Promote "Seek, Test, Treat and Retain" Paradigm and Opioid Substitution
for Injection Drug Users
An evidence-based approach is needed to help stem rapidly
growing HIV/AIDS epidemics in Eastern Europe, Central Asian,
and elsewhere associated with injection drug use, according
to a new report released at the XVIII International AIDS conference
(AIDS 2010) last week in Vienna.
The report calls for establishment of coordinated efforts
to test and treat drug users and then take steps to retain
them in care, and underscores the benefits of methadone maintenance
and similar opioid substitution approaches. The report's findings
support the demand for science-based national drug policies
set forth in the conference's official statement, the Vienna
is a press release issued by the International AIDS Society, sponsor
of AIDS 2010, describing the report and its findings.
Report Launched by the International AIDS Society Recommends a New Paradigm
for Treating Injecting Drug Users: "Seek, Test, Treat and Retain"
Access to Opioid Substitution Therapy such as methadone can
facilitate access to and retention in ART
HIV treatment for injecting drug users can prevent
HIV acquisition and transmission
Austria -- July, 22, 2010 -- Against the backdrop of some of the globe's
fastest growing HIV epidemics in Eastern Europe and Central Asia, a
report launched today at the XVIII International AIDS conference (AIDS
2010) in Vienna makes the case for a new model for scaling up treatment
and prevention of HIV amongst Injecting Drug Users (IDUs).
The report, "Prevention and Treatment of HIV/AIDS amongst Drug
Using Populations: A Global Perspective," advocates a science based
approach and stresses the urgent need to increase access and expand
take up of highly active anti retroviral therapy (HAART) among drug
using populations to improve health and reduce new infections.(1)
Increasing evidence supports the idea of expanding the implementation
of outreach to high-risk, hard-to-reach drug using populations (seek),
to encourage HIV testing (test), to link HIV+ individuals to care (treat),
and to sustain these individuals in care (retain). The seek, test, treat,
and retain model is also deliverable within the criminal justice system.
"The evidence is in, individuals with and without a history of
injection drug use derive similar survival benefit from HAART. There
is an urgent need to treat drug users, not abuse them as much of the
current drug policies do," said Dr Julio Montaner, President of
the International AIDS Society. "Sound public health policy demands
that we increase access to HIV treatment and prevention for this population."
Two decades of experience have demonstrated that needle exchange programs
are a proven way of preventing HIV infection amongst injecting drug
users (IDUs). The report outlines how programs can increase this effectiveness
by scaling up a comprehensive package of harm reduction interventions.
"Offering Opioid Substitution Therapy (OST), such as methadone
or buprenorphine, significantly decreases HIV acquisition and transmission
and increases the chances of HIV positive people who inject drugs taking
up and staying on highly active anti retroviral therapy (HAART),"
said Professor Dr. Charles O'Brien, a researcher from the University
of Pennsylvania and one of the contributors to the report. "This
in turn can lead to reductions in the community viral load and decrease
Wider uptake of HAART is associated with reduced community viral load
and reduced transmission as well as individual survival. "Not only
does treatment offer health benefits for the individual," said
Dr. Montaner, "but in diverse populations, we can now see that
HAART is HIV prevention."
The selection of Vienna as the host city of the XVIII International
AIDS Conference reflects the role the city has played in bridging Eastern
and Western Europe. During the past week there has been a strong focus
on Eastern Europe and Central Asia region, now home to what is the fastest
growing HIV/AIDS epidemic in the world. Injecting drug use is the main
driver of HIV infection in the region.
Some 65 percent of HIV infections in Russia for instance, are through
injecting drug use. The number of HIV infected people in Russia has
increased tenfold in the past decade from an estimated 100,000 to one
million. Eighty percent of HIV positive people are under 30 years of
age. Methadone is illegal in Russia.
"The Russian government does not implement an evidence based approach
to decision-making on public health," said Dasha Ocheret, spokesperson
for the Eurasian Harm Reduction Network (EHRN). "The prohibition
of substitution treatment such as methadone is based on Soviet ideology
and denies drug users the right to life saving treatment and prevention
that exist in the vast majority of countries in the region. Methadone
treatment began in Lithuania as far back as 1984.
"Russian Government funds are used for policing rather than sound
public health policy. All attempts by the Russian government over the
past decade to control drug trafficking have been counterproductive
and resulted in increased incarceration rates of people who use drugs
and social exclusion and led to numerous deaths from overdoses and HIV
and TB infections."
The report argues that it is now recognized that a punitive approach
leads to the creation of incubators for HIV, HCV and TB in prisons.
"We've been witness this week in Vienna to what is an all too familiar
story: the unacceptable criminalisation and stigmatisation of a group
of people, in this case, people who inject drugs," said Montaner.
"As a result of repressive drug policies and frankly, appalling
public health policy in many parts of Eastern Europe, people who inject
drugs are now shouldering the burden of an HIV epidemic that shows all
the signs of moving into the wider community.
"On the other hand we've also heard success stories in the region
that give hope to scientists, researchers and policy makers who are
committed to addressing HIV and injecting drug use based on sound scientific
empiric evidence along the lines suggested in the report we have released
today," concluded Montaner.
The report's recommendations include:
for scaling up in regions/countries with high or increasing prevalence;
scale-up strategies to epidemiologic need;
the impact of current interventions;
effective treatment that combines counselling, pharmacotherapy,
and wraparound services e.g. mobile units;
HIV prevention measures into all substance abuse treatment, including
information on access to condoms, needle exchange, etc.;
comorbid infections and conditions such as Hepatitis C and Tuberculosis;
every client in substance abuse treatment has access to primary
general health care providers in substance abuse recognition and
models for scale-up;
the cost-effectiveness analysis of scale-up in various locales;
barriers and facilitators of effective adoption and intervention.
The International AIDS Society (IAS) is the world's leading independent
association of HIV professionals, with 14,000 members from 190 countries
working at all levels of the global response to AIDS. Our members include
researchers from all disciplines, clinicians, public health and community
practitioners on the frontlines of the epidemic, as well as policy and
programme planners. The IAS is the custodian of the biennial International
AIDS Conference, which will be held in Vienna, Austria from 18 to 23
AIDS Society. New Global Report Launched by the International AIDS Society
Recommends a New Paradigm for Treating Injecting Drug Users: "Seek,
Test, Treat and Retain." Press release. July 22, 2010.
Family Foundation. Prevention and Treatment of HIV/AIDS Among Drug Using
Populations: A Global Perspective. Meeting report (recording and transcript)
July 23, 2010.