Transmission of HIV from injecting drug users to their wives in India

Women and substance use in India and Bangladesh

Given the feminization of the HIV epidemic in India and Bangladesh, understanding substance-use-related concerns among women is important for effective HIV prevention. This review is based on published research, reports (2000-2005), and primary data from treatment centers for drug-using women. We identify four main themes: (a) opioid use and injecting drug use in women, (b) alcohol use in sex work settings, (c) sexual transmission of HIV from male-injecting drug users (IDUs) to their regular female sex partners, and (d) sexual violence among female partners of substance-using men. We urge for focused HIV prevention interventions targeting substance-using women and female sex partners of male substance users to reduce vulnerability.

Gender differences in sex risk behaviors among Ukraine injection drug users

OBJECTIVE

To assess gender differences in drug and sex risk behaviors and evaluate predictors of HIV-related sex risk behaviors among heterosexual injection drug users (IDUs) in Ukraine.

DESIGN

Street-recruited IDUs from Kiev, Odessa, and Makeevka/Donesk, Ukraine.

METHODS

From June 2004 through November 2006, outreach workers recruited 1557 IDUs, including 526 from Kiev, 494 from Odessa, and 537 from Makeevka/Donesk. Participants were administered a standardized computer-assisted interview assessing HIV-related drug and sex risk behaviors, self-efficacy for practicing safe sex, and HIV knowledge.

RESULTS

Overall, 80% of the participants were sexually active in the 30-day period before their interview. They also engaged in high-risk sex behaviors during this brief 30-day window: 53% reported anal or vaginal sex without a condom, 27% had sex with more than 1 partner, 41% had an IDU sex partner, and 37% had an HIV-positive sex partner or a partner whose HIV status they did not know. Overall, women were at higher risk than men and were more likely to have been told they were HIV-positive.

CONCLUSION

The extremely high HIV prevalence rate in Ukraine and in this cohort, combined with their recent high-risk sex behaviors, forecasts not only a continuance of the epidemic in the region but an escalation.

Access, adherence, quality and impact of ARV provision to current and ex-injecting drug users in Manipur (India): an initial assessment

OBJECTIVES

This study aims to understand who is obtaining anti-retroviral therapy (ART) in Manipur, and to determine adherence, access, and impact amongst those who use it. It also explores the quality of these services, their impact and the level of user satisfaction.

METHODS

A mixed method approach was used for this assessment involving direct observations, analysis of service statistics, and a semi-structured survey (n=226).

RESULTS

Less than 5% of current injecting drug users (IDUs) were accessing ART (despite IDUs making up the single largest category affected by HIV in Manipur). Self-reported treatment adherence amongst patients is poor. Major factors influencing adherence are current alcohol use, the cost of ART, having attending any counselling in the last 6 months, income levels of below Indian Rupees (INR) 2000 and negative experience of side effects. Client satisfaction is associated with: duration of time spent with doctors, waiting time and how staff treat the patients. Service quality also requires improvement. A quarter of patients on ART perceive that it has benefited their health and report feeling well. Side effects were experienced by 61% of those on ART. Greater efforts to bring more active IDUs into treatment, whilst improving the manner in which ART is delivered in Manipur are required.

Sexually transmitted infections and sexual practices in injection drug users and their regular sex partners in Chennai, India

OBJECTIVE

Measuring sexually transmitted infections (STIs) and sexual practices in injection drug users (IDUs) and their regular sex partners.

GOAL

Informing HIV intervention programs.

DESIGN

Cross-sectional.

RESULTS

One percent IDUs and 2% of their regular female sex partners were syphilis infected; 40% (84/211) and 38% respectively (81/211) were infected with HSV-2. 30% IDUs and 5% of their female regular sex partners were HIV positive. Serodiscordant results for syphilis and HSV-2 were noticed. Women having first sex at age<or=17 years and those who had HIV-positive IDUs as their male sexual partner had two times the odds of having any non-HIV-STI (OR 2.04; 95% CI 1.1-3.8; P=0.02 and OR 2.38; 95% CI 1.1-5.1; P=0.02 respectively) in a multivariate model. Women>or=38 years had seven times the odds of having any non-HIV-STI.

CONCLUSION

Reaching out to IDUs and their female regular sex partners with modified STI management guideline and promoting women-controlled safer sex measures are needed harm-reduction measures.

