Rescuing people with HIV who use drugs. Comment (2010)

Injecting drug use is the most hidden dimension of the global HIV epidemic. Yet drug use is expanding across the world. As many as 16 million people inject drugs in at least 148 countries. Around 3 million (but perhaps as many as 6•6 million) people inject drugs and are HIV positive. Outside sub-Saharan Africa, about a third of HIV-related disease can be attributed to injecting drug use. Even within Africa, drug use is becoming an increasingly important driver of the epidemic.
Most countries have used the criminal justice system, not the health system, to address the problems of people who use drugs. But these legal approaches have failed. Criminalisation has reduced access to health care for people at risk of drug use. Legal approaches do nothing to tackle the root causes or risk environments of drug use (it might actually make them worse). Put simply, locking people up does not work.
As the Series of papers we publish today shows, governments should reject law enforcement and embrace health solutions - specifically, policies of harm reduction (see panel for a definition, together with other definitions of commonly used terms in this Series). Each nation's epidemic of HIV-related disease is different, calling for unique tailored approaches to control and defeat. But at the centre of any response to the virus in people who use drugs is combination prevention - a mix of safe-injection programmes and packages of care (eg, opioid substitution therapy and antiretroviral therapy) aimed at alleviating the risk environment faced by drug users. These initiatives could avert as many as two-thirds of HIV infections that are associated with drug use. The case for universal access to these prevention programmes is scientifically sound and morally urgent. [Extract]