Key populations and their sexual partners have higher HIV prevalence than the general population and 62% of global new HIV infections are amongst this group. UN agencies including UNAIDS, WHO, UNODC, UNDP, as well as the Global Fund, PEPFAR, bilateral donors and private foundations, such as the Bill and Melinda Gates Foundation recognize that effective and evidence-based HIV response must focus on key populations who are most vulnerable to HIV transmission. For example, in Pakistan, there is an estimated 37,173 – 111,330 number of people who inject drugs, with a HIV prevalence rate of 38.4%, a mere 4.3% of which are virally suppressed, and low HIV prevention coverage of 29%. In Ukraine, there are an estimated 319,500 people who inject drugs with a 19.1% - 22.6% HIV prevalence rate. In Nigeria, the number of people who inject drugs is estimated at 80,000, with 9.2% HIV prevalence rate.
People who use drugs are a population group disproportionately vulnerable to HIV and AIDS, and are often left out of HIV prevention and treatment services. Criminalisation, stigma and discrimination, including within health care settings, are some of the main barriers they face when accessing services. Accordingly, decriminalisation should be a core component of public health and HIV prevention responses. Moreover, policy makers often make political and moral judgements about who to prioritise in programmes. People who use drugs bear the brunt of these types of decision-making.
Imprisonment, arbitrary detention and compulsory forced rehabilitation is a reality for many people who inject drugs. UNAIDS estimates that 56-90% of people who inject drugs will be incarcerated at some stage during their life. Therefore, it is essential to promote harm reduction and provide services in closed settings as well as in the community.
Harm reduction interventions are evidence-based and have a proven record of effectiveness and cost-effectiveness in the fight against HIV. Additional benefits include a reduction in criminal activity related to the need to access drugs, and individual, family and community social and health benefits. The unit costs of harm reduction interventions are relatively low, making it good value for money at $100 - $1000 per HIV infection averted.