Somehow the Article by Bradley Mathers and colleagues (March 20, p 1014)¹ left us with a sense of despair. Strategically, preventing the spread of HIV among intravenous drug users (IDUs) through safe consumption and decreased viral load holds no mystery. Technically, effective and proven methods are clear: increased access to sterile syringes, prevention messages encouraging IDUs to use their own material, and wider access to methadone, buprenorphine, and antiretroviral treatments.

Yet experts can do little when confronted with governmental inertia. In Russia, opiate substitution treatment is currently illegal. In south and southeast Asia, Latin America, and Africa, vast populations of IDUs are being infected and are infecting their sexual partners, promoting HIV spread and vertical transmission.

However, unlike the modification of current sexual practices, which remains a difficult and often disappointing task, needle-sharing practices can be modified quickly and rapid results obtained.

France is an excellent example of a country that lagged behind, but which rapidly caught up once effective harm-reduction measures were instigated. Syringe sales were forbidden until 1987 and opiate substitution was not developed until 1995. After rising to a very high level, the prevalence of HIV among IDUs has been in line with average European levels for several years. The latest French figures show a prevalence of 0·3% among IDUs younger than 30 years.²

Prejudices are indeed the primary enemy to public health and these prejudices are longstanding, but even delayed concerted actions can help to curb the HIV epidemic among IDUs.

We declare that we have no conflicts of interest.

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References
1 Mathers BM, Degenhardt L, Ali H, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet 2010; 375: 1014-1028.
2 Jauffret-Roustide M, Emmanuelli J, Quaglia M, et al. Impact of a harm-reduction policy on HIV and hepatitis C virus transmission among drug users: recent French data—the ANRS-Coquelicot Study. Subst Use Misuse 2006; 41: 1603-1621.

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Amine Benyamina, Lisa Blecha, Bertrand Lebeau, Michel Reynaud

The Lancet,  Volume 375, Issue 9728, Page 1782, 22 May 2010
doi:10.1016/S0140-6736(10)60808-2