Aids and injecting drug use in the United Kingdom, 1987–1993: The policy response and the prevention of the epidemic

Abstract

Abstract--This paper assesses policy development, service changes and trends in HIV infection and risk behaviour among injecting drug users (IDUs) in the United Kingdom. In 1986, the U.K. was faced with the possible rapid spread of HIV infection among IDUs. The combination of an outbreak of HIV infection with prevalence levels of 50% or more in Edinburgh, the recent diffusion of drug injecting, and high levels of syringe-sharing risk behaviour, suggested that HIV infection might spread rapidly through IDU populations. HIV prevention activities commenced in 1986 and developed in 1987. The first report on AIDS and Drugs Misuse by the Advisory Council on the Misuse of Drugs in 1988 was a major catalyst for change. It supported and legitimized emergent views on new ways of working with drug users. Between 1988 and 1993 innovative public health projects increased the ability to target vulnerable populations through syringe distribution, expansion of methadone treatment and outreach to hard-to-reach populations. There were major changes in service philosophy and practices, as ideas of harm minimization, accessibility, flexibility and multiple and intermediate goals were developed. There is evidence that these public health projects encouraged extensive changes in the health behaviour of IDUs. There have been major reductions in syringe-sharing risk behaviour and sharing syringes is no longer the norm. Evaluation of specific interventions (e.g. syringe-exchange) shows their importance in encouraging reductions in risk behaviour. Levels of HIV infection in IDUs remain low by international standards. Outside of London rates of about 1% have been reported; London has a low and declining prevalence of infection to around 7% in 1993; previous high levels in Edinburgh (55%) have since declined to 20%. Britain has to date avoided the rapid increase in HIV infection among injectors that has occurred in many parts of the world. The same period saw the continuation of high prevalence levels in New York and many European cities, and the explosive spread of HIV in many countries in south-east Asia. This paper acknowledges the difficulties is proving links between social interventions and epidemic prevention. It argues that there is prima facie evidence for the success of public health prevention, that the collection of intervention approaches in the U.K. had a significant impact on IDUs behaviour, and that this has helped prevent an epidemic of HIV infection among IDUs. The U.K. experience adds to the growing evidence of the significance of early interventions in encouraging behaviour change and in limiting the spread of HIV infection.

Comportamentos de risco ao HIV em utilizadores de heroína em um distrito português: estudo qualitativo

“…Do ponto de vista político, poderia ser negativo oferecer programa de manutenção com metadona e seringas na mesma clínica, criando uma demanda de uma parcela do público que não está interessada em programas de tratamento. Entretanto, alguns estudos indicam que os programas de troca de seringas em clínicas de tratamento não aumentaram a taxa de exames positivos de urina para uso de drogas, reduziram os riscos e a prevalência de HIV e poderiam funcionar como um meio de arrecadar mais pacientes para os programas de manutenção [17][18][19][20][21] .…”

Comparing population estimates for drug users, the prevalence of blood-borne viruses and the provision of services in one London borough: Evidence of a gap in provision?

“…Hickman and colleagues (2004) noted high rates of hepatitis C infection among drug users and calculated that syringe and needle distribution was adequate for less than one third of all injections. Conversely, harm reduction interventions in the UK, including syringe exchange provision, have contributed towards maintaining a low prevalence of HIV (Stimson, 1995).…”

Emotions, ethnography and crack cocaine users

“…This lack of systematic observational work has been combined with an over emphasis on interview-based methods and a tendency to conflate 'ethnographic' with 'qualitative' interview-based research (see Moore 2002, Power et al 1996. In an 'interview age', which predominates over naturally-occurring visual 6 data (Silverman 1997, Stimson 1995, an ethnographic study of injecting-drug use, with an emphasis on visual data, in the UK is timely. Indeed, such a method would be most beneficial in considering the 'emotional realities' of damaging drug use in its home contexts.…”