HIV / STDs and drug use.

Unprotected sexual intercourse and sharing drug injecting equipment are the two major ways in which HIV is transmitted among adults. Despite considerable cultural disapproval of illicit drug injection, the health hazards associated with it, and expensive law enforcement efforts, there has been an enormous diffusion of illicit drug injection during the second half of the 20th century. HIV infection has spread very fast among some populations of injecting drug users (IDUs), with incidence rates of 10-50% observed in both developing and developed countries. Needle sharing occurs among large numbers of IDUs within short periods of time, promoting the rapid and efficient transmission of HIV within the IDU population. HIV and STDs are spread from IDUs to non-IDUs through unprotected sexual intercourse. Effective HIV prevention programs for IDUs provide ongoing and trusted communication links between health workers and IDUs. Such programs also provide ready access to the means of changing behavior. The relationships between sexual behavior and drug use are complex. Prevention efforts should be focused upon people who exchange sex to support an addiction, the partners of addicted sex workers, and people who have multiple problems in living. The successful prevention of HIV infection among drug users requires that politicians admit that drug use exists in the community, that such use is likely to persist indefinitely, and that it is necessary to work with drug users to change risk behaviors.