Injecting drug use (IDU) remains a significant HIV transmission factor in many regions of the world, driving fast-growing epidemics in Eastern Europe & Central Asia, Asia & the Pacific, Latin America and North Africa. For example, the HIV epidemic among adults in Libya has been driven by IDU, with 90% of all known HIV infections to date occurring among IDUs. Additionally, close to 25% of new HIV infections in the US and Canada last year were due to IDU, and in Portugal this mode of transmission was responsible for almost half of all HIV infections in 2002.
People who inject drugs are largely stigmatised - and often disenfranchised - minorities, complicating harm-reduction interventions - where they exist - and often making prevention outreach and testing an overwhelmingly difficult task. However, some countries - including those outside of the west - are acknowledging and tackling this hidden epidemic which not only transmits HIV, but also hepatitis C.
Speaking at the launch of the UNAIDS AIDS epidemic update report today in London, United Kingdom Secretary of State for International Development Hilary Benn said: "It is very important that we continue to work with drug users, sex workers and gay men - those at the margins of society - and that we do not lose sight of that."
In this year`s report, UNAIDS has chosen to emphasise two marginalised groups in particular, gay men and injecting drug users, as important groups driving the development of the epidemic in different regions of the world.
Eastern Europe and Central Asia
In the countries and satellites of the former Soviet Union injecting drugs is a relatively new phenomenon that has grown at a rapid pace, overtaking alcohol abuse in the past decade. A new generation of disfranchised youth has turned to drugs as a means of escape. This is particularly due to the availability of cheap heroin and other injectable drugs as drug-trafficking networks flourish in the region, with a background of a changing political regime and economy that has increased chronic poverty and unemployment.
UNAIDS reports that the potential for HIV transmission among IDUs in the Russian Federation alone is enormous, with estimates of up to three million IDUs, accounting for 2% of the entire population. There are also estimated to be more than 600,000 IDUs in Ukraine and up to 200,000 in Kazakhstan, while 1% of the population of Latvia and Estonia inject drugs, and up to 2% in Kyrgyzstan.
Asia and the Pacific
High rates of HIV prevalence have been found among IDUs in several Chinese provinces, including 35–80% in Xinjiang and 20% in Guangdong, helping to fuel the HIV epidemic there.
Viet Nam faces an epidemic of high intensity amongst its injecting drug user population. According to official estimates, 65% of Viet Nam’s HIV infections are occurring among drug users, due to the use of contaminated injection equipment; last year 20% of IDUs in most provinces were HIV-positive.
Myanmar and Indonesia are also facing an IDU-led epidemic. UNAIDS reports that in three major Indonesian cities, more than 90% of IDUs were found to be using unclean injecting equipment.
Pakistan may also have an IDU-driven epidemic waiting to happen. Although HIV prevalence appears to be low amongst IDUs there, a substantial number of the estimated three million heroin users in Pakistan only began injecting in the late 1990s, increasing the 'pool' of infectivity that may well be underreported: a recent study amongst IDUs in one Pakistani city found that 55% had used unclean injection equipment and only 16% had even heard of AIDS.
IDU is one of the two major methods of HIV transmission in the majority of South American countries - the other being sex between men. In the Caribbean, injecting drug use appears to be the main driver of the epidemic only in Puerto Rico.
UNAIDS notes that due to lack of basic information regarding HIV transmission routes there is subsequent heterosexual transmission to the sexual partners of IDUs, broadening the epidemics in the entire region.
As HIV ravages sub-Saharan Africa, the northern part of the continent is experiencing a rise in HIV infections among IDUs, particularly in Bahrain, Libya and Iran, the latter primarily taking place within the prison system. Additionally, increases of IDU-transmitted HIV infections have been reported in Algeria, Egypt, Kuwait, Morocco, Oman and Tunisia.
However, positive steps are being made by several countries in the region to stem the tide of IDU-related HIV transmission. "Some countries (notably Iran and Libya) appear more willing to acknowledge and tackle epidemics associated with injecting drug use," says the UNAIDS report, adding that Algeria, Lebanon, Iran and Morocco "are developing more substantial prevention programmes" that focus on both sexually- and IDU-transmitted HIV.
UNAIDS. AIDS epidemic update. 14 - 30, 2003.