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Political Declaration Target 2 - People Who Inject Drugs
Halve the transmission of HIV among people who inject drugs by 2015
Injecting drug users (IDUs) represent a significant proportion of people acquiring new HIV infections in several regions, but a general lack of data makes it difficult to quantify the extent of the problem. The HIV prevalence among IDUs varies a lot from country to country, which makes it difficult to make global statements. However, all regions have reported a high prevalence of HIV amongst the IDU population. It is estimated that IDUs make up between 5 and 10 percent of people living with HIV globally.
Positively, in countries with consistent reporting of data since 2009, HIV prevalence amongst IDUs has tended to decline or remain stable, rather than increase. This may indicate that more IDUs are accessing sterile injecting equipment.
However, it is hard to monitor the extent to which prevention, care and treatment services (such as HIV testing and counselling, needle and syringe programmes, opioid substitution therapy and antiretroviral therapy) are preventing new HIV infections.
Data is often not nationally representative (due to some services only being available in certain cities), and often the size of the IDU population is unknown. There are limited reliable estimates of the size of the IDU population in any given region. As a result, the coverage and uptake of prevention services remains low, and has not substantially increased since 2011.
What still needs to be done?
- Increase coverage for needle and syringe exchange programmes as well as opioid substitution therapy. In the first instance, more advocating is needed to influence governments to approve these essential harm reduction initiatives. Existing initiatives need to be further expanded.
- Make more of an effort to reach IDUs with sexual risk reduction strategies. Prevention programmes specific to IDUs need to work in conjunction with promoting safer sexual behaviour.
- Increase domestic funding for harm reduction programmes. Globally, international donors provide the majority of funding for harm reduction services. However, many countries with IDU-driven HIV epidemics are middle-income countries, meaning that the amount of international finance available to them is limited.
- A majority of the countries that identified prevention of HIV among IDUs as a national priority (27/45) have reported that they are on track to meet the target. However, this conclusion is not supported by the data that is available on HIV prevalence.
- After 2015, many middle-income countries will cease to receive support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. This puts harm reduction initiatives in those countries in turmoil, as national budgets are unlikely to be sustainable enough to include spending on harm reduction.