Human Immunodeficiency Virus (HIV)
Millions of people worldwide are IDUs, and blood transfer through the sharing of drug taking equipment, particularly infected needles, is an extremely effective way of transmitting HIV. Around 30 percent of global HIV infections outside of sub-Saharan Africa are caused by the use of injecting drugs, and it accounts for an ever growing proportion of those living with the virus. The illegal nature of injection drug use can also create barriers to accessing adequate treatment and prevention services making IDUs more vulnerable to HIV and its effects. Without adequate access to HIV testing and prevention services, there is a high risk that HIV will also be transmitted to the sexual partners of people who inject drugs and the crossover of drug use with sex work further means that HIV is likely to be transmitted to other at risk populations and their partners.
Why do people share needles?
Many factors specific to individual IDUs and countries influence or cause needle sharing. For many users sterile syringes are not readily available and drug paraphernalia laws in some countries make it an offence to distribute or possess syringes for non-medical purposes. In Mexico, a link has been found between arrests for carrying used or unused syringes, despite this being legal, with incidences of recent syringe sharing. Higher rates of needle sharing among Russian IDUs have similarly been associated with arrests for drug offences. One IDU in the Indian state of Manipur – where police can stop and search any suspected drug user – described fear of the law as a factor in needle sharing:
“When we [inject] drugs we need to be quick. Police might come at any time. For that reason... we don’t mind sharing with others." A lack of awareness or education about safe injecting can also lead to needle sharing. For example, fewer than half of IDUs surveyed in Afghanistan in 2005-06, who were aware of HIV, knew that using a new needle for each injection reduces the risk of transmission. Other possible reasons are that it is a social and cultural norm, and that it can act as a form of bonding.
What are the statistics of HIV infection amongst IDUs?
It was estimated that in 2008 there were 16 million injecting drug users worldwide and that 3 million (18.9 per cent) of them were living with HIV. Today, there are an estimated 33 million people worldwide living with the HIV, and injecting drug use accounts for approximately one-third of new HIV infections
Hepatitis & IDUs
Hepatitis, literally an “inflammation of the liver,” has a number of causes. Viral infection is one of them. The most common types are hepatitis A, hepatitis B, and hepatitis C.
Hepatitis virus (HCV) infection occurs when blood (or to a lesser extent, other body fluids such as semen or vaginal fluid) from an infected person enters the body of an uninfected person. Injection drug use is the major risk factor for HCV infection.
Hepatitis B virus (HBV) infection occurs when blood or body fluids from an infected person enter the body of an uninfected person. High-risk sexual behaviors (unprotected sex with multiple partners) and injection drug use are the major risk factors.
Hepatitis A virus (HAV) is primarily transmitted through the fecal-oral route, when a person puts something in his or her mouth (such as food or a beverage) that has been contaminated with the feces of a person infected with HAV. Outbreaks occur more easily in overcrowded areas where poor sanitary conditions exist. Outbreaks of hepatitis A also have been reported among IDUs.
Why is Viral Hepatitis is a Very Significant Problem Among IDUs?
Because HBV and HCV are transmitted through exposure to infected blood and body fluids, IDUs are at very high risk of acquiring and transmitting both viruses. HBV and HCV infections are also acquired relatively rapidly among IDUs. Within 5 years of beginning injection drug use, 50%-70% of IDUs become infected with HBV. Between 50%-80% of IDUs become infected with HCV within 5 years of beginning injection drug use; it is usually the first blood-borne virus they acquire.
What are the factors that affect the spread of the Virus among IDUs?
Several factors favor the rapid spread of HCV infection among IDUs:
Viral factors – HCV is transmitted efficiently through blood exposure.
Host factors – A large number of individuals are infected and this provides multiple opportunities for transmission to others.
IDU factors – IDUs often jointly purchase drugs and prepare the drug solution together; this solution is divided among users. Sharing the drug solution, syringes, or other drug preparation equipment (such as water, drug mixing containers, and cotton filters) all increase the risk of transmission if any of these components are infected with HCV.
Other circumstances also contribute to the heavy impact of viral hepatitis on IDUs:
IDUs are at very high risk of coinfection with HIV and HCV.
Many IDUs drink alcohol, which damages the liver and accelerates the progression of liver disease.
HAV infection can be severe and very dangerous in those who already have liver disease from chronic hepatitis B or chronic hepatitis C.
Treatment of chronic hepatitis B or chronic hepatitis C can be complicated and adherence difficult for infected IDUs because many have other conditions (HIV, mental illness, alcoholism, other illnesses), are poor, and have unstable living situations. The stigma surrounding injecting drugs also means that many IDUs are marginalized and have little or no contact with doctors.
What are the statistics on Hepatitis in IDUs?
Global prevalence of hepatitis C infection among injecting drug users in 2010 was 46.7 per cent, meaning that some 7.4 million injecting drug users worldwide are infected with hepatitis C. And some 2.3 million injecting drug users are infected with hepatitis B.