Prevention of infectious diseases

Syringe-exchange programmes are available in all countries, but coverage is very limited in Sweden and Greece. A proposal to continue the two existing programmes and to expand needle-exchange programmes nationwide has recently been made in Sweden. In many other countries, accessibility of sterile injecting equipment has further improved, and better coverage of rural areas has been achieved through installation of vending machines and involvement of pharmacists (Table 7 OL).



HIV

Voluntary counselling and testing (VCT) for HIV is commonly available in all EU countries, and is mostly free (Table 8 OL). Efforts to access ‘hard-to-reach’ drug users and encourage them to make use of VCT through new low-threshold services and outreach work have increased, though in several countries availability of free testing with full anonymity is limited.



Combination antiretroviral therapy (HAART (75)) is provided by healthcare systems in all EU countries, but serious problems of both access and compliance by HIV-infected drug users are observed. Active drug users are not well covered by HIV treatment, especially those who are homeless or leading unstable lives. Further obstacles include the attitudes of treatment providers and a lack of information among drug users about dramatic reductions in morbidity and mortality achievable through treatment. Some countries (e.g. Belgium, Germany, Austria, Portugal and Finland) have implemented innovative approaches, such as providing HIV treatment at drugs services and low-threshold centres or changing medicine-dispensing modalities to match clients’ lifestyles, but improving treatment uptake and success remains a challenge.

Hepatitis B

Free vaccination campaigns against hepatitis B are currently implemented in some countries (Table 9 OL). More proactive offers of vaccination by drug services and efforts by drug services to make vaccination available to drug users through contact points for high-risk populations can be noted. Pilot programmes in Germany, the Netherlands and Austria are proving successful in increasing immunisation rates. Combined vaccination against hepatitis virus A and B is recommended for drug users (BAG, 1997).



Although vaccination is available and covered by health systems in most countries, reported immunisation rates are low.

Drug users may not remain long enough in contact with one treatment service to complete the course of vaccinations and achieve full immunisation. Solutions that are tried include vaccine administration at different services, rapid dose schedules and specialised easy access programmes.

Hepatitis C

Treatment for hepatitis C is offered in all countries, but in practice access is difficult for drug users (Wiessing, 2001). Current guidelines suggest that drug users should not be treated until they are off drugs or have been stable on oral substitution for at least one year because of the risk of reinfection among active users. Limited access to treatment or low treatment compliance is reported by many countries (Table 10 OL). New possibilities to improve uptake and compliance by drug users include pegylated interferon, which involves a less demanding regime, and development of evidence-based treatment guidelines.



There are few national action plans to reduce hepatitis C virus infection. Safer use training and information and awareness campaigns for drug users have been implemented in several countries. Prison programmes to raise awareness about infectious diseases are reported in some countries, as are efforts to improve knowledge of hepatitis C prevention among professionals working with drug users.


(75) Highly active anti-retroviral treatment.