Injecting drug use, harm reduction and substitution treatment: a good practice update
26 November 2008
In our second HIV good practice update, Susie McLean, senior advisor on HIV and drug use in the Alliance secretariat’s HIV Best Practice team, explains substitution treatment for opiate dependency and examines some of the implementation and advocacy issues for organisations starting to work in the field of harm reduction. A summary of the update is set out below, or read the full article with references.
Injecting drug use is one of the major drivers of HIV worldwide. Where injecting drug use occurs, HIV infection associated with the sharing of injecting equipment follows. Reducing the level of injecting drug use through substitution treatment, and increasing access to clean needles, can reduce HIV transmission and other health problems.
Opiates, such as heroin, are commonly injected, and the sharing of injecting equipment spreads HIV infection. Substitution treatment is a form of medication (usually ‘methadone’ or ‘buprenorphine’) that treats opiate dependency. Because it is usually taken orally, it reduces the prevalence of injecting which in turn reduces the transmission of HIV.
By reducing or eliminating withdrawal symptoms, substitution treatment also helps drug users escape the daily chaos of finding money, scoring, injecting and hiding, enabling them to lead more stable lives, and helping HIV-positive drug users to adhere to antiretroviral treatment.
Substitution treatment is part of a wider approach to HIV prevention and drug use called harm reduction. Harm reduction programmes include substitution treatment, and needle and syringe programmes, and are promoted by the World Health Organisation as effective interventions to prevent HIV and hepatitis B and C transmission.
Access to substitution treatment is slowly growing in developing countries. However there are many barriers to implementing programmes in this area, including prohibitive legal barriers. These must be reformed in order to maximise the HIV prevention benefits of substitution treatment.
Although socially excluded, many people who use drugs have their own networks and friends, and their own communities where people are cared for and can get information and help. Community mobilisation with people who use drugs seeks to challenge the social stereotypes of drug users as ‘social evils’, and to support their networks as good networks for education and support.
