Meeting Report Prevention and Treatment of HIV/AIDS among Drug Using Populations: A Global Perspective Meeting supported by the National Institute on Drug Abuse and the International AIDS Society January 11-12, 2010 Washington, D.C. www.iasociety.org Table of Contents Table of Contents .............................................................................................................................................................i Executive Summary .........................................................................................................................................................1 Overview of the Report ..................................................................................................................................................... 1 Chapter 1. Introduction..................................................................................................................................................3 A Timely Opportunity: Why This Meeting Was Held ...................................................................................................... 3 Process and Outcomes ...................................................................................................................................................... 4 Chapter 2. Global Strategy for HIV and Drug Use .......................................................................................................5 President’s Emergency Plan for AIDS Relief ...................................................................................................................... 5 Office of National AIDS Policy ......................................................................................................................................... 7 Office of National Drug Control Policy ............................................................................................................................ 8 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention ..... 9 Office of AIDS Research ................................................................................................................................................ 10 National Institute of Allergy and Infectious Diseases ...................................................................................................... 12 United Nations Joint Programme on HIV/AIDS ............................................................................................................ 14 Conclusion ..................................................................................................................................................................... 15 References ....................................................................................................................................................................... 17 Chapter 3. Comprehensive Approaches to HIV Prevention for People Who Use Drugs ...............................................19 The Case for Comprehensive HIV Prevention for Injection Drug Users .......................................................................... 19 Challenges of Drug-Using Populations ........................................................................................................................... 22 Substance Abuse Treatment as HIV Prevention .............................................................................................................. 24 HCV and TB Co-infection and Drug–Drug Interactions in Substance Users .................................................................. 27 Future Directions ........................................................................................................................................................... 30 Conclusion ..................................................................................................................................................................... 30 References ....................................................................................................................................................................... 31 Chapter 4. Expanded HAART to Improve Individual and Public Health Outcomes ....................................................37 Seek, Test, Treat, and Retain ........................................................................................................................................... 37 HIV/AIDS Treatment for Drug-Using Populations ......................................................................................................... 40 Adherence to ART among Drug-Using Populations ........................................................................................................ 43 Conclusion ..................................................................................................................................................................... 46 References ....................................................................................................................................................................... 48 Chapter 5. Drug Abuse, HIV/AIDS, and the Criminal Justice System: Challenges and Opportunities ........................55 The “War on Drugs” and Increased Incarceration of Drug Abusers ................................................................................. 55 HIV Transmission and Prevention Strategies in Prisons ................................................................................................... 56 Opportunity to Implement “Seek, Test, Treat, and Retain” in Corrections Populations ................................................... 57 HIV Treatment in Prison ............................................................................................................................................... 58 Linkages to Care upon Community Reentry ................................................................................................................... 58 TB and HCV Infection in Criminal Justice Settings ....................................................................................................... 59 Conclusion and Recommendations ................................................................................................................................. 59 References ....................................................................................................................................................................... 61 Table of Contents i Chapter 6. Human Rights and At-Risk and Vulnerable Populations ............................................................................65 Stigma, Discrimination, and Vulnerability to HIV .......................................................................................................... 66 Gender Inequality ........................................................................................................................................................... 67 Sex Workers .................................................................................................................................................................... 68 Men Who Have Sex with Men ....................................................................................................................................... 70 Conclusion ..................................................................................................................................................................... 71 References ....................................................................................................................................................................... 72 Appendix A: Breakout Group Recommendations .........................................................................................................75 Breakout Group 1: Optimizing HIV Prevention Modalities ............................................................................................ 75 Breakout Group 2: Drug Abuse Treatment as HIV Prevention ........................................................................................ 76 Breakout Group 3: HIV Prevention Implementation: Integration and Rolling Out ........................................................ 77 Breakout Group 4: ART Therapy as HIV Prevention: Seek, Test, and Treat ..................................................................... 78 Breakout Group 5: Human Rights and Vulnerable Populations ....................................................................................... 79 Breakout Group 6: HIV/AIDS Treatment ....................................................................................................................... 80 Breakout Group 7: Comorbidity and Adherence ............................................................................................................. 81 Breakout Group 8: Criminal Justice: HIV Prevention and Treatment .............................................................................. 82 Appendix B: Meeting Agenda .......................................................................................................................................83 Appendix C: Participant List 2010 Consultation Meeting ...........................................................................................87 ii Prevention and Treatment of HIV/AIDS among Drug Using Populations: A Global Perspective Executive Summary On January 11–12, 2010, the National Institute on Drug Overview