Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 135

5 Clinical and Support Services

5.5 Additional services for sex workers who inject drugs
5.5.1 Introduction

2012 Recommendations: Evidence-based Recommendation 7

In some regions of the world there is a substantial overlap between communities of people who
inject drugs and sex workers. HIV transmission through injecting drug use accounts for 10% of the
world’s new infections, and in some countries is the primary route of transmission. The prevalence
of HIV among sex workers who inject drugs tends to be significantly higher than among those who
do not inject. This vulnerability may be greater in females who inject drugs, due to gender inequalities
and injecting practices. Therefore, when considering HIV prevention among sex workers, attention
should be paid to ensuring that those sex workers who inject any kind of drugs have access to the
services they need to keep themselves safe from the danger of acquiring or transmitting HIV, viral
hepatitis and other bloodborne infections.
Sex workers who inject drugs, including those who are HIV-positive, should have full access to a
comprehensive package of integrated HIV prevention, support, treatment and care services, as well
as access to support and voluntary treatment for drug dependence should they want it.
The WHO/UNODC/UNAIDS Technical Guide for countries to set targets for universal access to HIV
prevention, treatment and care for injecting drug users—2012 revision sets out nine key interventions
that have proven efficacy in reducing HIV transmission among people who inject drugs. Seven of these
interventions are already covered in other parts of this tool, and only the remaining two are exclusive
to injecting behaviour: opioid substitution therapy (OST) and needle and syringe programmes
(NSPs). These two interventions specifically reduce transmission among people who inject drugs and
should be prioritized in a comprehensive HIV prevention package for sex workers who inject drugs.
Only about half of the countries that report injecting drug use have also implemented OST and/or
NSP. In countries where these services do not exist it is essential to support advocacy activities and
community-led outreach services.

5.5.2 Opioid substitution therapy
There is overwhelming evidence gathered over 30 years that methadone substitution therapy is
highly efficient, cost-effective and safe and has many collateral benefits in terms of stabilizing and
improving the quality of life of people who are dependent on opioids. Some countries have started
using buprenorphine with similar results. While OST is designed to treat opioid dependence, it has
proven highly effective in preventing transmission of HIV and other bloodborne viruses through the
sharing of injecting equipment, and in supporting adherence to the treatment of HIV and other health
problems.
OST may be delivered in a wide range of settings and has been shown to be most effective when:
• dosage is adequate and individualized, based on the expressed needs of the user
• access to treatment is fast, easy and local, without overburdening bureaucracy

113