HIV prevalence and factors associated with HIV infection among male injection drug users under 30: a cross-sectional study in Long An, Vietnam

Background

Sufficient targeted HIV prevention activities aiming at reducing HIV transmission within and from an extremely marginalized population of injection drug users (IDUs) must urgently and efficiently be implemented in Vietnam. This study was conducted to facilitate the development of such activities by describing transmission risks of young IDUs and evaluating factors in association with HIV infection.

Methods

Thirty clusters were selected from 29 hotspot communes in Long An province by probability proportional to size (PPS) sampling method. The snowball technique was used for enrolling participants in each cluster. The cross-sectional association of factors obtained during direct structured interviews to 248 male IDUs aged 14 to 29 years old and with their HIV test results were examined.

Results

The HIV prevalence among the studied IDUs was 32%. Age range of 18–20 years old, low educational level, sharing injection equipment or injection drug use in the other cities were independently associated with HIV serostatus in the multivariate analysis. Sexual behaviors did not differ between HIV-positive and -negative IDUs. Among HIV seropositive IDUs who had sexual contact with primary (n = 37), casual (n = 6), and commercial (n = 15) partners, only 5.4% (n = 2), 33.3% (n = 2), and 46.7% (n = 7), respectively, responded that they had used condoms every time.

Conclusion

About one-third of young IDUs aged less than 30 identified in the hotspot communes in Long An, Vietnam was found to be infected with HIV, and socio-demographic and injection-related factors might account for the infection risk. Prevailing risky sexual behavior of this extremely marginalized population highlights the need to reduce their high transmission risks as a public health priority.

Socio Behavioural Profile of HIV Positive DSC Personnel

BACKGROUND

Few human immunodeficiency virus (HIV) positive Defence Security Corps (DSC) personnel reported for surveillance at one of the Air Force (AF) stations in 1992 and it was appropriate to study socio-behavioural profile of HIV positive DSC personnel to determine the reason for their vulnerability.

METHOD

The study was conducted among 46 HIV positive DSC personnel during 1992-2004 at various AF stations. Pretested questionnaires were introduced to the subjects to ascertain their demographic, social, educational and behavioural profile vis-à-vis their HIV-AIDS awareness.

RESULTS

Majority of the subjects detected during pre-donation screening were middle aged, rural, semiliterate, (56.5%) and acquired the disease through heterosexual (95.66%) mode, mostly from commercial sex workers (CSWs). All were aware of HIV-AIDS prevention and most of them (77.2%) stated that condoms were easily available but 70.7% did not use the same for the fear of failure to perform under the influence of liquor. 74% subjects were found complying with medical instructions.

CONCLUSION

The study brings out a discernable gap between the knowledge and practice of safe sex. Adequate preventive knowledge did not always result in practice of safe sex.

Intra-couple communication dynamics of HIV risk behavior among injecting drug users and their sexual partners in Northern Vietnam

This paper elucidates the social context of HIV risk behavior and intra-couple risk communication among injecting drug users (IDUs) and their main sex partner. Data on shared injection equipment, unprotected sex with multiple partners, unprotected sex with a main partner and couples' dynamics and risk communication were gathered through separate in-depth interviews with 11 active male IDUs and 11 of their primary female sex partners in Northern Vietnam. The majority of IDUs' sex partners does not inject drugs and is monogamous. In contrast, most IDUs reported a wide range of risky practices including needle sharing and unprotected sex with multiple, often concurrent, sex partners. Men rarely used condoms with primary partners. Many IDUs worried about their HIV-status, but none disclosed their injecting or sexual practices to their sex partners, leaving their partners unaware of their HIV risk. Among women who worried about HIV/AIDS, the vast majority was unable to influence their partner's needle sharing or extramarital affairs and most would not initiate condom use because they feared their partner's reaction. Couple-based interventions to facilitate risk communication combined with programs to promote condom use among male IDUs, may help to reduce HIV transmission from IDUs to their primary partners.

