Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward

Lancet. 2010 Jul 31;376(9738):355-66. doi: 10.1016/S0140-6736(10)60832-X.


We review evidence for effectiveness, cost-effectiveness, and coverage of antiretroviral therapy (ART) for injecting drug users (IDUs) infected with HIV, with particular attention to low-income and middle-income countries. In these countries, nearly half (47%) of all IDUs infected with HIV are in five nations--China, Vietnam, Russia, Ukraine, and Malaysia. In all five countries, IDU access to ART is disproportionately low, and systemic and structural obstacles restrict treatment access. IDUs are 67% of cumulative HIV cases in these countries, but only 25% of those receiving ART. Integration of ART with opioid substitution and tuberculosis treatment, increased peer engagement in treatment delivery, and reform of harmful policies--including police use of drug-user registries, detention of drug users in centres offering no evidence-based treatment, and imprisonment for possession of drugs for personal use--are needed to improve ART coverage of IDUs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-HIV Agents / economics
  • Anti-HIV Agents / therapeutic use*
  • Anti-Retroviral Agents / therapeutic use
  • Buprenorphine / therapeutic use
  • China
  • Cost-Benefit Analysis
  • Developing Countries / economics*
  • Drug Costs
  • HIV Infections / drug therapy*
  • HIV Infections / economics
  • HIV Infections / epidemiology
  • HIV Infections / etiology
  • Health Services Accessibility
  • Humans
  • Income
  • Malaysia
  • Methadone / therapeutic use
  • Narcotic Antagonists / economics
  • Narcotic Antagonists / therapeutic use*
  • Narcotics / economics
  • Narcotics / therapeutic use*
  • Narration
  • Prisoners
  • Prisons
  • Russia
  • Substance Abuse, Intravenous / complications*
  • Substance Abuse, Intravenous / drug therapy*
  • Substance Abuse, Intravenous / economics
  • Substance Abuse, Intravenous / epidemiology
  • Ukraine
  • Vietnam


  • Anti-HIV Agents
  • Anti-Retroviral Agents
  • Narcotic Antagonists
  • Narcotics
  • Buprenorphine
  • Methadone