HIV prevention, treatment, care and support for people who use stimulant drugs

Since the beginning of the HIV epidemic, the focus on HIV prevention, treatment and care among people who use drugs has concentrated on the needs of people who inject drugs, and mainly on those who inject opioids. However, data show that there are HIV-related risks associated with the use of non-injecting stimulant drugs, as well as with the unsafe injection of such drugs, including cocaine, amphetamine-type stimulants (excluding MDMA), and stimulant new psychoactive substances. Use of stimulant drugs has also been associated with higher risk of HIV transmission through unsafe sexual behaviours in certain subsets of key populations.

To achieve SDG target 3.3 and the UNAIDS Fast-Track strategy for ending AIDS by 2030, it is crucial to address the needs of people who use stimulant drugs who are at risk of HIV, with specific attention to the intersections among key populations. Ending the AIDS epidemic is only achievable if we ensure that the right people access the right services, delivered in the right place at the right time, leaving no one behind.

The purpose of this publication is to provide guidance on implementing HIV, hepatitis C (HCV) and hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting these viruses. It aims to:

• Increase awareness of the needs and issues faced by the affected groups, including the intersectionality among different key populations

• Provide implementation guidance to help establish and expand access to core HIV and hepatitis prevention, treatment, care and support services

It is a global document that should be adapted according to the specific context, including the type of stimulant drug used (cocaine, ATS or NPS) and the key populations involved, which vary considerably according to regions.

The present guide proposes a package of core interventions adapted from existing international guidance:

• WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users

• WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations – 2016 update

• Implementing comprehensive HIV and HCV programmes with people who inject drugs: practical guidance for collaborative interventions (the “IDUIT”)

It also incorporates guidance from the implementation tools for other key populations:

• Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions (the “SWIT”)

• Implementing comprehensive HIV and STI programmes with men who have sex with men: practical guidance for collaborative interventions (the “MSMIT”)

• Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions (the “TRANSIT”)

However, none of these guidance documents and tools addresses the specific needs of people who use stimulant drugs and are at risk for HIV and hepatitis B and C – hence the need for this publication.