Abstract
BackgroundOver the last two decades, the proportion of people who inject drugs among newly reported HIV cases in Italy has been continuously declining. This trend is reflected in the prevalence of HIV infection among problem drug users followed in drug treatment services. We report nationwide trends in the prevalence of HIV and HCV among tested clients in charge to drug addiction services from 2005 to 2011.MethodsData on the prevalence of HIV and HCV among drug users from public drug treatment services across Italy were collected and analyzed for the period from 2005 to 2011. Prevalence of HIV and HCV were compared between clients returning to treatment and those entering treatment for the first time, and by gender. Due to the high percentage of missing data, the “inverse probability weight” method was used. Trends in testing uptake were also analysed.ResultsA significant decrease of HIV and HCV prevalence is observed among all PDUs entering treatment (from 14.7% to 11.1% and from 61.6% to 50%, respectively, in 2005–2011). By contrast, among those entering the services for the first time, after an initial decline the prevalence of HIV infection steadily increased in both sexes, from 2.2% in 2009 to 5.3% in 2011. Self-reported injecting rates in this group decreased over time, and in 2011 the proportion reporting drug injecting was lower among new clients than in people returning to services (14.5 vs. 34.4%). We also observed a progressive and significant reduction in HIV and HCV testing in drug treatment services.ConclusionsChanges in injection practice and type of drugs used, coupled with a concurrent reduction in HCV prevalence, do not support drug injection as the main explanation for an increased HIV transmission in people entering drug treatment services for the first time. While reductions in testing rates raise concerns over data quality, the possibility of increased sexual transmission needs to be considered.
Highlights
Over the last two decades, the proportion of people who inject drugs among newly reported Human Immunodeficiency Virus (HIV) cases in Italy has been continuously declining
We observed a progressive decrease in HIV and Hepatitis C Virus (HCV) screening coverage in drug addiction services, and these differences were statistically significant (p < 0.0001 by χ2 for trend) (Figure 1)
The percentage of clients tested for HIV has decreased from 40.6% in 2005 to 30.5% in 2011, and that of clients tested for HCV from 46.5% in 2005 to 40.6% in 2011 (Table 1, Figure 1)
Summary
Over the last two decades, the proportion of people who inject drugs among newly reported HIV cases in Italy has been continuously declining This trend is reflected in the prevalence of HIV infection among problem drug users followed in drug treatment services. Drug use by any route (not just injection) can be associated with unsafe sexual practices, potentially putting people at risk for acquiring or transmitting HIV and other sexually transmitted infections. Stimulants, such as cocaine, crack cocaine and methamphetamine, have been linked to high-risk sexual behaviour [17,18,19]. Individuals who engage in high-risk sexual practices (e.g. sex workers, men who have sex with men) may have a higher prevalence of drug use than the general population so that drug use may be associated with high HIV prevalence even without being causally linked to high-risk sexual behaviour [19,20,21]
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