Harm reduction – including needle/syringe programmes, opioid substitution therapy and community distribution of naloxone – is an evidence-based approach to HIV and HCV prevention, treatment and care for people who inject drugs. Harm reduction interventions are essential to achieve the global targets for viral hepatitis elimination and control of HIV/AIDS epidemics. Another contribution of this study is characterizing the demographic characteristics of PWID in Kigali by age, sex assigned at birth, and sexual orientation. The 2020 World Drug Report highlighted the growing demand for injection drugs, particularly among young adults across African countries [2, 32]. This is evidenced by the fact that almost half of participants in our study reported injecting drugs for fewer than 3 years.

Model 3: integration of HIV and substance use services at other facilities

One abstract described counselling without HIV screening in an MMT program in Taiwan [82]. Six papers described programs integrating prevention counselling with HIV screening activities. One paper provided an overview of state-wide integration of HIV services with MMT programs, indicating efficacy in testing linked to pre- and post-test counselling in substance use treatment facilities [44]. Another found evidence of efficacy of HIV and hepatitis B (HBV) counselling and testing, as well as HBV vaccination, in high risk patients in a non-residential drug-rehabilitation program [51].

Harm Reduction

This is because the needles, syringes, or works may have blood in them, and blood can carry HIV. You should not share needles, syringes, or works for injecting silicone, hormones, or steroids for the same reason. In the past decade, NSEP and MAT have succeeded in reducing the rate of HIV infection;meanwhile, there is strong evidence that HAART is effective in reducing HIV transmissionrates and prolonging life59. However, as there is no proven cure for HIV, the best way to reduce infectionrates is to prevent its spread. NSEP is a widely used public health innovation which issignificantly reducing contaminated needle distribution, but the relationship between NSEPand the incidence of HIV is controversial. Only heroin agonist pharmacotherapy isavailable for treating heroin addiction in MAT, despite other substance such as cocaineand amphetamine being injectable.

Search and retrieval of studies

In 2022, WHO published the Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations…. Key populations (men who have sex with men, people who inject drugs, sex workers, trans and gender diverse people and people in prisons) are at increased… See the latest data on HIV among people who inject drugs, and learn what CDC is doing to prevent HIV infections among this population. People with HIV take a combination of HIV medicines (called an HIV treatment regimen) as prescribed to stay healthy. If you have HIV, substance use can make it hard to focus and affect your ability to stick to an HIV treatment regimen.

• Harm reduction – including needle/syringe programmes, opioid substitution therapy and community distribution of naloxone – is an evidence-based approach to HIV and HCV prevention, treatment and care for people who inject drugs.
• Sharing needles, syringes, or other equipment (works) to inject drugs puts people at high risk for getting or transmitting HIV and other infections.
• Most participants, 98% (301), reported getting sterile syringes and needles from pharmacies and 20% (61) reported also getting needles from their networks, including friends and sex partners.
• The sharing of injection equipment appears to be common behavior in both IV drug users who inject frequently and in those who inject less often (Friedland et al., 1985).
• Frequency of needle sharing, sharing of other injection materials, and needle reuse were assessed using 5-item scales ranging from never, rarely, half the time, most of the time, and always.

You may need help to stop or cut down using drugs, but there are many treatment resources available to help you. When you use drugs, you may be more likely to make decisions that increase your chance of getting or transmitting HIV. These include having anal or vaginal sex without HIV prevention tools, such as HIV prevention and treatment medications or condoms, having sex with multiple partners, or exchanging sex for drugs. This change between DSM-IV and DSM-V in substance-related disorders means the movement froma categorical view to dimensional approach. A categorical view is used by clinicians to meetthe needs of reporting for health care planners; on the other hand, a dimensional approachconceptualizes a quantitative disorder that is more useful for the purpose of research8. Substance use disorder is a complex phenotype, and is the result of a series of causalinfluences such as genetic factors, diverse environmental factors, and predicteddrug-induced effects1–4.

By sex at birth, in 2021, people assigned male at birth accounted for 81% (25,900) of the estimated 32,100 new HIV infections, while people assigned female at birth accounted for 24% (6,200) of new HIV infections. According to CDC, the annual number of new HIV infections in 2021, as compared to 2017, decreased among people assigned male at birth but remained stable among iv drug use people assigned female at birth. In 2021, the rate for people assigned male at birth (18.8) was 4 times the rate for people assigned female at birth (4.4). By race/ethnicity, in 2021, according to CDC, Black/African American persons made up approximately 12% of the population of the United States but accounted for 40% (13,000) of the estimated 32,100 new HIV infections.

In contrast, studies describing fully integrated harm reduction approaches reported positive patient perceptions, especially of holistic care provision to address unmet social needs [33,34]. Fifty-one papers met the inclusion criteria; 22 papers described integration at HIV facilities, 20 at substance use facilities and seven at other facilities (sexually transmitted disease (STD) clinic, syringe access sites, emergency department and mobile health van). Across sites, 11 involved screening activities, 29 treatment integration, and nine included services for other comorbidities. There were 18 descriptive studies; 14 cohort studies, seven qualitative studies, four RCT’s, one case-control, two mixed-methods and one cost analysis. However, criminalization of drug use and stigma and discrimination against people who inject drugs contribute to ongoing epidemics of HIV, viral hepatitis and TB. This is because people who inject drugs fail to access harm reduction and other health services.

There are data that describe the IV drug-using population as considerably smaller than the population of gay men at risk. The population of IV drug users that has already been infected with HIV is still concentrated in relatively few urban areas, such as New York City and northern New Jersey. Combining the results of research and improved understanding with the principles of intervention and evaluation presented in the next part of this report can bring the progress we seek in interrupting the spread of HIV among IV drug users and other at-risk groups. Several factors contribute to the geographic variability of HIV seroprevalence rates among IV drug users in the United States. In addition to limited economic resources, the need for a constant supply of drugs probably reduces their mobility, although they appear to travel some, especially to locations where friends can help them obtain drugs. Other IV drug users—for example, prostitutes or those who sell drugs—may be induced to travel by their ability to earn money in new cities.

Integrating HIV and substance use services: a systematic review