In November 2011, a strong increase of newly diagnosed HIV infections among IDUs during 2011 was reported to EMCDDA by the Romanian National Focal Point (NFP) on Drugs. This was based on the information provided by routine monitoring and case reporting coordinated by the Centre for Monitoring and Evaluation of HIV/AIDS Infection in Romania. The reported increase was further supported by data from Drug-related Infectious Diseases (DRID) indicator based on routine monitoring performed by Romanian NFP.

A risk assessment performed by the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) in 2011 together with the NFP and representatives of Centre for Monitoring and Evaluation of HIV/AIDS Infection in Romania / Romanian National Institute of Infectious Diseases ‘Prof. Dr. Matei Bals’ (INBI) documented an increased HIV incidence; increased hepatitis C prevalence (indicating increased injecting risk); recent changes in injecting patterns (with more frequent injecting and increased stimulant injecting); and low coverage of effective prevention services (needle and syringe programmes, opiate substitution treatment).

While reporting three to five cases annually from 2007 to 2009, HIV infections among IDUs increased to 12 cases in 2010 to 129 in 2011. Moreover, 102 new cases were registered until the end of June 2012 (2) which is over three times the number of cases reported for the same period in 2011 (30 cases).

Routine monitoring performed at registration for drug treatment services indicated also an increase in HIV-positive cases among IDUs tested (1.1% (2/182) in 2008, 3.3% (11/329) in 2009 and 4.2% (12/288) in 2010) and (11.6%, 25/216) in 2011 (3). The routine monitoring includes testing but also self-reporting.

In fresh unpublished data from the 2012 behavioural surveillance survey (BSS) among IDUs recruited using the RDS sampling procedure (n=417) in Bucharest the HIV prevalence among IDUs reached 52.5%.

No specific HIV testing campaigns had been initiated and most cases were detected when seeking drug treatment or hospital care for other conditions, suggesting that the increases reflected true increases in incidence of HIV infection rather than increased detection of cases.

In a BSS (4) among IDUs published in 2010, there were reports of changes in drug use patterns from 2009, where 97% of respondents reported heroin as the main drug of injection, to 2010, where 67% reported heroin and 31% reported amphetamine-type stimulants, mostly synthetic cathinones, as the main drug of injection. Stimulant use is associated with more frequent injection and there are reports of increased syringe sharing. In 2012 BSS significant changes are seen in drug use patterns. The main drugs of injection were NPS (the new amphetamine type stimulants) for 49.4% of the IDUs.

The HIV outbreak among IDUs in 2011 coincided with a significant reduction of harm reduction service provision due to the ending of the international programmes and funding available from the Global Fund and UNODC.

Following the recommendations of the risk assessment the Romanian National Antidrug Agency initiated efforts to improve the harm reduction service network. It provided about 145 000 extra syringes for the needle exchange programmes active in the field and supported the opening of a new outreach centre coordinated by the Carusel NGO which covers 40 clients per day 2 days a week. It also sustained several advocacy events and measures in order to speed up the adoption of the Anti HIV/AIDS Strategy1 2011-2015 (5) which is now under public debate. The syringes were distributed by 2 outreach centres2 in well-known areas and open scenes of IDUs in the capital city of Bucharest.

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HIV/AIDS among injecting drug users in Romania

As estatísticas sobre o consumo de drogas estimam que aproximadamente 14,5 milhões de europeus já consumiram cocaína pelo menos uma vez na vida (4,3% dos adultos com idade entre 15-64 anos), 12,5 milhões experimentaram anfetaminas e cerca de 11 milhões já consumiram ecstasy.

Actualmente, a panóplia de substâncias psicoactivas de uso recreativo disponíveis, com excepção do álcool, são ilegais em toda a Europa. Infelizmente, anos de experiência mostram que as medidas repressi-vas raramente impedem as pessoas de usar drogas. Além disso, o uso de drogas ilegais muitas vezes ocorre em situações duvidosas, em circunstâncias ambíguas, que surgem como consequência das mui-tas regras implícitas que actualmente regem o mercado ilegal, mas também são influenciados pelo local onde as drogas são produzidas, distribuídas e vendidas aos consumidores. A natureza clandestina do trá-fico de drogas e a vontade de maximizar os lucros são duas das principais forças que dão forma ao mer-cado ilegal. Um dos efeitos adversos deste mercado é que as drogas ilícitas são muitas vezes cortadas com outras substâncias mais baratas para aumentar os lucros ou são substâncias com doses perigosa-mente altas.

