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Cocaine injecting and homelessness create perfect storm for rapid rise in HIV

10 April 2019

A seven-year study by a team of blood-borne virus researchers has revealed for the very first time the scale and drivers of the UK’s largest HIV outbreak in over 30 years in Glasgow.

Experts from Glasgow Caledonian University (GCU) and Health Protection Scotland (HPS), working in collaboration with NHS Greater Glasgow and Clyde and the University of the West of Scotland found that a significant rise in cocaine injecting in the city, which more than doubled between 2011-12 and 2017-18, in addition to homelessness and other key factors combined to create a perfect storm for an HIV outbreak in 2015.

Dr Andrew McAuley, Senior Research Fellow/Senior Epidemiologist in Blood-Borne Viruses at GCU and HPS, is the lead author of the research paper published on Wednesday, April 10 in the prestigious Lancet HIV journal.

He said: “One of the key findings of our research is that we’ve detected a hugely significant increase in the prevalence of HIV infection in the population of people who inject drugs in Glasgow, largely driven by an outbreak of HIV in first detected in 2015.

“The prevalence of HIV has been low and stable in this population since major outbreaks of HIV in the 1980s in Edinburgh and Dundee. However, the prevalence of HIV in Glasgow has increased 10-fold among people who inject drugs in the past seven years, from just one per cent to over 10 per cent in the city centre.

“The key drivers of infection are an increase in cocaine injecting and homelessness. We also have a large population of people who inject in public places in Glasgow at a time when HIV has re-emerged. A combination of these factors has created a perfect storm for rapid transmission of HIV among people who inject drugs in Glasgow.”

“Although the outbreak has affected more than 100 individuals, until now we weren’t sure of the impact of the outbreak on the overall population of people who inject drugs in Glasgow.”

 

Dr McAuley said the research has been “vital in informing, not just the response to the outbreak itself, but planning to mitigate similar outbreaks occurring in the future”.

“It also provides further justification for interventions such as the proposed drug consumption room and heroin-assisted treatment services in Glasgow.

“Crucially, over 90% of the individuals diagnosed as part of the outbreak have been successfully engaged in HIV treatment as a result of the multidisciplinary response implemented by the health board,” he added.

The study used information from four in-depth surveys – collectively called the Needle Exchange Surveillance Initiative (NESI) – conducted between 2011 and 2018 and involving almost 4,000 people who inject drugs in Greater Glasgow and Clyde.

Dr Norah Palmateer, GCU Senior Research Fellow and co-author, said: “Our research identifies key determinants of HIV infection among a vulnerable population of individuals to inform public health interventions that can be targeted to prevent further new infections and to help test and treat those already exposed. This is in line with the vision of GCU – the University for the Common Good – one of whose aims is to deliver social benefit through research.”