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Int J Drug Policy. 2014 Jan;25(1):53-60. doi: 10.1016/j.drugpo.2013.08.004. Epub 2013 Sep 4.

What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010-2012? A review of the six highest burden countries.

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National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Electronic address:
Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
International Harm Reduction Development Program, Open Society Foundations, New York, NY, United States.
Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
INSERM, U912 (SESSTIM), Marseille, France; Université Aix Marseille, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
University of California, San Diego, Division of Global Public Health, Department of Medicine, United States.
Global Drug Policy Program, Open Society Foundations, Warsaw, Poland.
UN Secretary-General special Envoy on HIV/AIDS in Eastern Europe and Central Asia, Geneva, Switzerland.



In 2010 the international HIV/AIDS community called on countries to take action to prevent HIV transmission among people who inject drugs (PWID). To set a baseline we proposed an "accountability matrix", focusing upon six countries accounting for half of the global population of PWID: China, Malaysia, Russia, Ukraine, Vietnam and the USA. Two years on, we review progress.


We searched peer-reviewed literature, conducted online searches, and contacted experts for 'grey' literature. We limited searches to documents published since December 2009 and used decision rules endorsed in earlier reviews.


Policy shifts are increasing coverage of key interventions for PWID in China, Malaysia, Vietnam and Ukraine. Increases in PWID receiving antiretroviral treatment (ART) and opioid substitution treatment (OST) in both Vietnam and China, and a shift in Malaysia from a punitive law enforcement approach to evidence-based treatment are promising developments. The USA and Russia have had no advances on PWID access to needle and syringe programmes (NSP), OST or ART. There have also been policy setbacks in these countries, with Russia reaffirming its stance against OST and closing down access to information on methadone, and the USA reinstituting its Congressional ban on Federal funding for NSPs.


Prevention of HIV infection and access to HIV treatment for PWID is possible. Whether countries with concentrated epidemics among PWID will meet goals of achieving universal access and eliminating new HIV infections remains unknown. As long as law enforcement responses counter public health responses, health-seeking behaviour and health service delivery will be limited.


Injecting drug use, HIV, Needle and syringe programme; Opioid substitution therapy, Antiretroviral therapy, Prevention

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