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A Tale of Two Countries: Attempts to Control HIV among Injecting Drug Users in Australia and the United States

Prevalence of injectable drug use is surprisingly similar in Australia and the United States. HIV prevalence among injection drug users (IDUs) is less than 5% in Australia and about 14% in the United States. IDUs accounted for 2.5% of AIDS cases in Australia in 1994 and 28% in the United States in 1993. Harm reduction was officially adopted in Australia in 1985 but has been explicitly rejected by the U.S. government. In 1994, needle programs exchanged over 10 million syringes from over 4,000 outlets in Australia while 55 needle exchange programs in the United States exchanged almost eight million syringes. Since 1985, methadone maintenance expanded almost ten-fold in Australia but barely increased in the United States. Timely and vigorous adoption of harm reduction strategies in Australia and the relative lack of such programs in the United States is the most plausible explanation for the good control of HIV among IDUs in Australia and poor control in the United States.