WHO, UNODC and others have committed to scaling up access to antiretroviral therapy (ART) and have confirmed that people who inject drugs should have equitable and universal access to HIV/AIDS prevention, care and treatment.
While this guide has been produced specifically for countries in the WHO
South- East Asia and Western Pacific Regions, it will also be useful for countries
where people who inject drugs are entering HIV/AIDS care and treatment.
While a large proportion of individuals with HIV in the South-East Asia and Western Pacific Regions inject drugs, they are much less likely to receive ART when compared with persons who have acquired HIV through other routes.
Globally, drug users have reduced access to and utilization of ART, and
initiate treatment at more advanced stages of infection. People with a history of
injecting drug use (IDU) have lower rates of access to ART, even in developed countries with relatively good access in the general population.
Studies show that some clinicians may be reluctant to prescribe ART to
HIV infected people who inject drugs, due to the common belief that such people have lower levels of adherence which, in turn, may lead to elevated rates of
antiretroviral (ARV) resistance. Studies show that resistance to ARVs is similar among people who inject drugs and those who do not. Where comprehensive HIV care has been provided to people who inject drugs in an accessible and non-judgemental way, high proportions of patients have been attracted to and retained in
effective treatment. Combining HIV/AIDS care with substance dependence treatment services (including harm reduction, detoxification and opioid substitution therapy [OST]) and psychosocial services has been particularly successful.
In addition to the general principles governing the care and treatment of
people living with HIV/AIDS (PLWHA), the following specific principles should be applied to people who inject drugs:
- ART is as effective for people who inject drugs as for other people with HIV/AIDS.
- Given appropriate support, former and current users of injection drugs can adhere to and have equal success on ART.
- Current or past drug use should not be a criterion for deciding on who should receive ART.
- Special attention should be paid to the particular needs of former and current users of injection drugs, including those related to substance dependence, comorbidities and coinfections.
- A public health policy that acknowledges and addresses the need to treat both substance dependence and HIV/AIDS improves patient wellbeing, reduces stigma and promotes delivery of comprehensive, ethical medical care.
- The most effective response consists of a combination of prevention, care, treatment and support within a harm reduction framework.
- Provision of quality OST for opioid-dependent people who inject drugs is an important component of HIV/AIDS care and treatment, and is highly effective.
- A supportive environment, upholding the human rights and dignity of people who inject drugs and helping to expand and improve access to drug dependence treatment, should be ensured.
- Countries with HIV epidemics fuelled by IDU should respond immediately to the needs of people who inject drugs with preventive and treatment services.
This guide is designed to complement the global ART guidelines and is based on the WHO publications Antiretroviral therapy for HIV infection in adults and adolescents (2006) and the draft HIV/AIDS treatment and care for injecting drug users, clinical protocol for the WHO European Region (2006).
The guide is designed for primary care physicians who provide care and
treatment to individuals infected with HIV through IDU. It may also be useful for other health-care providers such as nurses, pharmacists, addiction specialists and professionals in other health-related fields. Although some patients would have used injection drugs in the past and are not current users, many who require HIV treatment will continue to inject drugs. This guide is designed to provide a practical and detailed approach to ART and addiction treatment, although supplementary documents will be useful.