The HIV/AIDS epidemic has seen dramatic shifts since the first cases were described in 1981. Initially perceived as a disease among gay men or Haitians in Western countries, HIV transmission has been reported in virtually all parts of the world. Prevalence levels in the 1990s reached more than 30 percent among adults in many Sub-Saharan African cities, and no accessible, effective treatment was available. Although treatment was available for a limited number of people in wealthier settings shortly after the studies on triple therapy in 1996, mortality nevertheless soared, particularly in Sub-Saharan Africa, slashing the hard-won gains in life expectancy resulting from social and economic development and advances in medical technology and nutrition (United Nations Population Division 2004) by more than a decade within a few years.

The modern antiretroviral therapy (ART) era has seen substantial reductions in mortality among people living with HIV. However, HIV-positive people who inject drugs (PWIDs) continue to experience high rates of suboptimal HIV-related outcomes. We review recent findings regarding factors contributing to premature and preventable mortality among HIV-positive PWID, and describe the promise of interventions to improve survival in this group.