The Role of Drug Abuse in the Evolving HIV Epidemic
Steffanie A. Strathdee, Ph.D.
According to the National Institute on Drug Abuse’s International Program, there is "no greater public health goal for addiction researchers than to help stem the continued spread of the intertwined epidemics of HIV and drug abuse." More than 15 million people have been diagnosed with drug use disorders worldwide. There are an estimated 13.2 million injection drug users (IDUs) in 130 countries. Although 10 percent of the world’s HIV infections are directly attributed to needle-sharing among IDUs, outside of Africa this percentage rises to 30 percent. In the United States, of the nearly 14,000 HIV infections associated with injection drug use diagnosed in 2005, 45 percent and 24 percent were heterosexual males and female IDUs, respectively; 16 percent were attributed to men who have sex with men (MSM)-IDUs; 15 percent were heterosexual partners of IDUs; and less than 1 percent were children of IDU parents.* Explosive HIV epidemics among IDUs have occurred in both developed and developing countries, including such recent examples as Ukraine, the Russian Federation, Vietnam, Iran, and China, with emerging epidemics in Pakistan, Tajikistan, Afghanistan, and northwestern Mexico. In mature HIV epidemics in developed and developing countries, diffusion from IDUs to non-IDU populations has been documented, with growing attention needed on bridging the populations (e.g., sex worker-IDUs, MSM-IDUs, paid blood donors). Examples of successful interventions to reduce HIV among drug users have been reported at the levels of the individual, social network, and community. In a recent meta-analysis of behavioral IDU interventions, the most successful strategies focused on both injection and sexual risks, but only 50 percent of the interventions were based on behavioral theory and only
6 percent had more than one followup visit. Only 12 percent were conducted outside the United States, even though 78 percent of IDUs reside in developing countries. Despite the heterogeneity of IDU-associated HIV epidemics between and even within countries, lessons from HIV prevention stories among drug users worldwide suggest that HIV risk environments are socially produced, and thus, prevention is a shared responsibility.
*The percentages listed are rounded and may not equal 100 percent.