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In their paper 1, Richter & Ellenberg advance an argument that a key way to improve public health is to reduce the number of smokers by increasing the uptake of tobacco cessation (and, one might add, harm reduction) programmes by current smokers. They note that in many health systems the default position is that patients seeking clinical care are only offered tobacco treatment if, in the opinion of the clinician, they are either expressing a wish to quit smoking or otherwise give signs of ‘readiness to quit’. They argue further that this creates a barrier to treatment, which can be removed by mandating clinicians to offer tobacco treatment to all patients who smoke without assessing ‘readiness to quit’, leaving the decision to the patients as to whether or not they take up this offer of treatment. The theory here is that some patients who might otherwise not have been considered ‘ready to quit’ by their clinicians will accept the offer of treatment, and that some of those will complete treatment successfully. Moreover, it is assumed that no (or minimally few) patients who would accept treatment under the current default will reject it under the new default. While the authors mention the possibility that the simple offer of treatment, by communicating implicitly that the treatment will be beneficial to the patient, will actively influence some patients to agree, they do not rely on this influence as the mechanism of action underlying the intervention. They simply suggest that offering treatment to more people will probably lead to more people accepting the offer, with net beneficial consequences.

Objective To describe and estimate the availability of antiretroviral treatment (ART) to injecting drug users (IDUs) in developing and transitional countries. Methods Literature review of grey and published literature and key informants' communications on the estimated number of current/former injecting drug users (IDUs) receiving ART and the proportion of human immunodeficiency virus (HIV) attributed to injecting drug use (IDU), the number of people in ART and in need of ART, the number of people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) and the main source of ART. Results Data on former/current IDUs on ART were available from 50 countries (in 19 countries: nil IDUs in treatment) suggesting that approximately 34 000 IDUs were receiving ART by the end of 2004, of whom 30 000 were in Brazil. In these 50 countries IDUs represent approximately 15% of the people in ART. In Eastern European and Central Asia IDU are associated with > 80% of HIV cases but only approximately 2000 (14%) of the people in ART. In South and South-East Asia there were approximately 1700 former/current IDUs receiving ART ( approximately 1.8% of the people in ART), whereas the proportion of HIV cases associated to IDU is > 20% in five countries (and regionally ranges from 4% to 75%). Discussion There is evidence that the coverage of ART among current/former IDUs is proportionally substantially less than other exposure categories. Ongoing monitoring of ART by exposure and population subgroups is critical to ensuring that scale-up is equitable, and that the distribution of ART is, at the very least, transparent.