The Global Network of People living with HIV/AIDS (GNP+) and the International Community of Women Living with HIV and AIDS (ICW) have this week released their joint position paper, Injecting Drug Users and Access to HIV Treatment. The paper highlights inequalities in antiretroviral access for injecting drug user (IDUs) worldwide, and calls for UNAIDS and other global policymakers to stand firm against attempts to deny or limit access to harm reduction services like needle exchanges, as well as support equal access to anti-HIV drugs worldwide.
Recent UNAIDS estimates suggest that one in ten of all new HIV infections worldwide are due to injecting drug use. Injecting drug use is driving fast-growing epidemics in Eastern Europe & Central Asia, Asia & the Pacific, Latin America and North Africa.
It is often the case that in these countries people who inject drugs are largely stigmatised and disenfranchised minorities, and they have complicating harm-reduction interventions - where they exist - often making prevention outreach, testing and treatment an overwhelmingly difficult task.
For example, HIV infection rates amongst Thailand's IDU is around 40%, but a 2004 report by Human Rights Watch highlights government-sponsored judicial killings, arbitrary arrests, and other human rights abuses against Thai IDUs.
In their press release announcing their position paper GNP+ and ICW say they "were shocked to find that injecting drug users have a disproportioned low level of access to antiretroviral therapy." In Russia - where the HIV epidemic is currently exploding - 85% of all HIV-positive individuals contracted the virus through injecting drug use, but the Russian government excludes active HIV-positive drug users from receiving free anti-HIV medication.
Some studies have suggested that individuals with a history of IDU are disproportionately non-adherent to anti-HIV therapy compared with non-IDUs. Consequently, due to concerns over the emergence of resistance - with treatment repercussions that affect both the individual and the wider community if resistant HIV is transmitted - both HIV clinicians and policymakers are being overly wary of prescribing antiretrovirals to IDUs.
However, a large Canadian study published earlier this year in the journal, AIDS, comparing rates of resistance in antiretroviral-naive individuals with and without a history of injecting drug use, concluded that there are no major significant differences between rates of resistance of the two groups during the first two and a half years of therapy.
"We believe that being an active drug user is not a valid criterion for denying an individual access to treatment and care," says former IDU, Mauro Guarinieri, Chair of GNP+. "Antiretroviral therapy is a proven means to improve the prognosis and quality of life of all people living with HIV and AIDS."
"Antiretroviral therapy is a starting point," continues Guarinieri. "It provides an incentive for HIV-positive injecting drug users to make contact with healthcare services. These services can facilitate prevention, HIV voluntary counselling and testing as well as AIDS care, support and treatment.They are also a prime entry point for the treatment of other co-morbidities like TB and hepatitis B and C."
GNP+ and ICW's position paper also urges international HIV donors, like the United States' PEPFAR programme, as well as individual governments, to adopt and promote harm reduction as best public health practice. "Governments that limit access to needle and syringe exchange, to opioid substitution therapies and related services do more as endangering the lives of injecting drug users, their sexual partners and children," adds ICW's Carmen Tarrades, another former IDU. "These governments are actively supporting the spread of HIV and AIDS. They make the HIV pandemic worse."
The full joint position paper, available in English, Spanish and Russian can be downloaded from both the GNP+ and the ICW websites.