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People who inject drugs are at risk of HIV and other bloodborne viral infections (such as hepatitis B and C) through the sharing of contaminated injecting equipment.

The comprehensive harm reduction package

A comprehensive package of evidence-based interventions to reduce harms associated with injecting drug use is outlined in the WHO, UNAIDS, UNODC technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users. This publication and the package of interventions have been widely endorsed by the United Nations and major international donors including the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and includes:

  1. Needle and syringe programs (NSPs)
  2. Opioid substitution therapy (OST) and other evidence-based drug dependence treatment
  3. HIV testing and counselling
  4. Antiretroviral therapy
  5. Prevention and treatment of STIs
  6. Condom programs for people who inject drugs and their sexual partners
  7. Targeted information, education and communication for people who inject drugs and their sexual partners
  8. Prevention, vaccination, diagnosis and treatment for viral hepatitis
  9. Prevention, diagnosis and treatment of TB


Needle and syringe programs

Once HIV is introduced in a population of people who inject drugs and commonly share syringes and injecting equipment, prevalence rates can reach epidemic proportions very quickly. Distributing free or low-cost sterile injecting equipment to people who inject facilitates the use of clean needles and syringes and reduces the number of injections with used needles and syringes.

NSPs substantially and cost-effectively reduce HIV transmission among people who inject drugs. NSPs may also reduce transmission of other bloodborne viruses, such as viral hepatitis B and C, among people who inject drugs. At the same time, needle and syringe programs do not encourage drug use. There is no evidence of major unintended negative consequences of NSPs.

All individuals from key populations who inject drugs should have access to sterile injecting equipment through needle and syringe programs (strong recommendation, low quality of evidence)

Opioid substitution therapy

Interventions that effectively treat drug dependence can reduce illicit drug use and, hence, the frequency of injection, as well as improve health and social functioning. For people dependent on opioids, agonist opioid substitution therapy (OST) – sometimes referred to as medically assisted treatment (MAT) – is highly effective in reducing injecting behaviors that put opioid-dependent people at risk for HIV. OST can reduce opioid use and improve retention in HIV treatment. Access and adherence to OST can improve health outcomes, reduce overdose and resulting deaths, reduce criminal activity, result in better psychosocial outcomes and decrease risk to pregnant women dependent upon drugs and to their infants.

All people from key populations who are dependent on opioids should be offered opioid substitution therapy in keeping with WHO guidance (strong recommendation, low quality of evidence)

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WHO HIV Topic

People Who Inject Drugs