Lessons from the History of the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Epidemic among Spanish Drug Injectors

Abstract

In Spain, approximately 10 years passed between the time when human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) harm-reduction programs should have been developed with sufficient coverage to have an optimum impact on public health (before the HIV/AIDS epidemic's explosion in 1984) and the date of their actual implementation. This delay yielded an enormous cost for the country. The introduction of the virus in drug injector networks during a period of widespread diffusion of heroin injection and the lack of political awareness of the growing problem were 2 important factors that contributed to the important diffusion of the HIV infection among Spanish injection drug users. Lessons can be learned that may be of great interest in countries or territories facing similar challenges now and in the future.

Injecting, Sexual Risk Behaviors and HIV Infection in Young Cocaine and Heroin Users in Spain

“…The recruitment period for the heroin cohort was determined by the need to study factors related to the intense epidemic of heroin injection and of blood-borne infections during the previous 30 years in Spain [3,9] , while recruitment of the cocaine cohort responded to the more recent phenomenon of widespread consumption of this drug among young people [8] . The inclusion criteria for both cohorts were the same with respect to age (18-30 years) and place of residence (having lived in Barcelona, Madrid or Seville for most of the last 12 months).…”

“…Over the last decade, the history of the heroin injection epidemic, the spread of HIV infection in heroin injectors, and the delay in responding to the HIV threat in Spain are unfortunately being reproduced in the Eastern European countries, which have undergone a similar social and political process: the end of an authoritarian regime -notable for its extreme cultural and economic isolation -and the transition to democratic governments in a climate of great effervescence and expectations of social change, especially among youth [9] . It is possible that, similar to what is happening in Spain, the cocaine epidemic will become the second stage in the drug use epidemic taking place in many of these countries given that the change in substances consumed is very frequently an intergenerational element of innovation and differentiation.…”

Methadone maintenance treatment in Spain: the success of a harm reduction approach

“…According to estimates, Spain reached its highest incidence of HIV infection related to the injection of illicit drugs in 1984: 79 cases per 100 000 inhabitants. 2 During the early 1980s, the network for dependence on illicit drugs had not been developed yet and therapy consisted mainly in sending patients to drug-free programmes or to residential rehabilitation facilities promoting abstinence and managed by people who were not health professionals. 3 Although physicians were allowed to prescribe methadone for heroin dependence, 4 treatment was available mainly in the private sector.…”

Differences between women and men in serial HIV prevalence and incidence trends

“…The Spanish HIV epidemic has been characterized by extremely high rates in injecting drug users (IDUs) from the mid 80s to current date [6,7]. The proportion of women among AIDS cases has been around 20% and, in the last years, the proportion of sexually transmitted cases has increased drastically at the expense of a decrease of AIDS cases in IDU [8].…”