In Europe, decades of investment in effective HIV prevention measures targeting people who inject drugs continue to bear fruit as demonstrated by the long-term decline in HIV diagnoses related to drug injecting. Over the past ten years, the rate of newly reported HIV diagnoses attributed to injecting drug use in the EU, Turkey and Norway has more than halved from 52 per million population in 2004 (2644 cases) to 25 in 2013 (1458 cases) (see figure below, data source: ECDC, 2014).
Uneven investment in HIV prevention makes Europe vulnerable
The trend can quickly change, however, as it did when HIV spread rapidly among injecting drug users in Greece and Romania in 2011 and 2012. In the absence of effective measures to curb these epidemics, the explosive spread of infections among injecting drug users in the capital cities resulted in these two countries accounting for more than one third of all new HIV diagnoses associated with injecting drug use notified in the whole of the European Union and European Economic Area (EU/EEA) in 2012, whereas in 2010 they had represented only 2% of the total.
In 2013, all but four EU/EEA countries reported rates of new HIV diagnoses associated with injecting drug use below 10 per million population. However, Lithuania reported a rate of 21 and Greece of 22 new diagnoses per million population, while Latvia and Estonia reported 38 and 55 new diagnoses per million population, respectively.
EMCDDA data show that while the coverage of interventions such as opioid substitution treatment and needle and syringe programmes is increasing in the EU, substantial populations of people who inject drugs have limited access to effective prevention services, making Europe vulnerable to outbreaks. In the most recent edition of its yearly expert meeting on drug-related infectious diseases, the EMCDDA addressed risks of outbreaks using a multi-indicator methodology. The agency has established close collaboration with ECDC, and the two EU agencies work together to assist Member States in carrying out tailored assessments of the HIV risk situation and prevention measures. In the most recent example of this cooperation, a joint ECDC-EMCDDA technical team visited Latvia at the invitation of the national authorities. The joint mission report will be presented to policymakers.
The EMCDDA warns that new HIV infections related to the injection of drugs – including stimulants – have been reported in many countries, particularly in Eastern Europe. Of particular concern is the fact that many of the injecting-related cases in Europe are detected too late. Special attention should be given to providing these often hard-to-reach groups of drug users with adequate prevention messages, early diagnosis and treatment referral and to scaling up effective integrated harm reduction measures.