HIV among injecting drug users on the rise

An estimated three million injecting drug users in 120 countries around the world are HIV positive, according to new research, but a lack of data from Africa, the Middle East and Latin America could be obscuring an even larger global health problem.

The study, published in British medical journal The Lancet on Wednesday, looked at the prevalence of injecting drug use in 148 countries and the prevalence of HIV among injecting drug users (IDUs) in those countries. It found that in nine countries, including Estonia, Ukraine, Argentina, Indonesia and Kenya, over 40 percent of IDUs were HIV-positive.

However, data for injecting drug use was only available for a small number of countries in sub-Saharan Africa - 13 out of 47. The authors, led by Dr Bradley Mathers of the Sydney-based National Drug and Alcohol Research Centre, cautioned that "a constellation of risk factors exists for the development of injecting drug use" in Africa including high levels of socio-economic hardship and the fact that many countries in the region are being used for the transit of illicit drugs into Europe. In Kenya, Mauritius, Nigeria, South Africa and Tanzania, injecting drug use is already well established.

China, Russia and the USA currently have the largest populations of IDUs out of an estimated global total of 16 million, while HIV prevalence among IDUs is highest in eastern Europe, southeast Asia and Latin America.

The study, which was conducted by a group of experts established to provide technical advice to the UN on HIV and injecting drug use, concludes that injecting drug use is an increasingly important mode of HIV transmission in many countries worldwide.

"There is a clear mandate to invest in HIV prevention activities such as needle and syringe programmes and opioid substitution treatment," write the authors, who also called for more research to accurately gauge the scale of the problem.

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Commenting on the research, Dr Kamyar Arasteh and Dr Don Des Jarlais of the Beth Israel Medical Centre in New York, noted that not enough IDUs were accessing HIV prevention, testing and treatment services.

In China, for example, a 2007 study found that less than half of IDUs knew their HIV status, 60 percent had used unsterile injection equipment the last time they injected and only a third used a condom the last time they had sex.

Nevertheless, Arasteh and Des Jarlais commented that "if HIV prevention efforts are implemented on a large scale when prevalence is low in injecting drug users, it is possible to avert HIV epidemics in users".

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