The Palestinian population has been facing on-going political and social struggles for decades. This has resulted in serious barriers to basic health service access (Horton, 2012). The Palestinian Drug Control Directorate (DCD) estimated that the number of drug users in the Palestinian Territories ranges between 32,000 and 45,000; excluding Jerusalem where the estimated number reaches 12,000 to 15,000 drug users (UNAIDS, 2007). There have been reports regarding a notable increase in drug use, including Heroin use (Progler, 2010; Štulhofer, et al., 2010; UNAIDS, 2007; USAID, 2010). In 2006, it was estimated that there are 900 to 1,400 Heroin users in the West Bank and Gaza (Abu-Raddad, Ayodeji Akala, et al., 2010). Heroin followed by Cocaine are reported to be the main drugs of injection (UNODC, et al., 2011). NGO-based rehabilitation is the most commonly used service for drug treatment (Štulhofer, et al., 2010).

There is a low prevalence HIV epidemic in Palestine. From the 66 identified cases of HIV, only two were attributed to injecting drug use. The main transmission route was heterosexual (UNAIDS, et al., 2012). There is only one study on HIV prevalence among PWIDs, conducted in part of East Jerusalem in 2010. None of the 199 PWIDs were HIV positive (Štulhofer, et al., 2010). However, high risk behaviors among PWIDs are common (Štulhofer, et al., 2010; UNODC, et al., 2011).

PWIDs are included in the National Strategic Program for HIV (2010-2015) as a main target group. It has been reported that two drop-in centers, one in Gaza and one in the West Bank are providing outreach services with condom and needle and syringe distribution programs. Hundreds of DUs have been reached and more than 1,000 sterile needles or syringes and condoms were distributed (UNAIDS, et al., 2012). About one fifth of DUs surveyed reported receiving free injection equipment and condoms during the previous year (Štulhofer, et al., 2010; UNODC, et al., 2011).

OST is not available in Palestine, but it has been reported that Palestinians in East Jerusalem are able to access an Israeli OST program (UN IDU Reference Group, 2010). Four labs in the West Bank and Gaza, a VCT center in Jerusalem and HIV clinics in Israeli hospitals provide testing services (Rosenthal, et al., 2011). However, access to VCT is not easy for MARPs. Four ART centers inside Palestine are providing treatment and care to HIV patients (UNAIDS, 2011a).

Political instability, daily struggles with security regulations, poverty, competing priorities for survival and economical development as well as fragmented health services in the West Bank and Gaza, and the increased restrictions in movement and access to services are strong barriers for health sector development (Štulhofer, et al., 2010; UNAIDS, 2007; UNAIDS, et al., 2012). As a result, existing HIV prevention and care services are disrupted and HIV surveillance in MARPs is lacking. However, the overall response to the HIV epidemic has improved in recent years, but the number of high-risk groups reached with interventions remains low (UNAIDS, et al., 2012).

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