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Improved treatment access requires end to portrayal of drug abusers as already dead
Date:7/21/2010

The Lancet Series on HIV in people who use drugs, published online July 20 and presented at the International AIDS conference in Vienna, reports that in order to improve access to antiretroviral therapy among injecting drug users (IDUs), health providers must focus less on the individual patient's ability to adhere to treatment, and more on conditions of health delivery that create treatment interruptions.

Among low-income and middle-income countries, almost half of all injecting drug users with HIV are in just five of these countries: China, Vietnam, Russia, Ukraine, and Malaysia. Access to antiretroviral treatment (ART) is disproportionately low in these countriesIDUs make up two thirds of cumulative HIV cases in these countries, but only 25% of patients receiving ART. This third paper is by Daniel Wolfe, Open Society Institute, International Harm Reduction Development Program, New York, M. Patrizia Carrieri, of INSERM, France, and Donald Shepard, a health economist at Brandeis University's Heller School for Social Policy and Management.

Injecting drug users (IDUs) have successfully started ART in at least 50 countries, with evidence showing clearly that these patients can achieve excellent virological outcomes and with no greater development of drug resistance than other patients. Early adherence to ART is associated with long-term virological response, with behavioural support and provision of opioid substitution treatment (OST) increasing treatment success of ART in IDUs. Preliminary evidence suggests that increased ART provision to IDUs also reduces infectivity and HIV transmission, independent of needle sharing.

Not only is ART vital for saving lives and preventing transmission, but the evidence shows it is cost-effective. Data show clear benefits of targeting of ART to IDUs in areas with concentrated HIV epidemics (such as these five countries). Furthermore, the cost of drug dependence treatment is as little as one
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Contact: Laura Gardner
gardner@brandeis.edu
781-736-4204
Brandeis University
Source:Eurekalert

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