PEPFAR Report - Comprehensive HIV prevention for people who inject drugs, revised guidance

As part of President Obama's Global Health Initiative, PEPFAR (US President Emergency Plan for AIDS Relief) has set forth ambitious goals to prevent new HIV infections.

PEPFAR supports prevention, treatment and care services in countries with both concentrated and generalised epidemics. Data show that people who inject drugs remain at extremely high risk for HIV infection and that injection drug use is a primary driver of the epidemic in a number of regions and communities around the world. In addition to services for HIV-positive people who inject drugs, effective interventions are needed to help HIV-negative people who inject drugs stay HIV-negative, protecting themselves and their partners and families.

The new guidance allows PEPFAR to support a comprehensive package of prevention services scientifically demonstrated to decrease HIV infection risk without increasing drug use, including:

1. Community-based outreach programmes;
2. Sterile needle and syringe programmes; and
3. Drug dependence treatment, including medication-assisted treatment with methadone or buprenorphine and/or effective medications as appropriate, based on the country context.

Under the guidance, PEPFAR teams in countries where epidemiologic data define a need to address people who inject drugs as a priority within the full range of country HIV prevention needs may propose these activities in their Country Operational Plan (COP) submissions. Like other interventions, the proposals will be reviewed by an interagency headquarters team and subject to ultimate approval by the U.S. Global AIDS Coordinator.

The new guidance promotes close collaboration with country partners, including multiple sectors of government and civil society. Their leadership is essential to combat stigma and discrimination and respect the human rights of IDUs, to provide safe spaces for them to access services, and to secure an environment in which evidence-based interventions for people who inject drugs can succeed.