Containing HIV/AIDS in India: the unfinished agenda

India's HIV epidemic is not yet contained and prevention in populations most at risk (high-risk groups) needs to be enhanced and expanded. HIV prevalence as measured through surveillance of antenatal and sexually transmitted disease clinics is the chief source of information on HIV in India, but these data cannot provide real insight into where transmission is occurring or guide programme strategy. The factors that influence the Indian epidemic are the size, behaviours, and disease burdens of high-risk groups, their interaction with bridge populations and general population sexual networks, and migration and mobility of both bridge populations and high-risk groups. The interplay of these forces has resulted in substantial epidemics in several pockets of many Indian states that could potentially ignite subepidemics in other, currently low prevalence, parts of the country. The growth of HIV, unless contained, could have serious consequences for India's development. India's national response to HIV began in 1992 and has shown early success in some states. The priority is to build on those successes by increasing prevention coverage of high-risk groups to saturation level, enhancing access and uptake of care and treatment services, ensuring systems and capacity for evidence-based programming, and building in-country technical and managerial capacity.

High HIV prevalence and risk factors among injection drug users in Tashkent, Uzbekistan, 2003-2004

OBJECTIVES

To determine HIV prevalence and potential associations with sociodemographic and behavioral factors among injection drug users (IDUs) in Tashkent, Uzbekistan.

METHODS

Subjects in this cross-sectional study provided sociodemographic and risk behavior data and were tested for HIV antibody with a saliva-based enzyme-linked immunosorbent assay (ELISA), followed by saliva-based Western blot confirmation.

RESULTS

Among the 701 IDU subjects enrolled, 209 (29.8%) were diagnosed with HIV infection, HIV infection was more likely among those unemployed (adjusted odds ratio [AOR]=1.47); whose first drug of abuse was heroin (AOR=2.21) or opium poppy extract (AOR=1.61); with a prior history of hepatitis (AOR=1.39); and those who reported never using condoms (AOR=1.65). Independent risk factors associated with HIV infection were heroin as the first illicit drug of abuse, prior hepatitis, lack of condom use, and unemployment.

CONCLUSIONS

Heroin use, sexual transmission, and high unemployment seem to play important roles in HIV transmission. Implementation of effective harm reduction strategies is critical to control the expansion of the HIV epidemic in this country as well as in this region.

High HIV prevalence among a high-risk subgroup of women attending sexually transmitted infection clinics in Pune, India

OBJECTIVE

To investigate changes over a decade in prevalence and correlates of HIV among high-risk women attending sexually transmitted infection (STI) clinics in Pune, India, who deny a history of commercial sex work (CSW).

DESIGN

Cross-sectional.

METHODS

From 1993 to 2002, 2376 women attending 3 STI clinics in Pune were offered HIV screening. Women who denied CSW were included (n = 1020).

RESULTS

Of 1020 women, 21% were HIV infected. The annual HIV prevalence increased from 14% in 1993 to 29% in 2001-2002 (P < 0.001). The change in HIV prevalence over time was paralleled by changes in clinic visitor characteristics; in later periods, women were older, more often employed, less likely to be currently married, and more likely to report condom use. In multivariate analysis, factors independently associated with HIV were calendar period (adjusted odds ratio [AOR], 1.9 for 1997-1999 vs. 1993-1996; 95% CI, 1.2-3.0; AOR, 2.3 for 2000-2002 vs. 1993-1996; 95% CI, 1.5-3.6), lack of formal education (AOR, 2.0; 95% CI, 1.4-2.9), having been widowed (AOR, 3.1; 95% CI, 1.6-6.1), current employment (AOR, 1.8; 95% CI, 1.2-2.6), and genital ulcer disease on examination (AOR, 1.8; 95% CI, 1.2-2.7).

CONCLUSIONS

Women attending STI clinics in India who deny a history of CSW represent a small, hidden subgroup, likely put at risk for HIV because of high-risk behavior of their male partners, generally their husbands. Educational and awareness efforts that have targeted other subgroups in India (men and CSWs) should also focus on these hard-to-reach women. Risk reduction in this subgroup of Indian women would also be expected to reduce perinatal infections in India.

Phase I safety study of 0.5% PRO 2000 vaginal Gel among HIV un-infected women in Pune, India

BACKGROUND

The objective of this study was to evaluate the safety of twice daily, intra-vaginal use of 0.5% PRO 2000 Gel for fourteen days in HIV un-infected women at lower as well as higher risk for HIV acquisition, in Pune, India.

METHODS

Forty-two eligible volunteers (30 low-risk and 12 high-risk) were given 0.5% PRO 2000 Gel for intra-vaginal application twice daily for 14 consecutive days.

