HIV prevalence amongst IDUs in England and Wales at highest level since 1992

HIV infections in England and Wales via injecting drug use (IDU) are at their highest level in more than a decade, according to data released on Thursday by the Health Protection Agency (HPA).

The latest figures from the HPA's Unlinked Anonymous Prevalence Monitoring Programme (UAPMP), which provides data to the end of 2005, show that one in 62 IDUs were found to be infected with HIV in 2005. This is equivalent to a national IDU HIV prevalence rate of 1.6%.

HIV prevalence among IDUs in England and Wales reached a peak of 5.9% in 1990 and a low of 0.6% in 1996. The 2005 figures show the highest level of HIV infection since the UAPMP found the same high prevalence of 1.6% in 1992.

Last October, the HPA's report Shooting Up: infections among injecting drug users in the United Kingdom, an update, October 2005 found wide regional variations in the prevalence of HIV infection amongst IDUs in England and Wales. The highest prevalence was in London where 4% were infected with HIV. Elsewhere in England and Wales, they found prevalence of HIV infection in IDUs to be 1%.

The latest data suggest that although levels of HIV infection in IDUs have remained stable in London, HIV prevalence increased to 1.2% outside of London in 2005.

A joint report from the HPA and Imperial College London published last year in the journal, AIDS identified a high prevalence (1.2%) of HIV infection in individuals who had been injecting for less than three years. The 2005 figures show that has also increased to 1.3%.

Both the HPA's earlier report and the AIDS article found evidence of a recent increase in risky injecting practices. Professor Peter Borriello, Director of the Health Protection Agency’s Centre for Infections said that these results confirm those findings, adding that "there is also evidence of an increase in the injecting of crack-cocaine which has been shown to be associated with transmission of blood-borne viruses such as HIV and hepatitis C."

Dr Fortune Ncube, who monitors IDU's health for the HPA, said that the latest figures "highlight the importance of improving healthcare services to prevent the spread of HIV and other infections among injecting drug users. Necessary steps to achieve this include the provision of enough needles and syringes and available information and practical advice on safer injecting practices, as well as guidance on the safe disposal of used equipment, the prevention of blood-borne virus transmission and easy access to diagnostic tests for HIV."

However, the authors of the AIDS report pointed out that in 1998, the UK's national drug strategy changed its focus from harm-reduction and the reduction of blood-borne viruses to "wider social harms, in particular drug-related crime," and suggested that this "simultaneous shift in the focus of policy and service provisioning for drug users in England and Wales" may have "unintentionally hindered the development and re-invigoration of harm reduction measures in response to evolving patterns of drug use and risk behaviours."

New HIV diagnoses amongst IDUs are also likely to have increased to an estimated 182 in 2005. In 2004, 131 new HIV infections were reported where IDU was the risk activity. However, between 1998 and 2003 only 118 new infections in total were attributed to IDUs. Previous reports from the HPA suggest that between 30% and 50% of IDUs are unaware that they are HIV-positive.

By the end of December 2005, 76,850 new HIV diagnoses had been made and reported in the United Kingdom since surveillance began in 1982. Of these, 5.7% were probably acquired through IDU.