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Eight recent HIV outbreaks in drug injectors point to prevention complacency
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22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018
Mark Mascolini
"Complacency for HIV prevention is emerging as an important threat to the success of combined HIV prevention for people who inject drugs" [1]. That conclusion emerged from an analysis of 8 recent HIV outbreaks among drug injectors by an international panel convened to scrutinize relevant data. The explosive spread of HIV among drug injectors in 8 countries involved nearly 1200 new cases in one instance and may be increasing in frequency.
To get a better understanding of the recent spread of HIV among people who inject drugs, the European Monitoring Center for Drugs and Drug Addiction empaneled a team of experts to analyze and compare these outbreaks. They performed both quantitative and qualitative reviews using a standardized template to allow structured comparisons.
The 8 analyzed HIV outbreaks in drug injectors occurred in Athens, Greece; Bucharest, Romania; Dublin, Ireland; Glasgow, Scotland; Luxembourg; Saskatchewan, Canada; Scott County, Indiana, United States; and Tel Aviv, Israel. The closely studied 2014 Indiana cluster involved almost 200 new HIV infections in an estimated 500 to 600 drug injectors. Glasgow recorded 48 new cases in 2015, 31 in 2016, and 37 in 2017, compared with a prior annual average of 10. Bucharest counted 1195 new HIV cases from 2011 through 2016.
The expert panel determined that outbreaks sometimes occurred in areas without large-scale combined prevention plans (Athens, Indiana), in places where prevention funding was interrupted (Bucharest), and also in areas with reasonable prevention programs but a shift in drug use patterns (Bucharest, Dublin, Glasgow, Luxembourg, Tel Aviv). In Athens, Dublin, and Indiana, community economic problems preceded the outbreaks. All recent outbreaks particularly involved homeless or low-income people.
Public health responses led to "substantial decreases" in new HIV infections in some sites (Athens, Indiana, Dublin, Tel Aviv). But the number of new cases fell to preoutbreak levels only in Tel Aviv.
The expert panel argued that earlier HIV outbreaks in drug injectors in Estonia, Finland, Sweden, and Lithuania "should have served as warnings about the possibility of additional outbreaks." Despite these red flags, though, new outbreaks did occur and are "possibly increasing in frequency."
The panel advised that successful HIV prevention in drug injectors must implement and maintain high-coverage prevention programs and adapt to changes in drug use patterns. Effective programs include needle and syringe exchange, opiate substitution treatment, and antiretroviral therapy. The experts urged particular attention to people who inject stimulants such as cocaine, to communities enduring economic difficulties, and to homeless people who inject drugs.
Reference
1. Des Jarlais D, Sypsa V, Wiessing L, et al. Complacency is the new problem: comparative analysis of recent outbreaks of HIV among persons who inject drugs in Europe and North America. AIDS 2018: 22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018. Abstract THPEC189.
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