RESULTS

Twenty-four participants (57%, 95% CI 41%-72%) experienced at least one adverse event (AE) judged to be possibly related to the product use. There were 17 (40%, 95% CI 26%-57%) mild AEs and 7 (17%, 95% CI 7%-31%) moderate AEs. There were no serious adverse events and no AEs judged probably or definitely related to product use. Genitourinary discomfort was reported by 2/30 (6.67%) participants in the low-risk cohort as compared to 4/12 (33.3%) women in the high-risk cohort (p = 0.03). Intermenstrual bleeding was reported in 2/30 (6.7%, 95% CI 1.0-22.1) women from the low risk cohort and 3/12 (25%, 95% CI 5.5-57.2) women from the high-risk cohort. One participant showed mild elevation of blood gamma glutamyl transferase and two showed mild elevations in total bilirubin. None of the participants showed detectable PRO 2000 in their blood after 14 days of product use.

CONCLUSION

0.5% PRO 2000 Gel appeared to be safe when used twice-daily by sexually active HIV-uninfected women from Pune, India. Although genitourinary discomfort and metrorrhagia were more common in the high-risk cohort, ongoing Phase II/IIb trial would provide data for generalization of this finding.

Behavior change and health-related interventions for heterosexual risk reduction among drug users

Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resource-constrained settings and to address relevant contextual factors.

How Effective are Harm Reduction Programmes for Drug Users? Some Insights from an Evaluation of the Programme at Sharan in Delhi

Drug use and the physical, psychological and social problems associated with it have been one of the major concerns among professionals in the domain of health and health psychology. One important reason for drug use being a matter of deep concern is the risk of HIV infection associated with it. Apart from the practice of unsafe sex among drug users, in recent decades sharing of needles/syringes by injecting drug users has contributed substantially to the spread of HIV/AIDS. The WHO has noted that the harm reduction approach provides an anxiety-free atmosphere (denied by the traditional abstinence-based intervention programmes) for drug users where they learn and discuss the personal social significance of not sharing needles/syringes and exchanging free needles/syringes. Importantly, apart from needle/syringe exchange, oral substitution of drugs, medical care and education to prevent HIV/AIDS, a harm reduction programme provides a psychological space to drug users that not only acts an emotional support but also enables them to reflect upon their life and risk behaviour. Apart from indicating the need of harm reduction programmes, this article also evaluates the effectiveness of such a programme run by Sharan, an NGO in Delhi, during 1999–2002. Apart from various components of the programme, unconditional acceptance of the drug users by the service providers has brought about substantial reduction in risk behaviour and noticeable improvement in their quality of life.

Comparative acceptability study of the Reality® female condom and the version 4 of modified Reddy female condom in India

OBJECTIVE

Affordable, acceptable and effective female controlled options are required worldwide for prevention of human immunodeficiency virus (HIV) infection and other sexually transmitted diseases. We carried out a comparative acceptability study of Reality and Reddy (version 4) female condoms.

METHODS

Sixty eligible couples were enrolled and randomly assigned to use either Reality or Reddy condom first. They used three Reality condoms and three Reddy condoms each with at least one condom use per week.

RESULTS

Reddy female condom had a significantly better acceptability than Reality condom among women who were less educated and who had not used male condom before. In spite of higher acceptability score, participants were less confident about the Reddy condom for protecting them from HIV disease or pregnancy as compared to a male condom.

CONCLUSIONS

Female condoms are being introduced in India. This study has generated data that is suggestive of optimism for this female controlled option.

Effectiveness of harm reduction programmes for injecting drug users in Dhaka city

This paper provides a brief overview of the harm reduction programme for injecting drug users (IDU) of CARE, Bangladesh in Dhaka city and uses data from surveillance and a focussed research study on a cohort of IDU, to evaluate the programme. The harm reduction programme in Dhaka is run by CARE, Bangladesh and includes needle/syringe exchange, awareness raising on HIV/STI, abscess management, condom distribution and advocacy with different groups of people. The needle/syringe exchange programme (NEP) has been in place since 1998, the 2^nd Generation Surveillance in Bangladesh is being conducted since 1998, and an in-depth cohort study, started in 2002, is being conducted in two areas of Dhaka city with approximately 500 IDU under CARE's NEP who are being followed bi-annually to assess risk behaviour, incidence of HIV, hepatitis C and syphilis. As the surveillance and the cohort study are both closely associated with the NEP of CARE, Bangladesh, these data can be used to monitor the NEP.

