ABSTRACT

This chapter utilizes information about the patterns of spread of HIV/AIDS and the public health responses to the epidemic in the cities involved in the World Health Organization Multi-City Study on Drug Injecting and Risk of HIV Infection. The emphasis here concerns the responses the different cities gave (and are giving) to the crisis evoked by the spread of HIV-1 among injecting drug users (IDUs) and their acquaintances (see also Appendix 2). The chapter contrasts positive and problematic responses from a range of cities clustered in terms of epidemic status using the classification by Des Jarlais (1994): prevented epidemics, intermediate patterns and established epidemics. It deals mainly with the period from 1990 onwards. Very powerful differences were observed. Significant is the difference between those cities which had early and vigorous implementation of prevention measures (and mainly low HIV-1 prevalence) and those cities with a lesser commitment to HIV-1 prevention and a greater commitment to law enforcement as a strategy for drug policy (often with higher prevalence).