New research suggests there could be three million injecting drug users (IDUs) worldwide who are HIV positive; and that the number of countries reporting injecting drug use has increased over the last decade.
The proportions of IDUs who are HIV positive is over 40% in nine countries with data. In an article published early online and in an upcoming edition of The Lancet, Dr Bradley Mathers, from the National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia, and colleagues from the 2007 Reference Group to the UN on HIV and Injecting Drug Use call for better data from around the world in view of the increasing importance of injecting drug use as a mode of HIV transmission in many regions.
This systematic review showed huge discrepancies worldwide. For example, in the UK, 0.39% of 15-64 year-olds are IDUs, of which 2.3% are thought to be HIV positive. In Spain, this proportion of IDUs is lower (0.31%), but the proportion of IDUs with HIV is many times higher (39.7%). Other examples of country figures, with proportion of 15-64 year old IDUs first and proportion of those who are HIV positive second are USA (0.96% / 15.6%), Australia (1.09% / 1.5%), Argentina (0.29%, 49.7%), China (0.25%, 12.3%), Ukraine (1.16%, 41.8%), Russia (1.78%, 37.2%), and Estonia (1.51%, 72.1%). In Europe, the highest proportions of IDUs among 15-64 year-olds were in Italy (0.83%) and Switzerland (0.65%); while the highest figures for proportions of IDUs that are HIV positive were Spain, mentioned above, and Portugal (15.6%). The authors estimate that there may be 15.9 million people worldwide who inject drugs.
The authors note a dearth of information from Africa, and express their concerns that in Africa a 'constellation of risk factors exists for the development of injecting drug use, as has occurred elsewhere'. For regions with data, the authors say: "Areas of particular concern are countries in southeast Asia, eastern Europe, and Latin America, where the prevalence of HIV infection among some subpopulations of people who inject drugs has been reported to be over 40%." A review in 1998 identified 129 countries with IDU, of which 103 reported HIV among IDUs. This latest research increases these numbers to 148 countries with IDU and 120 of those reporting HIV among IDUs. The authors say: "There is a pressing need to understand injecting drug use in all countries."