Structural interventions to reduce HIV transmission among injecting drug users

Increasing the availability of sterile injection equipment through pharmacy sales or syringe exchange or both is the most common and best-studied structural intervention for injecting drug users and usually but not always leads to large reductions in HIV-risk behavior.

Abstract

Preventing HIV infection among injecting drug users must be considered within the context of the continuing global spread of psychoactive drug use, and injecting drug use in particular. Some policies that are designed to reduce drug use may tend to increase HIV transmission among persons who do inject drugs. Evaluation of structural interventions can be difficult, as populations of drug users are usually the relevant unit of analysis. Typically, pre versus post comparisons must be used, hopefully with multiple pre and post data points. Structural interventions are often associated with 'large effects', increasing confidence that the intervention is the cause of the reduction in HIV-risk behavior. Increasing the availability of sterile injection equipment, through pharmacy sales or syringe exchange or both, is the most common and best-studied structural intervention for injecting drug users. The studies to date indicate that this usually, but not always, leads to large reductions in HIV-risk behavior. Involving drug users in the design and implementation of HIV-prevention programs can be considered a 'meta-structural' intervention that should lead to programs with increased effectiveness.