12 myths about HIV/AIDS and people who use drugs.

People who use drugs too often face stigma, discrimi­ nation, and mistreatment in HIV prevention, treatment, and care. Some societies consider such users less deserving of compassion than others with HIV who are not drug users, because users' health problems are self­inflicted or their substance use is judged as a moral or personal failing. Even among health­care providers, many preconceptions prevail about people who use drugs and are infected with HIV. What are these myths (panel)? Drug users are non-compliant—In a meta­analysis of adherence to antiretroviral therapy from 38 studies and nearly 15 000 patients, of whom 76% were drug users, overall adherence was similar to that reported for other populations with sexual exposure histories that were taking antiretrovirals. 1 Better outcomes with antiretrovirals were associated with being on opioid­ substitution therapy, receiving psychosocial support, or both. The meta­analysis concluded that HIV­positive drug users tended to be inappropriately assumed to be less compliant and unlikely to achieve desirable treatment outcomes than non­drug­using cohorts. Drug users do not respond as well to antiretrovirals as do non-drug-using patients—A comparison of survival rates in 3116 antiretroviral­naive patients started on antiretrovirals (in Vancouver, Canada), of whom 915 were injecting drug users, showed similar all­cause mortality by 84 months after starting antiretrovirals. 2 In a multivariate time­updated Cox's regression, the hazard ratio of mortality did not significantly differ between injecting drug users and those who did not inject drugs (1·09, 95% CI 0·92–1·29). Injection drug use was not associated with decreased survival in patients who had started on antiretrovirals. Drug users are difficult to study and have poor retention rates in cohorts, making prospective research studies with drug users difficult or impossible—The first phase 3 HIV­vaccine efficacy trial in a developing country was the AIDSVAX B/E (VaxGen) trial in 2546 injecting drug users in Bangkok, Thailand. 3 Although the vaccine failed to elicit protection, the trial was successfully conducted with 2295 (90·1%) of participants retained at 36 months and an overall HIV incidence of 3·4 per 100 person­years. Such excellent retention shows the willingness of people who use drugs to enrol and stay in prospective studies. Drug users are more concerned about getting high than using injecting equipment safely—In a study of 760 participants who used a supervised injecting facility in Vancouver, Canada, more consistent use of the facility was associated with safer injecting behaviours than was less consistent use, including less syringe re­use (odds …