The early, widespread use of needle and syringe programs (NSPs) in Australia has managed to keep down HIV prevalence among injection drug users, a new study suggests. To prevent an HIV epidemic among IDUs, Australia began setting up NSPs in 1986. In Australia's NSPs, IDUs do not have to turn in used sharps in return for sterile injecting supplies.
Researchers evaluated data for 22,478 individual clients attending NSPs from 1995 to 2009, a mean response rate of 44 percent per year (range 38 percent to 60 percent). Among these, 85 percent identified as heterosexual, 10 percent bisexual, and 5 percent homosexual. Of the 21,248 for whom serology was available, 230 (1.1 percent) tested HIV antibody positive.
"Variables independently associated with antibody seropositivity were homosexual or bisexual identity; male sex; older age at first injection; and survey participation between 1995 and 1997 rather than later periods," reported Libby Topp, of Australia's National Center in HIV Epidemiology and Clinical Research, and colleagues.
"There has never been a significant, generalized outbreak of HIV among people who inject drugs in this country," Topp said. The 1 percent rate mirrors that seen in studies of Australian IDUs generally, not just NSP clients, said Topp.
HIV prevalence among U.S. IDUs is an estimated 16 percent, and among Russian IDUs it is 37 percent. In 2009, the United States overturned a ban on the use of federal funds for NSPs. Injection drug use was the infection route for 19 percent of the 1.1 million U.S. residents living with HIV in 2006, according to CDC.
The study, "Fifteen Years of HIV Surveillance Among People Who Inject Drugs: The Australian Needle and Syringe Program Survey 1995-2009," was published in AIDS (2010; doi:10.1097/QAD.0b013e32834412cc).