THE HIV EPIDEMIC ASSOCIATED WITH INJECTING DRUG-USE IN EUROPE - GEOGRAPHIC AND TIME TRENDS

Objectives: To evaluate the magnitude and trends of the HIV epidemic a ssociated with injecting drug use in Europe. Methods: AIDS cases assoc iated with injecting drug users (IDU) diagnosed through 1995 were anal ysed, including IDU, homo-/bisexual IDU, heterosexual partners of IDU and children whose mothers were IDU. HIV seroprevalence studies among IDU were reviewed. Results: Of the 171932 cumulative AIDS cases, 73119 (43%) were IDU-associated (IDU, 89.0%; home-/bisexual IDU, 3.5%; hete rosexual partners of IDU, 6.2%; children with IDU mothers, 1.4%). Over 90% of IDU-associated cases were concentrated in south-western Europe an countries with considerably higher rates in Spain (124 cases per mi llion in 1995) than elsewhere (Italy, 68 per million; Portugal, 42 per million; France, 38 per million). During 1990-1995, incidence increas ed at an average annual rate of 11% overall and > 23% in central and e astern Europe; overall, incidence increased in older persons (12%) whi le decreasing in those aged 13-24 years (by 6%). HIV prevalence in IDU showed considerable geographic variation across and within countries. In several countries of western Europe, prevalence decreased. In the former Soviet Union, large HIV outbreaks have recently been detected a mong IDU through systematic HIV testing (e.g., in Ukraine, 6750 HIV in fections were diagnosed in IDU tested during 1995-1996. Conclusions: I DU have played a major role in the spread of HIV in Europe. In several western European countries, the incidence of HIV acquired through dru g use has declined following high rates in mid-1980s. Studies to asses s current transmission are needed and prevention efforts must be maint ained. In eastern Europe, emerging epidemics reinforce the urgency for prevention.