7. 1-7. 2 Introduction and aims

7.1 Introduction

Section 7 provides an overview of HIV and people who inject drugs.

This section is important because HIV transmission by injecting drug use accounts for the majority of new infections in many countries.

This is why UNAIDS and WHO include people who inject drugs as a key HIV population.

People who have injected drugs, even if they no longer do this, are already marginalised and are often excluded from medical care. They might also be reluctant to access health care because of negative experiences in the past

There are also medical issues to be aware of.

• People who inject drugs can be at a higher risk of other infections. These include HIV, TB, hepatitis B and C and skin infections. The risk of overdose is also very real, especially when drugs are contaminated with other substances, such as fentanyl.
• Potential interactions between ART and heroin, recreational drugs and opioid agonist drugs like buprenorphine and methadone.
• Social factors that often prevent access to medical care and treatment, including criminalisation.
• Although it involves different but related issues, many countries report high levels of drug use by gay and bisexual men linked to chemsex that include
  stimulant use, injecting drugs and problems with overdose and addiction. This needs new interventions to be developed that are different to services developed based on heroin use.

7.2 Aims for this section

Section 7 provides an introduction to the following issues. 

• Why people who inject drugs are a key HIV population.
• Principles of universal access to the best medical care.
• Beliefs and realities around treatment for people living with HIV who use drugs.
• Known and potential interactions between illicit drugs and ART.
• Known and potential interactions with methadone an buprenorphine.
• Awareness of chemsex and the importance of different support services.

Last updated: 1 January 2023.