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In the USA, 194 NSPs are thought to be operating across 33 states.66 One study estimated that the availability of clean needles in the USA covered just 18% of drug injections in 2014, including 2.8% coverage by NSPs.67 NSPs are also available in Canada, although coverage varies both between provinces and within provinces themselves.68 In Europe, an estimated 680,000 people who inject drugs received opioid substitution treatment (OST) in 2014 although numbers have fallen by around 50,000 since 2010.69 Methadone is the most commonly prescribed opioid substitution drug, received by 61% of people enrolled in substitution therapy.A further 37% are treated with buprenorphine-based medications.70 In England and Wales, progress in the provision of OST is being threatened by a drive towards abstinence-based treatment, even though these approaches often lead people to stop their treatment.71 OST is available in both the USA and Canada but is not accessed by all those who need it. The most recent data from 2009 showed that 640,000 people accessed OST, up from 96,000 in 2005.72 All ten Canadian provinces offer methadone maintenance therapy (MMT), however, the number of OST sites is unknown due to a lack of monitoring.73 Pre-exposure prophylaxis (often referred to as ‘Pr EP’), whereby someone who is at heightened risk of HIV takes antiretroviral drugs before possible exposure to the virus to greatly reduce the risk of transmission, is available in Canada, France and USA.

Both Canada and the USA have formed survey implementation teams but are yet to report findings.77 Eliminating stigma and discrimination is an important objective of the WHO European Action Plan for HIV/AIDS.

A further 17 European countries were engaged with Pr EP trials in 2015.74 As of 2016, issues surrounding which government body should fund Pr EP in the UK were affecting people’s ability to access the treatment.75 HIV-related stigma and discrimination is prevalent in the region.

For example, a 2014 survey of people living with HIV from 14 European countries found 32% had experienced HIV-related discrimination in the past three years.

For example, 96% people living with diagnosed HIV in the UK were on treatment in 2015.84 The USA launched the HIV Care Continuum Initiative in 2013 to systematically identify and re-engage people living with HIV on treatment.85 At the same time, thousands of additional people living with HIV in the USA were enrolled in comprehensive health insurance through the implementation of the Health Care and Education Reconciliation Act 2010.86 Early studies of the Act’s affect on the healthcare of people living with HIV in the USA, such as a 2014 study of five states by the Kaiser Family Foundation, suggest that many have used the systems established under the Act to find more affordable and comprehensive health insurance coverage.87 According to the Kaiser Family Foundation, Medicaid was the largest source of insurance coverage for people with HIV in 2014, estimated to cover more than 40% of people with HIV in care.88 As a result of these interventions, around three out of four (74.5%) people newly diagnosed with HIV were linked to ART within one month of diagnosis in 2014 (the most recent data available).

This result exceeded the USA’s annual target of 73.9%.

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