Preventing the spread of HIV among Australian injecting drug users

Control of HIV infection among and from injecting drug users is critical for the long-term control of HIV infection in Australia. There is now consistent and strong evidence that the prevalence of HIV infection among Australian injecting drug users is still low. Recent evidence suggests that Australian injecting drug users are reducing injecting behaviour associated with HIV infection. Australian adopted harm reduction policies early and implemented a comprehensive range of programmes vigorously. These were designed to reduce the spread of HIV infection in this population. The most plausible explanation for the low prevalence of HIV infection in Australia is the adoption and implementation of these policies and programmes, although it is unrealistic to expect that this can be proved in a definitive way. Control of HIV infection in Australian injecting drug users represents one of the major public health triumphs in this country in the past decade and probably reduced the present cumulative number of AIDS cases by 1200, AIDS deaths by 800 and expenditure on AIDS by at least $60 million. However, recent international experience in this area is alarming. The prevalence of HIV infection in injecting drug users in Australia will probably rise in the future. Complacency, failure to implement HIV prevention in prisons (including especially bleach distribution), continued emphasis on supply reduction drug policy and a failure to foster a research capability will ensure that this happens sooner rather than later.