On the 18th of March 2016, the International Network of People who Use Drugs (INPUD) published a report entitled “PrEP for People Who Inject Drugs: Community Voices on Pros, Cons, and Concerns”.
The report is based on three regional consultations and a series of one on one interviews with people who use drugs and other activists. Approximately 75 people from 33 different countries participated in the process.
The report highlights concerns raised by people who inject drugs on PrEP.
INPUD’s members expressed concern that the push for PrEP is unethical, given that the majority of people who inject drugs who currently live with HIV do not have access treatment. According to an article in The Lancet, “only 4% of people who inject drugs who live with HIV have access to antiretroviral therapy” and in some countries it is less than 1%.
Furthermore, current access to harm reduction programmes by and for people who use drugs is not good. The report states that “allocating scarce resources for PrEP for people who inject drugs might not be ethical given the extreme deficit of antiretroviral medicines for people who inject drugs who live with HIV and the extremely low levels of access to harm reduction services.” One INPUD member stated, “PrEP could be a potential extra option if harm reduction services were sufficiently scaled up to be satisfactory.”
Throughout the consultation, participants noted that PrEP would not prevent transmission of hepatitis C, abscesses, or endocarditis.
In NSWP’s Global Consultation on PrEP and Early Treatment as HIV Prevent Strategies, sex workers noted that PrEP would not prevent unwanted pregnancy, or other sexually transmitted infections. In the context of sex work, NSWP’s Global Consultation also raised concerns that PrEP may be used as a substitute for condom use, or might negatively impact condom-related programming. Similarly, INPUD found that access to PrEP should not impede access to harm reduction supplies. “Even if we had PrEP,” said one participant, “we would still need clean works.”
The INPUD consultation also points to concerns about the side effects of PrEP and how PrEP might interact with other drugs such as opioids. Very little research has been conducted on this, and the little research that has been done has had questionable ethics.
Both NSWP’s and INPUD’s Global Consultation point to the dangers of ‘biomedicalising’ HIV prevention, since the biomedical model does little to address the stigma, discrimination, and criminalisation faced by both drug users, and sex workers.
Key findings of INPUD’s consultation include:
- The promotion of PrEP was seen as unethical and unfeasible when access to treatment for people who inject drugs and are living with HIV is low (between 1-4% in some countries);
- The promotion of PrEP was seen as part of a wider, biomedial rhetoric that undermines the provision of community-led programming. There is worry that funding priorities will change and the scarce funding available for community-led programming would be allocated towards biomedical programmes;
- The promotion of PrEP was seen as premature, since there is insufficient evidence that PrEP works as effectively to prevent HIV transmission by the sharing of injecting equipment, as it does with other routes of transmission;
- The promotion of PrEP does not protect against hepatitis C, infections, and vein damage;
- The promotion PrEP does not address the stigma, discrimination, and criminalisation faced by people who inject drugs. Failure to remove these will leave people who inject drugs with the same limited access to services as is currently the case, and finally;
- Participants in the consultation expressed concern that PrEP may become mandatory for people who use drugs or that people who use drugs will be coerced to take it.
You can download INPUD’s consultation below. This 17 page resource is available in English.