The introduction of human immunodeficiency virus (HIV) among injecting
drug users (IDUs) in the Netherlands has been traced back to 1982, wh
ereas the first case of the acquired immunodeficiency syndrome (AIDS)
in an IDU was diagnosed in 1985. By the end of December 1995, 438 AIDS
cases among IDUs had been reported to the surveillance system, 53% of
whom were Amsterdam residents, making the capital the epicenter of th
e national HN epidemic. After a rapid spread of HIV during the first h
alf of the 1980s, HIV prevalence stabilized at about 30% during the se
cond half of that decade in Amsterdam. Since 1984, a variety of preven
tive measures have been implemented, including needle and syringe exch
ange programs. These measures have contributed to large reductions in
HIV risk behavior. However, an important residual of HIV risk behavior
remains and new infections of HIV continue to occur. In recent years,
new HIV infections have been outnumbered by the increasing number of
deaths occurring among HIV-infected IDUs. A large fraction of these de
aths have occurred without an AIDS diagnosis. By 1994, an estimated 1,
400 HIV-infected IDUs remained in the country who were still alive and
RIDS-free and this number is expected to decrease further in the near
future.