Is human immunodeficiency virus/acquired immunodeficiency syndrome decreasing among Brazilian injection drug users? Recent findings and how to interpret them

"The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil

“…However, other factors may contribute to the observed decline, including saturation and changes in the drug-using scene, making interpretation of the current findings rather tentative 14 .…”

“…Accordingly, high HCV infection prevalence rates (65-98%) have been reported in different contexts 7,8,9,10 . Recently, a declining prevalence of blood-borne pathogens has been described among IDUs in some contexts, such as the United States, Spain, and Brazil 11,12,13,14 . Despite such auspicious findings, the prevalence of HCV infection remains unacceptably high.…”

Reconstructing the AIDS epidemic among injection drug users in Brazil

“…This may reflect saturation, spontaneous behavior change, or the effects of preventive programs. The effectiveness of the latter has been demonstrated by numerous studies among IDUs using different indicators and outcomes, such as HIV prevalence and incidence, risk behaviors, and prevalence of different blood-borne infections 19,20,21,22,23,24 .…”

Descentralização, AIDS e redução de danos: a implementação de políticas públicas no Rio de Janeiro, Brasil

“…As razões para o declínio observado em três cidades que integraram estudo multicêntrico e foram avaliadas de forma coordenada [Rio de Janeiro, Santos (São Paulo) e Salvador (Bahia)] compreendem: a saturação desse segmento populacional, cujo contingente de suscetíveis é relativamente restrito; transformações na cena de uso, com uma redução do contingente de UDI em atividade 21 ; a mudança espontânea do comportamento dos UDI (no sentido de comportamentos mais seguros); além do papel de programas preventivos, apoiando os usuários de drogas e reforçando sua mudança comportamental espontânea, no sentido de prá-ticas de menor risco 20 .…”