Abstract
While unprotected sexual intercourse and the use of contaminated injection equipment account for the majority of HIV infections worldwide, other routes of HIV transmission have received less attention. We report on a case of HIV transmission attributable to illicit drug market violence involving a participant in a prospective cohort study of injection drug users. Data from a qualitative interview was used in addition to questionnaire data and nursing records to document an episode of violence which likely resulted in this individual acquiring HIV infection. The case report demonstrates that the dangers of drug market violence go beyond the immediate physical trauma associated with violent altercations to include the possibility for infectious disease transmission. The case highlights the need to consider antiretroviral post-exposure prophylaxis in cases of drug market violence presenting to the emergency room, as well strategies to reduce violence associated with street-based drug markets.
Highlights
Human immunodeficiency virus (HIV) transmission among injection drug users (IDU) represents a significant factor driving the global HIV epidemic [1], and HIV incidence remains elevated among this population in numerous settings globally [2]
We have described a case of an individual whose HIV infection appears to be attributable to blood-to-blood contact which occurred during a violent encounter
The assault that likely resulted in this infection was sparked by a conflict in the local street-based drug market. This individual recognized that he had come into contact with the blood of a person he thought to be HIV positive, and was cognizant that there was potential for infectious disease transmission, he did not seek medical assistance
Summary
Human immunodeficiency virus (HIV) transmission among injection drug users (IDU) represents a significant factor driving the global HIV epidemic [1], and HIV incidence remains elevated among this population in numerous settings globally [2]. HIV infection through violent interaction is likely rare, the potential of antiretroviral post-exposure prophylaxis to reduce the risk of HIV transmission under these circumstances makes it important to examine this potential route of transmission among drug user populations [4,5] This may be important given the high rates of drug market violence among IDU [6]. In 2006, approximately 3 months after the incident, Peter presented to our research office for his semi-annual HIV test Reviews of this participant's pre-test counseling nursing records from this study visit revealed that he suspected that he had been exposed to the HIV virus through the incident detailed above. While the present case was sexually active in the 6 months prior to his seroconversion, he reported consistently using condoms and did not report any unprotected sex
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