20/07/2021
Kenya Red Cross Society Ministry of Health and Sports, Kenya.
There are many things that you can do to help a friend or loved one who has been recently diagnosed with HIV:
Talk. Be available to have open, honest conversations about HIV. ...
Listen. Being diagnosed with HIV is life-changing news. ...
Learn. ...
Encourage treatment. ...
Support medication adherence. ...
Get support.
Health is wealth have started this program across to assist and encourage the young people living with HIV/AIDS.
World Health Organization (WHO) USAID - US Agency for International Development
Working towards supporting the youth.Health being the number one top priority.
THE NATURE OF THE HIV/AIDS EPIDEMICS
AMONG INJECTING DRUG USERS
HIV/AIDS epidemics among IDUs tend to manifest themselves very differently
from epidemics in which s*xual transmission is the main risk factor. Although
s*xually transmitted HIV may remain virtually invisible for several years until the
burden of disease slowly increases, sharing of injection equipment is a much
more efficient mode of transmission, and drug-related epidemics therefore
spread more rapidly. Once the virus is introduced into a community of IDUs, tens
of thousands of HIV infections may occur. Infection levels among IDUs may rise
from zero to 50–60% within 1–2 years, as demonstrated in cities as different
as St Petersburg (Russian Federation), Imphal (Manipur, India) or Ruili (Yunnan
Province, China).
The size of the drug-related HIV/AIDS epidemics that result largely depends on
the number of people in a given location that regularly or occasionally inject
(illicit) drugs and their risk behaviour. The size of the drug-injecting problem
in turn usually depends on several factors, including the supplies of injectable
drugs, such as he**in, amphetamines and co***ne; drug demand; and the
patterns and norms of use among young people, such as whether drugs tend
to be injected versus smoked or inhaled. Drug-related HIV/AIDS epidemics
have followed the spread of co***ne injecting in Latin America and of he**in
injecting in Asia in the 1980s and the massive spread of the injecting of he**in
and other opiates in eastern Europe in the 1990s.
Injecting drug use has now been documented in 129 countries, 79 of which
also report HIV transmission through contaminated needles, syringes and other
injecting equipment. About 13 million people worldwide inject drugs, and about
10% of all new HIV infections globally result from the use of contaminated
injecting equipment by IDUs. In many countries in Europe, Asia, the Middle
East and the Southern Cone of Latin America, the use of non-sterile injecting
equipment by IDUs has remained the most important mode of HIV transmission,
accounting for between 30% and 80% of all reported infections (Fig. 1). The
potential for HIV to spread from IDUs to their non-injecting s*xual partners
and the wider population differs from country to country and depends on the
s*xual behaviour of IDUs, their partners and the community at large and on
s*xual mixing patterns.
As the number of HIV-infected IDUs grows in many developing and transitional
countries, not only programmes for HIV/AIDS prevention and drug dependence
treatment but also AIDS care and support services are facing new and increasing
challenges. In many countries and regions, the twin epidemics of injecting drug
use and HIV infection linked to sharing of injection equipment have already
profoundly affected health, and social and economic well-being.
INTRODUCTION
4 ADVOCACY GUIDE: HIV/AIDS PREVENTION AMONG INJECTING DRUG USERS
Figure 1. Regions in which needle and syringe sharing is the major mode of HIV
transmission
Although injecting drug use is predominantly a city phenomenon, it is increasing
in non-urban or semi-urban areas, along drug trafficking routes, in economically
depressed communities and among marginalized ethnic minorities. The age at
which people begin to inject drugs varies considerably and depends on factors
such as social cohesion, norms and drug availability. In the Commonwealth of
Independent States, injecting is especially frequent among young people, with
initiation starting as early as 12 years of age. Between 65% and 90% of IDUs
in developing and transitional countries are men 15–35 years old. However,
the proportion of IDUs who are women and girls is reported to be increasing
in some countries. Although all IDUs using potentially contaminated injecting
equipment are at high risk of HIV infection, specific populations are especially
susceptible to infection. These include young IDUs, because of inexperience
in obtaining clean injecting equipment; female IDUs, because of s*xual risk
and injecting practices over which they may have less control and because
of exclusion from services; and the increasing number of drug-injecting s*x
workers, both male and female. Similarly, inmates of prisons and other
correctional institutions are at an increased risk of HIV infection because they
lack access to preventive services.
All these particularities of HIV/AIDS epidemics among IDUs, including their
linkage to illicit drug use patterns, their potentially explosive spread within
communities of IDUs, the risk of further spread via s*xual in*******se to the
wider community and the specific vulnerability and risks of particular groups of
IDUs need to be considered when advocating for services and programmes.
