Risk of HIV outbreaks among drug injectors in the EU

Harm Reduction International, 19 November 2011

Over the last decade, gains have been made within the EU in addressing HIV infection among injecting drug users — these include a greater availability of prevention, treatment and harm-reduction measures. Other factors, such as the decline in injecting drug use in several countries, are also likely to have played a role in the decrease in the number of new HIV infections.

The latest data show that the average rate of newly reported HIV cases continues to fall in Europe, reaching a low of 2.85 new cases per million population in 2009 (in total, about 1 300 cases). Here, the overall EU situation compares positively, both in a global and a wider European context.

Nevertheless, this year’s EMCDDA Annual report notes some worrying developments in respect of HIV among injecting drug users.

In July 2011, Greece — historically a low HIV-prevalence country — reported an outbreak of new HIV infections among drug injectors (170 cases at the time of writing). Recent increases in new infections have also been reported by Bulgaria, Estonia and Lithuania, indicating a continued potential for HIV outbreaks among injecting drug users in some countries (see Figure INF-2 in the 2011 Statistical bulletin). At a recent EMCDDA meeting (October 2011), national experts noted further HIV increases among drug users in Romania and potentially worrying changes in risk factors reported in Hungary.

Despite the declines in HIV infections among drug injectors in the European Union over the last decade, complacency must be avoided. HIV infection can spread rapidly in vulnerable populations of injectors especially if service provision is low. Interventions (especially needle and syringe programmes, opioid substitution treatment, diagnosis and anti-retroviral treatment) can be effective in reducing the spread of the virus among drug injectors. Joint European guidelines on the prevention of HIV and other infections among drug injectors were launched in October 2011 by the European Centre for Disease Control and the EMCDDA.

HIV epidemics among drug injectors also continue to pose a major public health problem for many countries bordering the EU (see Annual report, Chapter 7, Figure 15) (2). Within the EU, the current financial situation means that budgets for drug services are likely to come under increased scrutiny. It is therefore important that the social and financial costs of potential new HIV outbreaks, as well as the guidance on what kinds of interventions are likely to prove most effective in this area, are borne in mind when making decisions on the provision of services.

Apart from the direction of trends over time, the actual rate of reported new HIV diagnoses (per million population) in 2009 related to injecting drug use remained relatively high in Estonia (63.4), Lithuania (34.9), Latvia (32.7), Portugal (13.4) and Bulgaria (9.7), suggesting ongoing transmission. Injecting drug use accounts for over 2 000 AIDS-related deaths a year in the EU.

Following the first warning of the outbreak in Greece, the EMCDDA commissioned a rapid analysis of the situation with regard to the latest epidemiological data and prevention measures being taken. A summary of the findings can be found at this link.

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