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Although a number of studies have found an association between harm reduction interventions and a reduction in HIV incidence in PWID, at present, there is a dearth of research exploring the effectiveness of harm reduction cross-nationally. To date, no studies used longitudinal data across countries to explore the relationship between harm reduction and HIV rates. This methodology has neglected to consider country-wide policies and economic drivers in the epidemic.
Unlike previous studies, which explored this issue by examining individual risks and HIV rates, this study explored the association between the adoption and implementation of harm reduction policies and national incidence rates of HIV among PWID. We investigated the impact of the following harm reduction methods: methadone maintenance treatment (MMT), high-dosage buprenorphine treatment (HDBT), heroin assisted treatment (HAT), and needle and syringe programs (NSP) on incidence rates of HIV among PWID.
Methods: Data was extracted from several sources (WHO, Regional Office for Europe, the European Center for Disease Prevention and Control and the World Bank) to create an aggregate dataset containing variables measuring new cases of HIV infection among PWID, years of adoption of MMT, HDBT, NSP and HAT. Yearly data was retrieved on quantity of heroin seizures, gross domestic product (GDP) and expenditures on health as a percentage of GDP. Complete data was found for 28 European Countries.
A year and country-level fixed-effects model was used to estimate the effects of harm reduction policies on the rates of HIV among PWID.
Results: A significant effect was observed in the multivariable analyses for MMT on the measure of HIV rates among PWID. For each increase in one year of MMT implementation resulted in a decrease of .0008 in the log HIV rate among PWID. Insignificant results were found for NSP. A significant effect was observed between HDBT and HIV incidence among PWID in bivariate analysis but became insignificant after adding the control variables. In the bivariate analyses, HAT significantly predicted lower logged rates of HIV among PWID but this became insignificant after adding the control variables. An exploration of the control variables highlighted that the greater the proportion of GDP spent on health care services resulted in a decrease in logged HIV rates.
Conclusions and Implications: While this study’s findings indicate that harm reduction policies, particularly MMT, may reduce HIV rates among PWID. It is clear that further exploration of this issue needs to be carried out with a focus on country-wide policies and economic drivers of the epidemic. Moreover, it highlights the immense importance of public spending on reducing HIV rates.