6. Conclusion

Prevent transitions

—    to opioid use by licit drug users
—    to injecting by non-injecting opioid users

Deal with diffusion of pharmaceutical abuse
Reach IDUs and their regular sexual partners with prevention and care services
Implement comprehensive HIV interventions for drug users and their regular sexual partners

—    Address injection and sexual risk behaviours
—    Primary medical care abscess management
—    STI care
—    Voluntary Counselling and Testing

Provide scaled up drug dependence treatment (e.g., opioid substitution therapy)

The RSRAs conducted in Bangladesh, Bhutan, India, Nepal and Sri Lanka have demonstrated that it is possible to reach out to the hidden populations of drug users as well as their regular sexual partners. The assessments yielded valuable information that can guide future interventions targeting drug users and their regular sexual partners in this region. Interventions need to be designed and implemented to target licit drug users with the objective of preventing switch over to opioid drug use. Future interventions should aim to prevent the transitions to injecting by the non-injection opioid users. As diffusion of pharmaceutical drugs is increasing in the South Asian region, a multisectoral approach is required to stop the spread of pharmaceutical abuse.

Targeted interventions for drug users should address both the injection as well as sex related risk behaviours. Increasing access to sterile needles and syringes through needle syringe programmes is essential. Promoting condom use among the drug users and their regular sexual partners is an important challenge and individual, couple and community level interventions are needed to deal with this vital issue. Comprehensive HIV prevention interventions for drug users should include primary medical care for abscess management and STI care. Increasing the HIV risk perception among the drug users and scaling-up VCT for drug users are important. Drug dependence treatment, in particular, evidence based treatment like opioid substitution treatment needs to be implemented and scaled up in the region.