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Chapter 6: HIV Prevention for People Who Inject Drugs

Hand and AIDS ribbon

Outside of sexual transmission, using unsterile injection materials is the most common route of HIV transmission. Shared syringes and other injection materials, or ‘works’ (cookers, cottons, etc.) can lead to exposure of blood borne pathogens such as HIV, hepatitis, and syphilis. People who inject drugs (PWID) account for about 9% of all new HIV infections. Reducing the harms associated with injecting and using drugs through the provision of new, sterile injection equipment for each injection is the most effective way to prevent HIV among PWIDs. Harm Reduction, a set of practical strategies designed to reduce the risks associated with drug use and sex work, is an essential guiding concept for HIV prevention among PWID. Mitigating risk through a variety of harm reduction strategies such as syringe services programs (SSPs), supervised injection facilities (SIFs), medication assisted treatment (MAT), Naloxone administration, access to Medicaid, Medicare, and universal health care, as well as integrated HIV/HCV testing and treatment all reduce HIV infections and improve overall health for PWIDs.

Since 2015, federal funds can be used to support SSPs, with the exception of purchasing actual injection materials (syringes and cookers), which has allowed for significant expansion of SSPs within states and jurisdictions. In order to be allowed to use federal funds to support SSPs, jurisdictions must submit a Determination of Need application to the CDC, which demonstrates that the jurisdiction is experiencing, or at risk for, an HIV and/or HCV outbreak related to injection drug use. Adequately supporting SSPs through a variety of sources, including federal, state, and private is essential to adequately support and expand SSPs and provide comprehensive services that increase drug user health and prevent HIV among PWIDs.

Exploring Best Practices for Harm Reduction & Syringe Service Programs | NASTAD, AIDS United, NYC-CBA, Harm Reduction Coalition The content from this webinar was delivered at the Southern Regional SSP Institute and is a collaboration among NASTAD, AIDS United, NYC-CBA, and the Harm Reduction Coalition. The webinar explores the best practices for implementation and delivery of services pertaining to harm reduction and SSPs. 1 hr, 30 min 

Health Department Examples


The Southern Nevada Harm Reduction Program Trac-B Exchange is a storefront SSP designed to provide easier access to safe injection supplies and to allow participants to enroll in access to one of three SSP vending machines. The program supports linkage to medical and social services, thereby improving outcomes for PLWH and/or viral hepatitis.

Check Your Understanding

What strategies prevent HIV infection for PWID?

Syringe services programs (SSPs), supervised injection facilities (SIFs), medication-assisted treatment (MAT), PrEP, mental health services, insurance access, and other harm reduction strategies may prevent HIV transmission in PWID.

Has your jurisdiction applied for a Determination of Need (DON) through CDC? If not, how can you receive technical assistance in doing so?

The CDC tracks DON statuses here. NASTAD’s Laura Pegram, Senior Manager for Drug User Health, can provide technical assistance. Please email her at

What stigma-specific challenges hinder your state’s ability to utilize harm reduction strategies to prevent HIV among PWID?

Various challenges may be apparent, including, but not limited to policy challenges (e.g., state laws restricting SSPs), structural challenges (e.g., lack of access to housing), and social challenges (e.g., providers believing that PWID cannot adhere to medication, and therefore, not fully engaging them in care).