Drug use as a driver of HIV risks

Abstract

Purpose of Review We reviewed papers published in 2012–2013 that focused on re-emerging and emerging injection and non-injection drug use trends driving HIV risk behaviors and transmission in some parts of the world. Recent Findings While HIV incidence has declined in many countries, HIV epidemics remain at troubling levels among key drug using populations including females who inject drugs (FWID), FWID who trade sex, sex partners of people who inject drugs (SP-PWID), young PWID, and people who use non-injection drugs in a number of low- and middle- income countries such as in Central Asia, Eastern Europe, Southeast Asia, and parts of Africa. Summary HIV epidemics occur within contexts of global economic and political forces, including poverty, human rights violations, discrimination, drug policies, trafficking, and other multi-level risk environments. Trends of injection and non-injection drug use and risk environments driving HIV epidemics in Central Asia, Eastern Europe, Southeast Asia, and parts of Africa call for political will to improve HIV and substance use service delivery, access to combination HIV prevention, and harm reduction programs.

Women, drugs and HIV

“…FWID are more stigmatized and discriminated against than their male counterparts as reported from several countries (El-Bassel et al, 2014a). Stigma is prevalent through all strata of society starting with their own families, friends and neighbours to service providers and law enforcement.…”

“…Overlap between sex work and injecting drug use is especially high in parts of Eastern Europe and Central Asia and is a growing concern in some Latin American countries, such as Mexico (El-Bassel et al, 2014a; Morris et al, 2013). Women engaging in both the sex trade and use of illicit drugs are more likely to share needles/syringes and other injection paraphernalia amongst themselves and their clients, have unprotected sex with their clients as well as their intimate partners, have higher rates of STIs and they are also more likely to experience sexual violence and incarceration (Azim et al, 2006; Des Jarlais, Feelemyer, Modi, Arasteh, & Hagan, 2012; N.…”

“…FWID are more likely to have MWID as sex partners (El-Bassel et al, 2014a). Women’s relationships with their intimate male partners who also use drugs are complicated and dynamic.…”

“…Violence - both physical and sexual- is common and the experience of and the threat of violence serves to marginalize women further. Moreover, the intimate partner often controls decisions on condom use (Des Jarlais, Feelemyer, Modi, Arasteh, Mathers, et al, 2012), and lower rates of condom use have been reported by women who use drugs with both clients and their intimate partners (El-Bassel et al, 2014a). …”

Chronicity, crisis, and the ‘end of AIDS’

“…Twenty-two million people living with HIV are not accessing ART and later diagnosis remains a significant barrier to HIV treatment scale up (UNAIDS, 2016). Many individuals, particularly women, sex workers, men who have sex with men (MSM), transgender persons, those who engage in injection and non-injection drug use, migrants, and refugees continue to face discrimination, stigma, and lack of access to HIV information, testing, and treatment due to various policies and practices that uphold structural and social barriers (Arreola et al, 2015; Baral, Sifakis, Cleghorn, & Beyrer, 2007; Baral et al, 2012; Baral et al, 2013; Beyrer & Karim, 2013; Beyrer et al, 2014; Dellar, Dlamini, & Karim, 2015; El-Bassel, Shaw, Dasgupta, & Strathdee, 2014; Galeucia & Hirsch, 2016; Harrison, Colvin, Kuo, Swartz, & Lurie, 2015; Karim et al, 2010; Mayer, Grinsztejn, & El-Sadr, 2016; Tanser, Bärnighausen, Vandormael, & Dobra, 2015; Weine & Kashuba, 2012). …”