A falta de conhecimento concreto sobre os compostos activos e as doses de muitas drogas representa um risco para a saúde, com resultados muitas vezes fatais como temos visto em inúmeras situações. O Drug Checking apresenta-se como uma resposta directa à necessidade de reduzir os riscos para saúde do consumo de drogas ilegais. Apesar de já existir há algum tempo o Drug Checking continua a ser uma abordagem controversa. Alguns países têm abraçado totalmente este tipo de serviço, emergindo como parte integrante do sistema nacional de saúde, enquanto outros têm mostrado alguma relutância em implementar o Drug Checking a qualquer nível.

Esta publicação reúne respostas a muitas das mais frequentes perguntas sobre Drug Checking. O principal objetivo é dar uma visão geral e concisa do Drug CHecking actualmente.

Factsheet sobre Drug Checking na Europa

The global community has embarked on an historic quest to lay the foundation for the eventual end of the AIDS epidemic.

This effort is more than merely visionary. It is entirely feasible. Unprecedented gains have been achieved in reducing the number of both adults and children newly infected with HIV, in lowering the numbers of people dying from AIDS-related causes and in implementing enabling policy frameworks that accelerate progress. A new era of hope has emerged in countries and communities across the world that had previously been devastated by AIDS.

However, a world in which AIDS has been eliminated can only be achieved through renewed and sustained commitment and solidarity and only if the available evidence and limited resources are used as efficiently and effectively as possible.

Recognizing the genuine opportunity to plan for the end of AIDS, countries pledged in the 2011 United Nations Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS 

to take specific steps to achieve ambitious goals by 2015. Drawing from the 2011 Political Declaration, UNAIDS has articulated 10 specific targets for 2015 to guide collective action.

Reduce HIV transmission among people who inject drugs by 50%.

Eliminate new infections among children and substantially reduce the number of mothers dying from AIDS-related causes.

Provide antiretroviral therapy to 15 million people.

Reduce the number of people living with HIV who die from tuberculosis by 50%.

Close the global AIDS resource gap and reach annual global investment of US$ 22 billion to US$ 24 billion in low- and middle-income countries.

Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV.

Eliminate stigma and discrimination against people living with and affected by HIV by promoting laws and policies that ensure the full realization of all human rights and fundamental freedoms.

Eliminate restrictions for people living with HIV on entry, stay and residence.

Eliminate parallel systems for HIV-related services to strengthen the integration of the AIDS response in global health and development efforts.

In embracing the targets in the 2011 Political Declaration, countries committed to monitor and report on progress and challenges encountered in their national AIDS responses. To facilitate biennial reporting on national progress, UNAIDS collaborated with partners to develop a set of core indicators against which countries would report. In 2012, 186 countries submitted comprehensive reports on progress in their national AIDS response. With 96% of the 193 United Nations Member States reporting in 2012, the Global AIDS Response Progress Reporting system has among the highest response rates of any international health and development monitoring mechanism – a vivid reflection of the breadth and depth of global commitment to the response to AIDS.

Drawing on information provided by countries, this report summarizes the current situation in the effort to reach the 2015 targets set forth in the 2011 Political Declaration. In addition to providing a snapshot of the current situation for each target, it identifies key trends. Using a scorecard approach on key indicators, the report allows individual countries to compare their own achievements with those of others. Regional breakdowns enable comparison of progress between different parts of the world. This report highlights instances where recommended policies and programmes have yet to be implemented.

As part of global AIDS response monitoring, countries have completed extensive surveys on national AIDS policy frameworks. The National Commitments and Policies Instrument obtains information on the process of national strategizing on AIDS, engagement of civil society and other key constituencies as well as policy approaches for HIV prevention and treatment.

The results summarized here are encouraging, since progress achieved to date conclusively demonstrates the feasibility of achieving the targets set in the 2011 Political Declaration. However, the findings also reveal that, to reach most of those targets by 2015, a significant additional effort is required.

UNAIDS Report on the global AIDS epidemic 2012

Over the last decade, Europe has seen an increase in the size of its prison population. As of 1 September 2010, there were an estimated 635 000 inmates in prison in EU Member States (Aebi and Del Grande, 2012; Walmsley, 2012). Most of those in Europe’s prisons are from poor communities and vulnerable social groups (WHO Regional Office for Europe, 2007), with the proportion of inmates who are immigrants or from minority ethnic backgrounds on the increase (Ronco et al., 2011). Drug users form a large part of the overall prison population, with studies showing that a majority of prisoners have used illicit drugs at some point in their life and many have chronic and problematic drug use patterns. Because of the illegality of the drugs market and high cost of drug use, which is often funded by criminal activity, the more problematic forms of drug use are accompanied by an increased risk of imprisonment.

