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.
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.
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: firstname.lastname@example.org