Injection Drug Use and HIV/AIDS

6. HIV Prevention, Treatment, and Care Services

"Despite the fact that injecting drug use has led to the widespread transmission of HIV worldwide, the provision of HIV prevention, treatment, and care services to IDU populations remains dismally low. In 2009, only 8 per cent of injecting drug users worldwide enjoyed access to HIV prevention services of any kind, while substitution therapy–i.e. offering users methadone instead of heroin–is permitted in only 70 countries. Needle and syringe exchange programmes are available in only 82 countries."

"Out of harm’s way: Injecting drug users and harm reduction" International Federation of Red Cross and Red Crescent Societies (Geneva, Switzerland: December 2010), p. 12.

7. Global Review Shows Most Countries Lack Adequate HIV Prevention Resources

"Some of the most adverse health consequences of drug use are experienced by PWID. A global review of services aimed at reducing adverse health consequences among PWID has suggested that only 79 countries have implemented both needle and syringe programmes and opioid substitution therapy. Only four countries were classified as having high levels of coverage of both of those types of interventions.

"Information on the availability of HIV testing and counselling and antiretroviral therapy remains sparse: only 34 countries could confirm the availability of HIV-testing programmes for PWID, and 17 countries confirmed that they had no such programmes. There was no information on the availability of antiretroviral therapy for 162 countries."

World Drug Report 2018. United Nations publication, Sales No. E.18.XI.9.

8. Prevalence of Injection Drug Use Among Young Adults Aged 21-30 in the US

"• In the fifteen-year (2004–2018) combined samples of young adults aged 21–30, 1.5% report having ever used any drug by injection not under a doctor’s orders, and 0.5% reported doing so on 40 or more occasions (Table 4-1a). Thus, about 1 in every 67 respondents has ever used an illicit drug by injection, and about 1 in every 200 respondents reports an extended pattern of use as indicated by use on 40 or more occasions. There are appreciable gender differences—2.2% of males vs. 0.9% of females indicate ever injecting a drug (p<.001), and the percentages saying they injected on 40 or more occasions are 0.7% for males and 0.3% for females (p<.001). The percentages of young adults who have injected drugs during the past 12 months without medical supervision are considerably smaller: 0.5% overall—1 in every 200 respondents—including 0.8% of males and 0.3% of females (p<.001). The percentages using 40 or more times in the past 12 months are 0.2% overall—0.3% for males and 0.1% for females."

Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., Patrick, M. E., & Miech, R. A. (2019). HIV/AIDS: Risk & Protective Behaviors among Adults Ages 21 to 30 in the U.S., 2004–2018. Ann Arbor: Institute for Social Research, The University of Michigan.

9. Prevalence of Needle Sharing Among Young Adults Aged 21-30 in the US

"• The proportions of 21- to 30-year-olds who say they have ever shared needles in this way during their lifetime are 0.5% overall—0.6% of males and 0.4% of females (bottom of Table 4-1). As noted in the previous section, 1.5% of the full samples say they have ever injected a drug, so this indicates that a minority—but still a third (0.5%/1.5%)—of the people injecting any of the several drug classes mentioned in the question (heroin, cocaine, amphetamines, and/or steroids) shared a needle at some time.

"• The proportion of 21- to 30-year-olds who reported that they shared needles in the prior 12 months is 0.2%, with no significant gender difference. This compares to 0.5% who said that they have injected a drug in the prior 12 months, so about two fifths of past year injectors shared a needle at least once during the year.

"• Of respondents age 21-30, almost half of females who have injected in their lifetime reported having shared needles (0.4%/0.9%), compared to a little more than one-fourth of male injectors (0.6%/2.2%), suggesting that young adult female injectors are more at risk due to needle sharing. It seems likely that the rates are underestimates for the entire population in this age group due to the omission of high school dropouts, the likelihood that drug-addicted users would be more likely than average to leave the study, and the possibility of some underreporting of this behavior. But while the prevalence of needle sharing is low, it can still translate to sizable numbers of people engaging in shared needle use. An estimated 45 million Americans were between ages 20 and 29 in 2017 (US Census Bureau, 2018); just 0.5% of this group would be approximately 225,000 individuals.

"• To summarize, while young adult men are more likely to inject drugs than their female counterparts, they are only slightly more likely to share needles."

Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., Patrick, M. E., & Miech, R. A. (2019). HIV/AIDS: Risk & Protective Behaviors among Adults Ages 21 to 30 in the U.S., 2004–2018. Ann Arbor: Institute for Social Research, The University of Michigan.

10. Prevalence of Injection Drug Use Worldwide

"The joint UNODC/WHO/UNAIDS/World Bank estimate for the number of people who inject drugs (PWID) for 2014 is 11.7 million (range: from 8.4 to 19.0 million), or 0.25 per cent (range: 0.18-0.40 per cent) of the population aged 15-64. PWID experience some of the most severe health-related harms associated with unsafe drug use, overall poor health outcomes, including a high risk for non-fatal and fatal overdoses, and a greater chance of premature death.97 This is exacerbated by poor access to evidence-informed services for the prevention and treatment of infections, particularly HIV, hepatitis C and tuberculosis.98
"Eastern and South-Eastern Europe is the subregion with by far the highest prevalence of injecting drug use: 1.27 per cent of the population aged 15-64. The subregion accounts for almost one in four (24 per cent) of the total number of PWID worldwide; almost all PWID in the subregion reside in the Russian Federation and Ukraine. In Central Asia and Transcaucasia and in North America, the prevalence of injecting drug use is also high: 0.72 per cent of the population aged 15-64 in Central Asia and Transcaucasia; and 0.65 per cent in North America. Those three subregions combined account for 46 per cent of the total number of PWID worldwide. Although the prevalence of injecting drug use in East and South-East Asia is at a level below the global average, a large number of PWID (27 per cent of the total number of PWID in the world) reside in the subregion, given that it is the most populated subregion. Three countries (China, Russian Federation and United States) together account for nearly half of the total number of PWID worldwide."

United Nations Office on Drugs and Crime, World Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), p. 14.