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New illicit drugs threatening HIV prevention efforts
New and uncontrolled illicit drugs could threaten previously stable HIV epidemics among injecting drug users (IDUs), if new patterns of injecting drug use are not responded to rapidly in cities with high numbers of IDUs. According to a study presented last week at the 14th European AIDS Conference, Tel Aviv, Israel witnessed an alarming increase in HIV diagnoses among IDUs, despite the epidemic being stable among this group for the last decade. All of these new HIV infections had recently changed from injecting heroin, to injecting a cheaper synthetic drug called cathonine derivative.
The Israeli government has been successful in managing HIV epidemics among IDUs by funding harm reduction programmes - such as needle and syringe exchanges and opioid substitution therapy. HIV is transmitted through the sharing of injecting equipment, and harm reduction programmes have been proven to reduce HIV transmission rates among IDUs in areas where they have been established. Over a period of ten years, a clinic in Tel Aviv reported no new HIV infections among people who inject drugs.
However in 2012, 45 new cases of HIV infection among IDUs were reported. All had been long-term injecting heroin users who had frequently used needle exchange programmes. However, all of these individuals had recently switched to the cheaper injectable, cathinone derivative, or ‘hagitat’. Injecting drug behaviour between heroin and cathinone differ considerably. The effects of cathinone are shorter, meaning that people require many more injections, and therefore, needles. Cathonine is also more likely to be consumed in a social environment, meaning there is greater risk of re-using and sharing needles. Consequently, clinics have launched educational programmes, and increased the supplies of injecting equipment to respond to this surge in new infections.
Injecting drug use is a significant issue across much of Europe and its periphery, and organising a response is largely inhibited by stigma, criminalisation and a lack of political will to address these issues and expand access to harm reduction services. Quadruple epidemics of tuberculosis, HIV, hepatitis and injecting drug use are also seriously impacting upon public health in the region, as reported by AVERT last week. Adequate and rapid responses are needed to respond to new patterns in behaviour among drug users, as well as expanding access to prevention programmes for those who need it in order to combat HIV in these regions.