state of HIV-prevention interventions for IDUs including VCT, needle and syringe program (NSP), opioid substitution therapy (OST), ART and pre-exposure chemoprophylaxis (PrEP), and discusses ways to work towards true combination HIV prevention for IDU populations. Communities need to overcome tacit assumptions that IDUs can navigate through systems that are maintained as separate silos, and begin to take a rights-based approach to HIV prevention to ensure that IDUs have equitable access to life-saving prevention and treatments.

aUC San Diego Division of Global Public Health, Department of Medicine

bUCLA Departments of Family Medicine and Psychiatry and Biobehavioral Sciences

cDepartment of Epidemiology and Biostatistics University of Maryland College Park

dThe Johns Hopkins University Bloomberg School of Public Health, Maryland, USA

eThe Department of Family Medicine and Center for Substance Abuse Research, Research Institute for Health Sciences, Chiang Mai University, Thailand

Correspondence to Steffanie A. Strathdee, PhD, Harold Simon Professor, Associate Dean of Global Health Sciences, Chief, Division of Global Public Health, University of California, San Diego School of Medicine, USA. Tel: +1 858 822 1952; fax: +1 858 534 7566; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.