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International Journal of STD and AIDS. 2009 May; 20(5):295-9.A mass action model developed by the World Health Organization (WHO) estimates that the re-use of contaminated syringes for medical care accounted for 2.5% of HIV infections in sub-Saharan Africa in 2000. The WHO's model applies the population prevalence of HIV infection rather than the clinical prevalence to calculate patients' frequency of exposure to contaminated injections. This approach underestimates iatrogenic exposure risks when progression to advanced HIV disease is widespread. This sensitivity analysis applies the clinical prevalence of HIV to the model and re-evaluates the transmission efficiency of HIV in injections. These adjustments show that no less than 12-17%, and up to 34-47%, of new HIV infections in sub-Saharan Africa may be attributed to medical injections. The present estimates undermine persistent claims that injection safety improvements would have only a minor impact on HIV incidence in Africa.
Contact. 2006 Aug; (182):4-5.Saving lives is the paramount goal of all HIV programmes. Successful HIV prevention programmes utilize all approaches known to be effective, not implementing one or a few select actions in isolation. These include promoting sexual abstinence, fidelity among married couple and the use of condoms for those who are not in a position to abstain or be faithful. It also includes ensuring that injecting drug users have access to clean needles and syringes as well as programmes supporting them to stop drug use. The strategies also include assurance that HIV-positive pregnant women receive treatment to prevent HIV transmission to the child. These strategies (See insert) were endorsed by the UNAIDS board last year and provide the framework for re-energizing HIV prevention globally. (excerpt)
Peddro. 2001 Dec; 4.The world has been responding to HIV/AIDS for twenty years, and some universal lessons have been learned during that period. One is that effective AIDS responses have to start with the world as it is, not as we would like it to be. A second lesson is that blaming or castigating people at risk of HIV infection simply adds to the stigma, drives risky behaviour underground and fails to stop the spread of the epidemic. And a third lesson is that no matter how well-hidden it may be, HIV transmission via injecting drug use has been at least partly responsible for the epidemic nearly everywhere. Up to now, 114 countries have reported the occurrence of HIV infection among their drug injecting communities. Injecting drug use is either the main mode of transmission of HIV infection or one of the main modes in many countries in Asia, Latin America, Europe, and North America. Even in the epidemic in sub-Saharan Africa, although the great bulk of HIV transmission is attributable to sex, injecting drug use is also a source of risk. Since sharing injecting equipment causes a great deal of contamination, this practice can be responsible for the unpredictable mushrooming of the epidemic. But the spread of HIV as the result of injecting drug use is never confined to the injecting drug users alone: injecting drug users also have sexual partners, and may also be mothers needing to protect their infants from HIV, and in many places the sex trade and drug abuse are closely associated. HIV transmission via injecting drug use therefore has the potential to kick-start much wider epidemics, such as that which occurred at the end of the 1980s in Thailand. (excerpt)
Choices. 2001 Dec; 18-19.I don't have any used syringes. Somebody has stolen all, Anka was almost begging. In a worn-out black T-shirt and torn jeans, she looked helpless and desperate, standing in the middle of a vacant square, squeezed between Warsaw's main railway station and a Holiday Inn hotel. "I really don't have any," she repeated. "You know it's an exchange. Go and find some," Grzegorz Kalata said, patiently but firmly. Kalata comes to the square -- a meeting point for local drug users -- almost every evening. He is a streetworker from Monar, Poland's leading chain of non-profit detoxification centres. Under a harm reduction programme, partly sponsored by the United Nations Development Programme (UNDP), Kalata gives disposable syringes and needles, bandages, condoms and antiseptics to drug addicts who meet at the square. In return, he collects used syringes and needles in a plastic container, usually full by the end of his visit. After scouring the grass at the site, Anka came back with four used needles. Kalata gave her seven new ones and a package of bandages. On average, Kalata gives out some 200 needles and 150 syringes during an evening. (excerpt)
New York Times. 2004 Feb 11;  p..After a long, clumsy war against AIDS, Romania has finally declared itself the winner. "Yes — at this moment, we have a victory," said Dr. Adrian Streinu-Cercel, president of the National AIDS Committee. "Everyone who needs triple therapy is getting triple therapy." The country, which became infamous in 1990 for the squalid orphanages and babies dying of AIDS that marked the final years of Nicolae Ceausescu's dictatorship, is now being cited as a model of how governments, drug companies and international agencies can bring AIDS under control by ensuring that the necessary three-drug anti-retroviral cocktails are available and paid for. (excerpt)
Unintended consequences: drug policies fuel the HIV epidemic in Russia and Ukraine. A policy report prepared for the UN Commission on Narcotic Drugs and national governments.
New York, New York, Open Society Institute, International Harm Reduction Development program, 2003. 16 p.Taking action now to reduce HIV transmission rates and treat those already infected is critical. With the goal of avoiding adverse effects on social welfare and public health, the Russian and Ukrainian governments should reconsider how they interpret international treaties. Policy changes should be made in the following areas: Harm reduction. The governments should play an active role in establishing and supporting a large, strategically located network of harm reduction programs that provide services for IDUs, including needle exchange, HIV transmission education, condom distribution, and access to viable treatment programs such as methadone substitution. Similar services should be available in all prisons. Education. Simple, direct, and dear information about HIV transmission should be made available to all citizens-especially those most at risk. Similarly, society at large should be educated about the realities of drug use and addiction as part of an effort to reduce stigma. Discrimination and law enforcement abuse. Public health and law enforcement authorities should take the lead in eliminating discrimination, official and de facto, toward people with HIV and marginalized risk groups such as drug users. Authorities must no longer condone or ignore harassing and abusive behavior, including physical attacks, arrest quotas, arbitrary searches, detainment without charges, and other violations of due process. HIV-positive people, including IDUs, should be included in all policy discussions related to them in the public health and legal spheres. Legislation. Laws that violate the human rights of people with HIV and at-risk groups should be repealed or restructured to better reflect public health concerns. Moving forward with the above strategies may make it appear that the governments are backing away from the goals and guidelines of the UN drug conventions. They may be criti- cized severely by those who are unable or unwilling to understand that meeting the goals of the conventions, some of which were promulgated more than 40 years ago, is far too great a price to bear for countries in the midst of drug use and HIV epidemics. Governments ultimately have no choice, though, if they hope to maintain any semblance of moral legitimacy among their own people. (excerpt)
Bulletin of the World Health Organization. 2003; 81(4):307.Three recent studies challenge the assumption that the main cause of the spread of HIV in Africa is unprotected sex. They argue that it is unsafe injections, which transmit the infection on a far larger scale than has previously been thought. Most experts assume that unsafe sex between men and women is responsible for 90% of HIV infections in sub-Saharan Africa. The medical reuse of contaminated needles and syringes is thought to account for another 5%. The authors of the controversial trio of papers recently published in the International Journal of STD and AIDS (2003;14;144-73) take a radically different view. (excerpt)