Sharing of injecting equipment and sex without condoms is more frequently reported by people who inject drugs in eastern Europe, indicating a large unmet need for HIV prevention activities targeting this group,
investigators report in the online edition of AIDS. But there is substantial
risk for potential spread of the infection among this population throughout the
“On the basis of
the observed risk behaviour among PWIDs [people who inject drugs], there is
still a substantial potential for HIV transmission among PWIDs,” comment the
authors. “An intensification of HIV prevention and harm reduction interventions
targeting this population is warranted, especially in Eastern Europe.”
People who inject
drugs account for approximately 10% of the global HIV epidemic. The majority of
infections among this population involve individuals in southeast Asia and eastern Europe. The latter region has the fastest growing HIV epidemic of any
world region, largely due to high rates of new infections among people who inject drugs.
A team of investigators
wanted to determine HIV prevalence and rates of risk behaviours among people
who inject drugs across Europe. They therefore examined the results of twelve
cross-sectional studies conducted between 2000 and 2010 in European countries
with a high prevalence of HIV infections among people who inject drugs. Results
were compared between western Europe (The Netherlands, Portugal and Spain) and eastern Europe (Estonia, Latvia, Poland and Russia).
The total study
population consisted of 5328 current injecting drug users (1791 from western Europe,
3537 from eastern Europe). Their mean age was 31 years and 75% were male.
HIV prevalence was
significantly higher in eastern Europe compared to western Europe (38 vs 30%,
p < 0.0001).
Less than a
quarter (23%) of individuals in western Europe were recent injectors (stated within
the previous five years), compared to 34% of participants in eastern Europe (p <
significant differences in rates of reported sexual risk behaviours between
participants in eastern and western Europe.
was reported by 47% of the participants living with HIV in western Europe compared to 70% of participants living with HIV in eastern Europe (p < 0.0001). HIV-negative
individuals in eastern Europe were also more likely to report unprotected sex than
HIV-negative individuals in western Europe (82 vs 58%, p < 0.0001).
There was a higher
prevalence of syringe sharing among people in eastern Europe. This included both
distributive sharing (passing on a used syringe to someone else) and receptive
sharing (use of a syringe previously used by another individual).
In western Europe, 46%
of injecting drug users living with HIV reported frequent injecting compared with
64% in eastern Europe (p < 0.01). Among HIV-negative individuals, the prevalence
of frequent injecting was also higher in eastern Europe compared to western Europe (49 vs
44%, p = 0.0026).
differences between eastern and western Europe in the prevalence of risk behaviours,
comparison between people who inject drugs who are living with HIV or HIV negative in the
two regions yielded similar results. People living with HIV were less likely
to be sexually active (AORmeta = 0.69; 95% CI, 0.58-0.81) or report unprotected
sex (AORmeta = 0.58; 95% CI, 0.40-0.83) compared to their HIV-negative peers.
However, individuals living with HIV were more likely to report injecting-related
risk, including sharing syringes (AORmeta = 1.70; 95% CI, 1.30-2.00) and
frequency of injecting (AORmeta = 1.40;
95% CI, 1.20-1.70).
Overall a fifth of
people (27% in eastern Europe and 17% in western Europe, p < 0.0001) who inject drugs
had never been tested for HIV. “There is a need for continuous, population-based testing for PWIDs in Europe,” write the authors. They conclude, “there is
still a substantial potential for further HIV transmission among PWIDs in
Europe, given the high levels of self-reported risk behaviours.”