Two DM finalists (but not winners) are tackling one of the toughest challenges on the HIV/AIDS front—keeping the virus from spreading among the highest risk groups. Population Services International is getting pharmacies in the Kyrgyz Republic to give out sterile needles to drug users, and CARE Brazil wants to improve access to condoms and treatment among Brazil’s prison population. Heroin use is a huge problem in Central Asia, affecting 1 to 5 percent of urban adults in the countries surrounding Afghanistan, the world’s primary source of the drug, says Robert Gray. “In Central Asia, where we’re working, 80 percent of the cases of HIV are related to sharing needles while injecting drugs, so the Central Asian HIV epidemic is not driven by sex, primarily.” Gray says injecting drug users need sterile needles and syringes—maybe three or four times a day—to remain HIV free, creating a “huge distribution problem.” says Gray. Most countries of the region are setting up needle exchange points, where drug users can go to exchanges used needles for sterile ones. The problem is fewer than 10 percent of drug users use that service, says Gray. “That’s where we come in.” The organization has encouraged private-sector pharmacies to accept drug users with vouchers as clients and provide them with   sterile needles and syringes, as well condoms and other health supplies. PSI reimburses the pharmacies at the end of the month of the vouchers they have collected. A pilot project involving 750 clients and 10 pharmacies has been running for 10 months. At the beginning, pharmacies were worried the drug user clients would scare away other business. “In reality what happens is, because drug users are breaking the law, when they come into a pharmacy the last thing they want to do is draw attention to themselves, so typically they want to collect their products very quietly, and leave very quietly,” says Gray. “We’ve had absolutely no complaints from the 10 pharmacies.” Methadone treatment is difficult to get and the relapse rate for drug treatment programs is about 90 percent. “So the challenge is how to keep the drug users free of HIV during the five or six year period when they are injecting drugs. By their mid-30s, for various reasons, they themselves decide now is the time to quit drugs. So keeping people HIV-free during that period of time is the main challenge of this project.” The project will continue in a small number of communities with funding from Population Services International, but the group would like to replicate it nationally.

CARE Brazil wants to fight HIV in Brazil’s prisons, where the virus’ prevalence is as high as 30 percent. That’s much higher than the .5 percent prevalence in the general population and “even higher than in many African countries,” says Dr. David Oliveira de Souza. The victims are mostly young, poor, Afro-descendant men, who make up almost 95 percent of the prison population.  Prisoners are allowed intimate visits with their wives and girlfriends, increasing the risk of spreading HIV. “There are no works of prevention being done in this field right now,” he says. The project, known as Liberd’AIDS, would enlist prisoners as “health agents” who would be responsible for the health care of 7,000 prisoners, including helping them get HIV testing and ensuring condoms are available and accessible to all prisoners. Currently there aren’t enough condoms and they’re often used to barter for cigarettes or other goods, says de Souza. And more than 70 percent of prisoners have never had an HIV test. An estimated 10,000 visitors per week would also be affected by efforts to reduce HIV transmission, says de Souza.