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Mental Health/Substance Use – Risk Factors

Risk Factors

HIV transmission among drug users

Injecting drug users (IDUs) have a poor insight into HIV transmission, which is accompanied by risky behaviours.1

  • The sharing of injection paraphernalia by IDUs is a long identified risk factor for HIV infection2
  • Sexual transmission both among IDUs and from IDUs to people to do not inject drugs can be major factors in HIV epidemics2
  • Testing IDUs and notifying them of their HIV serostatus is an important step in enabling them to make informed decisions about their behaviours and consider treatment3
    • HIV testing and counselling has been associated with a decline in injecting and some sexual risk behaviours4
  • A 2008 United Nations report estimated that:1
    • 36% of IDUs had been tested for HIV in the previous 12 months
    • 45% of IDUs had the correct HIV prevention knowledge
    • 37% of IDUs used condoms
    • 63% of IDUs used clean syringes

Access the systematic review of risk factors for HIV infection in IDUs by Strathdee et al, 2010. 

Prevention of HIV infection for people who inject drugs

  • The primary approaches to the prevention of HIV infection and transmission in IDUs are:5
    • opioid substitution therapy (OST)
    • needle and syringe exchange programmes
    • antiretroviral therapy (ART)
  • High-coverage of these combined approaches would be required to reduce the incidence of HIV infection in IDUs by more than 50%5
    • short-term, small-scale, single interventions are unlikely to be effective


  1. Mathers B, Degenhardt L, Adam P, et al. Estimating the level of HIV prevention coverage, knowledge and protective behavior among injecting drug users: what does the 2008 UNGASS reporting round tell us? J Acquir Immune Defic Syndr 2009;52(suppl 2):S132–142.
  2. Strathdee S, Hallett T, Bobrova N, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet 2010;376:268–284.
  3. WHO/UNODC. Guidance on testing and counselling for HIV in settings attended by people who inject drugs: improving access to treatment, care and prevention, 2009. Accessed 01 December 2011.
  4. Denison JA, O’Reilly KR, Schmid GP, Kennedy CE, Sweat MD. HIV voluntary counseling and testing and behavioral risk reduction in developing countries: a meta-analysis, 1990–2005. AIDS Behav 2008; 12: 363–373.
  5. Degenhardt L, Mathers B, Vickerman P, et al. Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. Lancet 2010;376:285–301.