HIV Positive Injection Drug Users On Worldwide Scale

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Main Category: HIV / AIDS
Also Included In: Alcohol / Addiction / Illegal Drugs
Article Date: 26 Sep 2008 - 0:00 PDT

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There could be three million HIV positive injection drug users (IDUs) in the world, according to an article released on September 24, 2008 in The Lancet.

To investigate the current state of HIV status in IDUs, 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 performed a systematic review of data from 148 different countries.

In the analysis, the authors estimated that 15.9 million people worldwide inject drugs. In 1998, one study reported injecting drug use in 129 countries, and of these, 103 reported HIV status. Later research indicates that at least 148 countries have IDUs, with 120 reporting HIV positive IDUs. Over 40% of IDUs are HIV positive in at least nine countries, including Estonia, Ukraine, Burma, Indonesia,  Thailand, Nepal, Argentina, Brazil, and Kenya. In an examination of people between 15 and 64 years old, the analysis showed significant differences between different countries. Within this age group, the following notable proportions of IDUs and HIV status have been estimated:

• Italy and Switzerland showed the highest estimated proportions of IDUs in Western Europe, with 0.83% and 0.65% respectively. 
• Spain and Portugal showed the highest proportion of IDUs who are HIV positive in Western Europe, with 39.7% and 15.6% respectively. 
• The United States has an estimated rate of 0.96% IDUs, with 15.6% of these HIV positive.

The authors generally call for more data regarding IDUs and HIV status, especially in light of the importance of injecting drug use in HIV transmission. "There is a pressing need to  understand injecting drug use in all countries," they said. There was a notable absence of data from countries in Africa. Due to a number of influences, which the authors refer to as "constellation of risk factors exists for the development of injecting drug use," this is especially troubling. They also note that "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%."

The authors conclude, emphasizing the need for research in this area: "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. 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 be 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, contributed an accompanying comment in which they explore many risk factors taht could be contributing to injecting drug use. They say: "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 September 24, 2008
DOI:10.1016/S01406736(08)61311-2
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Written by Anna Sophia McKenney
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