Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence

An estimated 13 million people worldwide inject drugs. Of those, 78 percent live in developing or transitional countries. The sharing of contaminated injecting equipment has become a major driving force of the global AIDS pandemic, and is the primary mode of HIV transmission in many countries throughout Eastern Europe, the Commonwealth of Independent States, and significant parts of Asia. In some cases, HIV is spreading rapidly from injecting drug users to their partners through sexual transmission, and from injecting drug users and their partners to newborns. Reversing the rise of HIV infection among injecting drug users in these “high-risk” countries has thus become an urgent global public health challenge—one that remains largely unmet. In response to this crisis, in 2005 the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Bill & Melinda Gates Foundation commissioned the Institute of Medicine to evaluate strategies for preventing HIV transmission through contaminated injecting equipment.