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Latin America - Regional Overview
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HIV predominantly affects marginalised populations in this region, including people who inject drugs. Cocaine and its derivatives are the most commonly injected drugs in this region, with the exception of Northern Mexico and parts of Colombia, where heroin is widely used. Injecting drug use is associated with HIV transmission in several countries and recent evidence also shows a link between non-injecting drug use and HIV. Some governments are supportive of harm reduction in policy and/or practice. The vast majority of needle and syringe programmes operate in Brazil and Argentina, although there are some small projects in other countries. Mexico, with substantially more heroin users than other Latin American countries, is the only state which prescribes opioid substitution therapy, although coverage is low. Where harm reduction services exist, the heavy stigma surrounding drug use, as well as a fear of arrest, often deter people from accessing them.
There is no access to harm reduction in prisons within Latin America. This region has been under immense political pressure from the US government to reduce drug cultivation and production. This has overridden public health responses to drug use and has in many cases violated the human rights of local farming communities cultivating coca crops.
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Injecting Drug Use, HIV and Hepatitis C
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The following maps and table outline the current available data on injecting drug use, as well as the prevalence of HIV and hepatitis C among injecting populations in Latin America.
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The map below illustrates HIV prevalence among injecting drug users in countries of the region.
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The map below illustrates hepatitis C prevalence among injecting drug users in countries of the region.
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The following table provides the latest estimates of HIV and hepatitis C prevalence within injecting populations, as well as the estimated total number of injecting drug users in countries of the region.
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Countries/territory with reported injecting drug use
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| | Adult HIV prevalence amongst people who inject drugs**
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| Adult HCV prevalence amongst people who inject drugs***
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*Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008)
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The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
**Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
***Cook, C & Kanaef, N (2008) The Global State of Harm Reduction: Mapping the global response to drug-related HIV and hepatitis C epidemics. International Harm Reduction Association, UK
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Harm Reduction Policies
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Some countries in this region have an explicit supportive reference to harm reduction in their national policies on HIV and/or drugs. These are illustrated in the map and table below.
Although policy wording is not necessarily indicative of the implementation of effective harm reduction measures in a country, it does indicate governmental commitment to tackling drug related harms and is therefore an important advocacy target.
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| Explicit reference to harm reduction policies in official documents*
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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Harm Reduction Programmes
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Key harm reduction interventions (including needle and syringe exchange and opioid substitution therapy) are not available in the majority of countries in this region, as illustrated in the maps and table below. Where harm reduction services exist, the heavy stigma surrounding drug use, as well as a fear of arrest, often deter people from accessing them. The lack of a supportive legal and policy framework in many Latin American countries presents a substantial barrier to effective harm reduction implementation.
Prisons in Latin America do not currently provide needle and syringe exchange or opioid substitution therapy to prisoners.
The following table indicates which countries have a) one or more needle and syringe exchange sites operational both in and outside prisons, b) prescription of opioid substitution therapy for maintenance in and outside of prisons c) one or more drug consumption rooms in countries of the region.
A tick in this table does not indicate the scope, quality or coverage of services. Also it should be noted that in some countries, harm reduction services, NSP in particular, are NGO-driven and may be operating without government support.
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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The map below shows which countries have operational needle and syringe programmes and opioid substitution therapy programmes.
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There are currently no countries in the region with prison-based needle and syringe exchange programmes or opioid substitution therapy prescription.
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