Although some prisoners do stop or reduce their use of drugs on prison entry, others initiate drug use or engage in more damaging behaviours when they are incarcerated (Lukasiewicz et al., 2007). In addition to high levels of drug problems, prisoners also experience poorer health than the general population, with higher prevalence of blood-borne infections, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV), as well as mental illness. Reported rates of self-harm and suicide among prisoners are particularly high compared with the general population of the same age. In addition, overcrowding and poor hygienic conditions may further aggravate the stress, social and health problems experienced by prisoners.

For opioid users, the risk of dying from drug overdose greatly increases in the period after release from prison — due to high rates of relapse and lower opioid tolerance (Farrell and Marsden, 2008). This is a critical time for action, when ensuring continuity of care and targeted interventions can both support recovery and save lives. The services offered to prisoners, however, have historically compared poorly with those provided in the community (Stöver and Weilandt, 2007). In general, services provided for prisoners have tended to mirror those provided in the community, but with a considerable time lag.

Nevertheless, when appropriate drug services are in place, periods of incarceration may provide an opportunity for some to reduce their drug use and engage with treatment, and, in recent years, many European countries have increased the provision of services for drug users in prison, particularly substitution treatment.

Recent years have also seen an increasing acknowledgement from international and European institutions of the importance of treating prison health as an inseparable component of public health. The Council Recommendation of 18 June 2003 and the 2009–12 EU action plan on drugs have both called for the development and implementation of prevention, harm reduction and treatment services in prison that are equivalent to services outside prison.

This Selected issue approaches the important topic of prisons and drugs in Europe from two perspectives. The first section aims to provide an insight into patterns and levels of drug use among the European prison population, the health profile of prisoners and risk behaviours while incarcerated. The second section examines Europe’s prison health policies and models of delivery of drug-related healthcare to detainees, including the provision of prevention, treatment and harm reduction services. The report concludes with reflections on ways forward.

Prisons and drugs in Europe: the problem and responses

Most people don’t use drugs and don’t approve of drug abuse. But is someone who is drug dependent an out of control “junkie” slipping ever deeper into despair and degradation or a ‘heroin user’, in control of his or her use of an illegal substance leading what to the outside world is considered a“normal” life?

Both descriptions may fit and either candidate could be as desperate to overcome a powerful habit as much as any reformed alcoholic or someone desperate to give up smoking.

The award of a deviant social status to drug users may serve to discourage use but it does little to assist those most in need of help. Studies have consistently shown that perceived devaluation and worthlessness on behalf of the user does little to spur them towards recovery. The ‘shame’ of addiction is a reason why people with drug problems – and their families – often do not seek help.

Widespread stigma remains a barrier to recovery for drug users. And the media can help – just as it has had a positive influence on public understanding of the problems of stigma associated with mental illness, disabilities and poverty.

Whether used consciously or lazily, certain words continue to imply a moral judgment in an era when the explosion of digital technologies has created a bigger platform than ever before for education.

The UK Drug Policy Commission identified that, aside from being consistently distasteful and backward, negative connotations attached to the term ‘junkie” made it more difficult to encourage addicts to join rehabilitation programmes. ‘Getting serious about stigma’ found that more than twothirds of the sample agreed that we have a responsibility to provide the best possible care for people with drug dependence.

Newspapers and broadcasters, now more than ever, can set new benchmarks for recovering drug addicts to throw off the stigma and overcome the dependencies that prevent them leading full and valued lives.

With the badge of the Society of Editors on the front page, this simple, practical guide does not seek to criticise the media or tell editors and journalists what to think or say or write. David Seymour has mastered the issues and presents the facts to help journalists report accurately and objectively so that stigma born of ignorance can be replaced with proper understanding and support for drug users who want to help themselves.

Dealing with the stigma of drugs: A guide for journalists

Cannabis use is relatively common in the European Union (EU) and Norway, with around 23 million people (6.8 % of all 15- to 64-year-olds) having used the drug in the past year and about 12 million (3.6 % of all 15- to 64-year-olds) in the last month. Although the prevalence of last-year cannabis use among the general population is generally stable or decreasing in many countries, demands for treatment in which cannabis is the primary drug continue to rise, indicating a possible increase in related problems. The substance is currently the most frequently mentioned drug by those demanding drug treatment for the first time in the EU and Norway. This suggests that, even though most cannabis use at the population level is likely to be transitory and at low levels, a significant minority of users use the substance intensively and/or for long periods of time. These patterns of use are reported to be associated with harms to the user and possibly with a need for treatment. Although this problem has been increasingly recognised, knowledge of the prevalence of the more intensive forms of cannabis use has been limited at the EU level.

