Epidemiology of HIV Among Injecting and Non-injecting Drug Users: Current Trends and Implications for Interventions

Abstract

Injecting drug use is a major driver of HIV infections in Eastern Europe, the Commonwealth of Independent States, North Africa, the Middle East, and many parts of Asia and North America. We provide a global overview of the epidemiology of HIV infection among drug users and present current drug use trends that may constitute important epidemic drivers. We describe trends in ethnic disparities among injecting drug using (IDU) populations in the United States, and comment upon how these trends may now be changing. We present examples where HIV infection among non-IDUs who use cocaine, crack, and methamphetamine by other routes of administration is similar to that among IDUs, and discuss potential mechanisms of HIV spread in this overlooked population. Finally, we comment upon the potential implications of these observations for HIV interventions among IDU and non-IDU populations, taking into account different strategies that are needed in settings where HIV and/or injecting drug use has been established, or threatens to emerge.

Next steps in research on injection initiation incidence and prevention

“…The study by Sordo et al [2] provides the first review and meta-analysis of prospective observational cohort studies on initiation into drug injection among vulnerable populations. The major finding was a strong relationship between the incidence of initiation to injecting and the length of follow-up time.…”

“…In the last 30 years there have been several worrisome developments in injection drug use globally, including the continued spread of drug injection to new countries [1], HIV and viral hepatitis outbreaks among people who inject drugs (PWID) in eastern Europe and Asia, among other regions [2], and the adoption of methamphetamine and opioid prescription medications as injectable drugs [3]. However, Sordo et al's (2015) excellent systematic review and meta-analysis published in this issue of Addiction identified only nine cohort studies over this time-frame that provide information on injection initiation incidence [4].…”

Enrolment and retention of people who inject drugs in the Needle & Syringe Exchange Programme in Malaysia

“…1 Globally, injecting drug use accounts for a third of new HIV infections outside sub-Saharan Africa, 2 with the highest drug-related incidence occurring in Asia and Eastern Europe. 2,3 Of the 16 million people who inject drugs (PWID) worldwide, 3 million are HIV-positive.…”

HIV Testing in Non-Injection Drug Users: Prevalence and Associated Factors

“…NIDU exhibit several risk behaviors for acquiring HIV, such as polysubstance use, inconsistent use of condoms, sex work, and multiple sexual partners (8)(9)(10). Studies have shown elevated prevalence of HIV infection among NIDU worldwide, ranging from 3.7% in México to 16.0% in the United States of America (11)(12)(13)(14)(15).…”