Publications & Reports

Injecting drug use in low and middle income countries: opportunities to improve care and prevent harm.

O'Keefe D, Stoové M, Doyle J, Dietze P, Hellard M.


Inadequate response to injecting drug use (IDU) is a significant problem the world over. Low levels of funding, political inaction, poor levels of health service coverage, high prevalence and incidence of IDU-related blood-borne viruses (BBVs), and ongoing stigmatisation/marginalisation affect people who inject drugs (PWID) regardless of the income status of the country they reside in. These barriers and system failings are, however, exacerbated in low and middle income countries (LMICs), meaning that the potential consequences of inaction are more pressing. In this narrative review, we describe the levels of IDU and IDU-specific BBV prevalence in LMICs; levels of harm reduction implementation; the consequences of late or insufficient response, the short-comings of data collection and dissemination; and the barriers to effective LMIC harm reduction implementation. We also exemplify cases where IDU-related harms and BBV epidemics have been successfully curtailed in LMICs, showing that effective response, despite the barriers, is possible. In conclusion, we suggest four key priorities on the basis of the review: confirming the presence or absence of IDU in LMICs, improving the collection and dissemination of national IDU-specific data, increasing the level of harm reduction program implementation in LMICs, and increasing both national and international advocacy for PWID and attendant public health interventions. This article is protected by copyright. All rights reserved.

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Margaret Hellard is supported by a National Health and Medical Research Council (NHMRC) Principal Research Fellowship. Mark Stoove is supported by a NHMRC Career Development Fellowship, Joe Doyle is supported by a NHMRC Post-Doctoral Fellowship. The Burnet Institute receives support from the Victorian Operational Infrastructure Support Program.