HIV Positive Injection Drug Users On Worldwide Scale

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