The spread of HIV among IVDUs highlights many development issues. It is notable that some of the countries and communities most at risk from HIV and injecting drug use are often some of the least developed. Drug use and HIV affect the most vulnerable and marginalised groups within communities, from slum populations in New Delhi and hill tribes in Northern Thailand, to disadvantaged young people in Central and Eastern Europe. When IVDUs are women, the stigma and vulnerability they face is even worse.

Communities in remote areas, which are marginalised and have little control over their economic and social development, are natural habitats for the cultivation, trafficking and consumption of drugs. Production leads to economic dependence on drug traffickers rather than to social and economic development. Increased drug use also leads to increased health problems in producer countries, especially where the use and sharing of needles for injecting drugs facilitates the spread of HIV (Ahmed 1988). Risk behaviours leading to HIV transmission through shared needles and syringes are closely linked to development problems such as poverty and lack of sustainable livelihoods, exploitation, inadequate education and political repression. The exact nature of the links between risk behaviours and specific development problems remains unclear but exploring these links may make a significant contribution to increasing understanding of both development and the epidemic (Deany 2000).

Injecting drug use poses an enormous threat to sustainable human development. In some countries the scale of injecting drug use creates a potentially massive group of susceptible individuals for the further spread of HIV as once HIV enters the injecting population, countries can expect large and sustained HIV epidemics.

Drug use often provokes moralistic or judgmental attitudes and responses. Perceiving (and treating) drug users as a ‘species apart’ may reinforce a sense of moral superiority, but it is unproductive and indefensible. Potentially, anyone could become a drug user or find themselves the parent, partner, child, sibling, colleague or friend of a user. Stigmatising and marginalising injecting drug users are likely to leave them alienated, fearful, and out of touch with the support and services they may most need.

Legal and ethical factors are also creating challenges to the enabling environment. For example, the illegal nature of drug use can lead young people to hide their drug consumption, preferring to inject rather than risk detection through the smell of smoking. This is despite the risk that injecting poses for HIV transmission through clandestine sharing of injecting equipment (Hart 1989).

Countries experiencing these epidemics may lack the capacity to develop policy and programmatic responses which deal appropriately with drug use. Where responses are developed, they mainly target the long-term goals of eradication of drug supply and drug use, rather than the more pressing problem of HIV transmission. The relationship between drug use and HIV transmission differs between countries and changes to policies and programmes must therefore be developed separately through a process of ongoing analysis, policy dialogue and monitoring of responses.

There is a growing body of knowledge and experience in the development and implementation of effective HIV prevention responses among IVDUs and an increased willingness on the part of my countries to try to these in order to try to prevent or limit a HIV epidemic tried. These include drug and HIV/AIDS policy reform, methods for involving affected communities in developing responses, outreach and peer education, needle and syringe exchange, and drug substitution programmes to decrease injecting.

Despite recent expansion of responses, within individual countries, these tend to be several years behind the pace and scale of the actual epidemic. This appears to be the result of a range of factors closely linked to development and including:

• The current policy environment, making it difficult for community-based programmes to prevent HIV among injecting drug users.
• Lack of policy dialogue between sectors of government responsible for responses to HIV and drug use.
• Economic, social and political dislocation, leading to increases in drug injecting, needle sharing and, consequently, HIV.
• Low community capacity, in terms of skills, resources and experience to respond to HIV among IVDUs.
• Injecting drug users, especially women, being demonised for their drug use, rather than supported, placing them at particular risk of both human rights abuses and HIV infection.
• Donor agencies and countries alike failing to recognise the long-term threat to development posed by HIV and injecting drug use.

The challenge is to find new ways to build the capacity of communities to understand and respond more effectively to this emerging development problem. At the same time, donors, governments and the international community need to be persuaded to make HIV prevention among injecting drug users a much more urgent global priority, as well as a local reality.

Reference

Deany. HIV and Injecting Drug Use: A New Challenge to Sustainable Human Development UNDP HIV and Development Programme: UNDP Asia-Pacific Regional Programme on HIV and Development. 2000.