Methods to estimate the number of orphans as a result of AIDS and other causes in Sub-Saharan Africa

OBJECTIVE

To derive methods to estimate and project the fraction of children orphaned by AIDS and other causes.

METHODS

HIV/AIDS affects orphan numbers through increased adult and child mortality and reduced fertility of HIV-positive women. We extend an epidemiologic and demographic model used previously to estimate maternal orphans to paternal orphans. We account for the impact of HIV/AIDS on child survival by modeling the HIV status of the partners of men who die of AIDS or other causes based on data on the concordance of heterosexual partners. Subsequently, the proportion of orphans whose parents have both died is predicted by a regression model fitted to orphanhood data from 34 national demographic and health surveys (DHSs). The approach is illustrated with an application to Tanzania and compared with DHS estimates for the years 1992 and 1999.

RESULTS

Projections of the number and age distribution of orphans using these methods agree with survey data for Tanzania. They show the rise in orphanhood over the last decade that has resulted from the HIV epidemic.

CONCLUSIONS

The methods allow estimation of the numbers of children whose mother, father, or both parents have died for countries with generalized heterosexual HIV epidemics. These methods have been used to produce orphan estimates for high-prevalence countries published by Joint United Nations Program on HIV/AIDS, World Health Organization, United Nations Children's Fund, and US Agency for International Development in 2002 and 2004.

Drug use and harm reduction in Afghanistan

Opium has been cultivated in Afghanistan since 1100 A.D., although production has steadily increased since 1979. Currently, Afghanistan produces three-quarters of the global opium supply, with injection drug use and HIV currently following the opium trade route through Central Asia. Although systematic studies are lacking, heroin use appears to be on the rise in Afghanistan. The purpose of this paper is to briefly provide historical background and current statistics for drug production and use in Afghanistan, to discuss the new government's policies towards problem drug use and available rehabilitation programs, and to assess Afghan harm reduction needs with consideration of regional trends.

Risk factors for HIV infection in injection drug users and evidence for onward transmission of HIV to their sexual partners in Chennai, India

OBJECTIVES

Determining HIV prevalence in injection drug users (IDUs) and their regular sex partners in Chennai, India.

METHODS

A total of 226 IDUs and their regular sex partners were enrolled during April-July 2003. After informed consent was obtained, a semistructured questionnaire was administered and serum was tested for HIV antibody.

RESULTS

The HIV seroprevalence was 30% (68/226) in IDUs and 5% in their regular sex partners (11/226). While in 25% of couples only the male partner was HIV positive, 5% of the couples were concordant for HIV infection and 70% were HIV negative. Fifty-seven percent of the HIV-positive IDUs and 45% of the HIV-infected women thought that they had "no chance" or "very little chance" of getting HIV, reflecting low HIV risk perception. More than 20% IDUs reported borrowing or lending of injection equipment. In univariate analyses "sex" and "condom use" with sex workers had no bearing but "more than twice a day injecting frequency," "history of incarceration," "tattoos," "recruitment from northern part of the city," and ever-injecting drugs in drug-selling places had significant association with HIV infection in IDUs. In an adjusted model, the odds of HIV infection were 2 times higher among IDUs who had ever injected drugs in drug-selling places and 6 times higher in those who were recruited from the northern part of central Chennai.

CONCLUSION

Reducing sharing of injection equipment and unsafe tattooing through targeted and environmental interventions, increasing HIV risk perception, and promoting safer sex practices among IDUs and their sex partners are urgent program needs.