Latin America
Southern Cone
IDU is Major Mode of Transmission, 30-90 % of infections
North America
East Asia
Southern Europe
North Africa &
Middle East
Eastern Europe & Central Asia
5
COMPREHENSIVE HIV/AIDS PREVENTION
AMONG INJECTING DRUG USERS
Explosive epidemics have been occurring among IDUs in many different
locations, but evidence shows that HIV/AIDS epidemics among IDUs can be
prevented, slowed, stopped and even reversed.1 In principle, the risk of HIV
spread through the sharing of infected injection equipment can be reduced if:
fewer people use drugs and especially those that are injected;
those continuing to inject drugs do so less frequently and more
safely: without sharing injection equipment.
Numerous programme and service options aim to facilitate a continuum of
behavioural changes among IDUs. Young people at risk of using drugs are
assisted in avoiding drug use in the first place and in initiating drug injecting in
particular. Those experimenting with injecting drugs are encouraged to stop,
to revert to other means of consumption such as smoking and ingesting or
at least to inject less frequently. Those regularly injecting and dependent on
drugs are offered drug dependence treatment including, where appropriate,
substitution with oral drugs such as methadone. Those not willing to enter
or not having access to drug dependence treatment and not in contact with
health institutions are offered services through outreach and are provided risk
reduction information and clean injection equipment, as well as condoms, and
referral to treatment, as available.
Experience has shown that halting the epidemic requires: (i) preventing drug
abuse, (ii) facilitating entry into drug treatment and (iii) establishing effective
outreach to engage IDUs in HIV/AIDS prevention strategies that protect them
and their partners and families from exposure to HIV and encourage the uptake
of drug dependence treatment and health care. This three-part strategy is
often referred to as the comprehensive package of interventions for HIV/AIDS
prevention among IDUs. It may include, as individual service elements, drug
abuse prevention, AIDS education, life skills training, condom distribution,
voluntary and confidential counselling and HIV testing, access to clean needles
and syringes, bleach materials and referral to a variety of treatment options.2
INTRODUCTION
1 For example, all Australian cities, London (United Kingdom) and Dhaka (Bangladesh) have maintained HIV prevalence
among IDUs at less than 5%; the epidemic among IDUs in Nepal appears to have been delayed for several years; and HIV
prevalence among IDUs in New York City, Edinburgh and Brazilian cities has fallen.
2 Preventing the transmission of HIV among drug abusers: a position paper of the United Nations System. Annex to the Report
of the 8th Session of the Administrative Committee on Coordination Subcommittee on Drug Control, 28–29 September
2000. Geneva, United Nations, 2000 (http://www.unaids.org/publications/documents/specifi c/injecting/Hraids.doc).
6 ADVOCACY GUIDE: HIV/AIDS PREVENTION AMONG INJECTING DRUG USERS
Unfortunately, certain effective but controversial elements are neglected in
many countries. This imbalance must be redressed to reach many people at the
highest risk and halt HIV epidemics. Important service elements that tend to be
neglected include drug dependence treatment, outreach activities and needle
and syringe programmes.
Drug dependence treatment, especially drug substitution treatment such as
methadone maintenance, therapeutic communities and outpatient drug-free
programmes, assists IDUs in significantly reducing their drug consumption and
the frequency of injecting or in ceasing illicit drug use altogether. Voluntary
treatment tends to be much more successful than mandatory treatment. Drug
dependence treatment facilities in many developing and transitional countries
have low capacity and sometimes low quality and lack serious funding support.
Outreach activities motivate and support IDUs who are not in treatment to
reduce their risk behaviour, both sharing of injection equipment and s*xual
transmission. Research indicates that outreach activities taking place outside the
conventional health and social care environments can reach out-of-treatment
IDUs and increase the rate of drug treatment referrals. In many countries,
outreach to IDUs is not part of recognized service packages.
Needle and syringe programmes are usually part of outreach activities and
reduce the risk of HIV transmission through the sharing of drug use paraphernalia
among those not in treatment. They serve as points of contact between IDUs and
service providers, including from drug treatment programmes. The benefits of
such programmes are considerable and increase further if they go beyond needle
and syringe distribution to include AIDS education, counselling and referral to
a variety of treatment options. Nevertheless, resistance to needle and syringe
programmes remains considerable. They are sometimes believed to incite noninjectors to use drugs even though there is no evidence that such programmes
increase the rate of injecting drug use or other public health dangers in the
communities where they are implemented.
