ACCESS TO CLEAN NEEDLES KEY TO REDUCING HIV IN DRUG USERS

WASHINGTON - A prestigious U.S. scientific body is urging governments
to adopt politically controversial measures to cut the spread of
HIV-AIDS among injection drug users.

A new report from the Institute of Medicine, commissioned by UNAIDS
and the Bill and Melinda Gates Foundation, suggests the scientific
evidence is clear: programs that provide access to methadone therapy
and clean syringes reduce the risk of transmission of HIV among
people who inject illegal drugs.

"A clean needle won't prevent a sexual transmission. . . . But it
will prevent a needle-borne transmission," Dr. Hugh Tilson, chair of
the panel that wrote the report, said in an interview.

"So if your objective is to reduce the likelihood of HIV
transmission, you want to have the needle and syringe access program
embedded in a multi-component program which includes education,
outreach, access to medical care and certainly information about
effective methods of prevention of HIV transmission to sexual
partners and, God help us, to their offspring."

"The evidence is clear that needle and syringe access programs, in
such multi-component programs, are effective in achieving the social
objective of reducing the spread of HIV."

The report lists as "encouraging" but preliminary the evidence on
whether safe injection sites like Vancouver's Insite program reduce
the spread of HIV-AIDS among drug users. The federal government
recently put off deciding on the fate of the pilot program until the
end of 2007, saying there is still insufficient evidence to approve a
requested three-and-a-half year extension.

Dr. Evan Wood, an addiction researcher with the B.C. Centre of
Excellence in HIV-AIDS, disagreed with the report's assessment that
the evidence is still preliminary on the impact of safe injection
sites on the spread of HIV among drug users. But he said several key
scientific publications on the Insite program were published after
the panel began writing its report.

"That's not a disagreement of interpretation of research," he said of
the report's position. "It's more that this report was probably
finalized before those papers were published."

Tilson confirmed that the new studies were made public too late to be
considered by his committee.

There are an estimated 13.2 million injecting drug users worldwide.
And it is believed that in parts of Eastern Europe, countries of the
former Soviet Bloc and portions of Asia, the sharing of contaminated
injection drug paraphernalia is the leading mode of HIV transmission,
putting sexual partners of and children born to infected drug users
at risk as well.

"This is an urgent public health challenge that remains largely
unmet," Tilson said. "Several approaches to reducing injection drug
behaviours can work and affected nations cannot afford to wait to act."

While the report's recommendations are aimed primarily at developing
countries with major populations of injecting drug users, it notes
its findings are also applicable in other countries.

The Institute of Medicine - an agency of the U.S. National Academy of
Sciences - was asked to assess the evidence for or against programs
aimed at reducing the risk of HIV transmission through safer
injection drug use.