By Jeffrey V. Lazarus [jla@euro.who.int] and Martin C. Donoghoe, public health
officer, Sexually transmitted infections/HIV/AIDS programme, WHO/Europe
EDITOR--The editorial "Rising rates of HIV infection" [1] provides an
almost comprehensive picture of the unresolved issues related to reducing
HIV transmission globally, and specifically in the UK. A critical look at
the reduction in HIV incidence in Thailand and Uganda is provided and the
authors conclude with a call for sexual health to be prioritised in the
UK. While we do not contest the urgent need for this, and agree with the
authors that a substantial investment is needed in order to have any
impact, two key points were neglected. They refer to non-sexually
transmitted HIV and the often overlooked transition countries of central
and eastern Europe.
Injecting drug use is driving the HIV epidemic in central and eastern
Europe, and these countries report the greatest increase in incidence in
the world since 1999. There, specifically in the 15 countries of the
former Soviet Union, including Estonia, Latvia and Lithuania, which have
recently acceded to the European Union, some 80% of reported HIV cases are
male and about the same amount are injecting drug users. While sexual
health programmes need to be strengthened, as evidenced by outbreaks of
sexually transmitted infections throughout the 1990s, the main priorities
should be drug dependence treatment, harm reduction services and improved
access to highly active antiretroviral treatment for injection drug users,
as called for in the Dublin Declaration to fight HIV/AIDS in Europe and
Central Asia[2] and the recently published report of the UN Millennium
Project taskforce on HIV/AIDS.[3] While access to treatment is currently
severely limited, it is even more so for drug users, who often face
punitive measures if they seek to be tested or treated. Figures from a
recent survey we implemented show that in eastern European countries where
injecting drug users represent more than half of all reported HIV cases,
there are gross inequities in terms of who is treated. In some countries
this group only represents 9-35% of those on treatment.
There is strong evidence that where targeted interventions are
implemented rapidly on a sufficient scale, HIV epidemics among injecting
drug users can be averted 4 and that by reducing HIV incidence in drug
injectors, generalised epidemics can be avoided. In addition, the priority
in central and eastern Europe is to ensure universal access to treatment,
which means correcting current inequities by reaching out with
appropriate, evidence-based services to injecting drug users.
References
1. Robinson JA and Gazzard BG. Rising rates of HIV infection BMJ 2005;330:
320-321. (12 February).
2. Breaking the Barriers. Partnership to fight HIV/AIDS in Europe and
Central Asia conference (2003). "Dublin Declaration on Partnership to
fight HIV/AIDS in Europe and Central Asia". http://www.eu2004.ie/
(accessed 14 February 2005).
3. UN Millennium Project. Combating AIDS in the developing world.
Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines,
Working Group on HIV/AIDS, 2005:5-6.
4. Des Jarlais DC. Maintaining low HIV seroprevalence in populations
of injecting drug users J Am Med Assoc 1995;274: 1226-31.
Rapid Response:
HIV - much more than sexual health
By Jeffrey V. Lazarus [jla@euro.who.int] and Martin C. Donoghoe, public health officer, Sexually transmitted infections/HIV/AIDS programme, WHO/Europe
EDITOR--The editorial "Rising rates of HIV infection" [1] provides an almost comprehensive picture of the unresolved issues related to reducing HIV transmission globally, and specifically in the UK. A critical look at the reduction in HIV incidence in Thailand and Uganda is provided and the authors conclude with a call for sexual health to be prioritised in the UK. While we do not contest the urgent need for this, and agree with the authors that a substantial investment is needed in order to have any impact, two key points were neglected. They refer to non-sexually transmitted HIV and the often overlooked transition countries of central and eastern Europe.
Injecting drug use is driving the HIV epidemic in central and eastern Europe, and these countries report the greatest increase in incidence in the world since 1999. There, specifically in the 15 countries of the former Soviet Union, including Estonia, Latvia and Lithuania, which have recently acceded to the European Union, some 80% of reported HIV cases are male and about the same amount are injecting drug users. While sexual health programmes need to be strengthened, as evidenced by outbreaks of sexually transmitted infections throughout the 1990s, the main priorities should be drug dependence treatment, harm reduction services and improved access to highly active antiretroviral treatment for injection drug users, as called for in the Dublin Declaration to fight HIV/AIDS in Europe and Central Asia[2] and the recently published report of the UN Millennium Project taskforce on HIV/AIDS.[3] While access to treatment is currently severely limited, it is even more so for drug users, who often face punitive measures if they seek to be tested or treated. Figures from a recent survey we implemented show that in eastern European countries where injecting drug users represent more than half of all reported HIV cases, there are gross inequities in terms of who is treated. In some countries this group only represents 9-35% of those on treatment.
There is strong evidence that where targeted interventions are implemented rapidly on a sufficient scale, HIV epidemics among injecting drug users can be averted 4 and that by reducing HIV incidence in drug injectors, generalised epidemics can be avoided. In addition, the priority in central and eastern Europe is to ensure universal access to treatment, which means correcting current inequities by reaching out with appropriate, evidence-based services to injecting drug users.
References
1. Robinson JA and Gazzard BG. Rising rates of HIV infection BMJ 2005;330: 320-321. (12 February).
2. Breaking the Barriers. Partnership to fight HIV/AIDS in Europe and Central Asia conference (2003). "Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia". http://www.eu2004.ie/ (accessed 14 February 2005).
3. UN Millennium Project. Combating AIDS in the developing world. Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines, Working Group on HIV/AIDS, 2005:5-6.
4. Des Jarlais DC. Maintaining low HIV seroprevalence in populations of injecting drug users J Am Med Assoc 1995;274: 1226-31.
Competing interests: None declared
Competing interests: No competing interests