18
improve access and adherence to antiretroviral therapy, reduce instances of overdose and
associated mortality, and lessen criminal activity.
79
Opioid-substitution therapy (OST), needle-
syringe programmes (NSP) and antiretroviral therapy (ART) together have established
effectiveness in reducing drug dependency, reducing sharing of injecting equipment,
improving quality of life and averting HIV infections.
80
The burden of disease of viral hepatitis attributable to injecting drug use is even higher than
HIV. Of the 71 million people with chronic HCV, 8 per cent is among people who inject drugs.
However, 23 per cent of new HCV infections and 33 per cent of HCV related mortality are
attributable to injecting drug use. The WHO recommendations and elimination targets put a
strong focus on providing these services as well as prioritizing PWID to test and treat for HCV.
HCV is curable and countries that have implemented targeted programmes are likely to reach
the elimination targets.
81
The concern of HIV transmission is not only with people who inject drugs such as opioids. There
is evidence that among people who inject stimulants (cocaine and amphetamines) and among
men who have sex with men, those who use methamphetamine or amphetamine are more
likely to engage in higher-risk sexual behaviours and be HIV-positive than those who use other
drugs.
82
A systematic review found that the risk of acquiring HIV was 3.6 times greater among
people who used cocaine by injection than among those who used cocaine by other means,
and 3.0 times higher among people who used amphetamine-type stimulants by injection than
among those who used amphetamine-type stimulants by other means. Most evidence points
towards a positive
association between stimulant use, higher-risk sexual and injecting
behaviours and HIV infections.
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81
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