Evidence-based strategies to guide HIV prevention for people who use substances can be grouped into approaches that lower infectiousness among substance users living with HIV and those that prevent HIV acquisition among those who are uninfected. Dramatic successes in HIV prevention involving access to antiretroviral therapy (ART), opioid substitution therapies, and needle and syringe exchange programs have reduced both prevalence and incidence in the United States for people who use injection drugs, and modeling studies suggest that scale-up of these approaches will have a parallel impact worldwide. Medical HIV-prevention strategies that reduce infectiousness ("treatment as prevention" or early ART initiation) and that block HIV acquisition (pre-exposure prophylaxis, post-exposure prophylaxis) can constitute key elements of novel combination HIV-prevention approaches to the goals of reducing infectiousness and reducing acquisition of HIV among people who use substances. For individuals who use substances but do not inject, drug dependence treatments as HIV prevention have a meager evidence-base, with most consistent findings being reduction of sexual transmission behaviors that correspond with reductions in substance use, though not with prevention of HIV transmission. This approach may have value, however, when working with groups of substance users who face high rates of HIV prevalence and incidence. Some evidence exists to support HIV prevention interventions that target reduction of sexual risk behaviors in the setting of active stimulant use.

中文翻译：

---

吸毒者的艾滋病毒预防：循证策略

指导吸毒者艾滋病毒预防的循证策略可分为降低感染艾滋病毒的吸毒者传染性的方法和防止未感染者感染艾滋病毒的方法。在艾滋病毒预防方面取得的巨大成功，包括获得抗逆转录病毒疗法 (ART)、阿片类药物替代疗法以及针头和注射器交换计划，降低了美国注射吸毒者的流行率和发病率，模型研究表明这些方法将在全世界产生平行影响。降低传染性（“治疗即预防”或早期 ART 启动）和阻止 HIV 感染（暴露前预防、暴露后预防）可以构成新的艾滋病毒预防联合方法的关键要素，以实现降低传染性和减少使用物质的人感染艾滋病毒的目标。对于使用物质但不注射的个人而言，药物依赖治疗作为 HIV 预防的证据基础薄弱，最一致的发现是减少性传播行为与物质使用的减少相对应，尽管不是预防 HIV 传播。然而，当与面临高 HIV 流行率和发病率的吸毒群体合作时，这种方法可能具有价值。一些证据支持 HIV 预防干预措施，旨在减少在积极使用兴奋剂的情况下的性风险行为。