HIV/AIDS epidemics in Vietnam: evolution and responses

The goal of this study was to describe the evolution of the HIV epidemic in Vietnam and its responses. Surveillance was conducted in 8 provinces in 1994, expanded to 12 in 1995, 20 in 1996, and 30 in 2001. Sentinel populations were sexually transmitted disease (STD) patients, female sex workers (FSWs), injection drug users (IDUs), tuberculosis (TB) patients, antenatal women, and military conscripts. Vietnam is in the concentrated epidemic stage. HIV prevalence had increased significantly in all surveillance population groups in the 1990s. HIV prevalence in the south is higher than in other regions of the country. The national HIV prevalence increased from 10.1% in 1996 to 32% in 2002 among IDUs, from 0.6% in 1994 to 6.6% in 2002 among FSWs, from 0.4% in 1994 to 2.4% in 2002 among STD patients, from 0.03% in 1994 to 0.34% in 2002 among pregnant women, from 0% in 1994 to 0.7% in 2002 among army military recruits, and from 0.5% in 1994 to 3.6% in 2002 among TB patients. The government has a strong commitment to control the epidemic and has implemented many activities for HIV prevention and control. Vietnam's HIV epidemic is predominantly among IDUs. Current intervention activities have not been sufficient to reduce HIV transmission. Vietnam needs to strengthen responses by scaling up the best practices in the most affected population groups by implementing internationally recognised effective interventions appropriately.

Drug-related HIV in South and South-East Asia

While there has been significant advancement in the knowledge on effective HIV prevention methods among injecting drug users (IDUs), and their demonstrated success, in particular the impact of availability and use of clean injecting equipment on reducing HIV prevalence among IDUs, in Australia, the US and the UK, progress made in implementation of actual interventions focused on IDUs in South and South-East Asia is less than satisfactory. This paper examines some of the critical issues related to the context and causes of inadequate drug-related HIV prevention programmes in Asia. It also raises questions relating to evidence-based interventions to be scaled up in the region, including the need for sufficient resources anda conducive policy and legalenvironment.

Rise in needle sharing among injection drug users in Pakistan during the Afghanistan war

The war in Afghanistan in 2001 may have had direct or indirect effects on drug users' behaviors in nearby Pakistan. We studied drug use patterns and correlates of needle sharing among injection drug users (IDUs) in Lahore, Pakistan, before and after the beginning of the Afghanistan war. Between August and October 2001, 244 drug users registering for needle exchange and other services underwent an interviewer-administered survey on sociodemographics, drug use and HIV/AIDS awareness. chi(2)-tests were used to compare drug use behaviors among subjects interviewed before and after October 6th, 2001, coinciding with the start of the Afghanistan war. Correlates of needle sharing among IDUs were identified using logistic regression. Comparing IDUs interviewed before and after October 6th, 2001, levels of needle sharing were significantly higher after the war (56% versus 76%, respectively; P=0.02). Factors independently associated with needle sharing included registering after the war began (adjusted odds ratio, AOR=3.76 (95% CI: 1.23-11.48)), being married (AOR=0.36), being homeless (AOR=3.91), having been arrested (AOR=6.00), and re-using syringes (AOR=6.19). Expansion of needle exchange, drug treatment and supportive services is urgently needed to avoid an explosive HIV epidemic in Pakistan.

HIV/AIDS risk behaviors and correlates of injection drug use among drug users in Pakistan

We studied prevalence and correlates of injection drug use, awareness of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and risky behaviors among drug users serviced by a nongovernmental organization catering to drug users in three Pakistani cities (Quetta, Peshawar, and Rawalpindi). Logistic regression analysis was used to identify correlates of injection drug use. Of 608 drug users, 99.8% were male; median age was 32 years, and 44% were married. Most (79.8%) were Pakistani; 15.3% were Afghani. The majority used heroin (98.7%), mostly by inhalation; 15.2% injected drugs. Only 41% had heard of HIV/AIDS, and 30% had been paid for donating blood. Injection drug use and needle sharing were highest in Quetta. Injecting drug users (IDUs) were nearly twice as likely to have donated blood and to have heard about HIV/AIDS compared to other drug users. Interventions to discourage transitions to injection, increase HIV testing, and safeguard the blood supply in Pakistan are urgently needed.

A World Health Organization perspective on alcohol and illicit drug use and health

Alcohol and illicit drug use has a significant impact on global health. Alcohol consumption is increasing worldwide, particularly in developing countries and countries in transition, leading to an increasing number of health and social problems, both acute and chronic. Illicit drug use is also increasing, particularly injection drug use, followed by an epidemic spread of HIV and other blood-borne infections. Alcohol and illicit drug use are related to key determinants of population health and are also an outcome of poor health. Globalized marketing and trade, and rapid social changes and development in the absence of strong policies and investments in public health have led to an increased availability, use and problems related to alcohol and other substance use. Public health policies and substantial investments in effective prevention and treatment approaches are needed in order to reduce the negative impact of alcohol and other drug use at national and global levels.