Rights-based Approaches to HIV Prevention Among Drug Users

Human rights protections include national and international responsibilities for health protection using evidence-based public health strategies. The HIV/AIDS epidemic has played a significant role in bringing human rights and public health together. We focus on how human rights considerations apply to the health of persons who use illicit drugs in the context of HIV prevention and treatment. There are about 16 million injection drug users in 148 countries, of whom 10 million live in developing and transitional countries, and 3 million are infected with HIV. We examine three relevant aspects of drug use: prevention and treatment of drug dependence, prevention and control of HIV infection among drug users, and drug use and incarceration. The right to optimal health includes prevention and treatment for drug dependence, including prevention of initiation of drug use, addressing social determinants of drug use, opioid substitution therapy, cognitive behavioral therapy, contingency management therapy, and therapeutic communities and residential programs. Programs for prevention and treatment of HIV include needle and syringe exchange programs, pharmacy-based distribution of sterile needles and syringes, and HIV antiretroviral therapy for HIV-positive drug users. Expansion of the role of prisons regarding services for drug users include offering drug treatment and sterile needles and syringes. Respecting the human rights of persons who use drugs includes reducing the current reliance in many countries on law enforcement policies that have not been effective in prevention or control of drug use or in controlling HIV among drug users, and implementing sufficiently scaled and evidence-based public health programs.