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
Written by: Peter M Crosta