ALERT: UPSURGE IN HIV IN PEOPLE WHO USE DRUGS IN DUBLIN

The Dept of Public Health HSE East is investigating a rise in the number of new cases of recently acquired HIV in Persons who inject drugs (PWID) in Dublin in 2015. 

Evidence to date indicates that the increase has been occurring since June 2014. Fifteen confirmed and one probable case of recently acquired HIV infection have been diagnosed in PWID in Dublin from June 2014 to June 2015. A further 16 possible cases in PWID are currently under investigation and new cases continue to be detected. Amongst the 16 confirmed and probable cases, 11 are male and five are female, and the mean age is 35 years (range; 24 to 51 years).

From discussions with clinicians and those involved in addiction networks there is a concern about homelessness and unsafe injecting practices and/ or high risk sexual behaviour associated with this increase. A multidisciplinary incident team has been established to investigate and respond to this increase, and a case control study is underway to identify any association between use of Snow Blow leading to an increase in unsafe injecting practices, and at-risk sexual behaviour, and acquisition of HIV.

We have advised GP, doctors and clinicians working in addiction and homeless services, hospital clinics and various outreach settings of the problem. We are working with the HSE, NGOS and other services to raise awareness of the risk of HIV among PWID posed by unsafe injections and unsafe sex. Measures are underway to identify further HIV cases and treat as appropriate. Other important control measures include access to needle exchange and condoms for PWID in various settings and encouraging PWID who use heroin to access methadone treatment, and further measures are being considered by the incident team.

In order for better understanding of the burden of disease we in Public Health require information on HIV surveillance in order to capture the likely routes of transmission of all cases since January 2015. This is needed in order to know the true extent of the problem, to identify risk factors and take appropriate action.

In summary we are asking clinicians to endeavour to:

• Raise awareness of risk of HIV among PWID  posed by unsafe injections and unsafe sex and recent increase in HIV
• Ensure that those at highest risk for transmitting HIV are tested
• Ensure that HIV PWID already known to HIV services are engaged in care
• Ensure that those who test HIV positive are linked with HIV care
• Offer early HIV test to those at increased risk (e.g. homeless, in prisons and  not linked to addiction services or who are an extremely high risk group)
• Promote access to needle exchange for PWID in various settings
• Ensure access to condoms for PWID in various setting
• Encourage PWID who use heroin to access methadone treatment

Source: Dept of Public Health HSE