According to the authors of a systematic review published early online in the Lancet, worldwide coverage of HIV prevention, treatment, and care services in injecting drug user (IDU) populations is very low, and there is an urgent need to improve coverage of these services in this at-risk population.

The authors note that a range of core interventions are effective in preventing HIV in IDUs, including needle and syringe programmes (NSP), treatment of opioid dependence with opioid substitution therapy (OST) leading to reductions in drug injection and HIV risk behaviours), antiretroviral treatment (ART) for HIV-positive IDUs, and condom provision to reduce sexual risk behaviour.  These services form part of a comprehensive package of nine interventions endorsed by the Joint UN Programme on HIV/AIDS (UNAIDS), UN Office on Drugs and Crime (UNODC), and WHO for the prevention, treatment, and care of HIV in IDUs. 

This systematic review looked at data for provision and coverage of HIV prevention, treatment, and care services in IDUs.  It consisted of five major stages, each involving comprehensive searches of particular sources of information, or consultation with national, regional, and global stakeholders. 

The main findings reported were as follows (taken from the abstract):

• By 2009, NSPs had been implemented in 82 countries and OST in 70 countries; both interventions were available in 66 countries. Regional and national coverage varied substantially, with Australasia having the greatest rate of needle-syringe distribution (202 needle—syringes per IDU per year), and Latin America and the Caribbean (0.3 needle—syringes per IDU per year), Middle East and north Africa (0.5 needle—syringes per IDU per year), and sub-Saharan Africa (0.1 needle—syringes per IDU per year) having the lowest rates.

• OST coverage varied from ≤ 1 recipient per 100 IDUs in central Asia, Latin America, and sub-Saharan Africa, to very high levels in Western Europe (61 recipients per 100 IDUs).

• The number of IDUs receiving ART varied from <1 per 100 HIV-positive IDUs (Chile, Kenya, Pakistan, Russia, and Uzbekistan) to > 100 per 100 HIV-positive IDUs in six European countries.

• Worldwide, an estimated two needle—syringes (range 1—4) were distributed per IDU per month, there were eight recipients (6—12) of OST per 100 IDUs, and four IDUs (range 2—18) received ART per 100 HIV-positive IDUs.

The findings for the UK were as follows:

• 188 (range 183-192) needle-syringes are distributed per IDU per year
• There are 90 (range 88-92) OST recipients per 100 IDUs
• The ratio of IDUs receiving ART:100 IDUs living with HIV is 19 (range 11-77)

The authors conclude that although the number of countries with core HIV prevention services is growing, the level of coverage in IDUs is poor in many countries. They note that in countries such as Australia and the UK where HIV prevention interventions were swiftly and widely introduced, HIV outbreaks might have, so far, been averted.  By contrast, there are many countries in eastern Europe and southeast Asia with evidence of substantial HIV epidemics yet there is poor coverage of effective HIV prevention, treatment, and care services.

They say that their findings suggest that, worldwide, there are few countries in which the level of intervention coverage is sufficient to prevent HIV transmission.