Report on the Global HIV/AIDS epidemic

Prevention: daunting challenges ahead

health and social services to drug-using communities - suggest that the official figures underestimate the true rates of infection in this population. New data from
clients contacted by outreach programmes for drug users in the Russian city of St
Petersburg show that 12% of those tested are infected with HIV, whereas the rate is
just 0.2% in registered drug users. In the Ukrainian city of Poltava, some 40% of
clients of prevention projects are infected with HIV, compared with around 10% of
registered drug users.
While precise figures may be hard to come by, it is clear that HIV can explode
through drug-using populations with remarkable speed and can stabilize at very high
rates. For example, HIV infection among injecting drug users in various cities in the
Ukraine rose from virtually zero in 1994 to 31-57% in less than two years. In 1999,
there was a massive outbreak of HIV infection among injecting drug users in the
Russian capital, Moscow, with over three times as many new cases of HIV reported
in that year as in all previous years combined. HIV prevalence rates ranging between
30% and 70% have been found among injecting drug users in Argentina, Brazil,
India, Spain, Thailand and the USA (Puerto Rico). Risk behaviour in these populations remains common. Recent studies in various cities have found that close to a
third of injecting drug users in Brazil and two-thirds in Thailand regularly share injecting equipment, while in Argentina three-quarters of those surveyed said they had
shared syringes at some time.
Some countries - including several in central and eastern Europe - are recording a
rise in the absolute number of injecting drug users, with a distressing fall in the age
at which people start injecting drugs. In Slovakia, 2% of 15-16-year-olds said they
had injected drugs. In St Petersburg, over 40% of drug users attending a treatment
centre in 1999 were young people, up from just 13% two years earlier. In one study,
some Thai girls said they started injecting before they turned 16, on average two
years earlier than boys.
Drug injection poses a threat of HIV infection not only to the individuals who engage
in it but also to their sex partners. In the USA, it is estimated that 9 out of 10 cases
of heterosexual transmission of HIV in New York City are related to sex with a drug
user. In some places, including much of China and parts of India and Myanmar, more
women are infected through sex with drug users than in any other way. Fully 83% of
injecting drug users in Brazil's Rio de Janeiro said they did not use condoms with
their regular partners, and 63% never used them even with casual partners. Injecting
drug use also contributes to mother-to-child transmission of HIV. In Uruguay, 40%
of babies with HIV are born to mothers who inject drugs.
When injecting drug users sell sex to pay for drugs, the prospect of sexual transmission obviously looms large. But because both commercial sex and drug use are
hidden, they are doubly hard to quantify. In studies of injecting drug users in
Argentina (Buenos Aires), Brazil (Rio de Janeiro) and Canada, a third or more of
respondents of both sexes said they had exchanged sex for drugs at least once. The
overlap appears to increase the risk of infection. In a study among 212 male inject75

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