Theme: Epidemiology & Public Health Research Year: 2022
People who inject drugs (PWID) are at high-risk of blood-borne infections. We describe the
epidemiology of HIV among PWID in England, Wales, and Northern Ireland (EW&NI) since 1981.
National HIV surveillance data collected by the UK Health Security Agency and its predecessors were
used to describe trends in new diagnoses (1981-2019), prevalence (1990-2019) and risk and protective
behaviours (1990-2019) among PWID aged ≥15 in EW&NI. Access to HIV care and treatment was
assessed among PWID last attending services in 2019.
Over the past four decades, HIV prevalence among PWID in EW&NI remained low (range: 0.64%-
1.81%). In total, 4,978 PWID have been diagnosed with HIV (3.2% of cases). Diagnoses peaked at 234
in 1986, decreasing to 78 in 2019; the majority were among white men born in the UK/Europe (90%),
though the epidemic diversified over time. Late diagnosis (CD4 <350 cells/mm3
) was common, (2010-2019: 52% (429/832)). Of those PWID who last attended for HIV care in 2019, 97% (1,503/1,550) were receiving HIV treatment and 90% (1,375/1,520) had a suppressed viral load (<200 copies/mL). Behavioural surveillance shows a steady significant increase in HIV testing among PWID (32% since 1990). However, in 2019, one in five (18%; 246/1,404) of those currently injecting drugs reported never having been tested. Despite declining from 1999-2012, sharing of needles/syringes among current injectors subsequently increased significantly to 20% (288/1,426) in 2019, with sharing of needles/syringes and other injecting paraphernalia at 37% (523/1,429).
The HIV epidemic among PWID in EW&NI has remained relatively contained compared to in other
countries, most likely due to prompt implementation of an effective national harm reduction
programme. However, risk behaviours and varied access to preventative interventions among PWID
indicate potential for HIV outbreaks to occur. Services for PWID should be maintained and expanded
and the offer of HIV testing improved.
Disclosure of Interest Statement
No conflicts of interest to disclose.