HIV+ drug users lagging behind on the road to ARV treatment
Drug users living with HIV/AIDS make up only a tiny proportion of people receiving antiretroviral (ARV) drugs throughout the world. According to reports presented at the recently concluded International Conference on the Reduction of Drug Related Harm, held in Belfast, Northern Ireland [20-24 March], drug users are being left out of ARV treatment programmes as a result of double-standards within health services, even in countries where drug use is a major determinant of HIV spread.
Basic data were provided by Dr Chris Ford, a British-based general practitioner, who summarised conservative estimates that about 200 million people consume illicit drugs globally. Opiates are used by about 15 million, heroin specifically by 9 million, cocaine by 13 million, marijuana by 146 million and amphetamines and ecstasy by 38 million. Worldwide, there are in excess of 13 million injection drug users in over 130 countries. But most harm reduction and treatment resources go to 20% of those users, and mostly to those living in rich countries. That leaves the vast majority of drug users worldwide with little or no access to treatment options.
For example, injection drug users represent less than 8% of all people receiving antiretroviral treatment in developing and transitional countries.
Referring to the latest UN data on the availability of ARVs, Dr. Carmen Aceijas of Imperial College, London, reports that a total of 53 countries currently provide ARV treatment through some sort of public scheme, and that an additional 41 countries rely on the nongovernmental and/or private sectors. In total, as of Dec. 2004, 432,453 people in 44 developing and transitional countries were receiving antiretroviral treatment.
Of those people in developing/transitional countries receiving ARVs, only 35,391 people are identified as drug users and of these approximately 30,000 of them are in Brazil.
ARV treatment through any means is completely unavailable in at least eight countries: Azerbaijan, the Republic of Korea, Kyrgyzstan, Somalia, Syria, Tajikistan, Turkmenistan and Uzbekistan.
Discussing the urgent need of expanding ARV treatment for HIV-positive drug users, Dr Michel Kazatchkine of the Agence Nationale de Recherches sur le Sida, France, confirms that access among drug users who should be eligible for ARV treatment remains poor in many regions of the world. While injection drug users represent over 80% of patients currently in need of treatment in Ukraine, Belarus and Russia, for example, they represent less than 5 % of patients currently receiving ARV treatment in those nations.
For Kazatchkine, limiting access to treatment raises important ethical and societal issues - because it is an inappropriate approach from a public health perspective; and because there is a high risk of disease progression in patients initiating treatment at later stages and with HIV-associated conditions. For him, limiting IDU access to treatment stems from a double standard of thinking.
Olga Kuzenna and Susie McLean of the International HIV/AIDS Alliance, UK, describe how Eastern Europe has one of the largest and fastest growing HIV epidemics among drug users, who account for 71% of new HIV infections; according to World Health Organization (WHO) estimates, approximately 15,000 people living with HIV/AIDS in the region are in need of ARV treatment.
Prior to the initiation of a Global Fund Against AIDS, Tuberculosis and Malaria (GFATM) in the Ukraine, for example, 118 people were receiving ARV as part of a Medicines Sans Frontieres (MSF) programme and an additional 137 as part of a government programme. Now, after 8 months of the GFATM programme, over 1400 people are receiving treatment. Yet, these are still low numbers relative to estimates of active drug users, and deaths of people on ARV waiting lists, a lack of integrated tuberculosis care, poor access to health care generally for drug users and challenges in changing the attitudes of health care workers all remain formidable obstacles.
Dr Andrew Ball of the Department of HIV/AIDS at WHO provides an update on reaching drug users with through the current ‘3 by 5’ Initiative, aimed at expanding ARV access to reach 3 million people with HIV in developing countries by the end of 2005.
According to Ball, WHO is making it a priority to promote good drug-related practices through policy guidelines and position papers, incorporating harm reduction principles in key WHO resolutions and basic documents, conducting country advocacy visits to countries including China, India, Indonesia, the Islamic Republic of Iran, Libya, Russia, Ukraine and Viet Nam, as well as establishing collaborative partnerships with affected communities, including harm reduction networks.
In addition, WHO is developing models of HIV/AIDS treatment scale-up for countries with high levels of injecting drug use through linking and integration of HIV/AIDS treatment services with drug dependence and drug user outreach services; through advocating continuity of care for prisoners, capacity building, support for pilot programmes, adaptation of relevant tools and guidelines, and assisting countries to mobilize and utilize resources, including funds specifically for treatment of drug users.
As Ball summarised “Drug users are entitled to treatment and are worth investing in.”
