Shooting Up Infections among injecting drug users

Key Messages
1. Needle and syringe sharing has declined in recent years, however with around a quarter of injecting drug users continuing to share the level remains higher than in the mid-1990s.

2. Injecting into the groin and the injection of crack cocaine, which are associated with higher levels of
infection and risky injecting, have become more common.

3. Injecting site infections are common, with around one third of injecting drug users reporting having had an
abscess, sore or open wound at an injecting site in the last year.

4. Transmission of HIV and HCV infection through injecting drug use remains higher than in the late 1990s, with a fifth of recent initiates having hepatitis C and around one in 100 having HIV. Overall almost half of injecting drug users are now infected with hepatitis C and about one in 90 with HIV.

5. There has been a marked increase in the number of injecting drug users receiving the hepatitis B vaccine,
with two-thirds now reporting vaccination.

6. Services to reduce injecting related harms and support for those who want to stop injecting should continue to be developed in line with published guidance.

Key Findings
Behaviours: Levels of reported needle and syringe (direct) sharing have declined in recent years, following an increase in the late 1990s. In 2007, around a quarter of injecting drug users (IDUs) reported direct sharing in the previous month; this level remains higher than in the mid-1990s when about a sixth reported this. The sharing of other injecting equipment remains even more common. There are also indications that
two other factors associated with a greater risk of infection have become more common, with almost one in three IDUs now reporting injecting into the groin (femoral vein) and athird reporting the injection of crack-cocaine.

Hepatitis C: Overall, almost half of IDUs in the UK have been infected with hepatitis C. However, there are marked variations in hepatitis C prevalence within the UK, with low prevalences found in some areas. The overall prevalence of hepatitis C infection among IDUs has probably increased in recent years. Current levels of hepatitis C transmission remain higher than in the late 1990s with a fifth of IDUs becoming
infected within three years of starting to inject.

HIV: The incidence of HIV among IDUs is higher than in the late 1990s with around one in 100 now becoming infected within three years of starting to inject. The overall prevalence of HIV infection among IDUs however remains low compared to many other countries. In England & Wales, the overall HIV
prevalence among IDUs is currently around one in 90. Within England and Wales prevalence has increased amongst IDUs outside London: where it has risen from around one in 400 in 2002 to about one in 150 in 2007. However, the prevalence is higher in London, with around one in 20 HIVinfected. In Scotland, the prevalence of HIV among IDUs was around one in 350 in 2007, which is the lowest level reported
since this was first measured in 1989.

Voluntary confidential diagnostic testing: Uptake of testing for hepatitis C among IDUs in contact with drug services, after increasing markedly, now appears to be levelling off with around three-quarters having ever had a test. It is estimated that around half of IDUs with hepatitis C in contact with these services remain unaware of their infection, and that this proportion has not changed in recent years. There are also likely to be many current and former IDUs not in contact with services that will be unaware they have hepatitis C. Whilst most IDUs in contact with services report having had a test for HIV at some point, only two thirds
of those with HIV are aware of their infection.

Vaccination: The proportion of IDUs reporting uptake of hepatitis B vaccination has increased in recent years, with around two-thirds now reporting accepting at least one vaccine dose. However, the transmission of hepatitis B continues among IDUs.

Bacterial infections: Injecting site infections, which may cost the NHS as much as £47 million per annum, remain common with around one-third of IDUs reporting having had an abscess, sore or open wound at an injecting site in the last year. There are continuing problems ranging from localised injection site infection through to invasive disease associated with meticillin resistant Staphylococcus aureus and severe
group A streptococcal infection. The ongoing occurrence of wound botulism and tetanus cases also remains a concern.


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