IRIN examines a recent comment piece in the journal Lancet that argues PEPFAR can do more to prevent the spread of HIV among injecting drug users (IDUs) in Africa (IRIN, 6/24).
Although PEPFAR has helped to provide "antiretroviral therapy to 2.1 million people with HIV, almost all of whom live in sub-Saharan Africa, and has spent more than $18 billion on the continent," it has failed to reach "thousands of injecting drug users in PEPFAR countries in Africa, many of whom have HIV," according to the authors of the Lancet article (Kaiser Global Health Policy Report, 6/19).
According to IRIN, some HIV advocates have noted that PEPFAR has allocated "limited funds for programmes targeting high-risk populations such as sex workers and intravenous drug users." Last year, PEPFAR was reauthorized for an additional five years, and it is not clear if it will provide funds for needle-exchange initiatives. At the time, then U.S. Global AIDS Coordinator Mark Dybul said implementing such programs would be up to President Obama's administration and the U.S. Congress.
IRIN reports, "in sub-Saharan Africa there could be up to three million people who inject drugs … [and] prevalence is often higher among intravenous drug users than in the general population." But heterosexual transmission is still the main way that people acquire HIV in sub-Saharan Africa.
"The criminal nature of drug use in these countries means drug users are usually arrested and imprisoned, rarely ever getting treatment for their addictions," Anne Gathumbi of the Nairobi-based Open Society of East Africa, said. She said many HIV prevention methods endorsed by the WHO, including needle exchange programs are discouraged or illegal in many African countries, which makes it difficult for agencies to provide effective HIV prevention to IDUs.
"A ban on use of U.S. funds for domestic needle exchange programmes does not apply to international initiatives, but PEPFAR managers have acted as though it does," the authors of the Lancet article noted, adding that "Obama has stated that he favours lifting the ban" (IRIN, 6/24).