Online Program

Injecting drug use as a public health problem in transitional, low and middle income countries

Tuesday, November 5, 2013 : 11:30 a.m. - 11:45 a.m.

Don C. Des Jarlais, PhD, The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York, NY
Jonathan Feelemyer, MS, The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York, NY
Holly Hagan, PhD, Center for Drug Use and HIV Research, New York, NY
David C. Perlman, MD, Mount Sinai Beth Israel, New York, NY
Anneli Uuskula, M.D., Ph.D., Department of Public Health, University of Tartu, Tartu, Estonia
Objective: To assess recent developments in health problems associated with injecting drug use in transitional, low and middle-income countries (TLMIC).

Methods: A systematic literature review was performed, following PRIMSA guidelines.

Results: There are an estimated 13 million persons who inject drugs throughout the world, of whom 80% live in TMLC. Major problems identified: 1. HIV infection among PWID in TLIMC, with prevalence ranging up to 50%. 2. Hepatitis C virus (HCV) infection among PWID, with prevalence ranging up to 90%. 3. Lack of implementation of evidence-based programs for prevention of HIV and HCV. (Data on implementation will be reviewed by geographic region.) 4. Violations of human rights of PWID, such as involuntary detention without due process. (Specific examples will be presented.) 5. Substantial reductions in international funding, with the President's Emergency Program For AIDS Relief (PEPFAR) moving to “country ownership” phase and reductions in monies from the Global Fund for AIDS, Tuberculosis and Malaria (GFATM). 6. There are also several positive developments, including an increasingly strong evidence base for addressing drug dependence, HIV and HCV prevention and care, and increasing attention to the need for a human rights approach to injecting drug use.

Conclusion: While there are an increasing number of tools for addressing the health problems of injecting drug use in TLMICs, and addressing these problems would almost certainly be cost saving to the countries over the long term, the situation is likely to become worse over the short term.

Learning Areas:

Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
Assess recent developments in health status and injection drug use transitional and low/middle income countries Analyze health problems associated with injection drug use in transitional and low/middle income countries Evaluate HIV and HCV infection among injection drug users in transitional and low/middle income countries.

Keyword(s): Injection Drug Users, Developing Countries

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have published over 300 journal articles in relationship to HIV, infectious disease, and specific populations such as injection drug users and Hepatitis C. I have done extensive work evaluating prevention programs, and other interventions targeting high risk populations, particularly in international settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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