What Works for Women and Girls

Evidence from prospective cohort and case control studies show that continuous maintenancetreatment, such as methadone, is associated with protection against HIV seroconversion(Moses et al., 1994; Serpellini and Carrieeri, 1994 cited in IOM, 2007).(Gray III) (drug treatment)2. Comprehensive harm reduction programs, including needle exchange programs, condomdistribution, substitution therapy and outreach, can reduce HIV risk behaviors and prevalenceamong male and female IDUs.A review of the international evidence on needle exchange programs found that needleexchange programs reduce HIV infection among IDUs. Studies were mostly based inthe US, Canada and Europe, but included studies from Nepal and Russia. A review often studies that evaluated HIV seroconversion or seropositivity as outcomes found theneedle exchange programs were protective in six studies; had no effect in two studiesand were negatively associated in two studies. “There is compelling evidence thatincreasing the availability, accessibility, and both the awareness of the imperative toavoid HIV and utilization of sterile injecting equipment by IDUs reduces HIV infectionsubstantially… There is no convincing evidence of any major unintended negativeconsequences” (Wodak and Cooney, 2006: 802). (Gray I). (drug use, needle exchange,IDUs, United States, Canada, Europe, Nepal, Russia)A two-armed, prospective, community-randomized trial in China that provided accessto clean needles over a nine-month period resulted in needle sharing dropping significantlyin the intervention community. Four counties and townships in Gungxi andGuandong provinces were randomized to intervention and control in each province.The intervention effect was assessed on 443 IDUs in the intervention area and 382 inthe area of no intervention at the start of the project and 415 IDUs in the interventionarea and 407 in the area of no intervention at the end of the project. Of these, only 47women received the intervention and only 32 women were in the control group thatreceived the intervention at the end of the project. The intervention consisted of healtheducation sessions between health workers and IDUS, peer education and dispensingand recall of needles, with increased access to safe needles. While needle sharing behaviorsamong IDUs were similar in the intervention and nonintervention areas (68.4%compared to 67.8%), needle sharing dropped significantly to 35.3% after a year of theintervention in the intervention area. Lab testing was conducted for both HIV andHepatitis C (Wu et al., 2007a). (Gray II) (harm reduction, drug use, needle exchange, healtheducation, IDUs, China)Rates of sharing equipment at last injection declined from 55% in 2001 to 26% in 2006in north-east India, with HIV prevalence declining from 52% in 2002 to 13% in 2007(Sharma et al., 2009). (Gray III) (needle exchange, India)Australia and New Zealand have maintained very low levels of HIV infection, despitea higher prevalence of injecting than in some other countries; this difference has been94 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS