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THE NATIONAL ACADEMIES
Institute of Medicine
Board on Global Health
Committee on Prevention of HIV Infection among Injecting Drug Users in High Risk Countries

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Congressional Briefing
Thursday, September 14, 2006
2325 Rayburn House Office Bldg. – 4:00 p.m.

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on

Preventing HIV Infection among Injecting Drug Users in High-Risk Countries:
An Assessment of the Evidence

by

Hugh H. Tilson, Clinical Professor of Public Health Leadership and Adjunct Professor of Epidemiology and Health Policy, School of Public Health, The University of North Carolina at Chapel Hill; and Chair, Committee on Prevention of HIV Infection among Injecting Drug Users in High Risk Countries, Board on Global Health, Institute of Medicine, The National Academies

and

Richard S. Schottenfeld, Professor of Psychiatry, Yale University School of Medicine; and Member, Committee on Prevention of HIV Infection among Injecting Drug Users in High Risk Countries, Board on Global Health, Institute of Medicine, The National Academies

In 2005, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Bill & Melinda Gates Foundation commissioned the Institute of Medicine to undertake an expedited review of the scientific evidence on the effectiveness of strategies to prevent HIV transmission through contaminated injecting equipment, with a specific focus on countries throughout Eastern Europe, the Commonwealth of Independent States, and Asia, where injecting drug use is a primary driver of the HIV/AIDS epidemic. The committee reviewed the evidence regarding three categories of HIV prevention interventions for IDUs: (1) drug dependence treatment, including both pharmacotherapies and psychosocial interventions; (2) sterile needle and syringe access; and (3) outreach and education programs. Specifically, this review addressed the following questions:

1. How effective are the above mentioned programs in reducing HIV transmission among injecting drug users?

2. What impact do such programs have on the extent and frequency of drug injection?

3. To what extent do such programs also increase use of health and social services and drug treatment?

4. What evidence is there that programs aimed at reducing the risk of HIV transmission among injecting drug users are more effective in reducing HIV transmission when they are part of a comprehensive array of services which include outreach, HIV prevention education, counseling, and referral to substitution treatment, drug rehabilitation services and medical and psychosocial support?

5. What evidence is there on the extent to which these prevention strategies help reduce HIV transmission from injecting drug users to their sex partners and through maternal to child transmission to their offspring?

The report contains the committee’s conclusions and findings on these issues and provides recommendations to policymakers, particularly in high-risk countries, on implementation and areas for future research.

This briefing was for members of Congress and congressional staff only. The report was released to the public on September 15, 2006 and can be found, in its entirety, on the Web site of the National Academies Press.