By Rick Lines, Harm Reduction International

2015 is looking like it could be a watershed year for global health. As the United Nation’s millennium development goals come to fruition, and we move towards a post 2015 sustainable development goals model, there will no doubt be much reflection on where we’ve collectively succeeded—and failed.

There has been much talk in recent years about the beginning of the “end of AIDS,” and we certainly have seen incredible successes, such as the roll-out of antiretroviral drugs (ARVs) to some 14 million people. This has transformed HIV from a death sentence into a chronic and manageable disease—for those on treatment.

However, we’d do well at this juncture to reflect on a parallel but very different reality. Some 20 million people still do not have access to ARVs and so many of them are from the populations most affected: men who have sex with men, sex workers, transgender people, migrants, and people who inject drugs.

We are failing all of these people, but the clearest case of our inability to implement tried and tested science is that of people who inject drugs.

We have known for three decades that in settings where comprehensive harm reduction interventions—such as methadone, buprenorphine, and needle and syringe programmes—have been implemented, HIV rates among people who inject drugs are low—in some cases negligible. This was the primary reason that injection driven HIV epidemics in cities such as London, Glasgow, New York, Sydney, Amsterdam, and Berlin were avoided when AIDS first surfaced in the early 1980s.

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