Mathers BM, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, Myers B, Ambekar A, Strathdee SA, for the Reference Group to the United Nations on HIV and Injecting Drug Use.
International Harm Reduction Conference 2010, Liverpool UK
Needle and syringe programs (NSP) and opioid substitution treatment (OST) are implemented in an increasing number of countries worldwide. Theseinterventions must be implemented to scale and must successfully reach significant proportions of IDU populations. Global and regional estimates of NSP and OST coverage are lacking, but necessary to understand progress towards achieving an adequate response to HIV among IDUs.
The Reference Group to the United Nations on HIV and Injecting Drug Use undertook a systematic review of data describing NSP and OST service provision worldwide, gathering data from: peer-reviewed literature searches (1864 documents reviewed); online searches for non-peer-reviewed material (751 documents); document hand-searches (462 documents identified); requests for data from relevant organisations and individuals (300 personal/official communications plus 95 documents received). A multi-stage process of country-level consultation with experts from various sectors in-country was used to obtain feedback on data accuracy and completeness.
NSPs have been introduced in 82 countries containing 81% of the estimated global IDU population (GIP). Worldwide, <10% of IDUs access NSPs per year; only 8 countries (3% GIP) achieved a level of >50%. The extent of needle-syringe distribution varies substantially between countries; globally, fewer than 20 needles-syringes are distributed per IDU per year. Eastern Europe has the highest regional IDU prevalence, but less than 1 syringe is distributed per IDU per month. OST has been introduced in 73 countries (64% GIP), with approximately 1.2 million people in treatment. Only 65 countries (61% GIP) have implemented both NSP and OST.
Even where countries have introduced these core HIV-prevention interventions, the scale of implementation varies widely, and few have achieved coverage that may contain or reduce HIV epidemics among IDUs. These results confirm an urgent need for NSP and OST to be expanded globally.