1. Louisa Degenhardt 1, Bradley Mathers 1, Peter Vickerman 2, Tim Rhodes 3, Carl Latkin 4 and Matt Hickman 5 1.National Drug and Alcohol Research Centre, University of NSW, Australia 2.London School of Hygiene and Tropical Medicine, UK 3. Centre for Research on Drugs and Health Behaviour, LSHTM, UK 4. Johns Hopkins Bloomberg School of Public Health, USA 5. University of Bristol, UK

5. Inject. frequency Injecting risks Sex risks HIV infectivity HIV incidence HIV testing -- ↓↓ Individual interventions for HIV risk ↓↓↓ -- Network/peer interventions for HIV risk ↓↓↓ -- Needle syringe programs (NSP)  ↓-- ↓ Condom provision -- ↓ ↓ Opioid substitution therapy (OST) ↓↓  -- ↓ Naltrexone – Oral  -- Naltrexone – Implant ↓↓ -- Pharmacotherapy for stimulant dependence  -- CBT for stimulant dependence ↓ -- STI treatment -- ↓ Antiretroviral treatment (ART) -- ↓↓ Safe injecting centres (SICs)  ↓ -- Compulsory detention of drug users -- ↑↑

8. OST and NSP only, 50% recruitment annually: 9-37% reduction in HIV incidence ART only CD4 <200 OST + NSP only ART only, CD4 <350 OST + NSP + ART

9. ART only CD4 <200 OST + NSP only ART only, CD4 <350 OST + NSP + ART ART to CD4<200 only, 50% recruitment annually: 5-17% reduction in HIV incidence

10. ART only CD4 <200 OST + NSP only ART only, CD4 <350 OST + NSP + ART ART to CD4<350 only, 50% recruitment annually: 9-34% reduction in HIV incidence

11. ART only CD4 <200 OST + NSP only ART only, CD4 <350 OST + NSP + ART OST+NSP+ART<350, 50% recruitment annually: 18-63% reduction in HIV incidence

13. © Reference Group to the United Nations on HIV and Injecting Drug Use 2010