Researchers Study Relationship Between Injecting Drug Use And HIV

Estonia, Ukraine, Burma, Indonesia, Thailand, Nepal, Argentina, Brazil,
and Kenya all have one disturbing fact in common: an HIV positive rate
of over 40% for injecting drug users (IDUs). An article published early
online and in an upcoming edition of The Lancet estimates
that worldwide there are some 15.9 million IDUs - 3 million of whom are
HIV positive. In the last ten years, the number of countries that
report injecting drugs use has increased. However, Dr Bradley Mathers
(National Drug and Alcohol Research Centre, University of New South
Wales, Sydney, Australia) and colleagues from the 2007 Reference Group
to the UN on HIV and Injecting Drug Use maintain that HIV transmission
in many regions is bolstered by IDUs, and the research community needs
better data from around the world in order to address the problem.



The authors conducted a systematic review of HIV use among IDUs and
found some interesting differences around the world. In the United
Kingdom, 0.39% of 15-64 year-olds are IDUs and 2.3% are
estimated to be HIV positive. These data contrast with Spain, where
0.31% of the same age group are IDUs, but the percentage of IDUs with
HIV is 39.7% - several times higher. The table below summarizes these
figures for other countries:






Country
%15-64
year-old IDUs
%HIV
positive IDUs


USA
0.96%
15.6%


Australia
1.09%
1.5%


Argentina
0.29%
49.7%


China
0.25%
12.3%


Ukraine
1.16%
41.8%


Russia
1.78%
37.2%


Estonia
1.51%
72.1%





Italy and Switzerland had the highest proportion of IDUs among 15-64
year-olds in western Europe, with 0.83% and 0.65%, respectively.
However, Spain and Portugal had the highest proportions of IDUs that
are HIV positive with 39.7% and 15.6%, respectively.



In Africa, where a "constellation of risk factors exists for the
development of injecting drug use," there is not as much information
compared to European countries - a serious concern for the authors. The
researchers note that for regions with data, "Areas of particular
concern are countries in southeast Asia, eastern Europe, and Latin
America, where the prevalence of HIV infection among some
subpopulations of people who inject drugs has been reported to be over
40%." Although a 1998 review identified 129 countries with injecting
drug use, only 103 reported HIV use among the IDUs. This new research
from Mathers and colleagues expands the knowledge base to 148 countries
with IDU and 120 of reporting HIV among this population. "There is a
pressing need to understand injecting drug use in all countries,"
emphasize the authors.



"Injecting drug use occurs in most countries and HIV infection is
prevalent among many populations of IDUs, representing a major
challenge to global public health. People who inject drugs have the
right to enjoy the highest standard of health attainable," conclude the
researchers. "There is a clear mandate to invest in HIV prevention
activities such as needle and syringe programmes and opioid
substitution treatments and to provide treatment and care for those
living with HIV/AIDS. The magnitude of this risk has not been met with
an equally concerted investment in research to accurately quantify the
problem."



Dr Kamyar Arasteh and Dr Don C Des Jarlais (Beth Israel Medical Center,
Baron Edmond de Rothschild Chemical Dependency Institute, New York,
USA) write in an accompanying comment about various factors that could
explain the rise in injecting drug use worldwide. "The one optimistic
aspect of this rather gloomy situation is that, if HIV-prevention
efforts are implemented on a large scale when prevalence is low in
injecting drug users, it is possible to avert HIV epidemics in users.
Thus it should be an imperative - for both resource-constrained
countries and international donors - to implement large-scale
evidence-based programmes for HIV-prevention whenever there is an
indication of a developing injecting-drug-use problem."



Global epidemiology of injecting drug use and HIV
among people who inject drugs: a systematic review

Bradley M Mathers, Louisa Degenhardt, Benjamin Phillips,
Lucas Wiessing, Matthew Hickman, Steffanie A Strathdee, Alex Wodak,
Samiran Panda, Mark Tyndall, Abdalla Toufik, Richard P Mattick, for the
2007 Reference Group to the UN on HIV and Injecting Drug Use

The Lancet (2008).

DOI:10.1016/S0140-6736(08)61311-2

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Written by: Peter M Crosta