In Syria, the size of drug use and injecting drug use is not well known. Heroin is the most common drug used by PWIDs. Treatment for drug dependence is mainly available in Damascus and only a small proportion has been treated for their drug problems (Syria Mental Health Directorate, 2008).

Syria has a low-prevalence HIV epidemic (Syria MoH, 2012). It appears that the epidemic has remained low in most at risk groups. However, HIV trend shows a slow but steady increase of new cases over time and heterosexual relationships are known as the main route of HIV transmission. Up until June 2010, injecting drug use had contributed to 4.85% of HIV epidemics. Testing of PWIDs is included in the national HIV surveillance, mostly among those arrested or incarcerated. A positive case has rarely been found (Syria MoH, 2012). A bio-behavioral survey conducted on drug users in 2006 in Greater Damascus showed a low HIV prevalence. Nevertheless, unsafe injection and unsafe sex were highly common in the recruited sample (Syria Mental Health Directorate, 2008).

A comprehensive National AIDS Strategy has been developed for 2011-15. It constitutes a pilot project of harm reduction, including NSP, but the project has not yet begun (Syria MoH, 2012). OST is not planned. VCT and ART are provided in many centers (Syria MoH, 2012; UNAIDS, 2011a; WHO, et al., 2011). In 2011, NGOs were not actively involved in HIV prevention. Severe social stigma and criminalization of MARPs exist. The National AIDS Program has been slowly implemented and NAP cooperation with the GFATM involves NGOs in HIV prevention programs. Political support should be strengthened and studies should be carried out to assess the size and risk behaviors of PWIDs. HIV prevention activities should be launched rapidly, as envisaged in the National Program.