Polly Clayden, HIV i-Base

A report in the 24 September 2008 online edition of the Lancet estimates that about 3 million injecting drug users worldwide could be HIV-positive.

Bradley Mathers and co-authors, on behalf of the 2007 Reference Group to the UN on HIV and Injecting Drug Use, performed a literature search of peer reviewed and non-peer reviewed “grey” literature databases. Requests were also made to UN agencies and other international experts.

The authors considered 200 countries and the review revealed documented drug use in 148 of these. They reviewed 11,022 documents and noted that reports were only available for a small number of countries in the Caribbean (6/15) and sub-Saharan Africa (13/47).

They found that prevalence estimates of injecting drug use could be made for 61 countries representing 77% of the total population worldwide aged 15-64 years.

Extrapolated estimates from this review suggested that 15.9 million (range 11.0-21.2 million) people worldwide could be injecting drug users.

They found the largest numbers of injecting drug users in China, the USA and Russia with midpoint prevalence estimates of 12%, 16% and 37% respectively.

HIV prevalence among injecting drug users was 20–40% in five countries and was greater than 40% in another nine (they noted that areas of particular concern are countries in southeast Asia, eastern Europe, and Latin America). China, Russia, and the USA all had midpoint estimates of HIV prevalence in these populations of over 10%.

The authors estimated that worldwide about 3 million (range 0.8-6.6 million) people might be HIV positive.

They explain that the study has many limitations, not least that data from which to extrapolate prevalence estimates are inconsistent and populations typically hard to access.

They write: “People who inject drugs have the right to enjoy the highest standard of health attainable. There is a clear mandate to invest in HIV prevention activities such as needle and syringe programmes and opioid substitution treatment and to provide treatment and care for those who are living with HIV/AIDS.”

Ref:
Mathers BM, Degenhardt L, Phillips B et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet. Published online September 24, 2008.