New EMCDDA Rapid Assessment on HIV in injecting drug users in the EU/EEA, following a reported increase of cases in Greece and Romania

In response to a notified increase in HIV cases among injecting drug users (IDU) in Greece and Romania, the European Commission asked the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in November 2011 to conduct a rapid inquiry to investigate whether such increases had occurred in other countries.

Background

EU Member States report HIV prevalence rates among injecting drug users ranging from less than 1% to more than 60% (Figure 1). For instance, of 27,116 newly diagnosed HIV cases reported in 28 countries in the EU/EEA in 2010, 1,212 were identified as having a current or past history of injecting drug use.

Since 2004, the number of new HIV diagnoses reported among IDUs has declined by 44% in the 26 EU/EEA Member States. National trends have been similar during this period, with most countries reporting declining numbers of newly reported cases of HIV among injecting drug users (IDU's). Despite a decreasing trend of HIV cases among IDUs in the EU/EEA, there are still countries where relatively high rates of HIV transmission are occurring among IDUs, as you can see in the map below in Figure 1.

Main conclusions and recommendations of the Joint EMCDDA and ECDC Rapid Risk Assessment (January 2012)

Two countries in the European Union/European Economic Area (EU/EEA) have reported a significant increase in HIV case reports and HIV prevalence among injecting drug users (IDUs) during 2011 (Greece and Romania).

Although the magnitude of the increases in case reports may be partially related to enhanced surveillance and active case-finding, evidence indicates a real increase in HIV transmission in both countries.

There is a temporal association between low levels (or reduction) of provision of prevention services in Greece and Romania and these increases. However, any causal association is difficult to prove.

Increased focus on prevention measures, seems essential to prevent new HIV cases among IDUs in Greece and Romania. Guidance is given in the ECDC–EMCDDA Guidance on the prevention of infectious diseases among people who inject drugs (2011).

Epidemiological investigation of these outbreaks would facilitate better understanding of the current situation to prevent further outbreaks.

Fay Watson, Secretary General of EURAD said: "Whilst the rates of HIV in injecting drug users are generally decreasing across Europe, these increases reported in Greece and Romania are very concerning. These countries are facing tough economic times and their public health budgets will be under threat. We urge governments to ensure that they have comprehensive drug strategies in place at this time, which should include prevention as well as treatment and recovery measures".

The full PDF report can be downloaded below: