The increasing prevalence of injection drug use in Asia over the last fifteen years has created serious concern about the risk to individual and public health. Directly or indirectly, injecting drug use affects everyone in the community and is regarded as the most dangerous method of administering illicit drugs.

One of the main reasons for this is the association between injection practices and the possibility of contacting HIV/AIDS.

HIV/AIDS

Acquired Immune deficiency syndrome (AIDS) is caused by variants of the human immune deficiency virus (HIV) which reduces the capacity of the boy’s immune system to combat infections. HIV is spread in three ways; through unprotected sexual intercourse and through contaminated blood.

Once affected, there is no cure. Over a period up to approximately 10 years, chronic infections gradually destroy the immune system until AIDS is developed. After being diagnosed with AIDS, the drug user will usually die within a period of two years.

Risk Factors

The particular risk of HIV infection for injecting drug users (IDUs) comes from sharing injecting equipment that contains contaminated blood. The level of risk is thought to be higher than from unprotected sexual intercourse because the HIV is injected directly into the blood or body tissue. IDUs also generally tend to underestimate the importance of condom use in sexual intercourse.

Prevalence of HIV among IDUs

The prevalence of injecting drug use and related infection in Asia has increased since the early 80s and now accounts for the most frequent type of exposure to HIV, next to unprotected sexual intercourse.

Sexual factors contribute to the trend toward injecting drugs. These include the presence of other forms of drug taking, the influence of migrating drug users, the custom of injecting for self-medication, involvement in the cultivation and manufacture of drugs or nearness to drug transhipment routes, and the availability of drugs which are easy to inject.

The Challenge

Within the broad framework of drug demand reduction strategies, the basic challenge for the prevention of HIV in the general population is to provide convincing information while also encouraging and reinforcing behavior which minimizes the risks of transmission by drug use. For IDUs, the additional challenge is to provide specialized services which encourage a change in their existing risky behaviors, especially the use or shared use of injecting equipment. Within the IDU population, there are also groups which are particularly vulnerable because of their circumstances; IDUs in prisons, ethnic minorities with poor participation in the general community, and women who may have subordinate social status, especially from involvement in commercial sex work, in order to address the needs of these groups, a range of programme options are required which consider the particular socio-cultural context of each community.

Injection causes serious health risks to drug users and their partners

Use of Sterile Equipment

.The basic programme models that have been most successfully adopted are the sale of needles and syringes to IDUs at minimum prices through pharmacies or other outlets, and needle/syringe exchange programmes (NSEP). The latter provide sterile needles and syringes in exchange for old ones, and usually include in their aims the distribution of education material. An important principle for community acceptance of thee programmes is ensuring that needles and syringes are properly disposed of after yse and do not pose a threat to the non-IDU community

Peer Education

Many studies have shown that education and behavior change flavoring safer injecting methods and reducing HIV risk among IDUs is most effective and sustainable when it is delivered by peers in a supportive environment. Peer education promotes contact with those IDUs who do not wish to associate with treatment or law enforcement agencies. Developing organizations to provide peer education has been an effective strategy in countries that have allowed them. These organizations also provide programme planners and policy makers with informed advice among IDUs for educational and other interventions. Advocacy on behalf of IDUs can be an important function of these organizations.

Primary Health Care

Because IDUs often come from poor disempowered backgrounds, their access to primary health care is usually limited or non-existent. IDUs often have pressing health problems, including infections associated with drug injecting and malnutrition, along with the full range of health problems which are common to their community. Protection from HIV infection must be seen as one part of a holistic approach to health care.

Drug Treatment and Substitution Programmes

Treatment for drug addiction has been shown to be effective as an HIV prevention strategy, especially when it is available to the drug user at the time when he or she seeks help. Therefore a comprehensive approach towards IDUs should include flexible accessible and caring treatment . Within these systems, drugs substitution programmes are the most commonly used for IDUs who are addicted to opates, and within the developed world, methadone is the preferred prescription. It may be used for gradual withdrawal of various age groups or for long term maintenance in populations of older chronic users. Substitute programmes for not “cure” the addition, but by removing IDUs from lifestyles in the criminal world and attracting them to socially acceptable clinical surroundings, there are better opportunities to decrease injecting and needle sharing behavior, thereby contributing to a decrease of HIV transmission. In Asia, a range of drug substitution programmes under the guidance of WHO is currently being investigated through inter-country trials.

Removing the Barriers to Safer Injection

Examinng the social, cultural and political dimensions of IDU is necessary in order to eliminate use. These barriers may include limited access to factual inforamtion, primary health care and effective treatment. There may also be legal barriers. For examples, in some countries, ‘paraphernalia laws’ consider the possession of injecting equipment as a criminal offense. These laws have the unintended effect of promoting the sharing of injection equipment, since IDUs are usually more fearful of criminal prosecution than the risk of their injection practices. The abolishing of these laws in some countries has not been associated with increasing participation in ellicit drug use, but has prompted safer use by motivated IDUs.