New data from the on-going Unlinked Anonymous Monitoring (UAM) Survey of HIV and Viral Hepatitis among People Who Inject Drugs (PWID) have been published on the PHE website.

The updated set of tables present data from the survey for the period 2004 to 2014 inclusive. These data are from the main UAM Survey, which is targeted at people who inject psychoactive drugs, such as, heroin, crack cocaine and amphetamines.

This article presents an overview of the trends between 2004 and 2014 for HIV, hepatitis B, hepatitis C and risk behaviours from people who inject psychoactive drugs participating in the main UAM Survey. In addition to data for the whole of England, Wales and Northern Ireland (the areas covered by this survey), the tables include data for each country separately and the regions of England. Further data from this survey related to hepatitis C will appear in the Hepatitis C in the UK: 2015 report [3] to be published later this month.

HIV

The prevalence of HIV among the 3,091 PWID who took part in the main UAM Survey across England, Wales and Northern Ireland in 2014 was 1.0% (95% CI, 0.07%-1.4%). Between 2004 and 2013, prevalence varied between 1.1% and 1.6%. In 2014, the HIV prevalence was 1.1% (95% CI, 0.22%-3.4%) in Wales and 0.65% (95% CI, 0.01%-3.9%) in Northern Ireland. In England, the HIV prevalence was 1.0% (95% CI, 0.69%-1.5%) in 2014, not significantly different from 2004 when the prevalence was 1.4% (95% CI, 1.0%-2.0%).

The HIV prevalence among “recent initiates” to injecting drug use (i.e. those who first injected during the preceding three years) is an indicator of recent transmission. The prevalence of HIV among the recent initiates surveyed in England, Wales and Northern Ireland varied over time and ranged from 0.37% to 1.3% between 2004 and 2014. In 2014, the prevalence in this group was 0.41% (95% CI, 0.01%-2.5%; see figure 1; table 26 of the dataset; and statistical note b) and is similar to that found in previous years. This indicates that HIV transmission is continuing to occur among PWID at a low level.

Hepatitis B transmission among PWID

The prevalence of antibodies to the hepatitis B core antigen (anti-HBc, a marker of past or current infection with hepatitis B) has declined since 2006. During the period 2004 to 2006 the anti-HBc prevalence fluctuated between 26% and 28%, before declining to 14% (95% CI, 13%-16%) in 2014, 11% (95% CI, 7.9%-15%); and England, 15% (95% CI, 14%-17%).

The prevalence of anti-HBc among recent initiates to injecting drug use taking part in the survey across England, Wales and Northern Ireland was 2.1% (95% CI, 0.74%-4.9%) in 2014. During the period 2004 and 2013 the prevalence in this group fluctuated between 3.1% and 14%, with the prevalence in 2014 significantly lower than in 2004 (8.9%, 95% CI, 4.4%-9.9%).

Hepatitis C transmission among PWID

The prevalence of antibodies to the hepatitis C virus (anti-HCV) among the survey participants across England, Wales and Northern Ireland was 49% (95% CI, 47%-51%) in 2014.

This is similar to the anti-HCV prevalence of 45% (95% CI, 43%-47%) seen in 2004. However, the level seen during the last decade, though a little higher than at the end of the 1990s, is much lower than those found in the early 1990s when prevalence was over 60%. By country, anti-HCV prevalence in 2014 was as follows: Northern Ireland, 23% (95% CI, 17%-31%); Wales, 50% (95% CI, 44%-56%); and England, 50% (95% CI, 49%-52%).

The anti-HCV prevalence in England and Northern Ireland has not changed significantly over the last decade. In Wales, although the anti-HCV prevalence in 2014 was significantly higher than it was a decade ago, it had not changed greatly in recent years.

The prevalence of anti-HCV among the recent initiates taking part in the survey across England, Wales and Northern Ireland was 19% (95% CI, 15%-25%) in 2014. This is a similar level to that seen in this group over the last decade; prevalence in this group was 21% (95% CI, 17%-26%) in 2004.

Infections among people who inject drugs: 2014

These data should be great cause for concern for those dealing with the problems of IV drug abuse from the perspective of sharps retrieval and disposal. The risks are significant, with almost 50% of users positive for Hepatitis C, that unfortunately ins the most infectious of the three key bloodborne virus agents.

Sharps injury may have a significant and severe impact. Data for users of other IV drugs, most particular of IV steroid preparations used by those who wish to ‘bulk up’ for largely cosmetic purposes, to manifest aggression, are presently unavailable. However, with sharing of illicit steroid vials and perhaps of syringes and needles, similar rates of infection are perhaps likely, though presently may be rising fast from a low background level as this particular trend expands rapidly.

Gym users will be a key study group as the output of sharps waste from gyms increases considerably to testify to this at risk group. Others include some service personnel. Remarkably, it seems that the police force, who bulk up from a bottle of steroids and increasingly cover themselves in tribal tattoos, may be another risk group.  Seemingly, the driver for this dangerous activity is one of bullying, aggression and perhaps of violence to counter the difficult conditions and violence that the face in the policing role.

That seems a weak and inappropriate excuse. Worse is the attitude of an ex-senior police officer who smugly justifies this as being “not a crime” since these steroids are themselves not illegal to possess of to use.

And of course, the entire problem is fed by Amazon who sell needles and syringes for ‘personal use’. If the Government is intent on making psychoactive drug use illegal, it is essential that the supply of syringes and needles from the likes of Amazon is restricted if not prohibited.  This might immediately increase the incidence of needle sharing with its attendant risk of spread of infection. Thus, in parallel, accessible needle exchange schemes must be created and properly funded, to draw into the healthcare fold all those illicit users who might put themselves and others at risk of bloodborne virus infection.