HIV increasing among UK injection drug
From: Foster, Roland (Coburn) [mailto:Roland_Foster@coburn.senate.gov]
Sent: 20 July 2005 23:22 To: undisclosed-recipients:
Needle exchange was first introduced in
the United Kingdom in 1985 in response to
the AIDS epidemic. Most areas within the
UK have pharmacy-based needle-exchange
services. Mobile, agency-based and
automated needle exchange programs also
A new study finds that despite this
widespread availability of syringes, there
is an increase in HIV infection among
injection drug users (IDUs) as well as an
increase is the sharing of needles.
These results echo the findings of another
study published a year ago in the British
Medical Journal which found that HIV and
hepatitis C (HCV) rates are increasing
among IDUs in the United Kingdom. Nearly
half (44%) of injection drug users under
the age of 30 are already infected with
HCV and 4.2% are infected with HIV-- and
these rates are increasing, according to
the BMJ article.
While the recent study claims that the
increase may be a result of an increased
focus on crime, it ignores what may be the
real cause driving the epidemic which was
reported in a university study release
last year: Widespread drug abuse. One in
50 young people and adults in London and
two other major U.K. cities inject illicit
drugs-- making drug abuse as common as
diabetes. Five million needles are
provided to drug addicts in London each
year, yet harm reduction advocates claim
that this amount is 80% short of the total
increases seen in HIV transmission among
Friday, July 15, 2005
New HIV infections via
injecting drug use (IDU) appear to be on
the increase in England and Wales,
according to a collaborative study from
the UK's Health Protection Agency (HPA)
and Imperial College London, published in
the July 22nd issue of the
The study, which combines anonymous HIV
testing data with community surveys for
the first time, suggests that recent
increases in HIV IDU transmission are most
pronounced in younger, recent IDUs, in
London. This increase in new infections
coincides with a shift in UK drugs policy
away from public health concerns towards a
stronger focus on crime.
In the UK, harm reduction initiatives such
as the provision of clean needles through
needle exchange programmes (NEPs) have
been relatively effective in limiting the
spread of HIV among injecting drug users (IDUs).
By the end of 2002, only 7% of the 56,000
diagnosed HIV infections were associated
with IDU. However,
there has been some recent evidence of an
increase in risky injecting practices
suggesting that new HIV infections amongst
IDUs may be on the increase.
In order to examine trends in HIV
prevalence amongst IDUs, researchers from
the HPA and Imperial College, London
combined data from two voluntary
unlinked-anonymous survey programmes that
included adults (aged 15-49) who had
injected drugs in the previous four weeks.
The first is an annual survey of IDUs via
drug agencies in England and Wales
(ranging in number over the years between
29-59; providing advice, support,
harm-reduction and/or treatment services)
has been ongoing since 1990, and includes
a brief self-completed questionnaire and
oral fluid samples for HIV testing.
The second was a series of community-based
surveys in London (1990-1993); London and
seven other English cities (1997-1998);
and London and Brighton (2001-2002). This
was conducted in the field (e.g. street
locations, homes and social venues) and
included an interviewer-administered
questionnaire and oral fluid samples for
HIV testing. This provided the researchers
with a cross-sectional data set, including
almost 28,000 oral fluid samples on which
to test anonymously for HIV.
Evidence of increase in HIV prevalence
HIV prevalence among IDUs in England and
Wales declined from a peak of 5.9% (67
positive HIV antibody tests out of a total
of 1132 samples) in 1990 to a low of 0.6%
(14/2270) in 1996. It then remained stable
until 2000, after which there was, say the
researchers, "some evidence of an
increase" to 1.4% (21/1529) in 2003.
Individuals who had been injecting for the
shortest period of time (less than three
years; 1.2%) and those who had been
injecting for the longest period of time
(more than twelve years; 2.9%) had the
highest HIV prevalence in 2003. In
contrast, those who had been injecting
drugs between three and five years, or six
and eleven years, had lower HIV prevalence
(0.3% and 0.7%, respectively).
HIV prevalence was found to be higher in
London (5%) compared with elsewhere in
England and Wales (0.4%) and similar in
women (1.8%) and men (1.6%).
Five factors were included in multivariate
modelling after adjustment: survey year;
recruitment location; length of injecting
career; recruitment setting; and having
had a voluntary confidential HIV test.
