There are 13 million injection drug users (IDUs) worldwide and injection drug use remains the second most prevalent risk factor for contracting HIV. Injection Drug Use and Infectious Diseases examined the comprehensive services and systems of care needed to address the healthcare needs of this population.  

Eric Goosby, MD, emphasized that antiretroviral treatment (ART) works with IDUs, and they should not be denied care because of their drug use.

Goosby discussed as well the manyl challenges in treating IDUs. Despite the evidence to the contrary, systems of care still often treat addiction as "substance abuse" rather than a medical disease.  In addition, they lack the continuum of services necessary to treat it, and so the relapse rate is high. Meanwhile, complications abound, from psychiatric illness, hepatitis C, and renal failure to compounding conditions such as unemployment, homelessness, and decayed family relations.  

Twenty-five percent of IDUs reside in Eastern Europe -- their sheer number posing an additional challenge -- and largely account for the rise in TB and HIV in the countries of the former Soviet Union.  

Daria Podekareua, PhD, presented sobering data on both epidemics along with the intersecting barriers to addressing IDU, TB, and HIV in this region. 250,000 Eastern Europeans contract TB each year and in Russia alone 30,000 die annually from TB, while another 30,000 are left disabled.  

Nonetheless, IDU-focused harm-reduction programs are scarce due to very limited government support, with only 2% of Russian IDUs having access. Also, the decentralized health system forces IDUs to navigate a complex system, making reliable epidemiology studies difficult.  

Podekareua insisted an integrated approach to addressing TB, IDU, and HIV is needed along with support for harm reduction, improved screening, and access to prophylaxis TB treatment improved access to ART for IDUs, as well as increased public education.