This report brings together, for the first time in Europe, an integrated overview of the prevalence of intensive cannabis use, defined as daily or almost daily cannabis use (use on 20 or more days in the month preceding survey). Self-reported data regarding frequency of cannabis use from large, probabilistic, nationally representative samples of general population surveys from 20 countries, representing more than 83 % of the population of EU and Norway, were collected through two rounds of ad hoc data collection in 2004 and 2007 and through a routine, standard data collection instrument since 2010.

Prevalence of daily cannabis use in the European Union and Norway

Article 5.1 of Council Decision 2005/387/JHA stipulates that ‘Where Europol and the EMCDDA, or the Council, acting by a majority of its members, consider that the information provided by the Member State on a new psychoactive substance merits the collection of further information, this information shall be collated and presented by Europol and the EMCDDA in the form of a Joint Report. The Joint Report shall be submitted to the Council, the European Medicines Agency (EMA) and the Commission.

At the end of 2011 and in 2012, the EMCDDA and Europol examined the available information on a new psychoactive substance, 4-methylamphetamine, through a joint assessment based upon the following criteria:

evidence of the potential for further (rapid) spread; and,

evidence of cases of serious intoxication or fatalities.

The EMCDDA and Europol agreed that the information collected on 4-methylamphetamine satisfied all criteria (1 to 6). The two organisations therefore concluded that sufficient information had been accumulated to merit the production of a Joint Report on 4-methylamphetamine as stipulated by Article 5.1 of the Decision.

EMCDDA-Europol joint report on 4-methylamphetamine

The Trans European Drug Information project (TEDI) is a network of European fieldwork Drug Checking services that share their expertise and data within a European monitoring and information system. TEDI’s chief aim is to improve public health and intervention programs. Toward this goal, TEDI has developed a database system that collects, monitors and analyses the evolution of various European drug trends in recreational settings. TEDI project is inside of the European NEWIP project.

This very first trend report includes 1,690 analyses from the period January–May 2012. These analyses were developed by four Harm Reduc2on groups located in three countries: Spain’s Ai Laket!! Analysed 71 samples and Energy Control 808 samples, Austria’s Checkit! Analysed 444 samples, while Switzerland’s Saferparty.ch analysed 367 samples. As is usual for these types of services, the most analysed substances remain MDMA (29%), cocaine (25%) and amphetamine (24%), which combined represent over 78% of the total analysed samples. This further mirrors current usage trends of substances in recreational settings. However, it must also be emphasised that the number of samples of LSD (58), heroin (41), ketamine (28), methamphetamine (24) and 2C--‐B (19) were also not insignificant.

First trend report of the Trans-European Drug Information project

Injecting drug use is a growing problem in Africa and a growing risk factor for contracting HIV in the region. It is imperative that HIV research includes injecting drug users so that they too are able to benefit from safe and effective behavioural interventions and biomedical HIV prevention and treatment products.

This article relates a critical review of the findings of a desk review of previously published literature. The article examines injecting drug use in relation to HIV-related risk and research in Kenya, Mauritius, Nigeria, South Africa and Tanzania. The ethical challenges of including people who inject drugs in HIV research in Africa are also presented. The review found injecting drug use to be on the increase in all the countries reviewed.

HIV-risk behaviour among people who inject drugs, such as needle-sharing and higher-risk sexual behaviour, was also found to be widespread. Furthermore, criminalisation of drug use and strict anti-drug laws are common in the countries reviewed, while harm-reduction programmes for people who inject drugs were found to be limited.

The review identified a number of ethical challenges to the involvement of people who inject drugs in HIV research in Africa. This includes the illegal status and stigma surrounding injecting drug use, which may complicate participant recruitment, enrolment and retention. In addition, a lack of funding for supportive programmes to help injecting drug users may hinder the provision of appropriate standards of prevention and care and treatment for those who seroconvert.

The ethics of HIV research with people who inject drugs in Africa: a desk review

Guerra as drogas

This comic book by Stuart McMillen highlights the consequences of the war on drugs. To read the full document, please click here.

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