A systematic review of HIV prevention, treatment and care for injecting drug users (IDUs) throughout the world, published Monday in the journal Lancet, found that international efforts to fight the disease are largely overlooking this population, the Australian Associated Press/Sydney Morning Herald reports (Rose, 3/1).

According to the researchers, lack of attention to preventing and treating HIV/AIDS in IDUs is creating a growing “‘critical health problem’… in places like Russia, China, Malaysia and Thailand,” Reuters reports. “Of the estimated 16 million injecting drug users worldwide, 3 million are thought to be HIV-positive, and drug users are thought to account for 10 percent of all those living with HIV,” according to the news service.

“Although the number of countries with core HIV prevention services is growing, the level of coverage in injecting drug users is poor in many countries,” said Bradley Mathers, of the University of New South Wales, Australia, who led the study. “Infection prevention steps like providing needles, condoms and substitute drugs like methadone – collectively known as ‘harm reduction’ – are seen by many experts as key to halting the spread of HIV and AIDS, but some governments are reluctant to provide them for fear of being seen to condone drug use,” Reuters writes (Kelland, 3/1).

From their review, the researchers found “large discrepancies in HIV prevention measures across the globe, and its effect on the local transmission rates” in IDUs, AAP/Sydney Morning Herald writes. For instance, “Mathers said only eight percent of injecting drug users had accessed a needle and syringe program in the past year,” and “[o]pioid substitution therapy – such as methadone – was available in less than half (70) of the 151 countries with known injecting drug user populations.” The researchers also found “only one in every 25 injecting drug users who had contracted HIV were receiving antiretroviral treatment for it,” according to the news service (3/1).

“There is considerable evidence that HIV-prevention programmes for IDUs, particularly combined programming, in which multiple programmes are provided, can be very effective in reducing injecting-related HIV transmission,” write the authors of an accompanying Lancet comment. “This evidence suggests that the primary global need is not for new interventions to change the behaviour of IDUs, but for effective interventions to change the behaviour of policy makers to make policies and programmes consistent with the evidence base for HIV prevention and care for IDUs” (Des Jarlais/Arasteh/Gwadz, 3/1).

The Reuters article includes comments by several health experts who discuss HIV prevention and treatment efforts among IDUs (3/1).