Treatment training manual

7. 3 Drug users and HIV overview

“Access to HIV treatment should not be artificially restricted due to political or social constraints. Specifically there should be no categorical exclusion of injection drug users from any level of care. All patients who meet eligibility criteria and want treatment should receive it, including IDUs, sex business workers and other populations.” – WHO, 2004

Injecting drug use is main route of HIV transmission in many countries

Transmission of HIV through injecting drug use accounts for the majority of new infections in: Russia, Ukraine, Central Asia, some countries in Eastern Europe, South East Asia, North Africa, Iran, Afghanistan, Pakistan, Nepal, Indonesia, Portugal and the Southern Cone of Latin America.

People at risk of becoming HIV positive through injection drug use are often among the poorest and most marginalised sections of society: ethnic minorities, unemployed, youth, migrants, and sex workers.

Recreational drugs and interactions with ART

There are potential interactions between injection and non-injection recreational drugs, substitution therapies and HIV treatment (ART).

There is little or no research to address this.

Drug users sometimes excluded from ART programmes

In many countries drug users are routinely excluded from ART. This is because of a widespread belief that they are less likely to adhere to treatment and less likely to have a good response to treatment.

Reluctance to offer ART to people who inject drugs (PWIDs) includes not only injecting drug users (IDUs), but also those on medically prescribed substitution treatment such as methadone, users of non-injection drugs, and former drug users.

Excluding drug users from ART is unjustified

Beliefs that drug users are non-adherent and untreatable are based on prejudice rather than science.

Several studies suggest drug users can achieve high levels of adherence and that they benefit from treatment just like any other group of people with HIV. This is particularly when ART is provided with adherence, social and medical support.

  • A large Western European study of people receiving ART found no significant difference between IDUs and non-drug users in rise in CD4 count or treatment response.
  • Another study in Canada found that drug users who were adherent to treatment gained the same increases in CD4 count as adherent non-drug users.
  • In an American mobile needle exchange programme, 77% of drug users offered peer support along with ARVs achieved reduction of viral load to less than 400 copies/mL and a 25% increase in CD4 count after six months.
  • A French study of people receiving ARVs found that those also receiving buprenorphine achieved higher levels of adherence (78.1%) than either former drug users (65.5%) or active IDUs not on buprenorphine (42.1%).

Last updated: 1 December 2015.