When someone who has HIV uses a needle and syringe to inject drugs, HIV can stay on the injecting equipment. If someone else then uses the same equipment, HIV can pass into their body.
HIV and people who use drugs
- People who inject drugs are 35 times more likely to have HIV than people who don’t.
- Of all new HIV infections in 2021, 10% were among people who inject drugs. This rises to 20% outside of sub-Saharan Africa.
- Between 10-30% of people who inject drugs are women, but they are more likely than men to have HIV.
There are various ways to consume drugs, such as injecting, snorting, inhaling, smoking or swallowing them. Injecting drugs causes a greater risk of HIV compared to consuming drugs in other ways.
Drug use is criminalised in many countries which makes people who use drugs fearful of accessing HIV services.
Why are people who use drugs at higher risk of HIV?
The effect of drugs can make people do things they wouldn’t normally do, like forgetting to use a condom or engaging in risky sexual activities, increasing their risk of HIV.
Women who use drugs often experience physical and sexual violence which puts them at risk of HIV. They are often the last in a group to take drugs, meaning they are more likely to use a needle that has already been used.
Drug use and possession is illegal in many countries. So, people who use drugs tend to avoid seeking healthcare for fear of others finding out that they use drugs.
Because drug use is criminalised, people who use drugs often live or take drugs in underground, hidden places, making it harder for services to reach them.
Healthcare workers, the police and other law enforcement agents are often discriminatory towards people who use drugs. This stops them from wanting to access HIV services.
How can HIV services meet the needs of people who use drugs?
Harm reduction services aim to prevent HIV and reduce other harms associated with drug use. These services can reduce the number of new HIV infections to practically zero.
- Needle and syringe programmes
Needle and syringe programmes (NSPs) give people who inject drugs new, sterile needles and other drug equipment at little or no cost, so they don’t have to use shared needles.
- Opioid agonist therapy
Opioid agonist therapy (OAT) is a medicine (such as methadone or buprenorphine) which replaces an opiate (such as heroin). This helps people to reduce or stop injecting drugs, which reduces their HIV risk.
- Drug consumption rooms
Drug consumption rooms (DCRs) are where people can go to inject drugs under medical supervision. This decreases the risk of HIV because they can get new injecting equipment and learn how to inject safely.
- Safer crack smoking resources
Smoking crack cocaine can cause sores, burns or cuts on the lips or mouth. Safe crack kits can reduce the sharing of pipes and the use of broken ones, which can transmit HIV.
People who use drugs are not all in one place. To reach as many people as possible, provide HIV services at:
- fixed places
- mobile facilities, such as vans
- outreach programmes where people often gather
- vending machines
Most people who inject drugs are men. This means women are often ignored by harm reduction services. Make sure that harm reduction services meet the needs of women as well as men.
Involve people who use drugs in the design and delivery of HIV services. This way the service is more likely to meet their needs.
Provide education and sensitisation training for healthcare staff to help reduce negative attitudes among healthcare workers towards people who use drugs. This can encourage people who use drugs to use and return to healthcare services.
What systemic changes could reduce the risk of HIV for people who use drugs?
The 'war on drugs' seeks to punish rather than support people who use drugs, often denying them health services. A better approach to drug use is to support rather than punish people who use drugs, respecting their human rights and providing healthcare.
Criminalisation drives people who inject drugs away from health and HIV services. When drug use is decriminalised and people who inject drugs can access harm reduction, HIV infections fall.
Law enforcement authorities must stop criminalising the possession of needles and syringes and stop 'crackdowns' on people who inject drugs.
These are places where people who use drugs can be forced to go to stop drug use. But are ineffective and violate people’s rights. Human rights bodies have called for their immediate closure.
Despite the proven benefits, harm reduction services are not available in many countries and access is insufficient in most.
One of the biggest barriers to harm reduction is a lack of funding, which limits its effectiveness.
Some countries have legal age restrictions for harm reduction services. Removing these restrictions would allow people who are under 18 to access them. This is important, as evidence shows that people often start injecting drugs during adolescence.