Further, HIV/AIDS prevention usually needs to be strengthened within the
criminal justice system. HIV/AIDS prevention in penal institutions may include
two distinct strategies, both of which tend to be lacking, even in severely
affected countries.
Firstly, where there is increased risks of HIV transmission in penal institutions,
the number of drug-dependent IDUs incarcerated should be reduced if possible.
There may, for instance, be scope to replace mandatory prison sentences for those
possessing small amounts of drugs by alternatives, including community service,
and offers of drug dependence treatment.
Secondly, HIV prevention and drug treatment programmes within penal institutions
are important components of a comprehensive response to prevent the transmission
of HIV, as injecting and dependence tend to continue in detention.
7
Both strategies are too rarely implemented. Programmes to prevent HIV/AIDS in
prisons are often hampered by governments denying the existence of injecting
drug use and s*xual in*******se in institutions of criminal justice. In reality, drug
use in general and injecting drug use in particular (as well as s*xual in*******se
between men) are frequent in such institutions in many, if not most, countries.
Available data indicate that the rates of HIV infection among inmates are
significantly higher than in the general population in some countries, reflecting
at least in part continued exposure to HIV among inmates.
In addition, the trafficking, injecting (and consumption in general) of substances
such as he**in, other opiates, co***ne and amphetamines are illegal in most
countries worldwide. HIV/AIDS prevention and drug control policies often need
to be harmonized further, for example, to avoid that punishment renders IDUs
more vulnerable to HIV. A balance must be struck between public health and
public order.
Another programme area that is often neglected is the lack of appropriate HIV
prevention services for young IDUs. Most services concentrate on adults or those
who have already injected for some time and are addicted and perhaps already
infected. Especially in some regions, such as eastern Europe, many young people
experiment with drugs, using drugs on weekends, irregularly and recreationally
– making standard interventions that only target marginalized addicted drug
users, the stereotypical “junkie in the street”, inappropriate. Similarly, female
IDUs are frequently underserved.
In conclusion, drawing on policies expressed in the United Nations drug control
conventions and the Declaration on the Guiding Principles of Drug Demand
Reduction, United Nations human rights documents and United Nations
documents on health promotion policy, the following principles and strategic
approaches should be used for addressing HIV/AIDS among IDUs.
Protecting human rights is critical to success in preventing HIV/AIDS.
People are more vulnerable to infection when their economic, health,
social or cultural rights are not respected. Responding effectively to the
epidemic is difficult if civil rights are not respected.
HIV prevention should start as early as possible. Once HIV has been
introduced into a local community of IDUs, it may spread extremely
rapidly.
Interventions should be based on regular assessment of the nature and
magnitude of drug use as well as trends and patterns of HIV infection.
Comprehensive coverage of the entire population is essential. As many
individuals in the at-risk populations as possible must be reached for
prevention measures to be effective in changing the course of the
epidemic in a country.
INTRODUCTION
8 ADVOCACY GUIDE: HIV/AIDS PREVENTION AMONG INJECTING DRUG USERS
The reduction of drug demand and HIV prevention programmes should
be integrated into broader social welfare and health promotion policies
and preventive education programmes. A supportive environment
in which healthy lifestyles are attractive and achievable, including
poverty reduction and opportunities for education and employment,
should sustain specific interventions for reducing demand for drugs and
preventing HIV transmission.
Drug problems cannot be solved by criminal justice initiatives alone. A
punitive approach may drive the people who most need prevention and
care services underground.
Treatment services need to be readily available and flexible. Treatment
systems need to offer a range of treatment alternatives, including substitution
treatment, to respond to the different needs of groups of IDUs.
Developing effective responses to the problem of HIV among IDUs is
facilitated by assuring the active participation of the target group in all
phases of developing and implementing the programme.
Drug treatment programmes should provide assessment for HIV/AIDS
and other infectious diseases and counselling to help IDUs change
behaviour that places them or others at risk of infection.
HIV/AIDS prevention programmes should also focus on s*xual risk
behaviour among people who inject drugs or use other substances.
Outreach work and peer education outside normal service settings, and
normal working hours are needed to extend services to groups that are
not effectively reached by existing traditional health services. Specific
services may be needed for young IDUs, women and s*x workers.
Adequate resources are required to respond to the increase in client
load that is likely to result from outreach work.
Care and support, involving community participation, must be provided
to IDUs living with HIV/AIDS and to their families, including access to
affordable clinical and home-based care, effective HIV prevention
interventions, essential legal and social services, psychosocial support
and counselling services.
I need support reach out to this young,energetic,talented young men and oustanding women outside here/.
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