Drug use and the spread of HIV/AIDS in South America and the Caribbean

We review available data on drug use with respect to the spread of HIV/AIDS in South America and the Caribbean. Although many information gaps remain, the emerging picture clearly shows the significant role of both injected cocaine and crack cocaine in the Brazilian epidemic, and the increasingly large role of injecting cocaine in the Southern Cone. The Caribbean and the Andean regions are thus far spared from extensive diffusion of injecting drugs and its consequences. However, these regions are now experiencing a significant transition, in terms of an increasing role of crack cocaine in the Caribbean HIV/AIDS epidemic, and the recent introduction of heroin and initiation of drug injection in the Andean region. Harm-reduction strategies are being implemented for the first time in recent years after a long delay, but remain primarily restricted to Brazil, and to a lesser extent, Argentina. Yet even in these settings, harm-reduction programmes such as needle-exchange programmes face considerable challenges with respect to restrictive legislation and lack of broader support.