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Emerging HIV epidemics in Muslim countries: assessment of different cultural responses to harm reduction and implications for HIV control

Todd CS, Nassiramanesh B, Stanekzai MR, Kamarulzaman A

Curr HIV/AIDS Rep, 2007 Dec;4(4):151-7.
PMID: 18366945

Harm reduction, including needle exchange and opioid substitution therapy, has been demonstrated to reduce high-risk behavior and HIV infection among injection drug users. An increasing number of countries in the Middle East, North Africa, and Asia, including those with Muslim majorities, have experienced or are at risk for HIV epidemics initiated by burgeoning injection drug use. Although use of intoxicants is expressly forbidden within Islam, the local culture impacts the interpretation of Islamic law and influences the response to drug misuse, whether punitive or therapeutic. Harm reduction programming has received varying acceptance within this global region, which may be reflected by national trends in HIV prevalence. The purpose of this paper is to examine cultural and religious response to injecting drug use and associated HIV prevalence trends in Malaysia and Iran, with possible application of lessons learned to an emerging situation in Afghanistan.
The Impact of Alcohol Use and Related Disorders on the HIV Continuum of Care: a Systematic Review : Alcohol and the HIV Continuum of Care

Vagenas P, Azar MM, Copenhaver MM, Springer SA, Molina PE, Altice FL

Curr HIV/AIDS Rep, 2015 Dec;12(4):421-36.
PMID: 26412084 DOI: 10.1007/s11904-015-0285-5

Alcohol use is highly prevalent globally with numerous negative consequences to human health, including HIV progression, in people living with HIV (PLH). The HIV continuum of care, or treatment cascade, represents a sequence of targets for intervention that can result in viral suppression, which ultimately benefits individuals and society. The extent to which alcohol impacts each step in the cascade, however, has not been systematically examined. International targets for HIV treatment as prevention aim for 90 % of PLH to be diagnosed, 90 % of them to be prescribed with antiretroviral therapy (ART), and 90 % to achieve viral suppression; currently, only 20 % of PLH are virally suppressed. This systematic review, from 2010 through May 2015, found 53 clinical research papers examining the impact of alcohol use on each step of the HIV treatment cascade. These studies were mostly cross-sectional or cohort studies and from all income settings. Most (77 %) found a negative association between alcohol consumption on one or more stages of the treatment cascade. Lack of consistency in measurement, however, reduced the ability to draw consistent conclusions. Nonetheless, the strong negative correlations suggest that problematic alcohol consumption should be targeted, preferably using evidence-based behavioral and pharmacological interventions, to indirectly increase the proportion of PLH achieving viral suppression, to achieve treatment as prevention mandates, and to reduce HIV transmission.
Fulltext Integrated Models of Care for Individuals with Opioid Use Disorder: How Do We Prevent HIV and HCV?

Rich KM, Bia J, Altice FL, Feinberg J

Curr HIV/AIDS Rep, 2018 06;15(3):266-275.
PMID: 29774442 DOI: 10.1007/s11904-018-0396-x

PURPOSE OF REVIEW: To describe models of integrated and co-located care for opioid use disorder (OUD), hepatitis C (HCV), and HIV.
RECENT FINDINGS: The design and scale-up of multidisciplinary care models that engage, retain, and treat individuals with HIV, HCV, and OUD are critical to preventing continued spread of HIV and HCV. We identified 17 models within primary care (N = 3), HIV specialty care (N = 5), opioid treatment programs (N = 6), transitional clinics (N = 2), and community-based harm reduction programs (N = 1), as well as two emerging models. Key components of such models are the provision of (1) medication-assisted treatment for OUD, (2) HIV and HCV treatment, (3) HIV pre-exposure prophylaxis, and (4) behavioral health services. Research is needed to understand differences in effectiveness between co-located and fully integrated care, combat the deleterious racial and ethnic legacies of the "War on Drugs," and inform the delivery of psychiatric care. Increased access to harm reduction services is crucial.

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