[HIV infection and injecting drug users: The urgency of reinvigorating harm-reduction programmes]

The HIV epidemic among injecting drug users (IDUs) has led to greater support for the development of the harm-reduction perspective. This has proven to be a driving force for initially reluctant policy makers, managers and health care providers and has facilitated the implementation of harm-reduction programmes. This article presents recent data, both global and at the European and Spanish levels, about a) the epidemiological situation of HIV infection among IDUs, and b) the state of development of harm-reduction programmes. The incidence of HIV infection among IDUs not only continues to grow in different areas of, for example, Southeast Asia or Eastern Europe, but has even shown an upturn in cities or specific IDU groups in parts of Western Europe with apparently comprehensive harm-reduction strategies. On the other hand, of the 158 countries that acknowledge illegal drug use via injection in their territory, only 82 support harm reduction, explicitly in national policy documents and/or through the implementation or tolerance of interventions such as needle exchange programmes or opioid agonist programmes. These data, in conjunction with the high-quality and consistent evidence on the efficacy and effectiveness of harm- and risk-reduction programmes for HIV prevention and management among IDUs, should serve as a call to avoid complacency with regard to the diversification, accessibility and coverage of harm- and risk-reduction programmes for IDUs.