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 c ocaine and crack cocaine in the Brazilian epidemic, and the increasingly la rge role of injecting cocaine in the Southern Cone. The Caribbean and the A ndean regions are thus far spared from extensive diffusion of injecting dru gs and its consequences. However, these regions are now experiencing a sign ificant transition, in terms of an increasing role of crack cocaine in the Caribbean HIV/AIDS epidemic, and the recent introduction of heroin and init iation of drug injection in the Andean region. Harm-reduction strategies ar e being implemented for the first time in recent years after a long delay, but remain primarily restricted to Brazil, and to a lesser extent, Argentin a. Yet even in these settings, harm-reduction programmes such as needle-exc hange programmes face considerable challenges with respect to restrictive l egislation and lack of broader support.