Utilization of a combined evidence–based and human rights approach to HIV prevention among injection drug users (IDUs)

The extent of implementation of evidence-based interventions in conjunction with the use of a human rights approach can reflect countries' differing harm reduction programs (programs) and human rights' policies (policies). Programs and policies, moderated by resources, can influence HIV rates among IDUs. We grouped countries into three categories in terms of implementation of programs (minimal vs. moderate or extensive) and type of policies (human rights vs. law enforcement). We stratified the categories by level of resources (Word Bank classification of high- vs. low-resource countries) and by reported HIV prevalence rates. Published data and indicator checklists were used in the categorization, including IDU-specific (e.g., the 2009 WHO, UNODC, UNAIDS technical guide for IDUs), and generic (e.g., the 2008 AIDS accountability country score card) sources. Countries were grouped into three categories: high on both programs and policies, low on both programs and policies, and inconsistent (high or low on either programs or policies). For example, the Netherlands, Australia, and the United Kingdom are in the high category. The United States and China are in the inconsistent category (high on programs with policies favoring law enforcement). Burma is in the low category. The categories reflected HIV prevalence rates among IDUs (e.g., 2 % in Australia, 16% in the United States, 43% in Burma). The categories show that country-classification on resources do not necessarily align with policies or prevalence. The checklists and categories illustrate the role of both programs and policies in HIV prevention among IDUs. With worsening economic conditions, HIV prevention remains important.