AN HIV epidemic is currently racing through Eastern Europe and Asia, mostly driven by injection drug use. Already, injection drug use accounts for one third of new human immunodeficiency virus (HIV) infections outside sub-Saharan Africa. Because of the efficient, blood-to-blood mode of transmission, HIV rates among drug users can skyrocket within a matter of months and, without effective interventions, can lead to a generalized epidemic. The good news is that there is overwhelming evidence that targeted interventions can dramatically reduce the spread of HIV among injection drug users and their sexual partners. A recent study conducted by the Institute of Medicine recommends these immediate steps: (1) treat drug dependence, particularly with medications such as buprenorphine (Subutex) and methadone (Dolophine); (2) provide sterile needles and syringes as part of multicomponent HIV-prevention programs; and (3) bolster outreach efforts to link injection drug users to health and social services.

While there is general consensus in the medical and public health communities to support these steps, there has been strong opposition among many in the US government. A ban on federal funding for syringes has been in force since the Reagan administration and is applied both domestically and internationally. Access to sterile syringes as an HIV-prevention measure remains controversial among some members of Congress. In fact, US PEPFAR guidelines for HIV prevention for drug injectors were slow to emerge, and when they did-in March 2006-they did not clearly promote the best science-based plans to prevent HIV. For example, they allowed large-scale medication-assisted addiction treatment for those who are HIV-positive, but those who are still HIV-negative.

With this in mind, Physicians for Human Rights organized a Health Professional Summit on US Global AIDS Policies for Injection Drug Users, held earlier this year in Washington, DC. Twenty-three healthcare professionals from 15 states in the United States attended the summit, most with professional experience working with injection drug users. The doctors, nurses, and HIV prevention and addiction specialists discussed ways to use their expertise to help policy makers understand the urgency of the pandemic of drug injection and HIV and the most effective responses to help contain it. Participants met with a total of 46 House and Senate offices to educate their Congressional delegations about the need for a plan grounded in scientific evidence.

PHR also organized and cosponsored a lunchtime Congressional briefing together with amfAR-the Foundation for AIDS Research-and the HIV Medicine Association, entitled "Confronting Rapidly Emerging HIV Epidemics in Asia and Eastern Europe: A Special Focus on Vietnam." The briefing included discussion from internationally respected scientists in the field of HIV prevention among injection drug users: Chris Beyrer, MD, MPH, director, Johns Hopkins Center for Public Health & Human Rights and the Johns Hopkins Fogarty AIDS International Training and Research Program; Don Des Jarlais, PhD, director of Research, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center; and Ted Hammett, PhD, Vice President, Abt Associates, Inc. HIV epidemics emerging rapidly across Eastern Europe and Asia are largely driven by increasing heroin use and unsafe injection practices.

Such epidemics move quickly not only because of the means of transmission but also because of lack of access to healthcare, including HIV prevention and treatment, among the highly marginalized users. Globally, estimates are that only 5% to 8% of people who inject illicit drugs have access to HIV prevention of any kind. This problem is only growing more urgent across Asia and the Middle East because of unprecedented quantities of heroin coming out of Afghanistan. The United Nations Office on Drug Control and Crime expects 200,000 overdoses globally this year. This is a sobering reminder of the escalating levels of drug use in neighboring countries and throughout Asia, the Middle East, and countries of the former Soviet Union. While efforts are made to curb the drug trade altogether, the United States must also help countries deal with the public health impact of increasing drug use. In many countries, people who have injected illicit drugs constitute the vast majority of people living with HIV, yet they are routinely denied access to anti-retroviral treatment. PHR views this lack of access to healthcare as a violation of the human rights of these individuals.

Without sufficient health interventions, the virus has begun to spread to the partners and to infants of drug users in numerous countries. Parts of Russia and of China are experiencing generalized epidemics that have moved beyond groups vulnerable to infection through drug use or commercial sex. The presentations made during the Congressional briefing indicated that while HIV infection rates among drug users are as high as 70% in a number of countries, research is showing that infection rates can be reduced in resource-poor settings. The Vietnamese government, for instance, has recently changed some of its punitive policies toward people dependent on illicit drugs in favor of an approach that includes medication-assisted addiction treatment and access to sterile syringes. Drs Des Jarlais and Hammett have led a cross-border HIV-prevention project in Southern China and Northern Vietnam that has dramatically slowed the number of new infections. The number of new drug injectors in the region has also decreased, adding to the evidence that programs providing sterile needles and syringes do not increase drug injection. PHR advocates for an approach to HIV prevention among injection drug users that includes access to condoms and sterile syringes, addiction treatment, outreach, and education. For information on how you can help, go to http://www.physiciansforhumanrights.org.