Epidemiology of HIV infection and associated behaviours among people who inject drugs in England, Wales, and Northern Ireland: Nearly 40 years on

Sara Croxford*, Eva Emanuel, Ammi Shah, Cuong Chau, Vivian Hope, Monica Desai, Samreen Ijaz, Justin Shute, Claire Edmundson, Ross J. Harris, Valerie Delpech, Emily Phipps

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)
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Abstract

Introduction: People who inject drugs are at high risk of blood-borne infections. We describe the epidemiology of HIV among people who inject drugs in England, Wales, and Northern Ireland (EW&NI) since 1981. 

Methods: National HIV surveillance data were used to describe trends in diagnoses (1981–2019), prevalence (1990–2019), and behaviours (1990–2019) among people who inject drugs aged ≥15 years in EW&NI. HIV care and treatment uptake were assessed among those attending in 2019. 

Results: Over the past four decades, the prevalence of HIV among people who inject drugs in EW&NI remained low (range: 0.64%–1.81%). Overall, 4978 people who inject drugs were diagnosed with HIV (3.2% of cases). Diagnoses peaked at 234 in 1987, decreasing to 78 in 2019; the majority were among white men born in the UK/Europe (90%), though the epidemic diversified over time. Late diagnosis (CD4 <350 cells/µl) was common (2010–2019: 52% [429/832]). Of those who last attended for HIV care in 2019, 97% (1503/1550) were receiving HIV treatment and 90% (1375/1520) had a suppressed viral load (<200 copies/ml). HIV testing uptake has steadily increased among people who inject drugs (32% since 1990). However, in 2019, 18% (246/1404) of those currently injecting reported never testing. The proportion of people currently injecting reporting sharing needles/syringes decreased from 1999 to 2012, before increasing to 20% (288/1426) in 2019, with sharing of any injecting equipment at 37% (523/1429). 

Conclusion: The HIV epidemic among people who inject drugs in EW&NI has remained relatively contained compared with in other countries, most likely because of the prompt implementation of an effective national harm reduction programme. However, risk behaviours and varied access to preventive interventions among people who inject drugs indicate the potential for HIV outbreaks.

Original languageEnglish
Number of pages12
JournalHIV Medicine
Early online date30 Mar 2022
DOIs
Publication statusE-pub ahead of print - 30 Mar 2022

Bibliographical note

Funding Information: EP, RJH, AS, EE, CC, VH, MD, VD, SI, and CE have no conflicts of interest to declare. SC has received consultancy fees from the Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, outside the submitted work. JS has contracts via Public Health England with two diagnostic manufacturers for the evaluation of hepatitis kits as part of the World Health Organization kit evaluation programme outside the submitted work. CC has received consultancy fees from Watipa outside the submitted work.

Open Access: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Publisher Copyright: © 2022 Crown copyright. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association. This article is published with the permission of the Controller of HMSO and the Queen’s Printer for Scotland.

Citation: Croxford, S, Emanuel, E, Shah, A, et al. Epidemiology of HIV infection and associated behaviours among people who inject drugs in England, Wales, and Northern Ireland: Nearly 40 years on. HIV Med. 2022; 00: 1– 12.

DOI:10.1111/hiv.13297

Keywords

  • HIV infection/diagnosis
  • HIV infection/epidemiology
  • United Kingdom
  • injecting drug use
  • patient care

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