Human immunodeficiency virus and drug misuse: the Edinburgh experience.

Abstract

During 1985 many drug abusers who lived in Edinburgh were found to be infected with the human immunodeficiency virus (HIV). As a result an alternative counselling and screening clinic for testing for antibodies to HIV was established for use by drug abusers. Four hundred and forty one patients were counselled in the first year, and over 60% were either drug abusers or their sexual contacts. One hundred and fourteen (26%) patients were positive for HIV antibody, and 100 (88%) ofthese were current or former drug abusers. The HIV seropositivity rate in drug abusers was 52% but was only 7% in their sexual contacts. Services were provided for these people as well as counselling before and after the test. The cost of this counselling service for the first year was £27 000 or £61.22 per patient.The unexpected mobility of 23% of the Edinburgh drug abusers, particularly to other areas of Britain, suggests that similar services need to be set up elsewhere.City Hospital, Edinburgh EH10 5SB R P BRETTLE, FRCP, consultant physician, infectious disease unit K BISSET, MB, CHB, medical officer, city screening clinic S BURNS, MB, CHB, senior registrar and counsellor, regional virus laboratory and city screening clinic J DAVIDSON, MB, CHB, medical officer, city screening clinic S J DAVIDSON, SRN, SCM, counsellor, city screening clinic J M N GRAY, RGN, SCM, counsellor, city screening clinic J M INGLIS, MRCPATH, top grade virologist, regional virus laboratory J S LEES, MB, CHB, medical officer, city screening clinic J MOK, MD, MRCP, consultant, community child health Correspondence to: Dr Brettle.

Risk behaviours for HIV infection among injecting drug users attending a drug dependency clinic.

“…The mean age at which they had begun injecting on a regular (that is, weekly) basis was 22; they had been injecting for a mean of seven years. Of 111 patients questioned, only six had not been introduced to injecting by another drug user; the rest had been helped to inject on the first occasion by friends (62), partners (25), acquaintances (13), or dealers (five). This was also the occasion when most had first shared needles and syringes: 75 patients had shared on the first occasion of injecting.…”

Consistent risk group-associated differences in human immunodeficiency virus type 1 vpr, vpu and V3 sequences despite independent evolution

“…The fact that the 'Dutch distinction' is also present in part of the United States drug user population suggests that this particular variant may have originated from the United States, and then having crossed the Atlantic subsequently spread among Dutch, German and Scottish, and some Italian drug users. A sizeable proportion of Amsterdam drug users are German or Italian; a study among Edinburgh drug users showed that several of them had shared needles in Amsterdam (Brettle et at., 1987). The source of the homosexual infection could be a different one.…”

“…One sample from a Scottish homosexual was negative for vpr despite repeated isolation attempts, so for vpr only four Scottish homosexual samples were available. Two Scottish samples from heterosexual women were assigned to the drug user group, because the Scottish epidemic is most severe among drug users (Brettle et al, 1987;Peutherer et al, 1985), and because in northern Europe the largest risk factor for women who do not use intravenous drugs is sexual contact with a drug user. Both samples yielded a V3 sequence that was unmistakably of the drug user type.…”

The epidemiology of HIV infection and AIDS

“…In the U.K. only 118 cases of AIDS had been reported amongst intravenous drug users up to 31 December 1989, but 1,819 reports of HIV positive intravenous drug users had been received. A large proportion of these have been reported in Edinburgh where a substantial level of infection (at least 50% seropositive) has developed amongst the population of intravenous drug users (Robertson et al, 1986;Brettle et al, 1987;Hart et al, 1989). 8.7 The prevalence of HIV infection amongst intravenous drug users in some parts of the U.S.A. has lead to a serious public health problem (Weinberg & Murray, 1988).…”