BMJ  2005;330:147 (15 January), doi:10.1136/bmj.330.7483.147-a

Letter

HIV in injecting drug users in Asian countries

Authors' reply

The first 150 words of the full text of this article appear below.

EDITOR—Reece concedes the critical importance of controlling the epidemic of HIV among and from injecting drug users, especially in Asia. This is a useful start. However, his subsequent comments are less than helpful.

Reece argues that the high incidence of hepatitis C indicates that harm minimisation is ineffective. A recent study estimated that needle syringe programmes between 1988 and 2000 avoided 25 000 cases of HIV and 21 000 cases of hepatitis C in injecting drug users in Australia.1 How does Reece explain the excellent control of HIV in injecting drug users achieved in Australia, which explicitly accepted harm minimisation and vigorously implemented harm minimisation programmes, whereas high rates of HIV infection occurred in the United States where harm reduction was explicitly rejected?

Reece claims that methadone treatment is unsafe: yet the risk of death is three to four times less for patients continuing in treatment than in . . . [Full text of this article]

Alex Wodak, director

Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia awodak@stvincents.com.au

Robert Ali, director of clinical policy and research

University of Adelaide robert.ali@adelaide.edu.au

M Farrell, senior lecturer in addictions

PO Box 48, National Addiction Centre, Institute of Psychiatry, London SE5 8AF m.farrell@iop.kcl.ac,uk


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