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Curtin, Margaret (2016) HIV infection among homeless people who inject drugs. Drugnet Ireland , Issue 58, Summer 2016 , pp. 15-16.

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A paper published in September 2015 outlines a case-control and epidemiological study conducted in response to an increase in recently acquired HIV infection among a population of homeless people who inject drugs (PWID) in Dublin.1 The report defines recently acquired HIV infections as those in which the person who tests positive is p24 antigen, or has had an HIV negative test within the previous 12 months, or suffers an acute HIV sero-conversion illness.

 

Clinicians in the drug treatment services were concerned that the increase might be linked to injection of a synthetic cathinone PVP, with the street name ‘Snow Blow’, which was being used by homeless drug users. In response, an epidemiological investigation and case-control study were instigated.

 

Between 2014 and 2015, 38 confirmed or probable cases of recently acquired HIV were reported (see Figure 1). Of these, 16 were female, the median age was 35 years (range 24–51) and 29 were registered homeless. Of the 20 for whom injecting information was available, 18 reported recent injecting of ‘Snow Blow’. Twenty reported having sex with a person who injected drugs or with an HIV-positive partner.

 

For the case-control study, 15 of the reported cases were recruited. A random sample of 39 HIV-negative, homeless, chaotic drug users were recruited from National Drug Treatment Centre as a control group. There was no difference between cases and controls in age, duration of injection or living circumstances. The study found that compared with the controls, the cases were more likely to have reported injecting methamphetamine and Snow Blow, and using amphetamines, other head shop drugs or benzodiazepines. Cases were also more likely to have reused needles or syringes, and to have had sex with partners who inject drugs.

 

Multivariate logistic regression was used to determine which of these factors were associated with HIV infection. The factor with the strongest association with HIV infection was injecting Snow Blow. However, being female, reusing needles and syringes and having sex with a partner who injects drugs were all independently associated (see Table 1).

In response to the increased incidence of HIV, the authors report that the following control measures were immediately implemented:

  • provision of antiretroviral therapy to PWID diagnosed with HIV, where possible, and contact tracing to detect any additional cases among sexual or drug-sharing partners;
  • review of clients attending drug services, to identify those most at risk, and offering urgent HIV testing;
  • pilot point-of-care testing (POCT) of PWID clients attending Safetynet homelessness services (Safetynet is a networking organisation for nurses, doctors and voluntary agencies providing primary health care to homeless people in Dublin, Cork and Galway);
  • enhanced surveillance to identify new HIV cases as early as possible, including mode of transmission;
  • awareness-raising among clients, clinicians, networks of PWID and other stakeholders;
  • provision of greater access to needle exchange and other preventive activities within the drugs, homeless hostel services and prisons (the need for additional measures, including extended opening hours for needle exchanges, is being evaluated);
  • development and distribution of communications material, aimed at raising awareness of the risk of HIV posed by unsafe injecting and unsafe sex (available on the website of the Health Protection Surveillance Centre [HPSC]); and
  • active case finding including Recent Infection Testing of possible cases, and phylogenetic analysis of cases.1

Giese C, Igoe D, Gibbons Z, Hurley C, Stokes S, McNamara S, Ennis O, O'Donnell K, Keenan E, De Gascun C, Lyons F, Ward M, Danis K, Glynn R, Waters A, and Fitzgerald M (2015) ‘Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015’. Euro surveillance: bulletin Européen sur les maladies transmissibles = European communicable disease bulletin 20(40): Euro Surveill. https://www.drugsandalcohol.ie/25015/

 

Item Type:Article
Issue Title:Issue 58, Summer 2016
Date:August 2016
Page Range:pp. 15-16
Publisher:Health Research Board
Volume:Issue 58, Summer 2016
EndNote:View
Subjects:G Health and disease > Disorder by cause > Communicable disease > HIV infection
J Health care, prevention and rehabilitation > Risk and protective factors > risk factors
J Health care, prevention and rehabilitation > Health-related prevention > Health information and education > Communicable disease control > HIV prevention
MA-ML Social science, culture and community > Social condition > Homelessness > Homeless services
T Demographic characteristics > Intravenous / injecting drug user
T Demographic characteristics > Homeless person
VA Geographic area > Europe > Ireland

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