The odds of being HIV-positive were higher
for the survey years 1990-95 and 2001-2003
compared with 1996 (p=0.001); higher for
recruitment in London compared with
outside London (Adjusted Odds Ratio 7.33;
95% CI, 5.60-9.59); highest for those
injecting for 15 years or more (AOR 2.3;
95% CI, 1.61-3.28); higher for those
recruited in the community versus those
from the agency survey (AOR 1.76; 95% CI,
1.37-2.24); and higher for those who had
ever had a voluntary HIV test outside of
the survey (AOR 2.49; 95% CI,1.95-3.18).
IDUs in London at highest risk of new HIV
investigators used an adjusted model
(adjusted for number of years injecting,
recruitment setting and having had a
voluntary HIV test outside of the survey)
to fit location and survey year together,
the results suggested that the recent
increase in HIV prevalence was mainly
occuring in London
To examine this futher, force of infection
in and outside of London, defined as the
yearly rate at which HIV-negative IDUs
become HIV-positive, was estimated by
fitting a model to prevalence data by
calendar year and injecting career length.
The results suggest that force of
infection in London is higher amongst
novice IDUs (those injecting for less than
one year) and has increased over time.
Between 1992-1997, the force of infection
amongst novice IDUs in London was 0.008
(95% CI, 0.002-0.02), whereas between
1998-2003 it was 0.028 (95% CI,
0.016-0.045), or almost 3% per year. For
IDUs who had been injecting for more than
a year, the force of infection was 0.13
lower across all time periods. Since age
and length of injecting habit were found
to be highly correlated (p=0.001), this
suggests younger IDUs in London are
acquiring HIV more rapidly than older IDUs
in London or elswhere.
This increase in new HIV infections is
similar to the 3.4% rate found in a recent
London-based cohort study.
Awareness of HIV infection
of the total cohort had ever taken an HIV
antibody test outside of the surveys.
Of those testing HIV-positive, 81%(
371/461) reported ever having taken an HIV
antibody test. Of those who reported the
results of their last HIV test, 75%
(193/259) were aware of their infection.
In 2002-2003, however, only 69% (25/36) of
those who were HIV-positive and who
reported the results of their HIV antibody
test were aware of their infection.
policy to blame?
combined surveys found that
reported needle- and syringe-sharing in
the previous month remained uniformly high
both in London (31%) and outside London
(29%) in 2002, the
higher force of infection in London may
reflect higher HIV prevalence amongst IDUs
in London compared with those outside
London, as well as an increased prevalence
of injecting drugs, crack cocaine in
However, the authors point out that in
1998, the UK's national drug strategy
changed its focus from harm-reduction and
the reduction of blood-borne viruses to
"wider social harms, in particular
drug-related crime." They suggest that
this "simultaneous shift in the focus of
policy and service provisioning for drug
users in England and Wales" may have
"unintentionally hindered the development
and re-invigoration of harm reduction
measures in response to evolving patterns
of drug use and risk behaviours."
In addition, younger IDUs would not have
been exposed to either national or
targeted HIV prevention campaigns that
took place earlier in the HIV epidemic.
It also appears that many of the
recently-infected IDUs are foreign
nationals. "Data on country of birth from
clinicians' reports of newly diagnosed HIV
infections indicate that two-thirds of
HIV-infected IDUs diagnosed in the UK in
2003 were born in another country," the
authors write. Thus the recent increase in
HIV prevalence in London may reflect
recent patterns of emigration to London,
particularly from south-western and
eastern Europe where the prevalence of HIV
is higher among IDUs than in other risk
Hope VD et al. HIV
prevalence among injecting drug users in
England and Wales 1990 to 2003: evidence
for increased transmission in recent
years. AIDS 19:1207-14, 2005.
November 12, 2004, Friday
HEPATITIS C 'EPIDEMIC AMONG
LONDON DRUG USERS'
By Lyndsay Moss, PA Health Correspondent
Cases of hepatitis C among young drug
users in London are reaching epidemic
levels, researchers warned today.
The number of people who inject drugs who
now have HIV is also worryingly high,
according to a study published in the
British Medical Journal.
The researchers blamed the Government's
current drug policy for failing to protect
this high risk group from bloodborne
viruses like hepatitis C.