[This is an HDN Key Correspondent report from the International Conference on the Reduction of Drug Related Harm, held in Belfast, Northern Ireland, March 20-24, 2005.]
HDN Key Correspondent Team
Email: Correspondents@hdnet.org
(April 2005)
Basic data were provided by Dr Chris Ford, a British-based general practitioner, who summarised conservative estimates that about 200 million people consume illicit drugs globally. Opiates are used by about 15 million, heroin specifically by 9 million, cocaine by 13 million, marijuana by 146 million and amphetamines and ecstasy by 38 million. Worldwide, there are in excess of 13 million injection drug users in over 130 countries. But most harm reduction and treatment resources go to 20% of those users, and mostly to those living in rich countries. That leaves the vast majority of drug users worldwide with little or no access to treatment options.
For example, injection drug users represent less than 8% of all people receiving antiretroviral treatment in developing and transitional countries.
Referring to the latest UN data on the availability of ARVs, Dr. Carmen Aceijas of Imperial College, London, reports that a total of 53 countries currently provide ARV treatment through some sort of public scheme, and that an additional 41 countries rely on the nongovernmental and/or private sectors. In total, as of Dec. 2004, 432,453 people in 44 developing and transitional countries were receiving antiretroviral treatment.
Of those people in developing/transitional countries receiving ARVs, only 35,391 people are identified as drug users and of these approximately 30,000 of them are in Brazil.
ARV treatment through any means is completely unavailable in at least eight countries: Azerbaijan, the Republic of Korea, Kyrgyzstan, Somalia, Syria, Tajikistan, Turkmenistan and Uzbekistan.
Discussing the urgent need of expanding ARV treatment for HIV-positive drug users, Dr Michel Kazatchkine of the Agence Nationale de Recherches sur le Sida, France, confirms that access among drug users who should be eligible for ARV treatment remains poor in many regions of the world. While injection drug users represent over 80% of patients currently in need of treatment in Ukraine, Belarus and Russia, for example, they represent less than 5 % of patients currently receiving ARV treatment in those nations.
For Kazatchkine, limiting access to treatment raises important ethical and societal issues - because it is an inappropriate approach from a public health perspective; and because there is a high risk of disease progression in patients initiating treatment at later stages and with HIV-associated conditions. For him, limiting IDU access to treatment stems from a double standard of thinking.
Olga Kuzenna and Susie McLean of the International HIV/AIDS Alliance, UK, describe how Eastern Europe has one of the largest and fastest growing HIV epidemics among drug users, who account for 71% of new HIV infections; according to World Health Organization (WHO) estimates, approximately 15,000 people living with HIV/AIDS in the region are in need of ARV treatment.
Prior to the initiation of a Global Fund Against AIDS, Tuberculosis and Malaria (GFATM) in the Ukraine, for example, 118 people were receiving ARV as part of a Medicines Sans Frontieres (MSF) programme and an additional 137 as part of a government programme. Now, after 8 months of the GFATM programme, over 1400 people are receiving treatment. Yet, these are still low numbers relative to estimates of active drug users, and deaths of people on ARV waiting lists, a lack of integrated tuberculosis care, poor access to health care generally for drug users and challenges in changing the attitudes of health care workers all remain formidable obstacles.
Dr Andrew Ball of the Department of HIV/AIDS at WHO provides an update on reaching drug users with through the current ‘3 by 5’ Initiative, aimed at expanding ARV access to reach 3 million people with HIV in developing countries by the end of 2005.
According to Ball, WHO is making it a priority to promote good drug-related practices through policy guidelines and position papers, incorporating harm reduction principles in key WHO resolutions and basic documents, conducting country advocacy visits to countries including China, India, Indonesia, the Islamic Republic of Iran, Libya, Russia, Ukraine and Viet Nam, as well as establishing collaborative partnerships with affected communities, including harm reduction networks.
In addition, WHO is developing models of HIV/AIDS treatment scale-up for countries with high levels of injecting drug use through linking and integration of HIV/AIDS treatment services with drug dependence and drug user outreach services; through advocating continuity of care for prisoners, capacity building, support for pilot programmes, adaptation of relevant tools and guidelines, and assisting countries to mobilize and utilize resources, including funds specifically for treatment of drug users.
As Ball summarised “Drug users are entitled to treatment and are worth investing in.”
[This is an HDN Key Correspondent report from the International Conference on the Reduction of Drug Related Harm, held in Belfast, Northern Ireland, March 20-24, 2005.]
HDN Key Correspondent Team
Email: Correspondents@hdnet.org
(April 2005)
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