Epidemiology of HIV infection and associated behaviours among people who inject drugs in England, Wales, and Northern Ireland: Nearly 40 years on

Abstract

Introduction: People who inject drugs are at high risk of blood-borne infections.We describe the epidemiology of HIV among people who inject drugs in England, Wales, and Northern Ireland (EW&NI) since 1981.Methods: National HIV surveillance data were used to describe trends in diagnoses (1981-2019), prevalence (1990-2019), and behaviours (1990-2019) among people who inject drugs aged ≥15 years in EW&NI. HIV care and treatment uptake were assessed among those attending in 2019.Results: Over the past four decades, the prevalence of HIV among people who inject drugs in EW&NI remained low (range: 0.64%-1.81%). Overall, 4978 people who inject drugs were diagnosed with HIV (3.2% of cases). Diagnoses peaked at 234 in 1987, 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/µl) was common (2010-2019: 52% [429/832]). Of those who last attended for HIV care in 2019, 97% (1503/1550) were receiving HIV treatment and 90% (1375/1520) had a suppressed viral load (<200 copies/ml). HIV testing uptake has steadily increased among people who inject drugs (32% since 1990). However, in 2019, 18% (246/1404) of those currently injecting reported never testing. The proportion of people currently injecting reporting sharing needles/syringes decreased from 1999 to 2012, before increasing to 20% (288/1426) in 2019, with sharing of any injecting equipment at 37% (523/1429). Conclusion:The HIV epidemic among people who inject drugs in EW&NI has remained relatively contained compared with in other countries, most likely because of the prompt implementation of an effective national harm reduction programme. However, risk behaviours and varied access to preventive interventions among people who inject drugs indicate the potential for HIV outbreaks.

Global overview of suicidal behavior and associated risk factors among people living with human immunodeficiency virus: A scoping review

“…In the Post-HAART era, from 1997 to 2021, the suicidal ideation prevalence rate was 60% to3.3% in the United States [ 10 , 20 , 34 – 36 , 39 , 41 , 43 , 44 , 45 – 49 , 55 , 63 , 66 , 68 , 71 , 74 – 76 , 133 ]; 69% to 16% in the United Kingdom [ 80 , 105 , 112 ]; 13.2% to 6.3% in France [ 82 , 85 , 95 , 106 ]; 9.2% in Greece [ 115 ]; 11.4% to 6.2% in Africa [ 13 , 21 , 125 , 126 , 130 , 134 , 135 , 138 , 154 , 156 ]; 8.8% to 6.2% in Uganda [ 142 – 144 , 147 , 148 , 153 ]; 34.7% to 35.3% in Nigeria [ 129 , 145 , 149 , 157 ]; 35.6% to 21% in Argentina [ 75 , 77 ]; 67% in Australia[ 195 ]; 50% in Brazil [ 16 , 17 ]; 9.2% to 22% in Canada [ …”

“…In the Post-HAART era, from 1997 to 2020, the completed suicide prevalence rate was 8.7% to 7.6% in the United States [ 17 , 33 , 47 , 52 , 70 , 84 , 86 , 87 ]; 12.9% to 7% in the United Kingdom [ 88 , 91 , 102 , 104 , 107 , 113 ]; 6% to 4.1% in France [ 81 , 83 , 95 , 108 , 111 ]; 1.48% in Greece [ 110 ]; 0.6%–1.3% in Spain [ 90 , 117 ]; 4% to 6.2% in Germany [ 114 , 136 ]; 6% to 1% [ 104 , 105 , 120 ]; 4% in Australia [ 196 ]; 7% to 8.2% in Canada [ 16 , 61 ]; 7.8% in Japan [ 184 ]; 5.5% in Taiwan [ 163 ]; 15.5% in Thailand [ 168 ]; and 38.6% in Denmark [ 94 ]. The death due to suicide incidence rate went from 0.03 per 100 person years in 2010 to 0.47 in 2016 in Canada [ 16 , 61 ], 0.16 per 100 person-years in Switzerland [ 5 ], and was 0.04 per 100 person years in 2015 to 0.02 in 2017 in UK [ 102 , 107 ] ( S3 Table ).…”

“…Among the demographic factors, there were inconsistent risk factors for suicidal behavior such as gender (male [ 5 , 33 , 34 , 81 , 90 , 111 , 120 ], female [ 41 , 92 , 105 ]), age (young age [ 13 , 16 , 75 , 77 , 113 , 138 , 164 ], middle age[ 10 , 18 , 80 , 142 , 178 ], older age [ 9 ]), sexual orientation, education level, In respect to specific psychological symptoms and disorders, depression, substance abuse, anxiety, intravenous drug use, post-traumatic stress disorder, major mood disorders, and mental disorders were found to be consistent suicide risk factors [ 21 , 22 , 56 , 65 , 68 , 74 , 78 , 97 , 102 , 116 , 132 , 135 , 138 , 141 , 145 – 147 , 149 , 154 , 155 , 157 , 158 , 159 , 172 , 173 , 154 , 187 , 192 ]. Among th...…”

“…Among the demographic factors, there were inconsistent risk factors for suicidal behavior such as gender (male [5,33,34,81,90,111,120], female [41,92,105]), age (young age [13,16,75,77,113,138,164], middle age [10,18,80,142,178], older age [9]), sexual orientation, education level, In respect to specific psychological symptoms and disorders, depression, substance abuse, anxiety, intravenous drug use, post-traumatic stress disorder, major mood disorders, and mental disorders were found to be consistent suicide risk factors [21, 22, 56, 65, 68, 74, 78, 97, 102, 116, 132, 135, 138, 141, 145-147, 149, 154, 155, 157, 158, 159, 172, 173, 154, 187, 192]. Among the physiological factors were HAART side effects, poor immune status, physical symptoms, comorbid illnesses, insomnia, CD4 cell count, unmonitored viral load, neurocognitive developmental disorders, opportunistic infections, and medical status; an inconsistent risk factor was HIV exposure time.…”

“…Gender: 1 article [192] Gender:1 article [61] Gender: 1 articles [64] Male:6 articles [9,40,49,131,176,180] Male: 3 articles [38,100,125] Male: 7 articles [5,33,34,81,90,111,120] Female:15 articles [14,16,18,45,75,79,84,109,110,133,137,143,146,150,153] Female: 13 articles [15,43,45,79,84,124,132,133,136,143,146,150,153] Female: 3 articles [41,92,105] Age (Young, middle, and old age) ...…”