The team, from Imperial College London,
the Health Protection Agency and the
London School of Hygiene and Tropical
Medicine, estimated that
four in 10 new drug users in London now
had hepatitis C,
which can cause fatal liver damage.
They also estimated that 3% of injecting
drug users was now infected with HIV.
The results were based on tests involving
428 drug users who had been injecting for
six years or less.
Hepatitis C and HIV can be spread by
sharing needles and the researchers found
high levels of syringe-sharing during
One in four reported injecting with
needles and syringes used by someone else
in the past four weeks.
Researcher Dr Ali Judd, based at Charing
Cross Hospital, west London, said:
"Hepatitis C is now spreading at epidemic
levels across London and HIV incidence is
worryingly high, which if unchecked will
lead to an increase in the total number of
"There is an urgent need for new and
comprehensive programmes to tackle this
Dr Matthew Hickman, from Imperial College
London, added: "For the past six or seven
years Government drug policy has focused
on drugs and crime, and has been
successful in expanding specialist drug
treatment, especially through referral
from criminal justice.
"However there is a need now to
reinvigorate harm reduction policies that
prevent transmission of hepatitis C and
A Department of Health spokeswoman said
the Government was committed to driving
down cases of hepatitis C and other
blood-borne infections like HIV.
"Almost £500 million will be spent on drug
treatment in 2004-05 and we recently
announced that all Drug Action Teams will
get a 55% increase in their allocations
between 2006 and 2008.
"The extra funding in the last few years
has led to many more drug users engaging
in treatment and an increase in the
numbers successfully completing treatment.
"This is good news as there is clearly a
link between getting people into treatment
and substantially reducing the rate of
The spokeswoman added: "A Hepatitis C
Action Plan for England was launched by
the Department of Health in June 2004
calling for a review of harm reduction
services to prevent hepatitis C
"Such services include provision of needle
exchange services in the community, safe
disposal of used needles and syringes and
provision of specialist drug treatment
One in 50 injects drugs, research finds
The [U.K.] government has been urged to
step up its efforts to tackle drug use
after research showed levels of use in
English cities to be higher than
A study published today revealed that as
many as one in 50 young people and adults
in three major English cities were
This statistic is higher than previous
Home Office figures, which estimated that
in 2001, 0.3% of the population between 15
and 64 years old were injecting drug
Using information from sources including
drug treatment centres and syringe
exchange schemes between 2000-01,
researchers from Imperial College London
and Liverpool John Moores University
studied levels of drug use in London,
Liverpool and Brighton.
They discovered that the proportion of
adults and young people between 15 and 44
who were injecting drugs was 2% in
Brighton, 1.5% in Liverpool and 1.2% in
Based on the rates for each city, the
researchers said that these figures
equated to between 10 and 18 patients in a
typical general practice list of 2,000
patients, with 900 aged 15 to 44.
in Brighton, Liverpool and London the
prevalence of injecting drug use among
young adults is as common as diabetesand greater than many
other chronic conditions such as epilepsy
or psychosis," the researchers said.
The study also found injecting drug-users
(IDUs) were more likely to die of their
habit in Brighton. Overall, around 1% of
IDUs die from an overdose each year, but
in Brighton this rate was twice as high.
The government wants to increase the
number of problem drug users in treatment
programmes in coming years, but
researchers said the figures on which the
target was based were flawed and more
effort was needed to reach the targets.
"The government aims to double the number
of problem drug users in treatment," the
authors said. "In the three sites [looked
at in the study], there is ample
opportunity for this [drug treatment],
given that less than one in four IDUs are
in receipt of treatment at any one time.
Unfortunately, the data on the numbers in
treatment were of poor quality and
requires urgent improvement."
The research also revealed a shortage of
sterile needles in each of the cities
studied. Around 5 million syringes were
distributed each year in London, 400,000
in Brighton and 560,000 in Liverpool.
This works out at 190 syringes per person
in Brighton and Liverpool - one used every
two days - and slightly less in London at
about one used every 2.5 days.
users inject on average twice a day, this
would suggest that current levels of
activity provide sterile equipment for
approximately 27% of all injections by
users in Brighton and Liverpool and 20% in
researchers said, adding that this low
take-up increased the risk of diseases