High prevalence of risk behaviour means there's potential for worsening of HIV epidemic among people who inject drugs in Europe

Situation especially severe in eastern Europe

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 continent.

“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.


harm reduction

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use (including safer use, managed use and abstinence). It is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.


Receptive anal intercourse refers to the act of being penetrated during anal intercourse. The receptive partner is the ‘bottom’.

risky behaviour

In HIV, refers to any behaviour or action that increases an individual’s probability of acquiring or transmitting HIV, such as having unprotected sex, having multiple partners or sharing drug injection equipment.

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 < 0.0001).

There were significant differences in rates of reported sexual risk behaviours between participants in eastern and western Europe.

Unprotected sex 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).

Despite the 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.”


Uusküla A et al. Self-reported testing, HIV status and associated risk behaviours among people who inject drugs in Europe: important differences between East and West. AIDS 28, online edition. DOI: 10.1097/QAD0000000000000299, 2014.