Some countries have lower standards of medical and dental care; needles (for injection and acupuncture) and other equipment may be reused without adequate sterilization and blood for transfusion may not be screened for HIV virus. In regions like Africa, the majority of people believe that the only effective medicine is through injection. This means that transmission of HIV/AIDS through the health systems poses a challenge which in some places can be almost as important as heterosexual and homosexual transmission.
Strong prevention programmes seem to have reduced HIV risk and lowered or stabilized HIV rates in some countries of Asia, such as Thailand and the Philippines. Other Asian countries have raised warning flags after collecting new information showing that injecting drug use is spreading and that condom use is uncommon, including among clients of prostitutes and men who have sex with men. In many places prevention efforts are hampered by the shame and stigma attached to AIDS.