Annals of Health Law
ACHIEVING AN AIDS-FREE GENERATION
in HIV infection may further exacerbate disparities in the populations most
affected by HIV. As discussed in the next section, SEPs are an important
component of prevention measures for IDUs.
C. Preventing the Spread of HIV
National efforts to provide education on HIV prevention techniques have
decreased the number of new infections since the epidemic began in the
1980’s.48 Despite continued education on the modes of transmission and
means for prevention,49 risky behavior among IDUs continues, in part,
because of the lack of available clean syringes.50 Recognizing that an IDU
may not be ready or able to stop using drugs, the CDC recommends using
clean or sterile drug equipment to avoid contact with HIV-infected blood.51
PERINATAL TRANSMISSION, RECOMMENDATIONS FORUSE OFANTIRETROVIRALDRUGS IN
PREGNANT HIV-1-INFECTED WOMEN FOR MATERNAL HEALTH AND INTERVEN TIONS TO REDUCE
PERINATAL HIV TRANSMISSION IN THE UNITED STATES B-1 (2012), available at
http://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/; see also MICHAEL A. STOTO
ET AL., REDUCING THE ODDS: PREVENTING PERINATAL TRANSMISSION OF HIV IN THE UNITED
STATES 45, 47–50 (1999). HIV testing is recommended during pregnancy, but is not always
offered or accepted. Id. at 68. Moreover, IDUs may be less likely to access care. See generally,
Lesley Simmonds & Ross Coomber, Injecting Drug Users: A Stigmatised and Stigmatising
Population, 20 INT’L J. DRUG POL’Y 121, 121 (2009). “In general, IDUs have poorer levels of
access to ART compared with non-IDUs, despite the fact that provision of [antiretroviral
therapy (ART)] to IDUs has population-wide health benefits and despite evidence that IDUs
can successfully undergo treatment and benefit from ART.” WORLD HEALTH ORG. ET AL.,
WHO, UNODC, UNAIDS TECHNICAL GUIDE FOR COUN TRIES TO SET TARGETS FOR UNIVERSAL
ACCESS TO HIV PREVENTION, TREATMENT AND CARE FOR INJECTING DRUG USERS 6 (1999)
(citations omitted), available at http://www.unodc.org/
48. NATIONAL CTR. FOR HIV/AIDS, CTRS. FOR DISEASE CONTROL & PREVENTION, HIV
PREVENTION IN THE UNITED STATES 2 (2009), available at http://www.cdc.gov/hiv/
resources/reports/pdf/hiv_prev_us.pdf; see also H. Irene Hall et al., Estimation of HIV
Incidence in the United States, 300 J. AM. MED. ASSOC. 520, 528 (2008). However, by the end
of 2006, one in five people infected with HIV still did not know their HIV status. HIV Testing,
CTRS. FOR DISEASE CONTROL & PREVENTION, http://www.cdc.gov/hiv/topics/
testing/ index.htm (last modified Feb. 27, 2013).
49. WHITE HOUSE OFFICE OF NAT’L AIDS POL’Y, supra note 23.
50. Des Jarlais, supra note 37, at 584. Despite their local success, SEPs in the United
States cannot meet the needs for clean injection equipment, reaching only an estimated 3% of
the IDU population. Semaan et al., supra note 41, at 104. A study in China demonstrated that
education alone is not enough to significantly decrease an IDU’s risk for HIV transmission.
Joseph T.F. Lau et al., Clustering of Syringe Sharing and Unprotected Sex Risk Behaviors in
Male Injecting Drug Users in China, 34 SEXUALLY TRANSMITTED DISEASES 574 (2007). Over
80% of the study subjects correctly answered four out of five questions on modes HIV
transmission, but 35.7% of the subjects reported injecting with a syringe used by another IDU
in the last 6 months. Id. at 575–76. These studies suggest that this discrepancy is because
“necessary materials (clean needles and syringes, condoms)” are not sufficiently available.
Des Jarlais, supra note 37, at 584.