1. audio file - high quality (mp3 format, 76.1 MB)

The session focused on global responses to HIV prevention among injecting drug users.

Suphak Vanichseni et al. from Bangkok reported early results from the Bangkok TDF trial, showing that the proportion of participants reporting injecting in the last 3 months reduced by half and needle and syringe sharing reduced from 17% to 3%. Participants in the trial were probvided with a prevention package, consisting of risk reduction counselling, methadone, condoms and bleach but not sterile needles and syringes. 

Two papers presented data from Needle and Syringe Program (NSP) participants. Carolyn Day et al. reviewed 10 years of national data from Australia's Needle and Syringe Survey to identify factors associated with low and declining HIV prevalence among IDUs. Thomas Kerr used data from an ongoing prospective cohort of Vancouver IDUs to examine the impact of NSP policy changes between 2000 and 2002 on HIV-related injection risk practices. Results indicated substantial declines in the proportion of IDUs reporting syringe borrowing and lending following the implementation of efforts to decentralize NSPs and remove distribution limits. The importance of prisons as a site for HIV transmission was reinforced by a presentation by Motevalian from Iran and Dvoriak reported on 2 pilot studies demonstrating the feasibility and effectiveness of buprenorphine treatment in the Ukraine.

The importance of prisons as a site for HIV transmission cannot be underestimated particularly due to the high prevalence of injecting drug use among prisoners. Seyed Abbas Motevalian  et al. showed high levels of injecting risk in prisoners and despite the availability of methadone, high levels of unprotected sex and a lack of interventions to reduce sexual transmission.

Opioid substitution treatment (methadone or buprenorphine) is a critical component of an effective response to HIV among injecting drug users. Sergii Dvoriak reported on 2 pilot studies have shown buprenorphine to be feasible and effective in the Ukraine, where over the last 10 years injecting drug use has increased markedly as a mode of HIV transmission. Although participants indicated a reduction in drug use, crime, risk behaviour and an increased quality of life and the findings were similar across other countries in the region (Lithuania and Poland), public policy is still ambivalent towards OST, illustrating the importance of political advocacy.

Overall, the session examined at a number of key components of HIV prevention among injecting drug users. While people who inject drugs remain at risk of HIV in many settings, particularly those injecting in prison, there is increasing evidence that easy access to clean injecting equipment and opioid substitution are effective interventions. The politics of these issues remains difficult.