HIV in injecting drug users in the EU/EEA, following a reported increase of cases in Greece and Romania

Two countries in the European Union/European Economic Area (EU/EEA) have reported a significant increase in HIV case reports and HIV prevalence among injecting drug users (IDUs) during 2011 (Greece and Romania).

• Although the magnitude of the increases in case reports may be partially related to enhanced surveillance and active case-finding, evidence indicates a real increase in HIV transmission in both countries.
• There is a temporal association between low levels (or reduction) of provision of prevention services in Greece and Romania and these increases. However, any causal association is difficult to prove.
• Increased focus on prevention measures, such as needle and syringe programmes and opioid substitution treatment, seems essential to prevent new HIV cases among IDUs in Greece and Romania. Guidance is given in the ECDC–EMCDDA Guidance on the prevention of infectious diseases among people who inject drugs (2011).
• Epidemiological investigation of these outbreaks would facilitate better understanding of the current situation to prevent further outbreaks.

A few other countries in the EU/EEA report slight increases in HIV among IDUs in 2010–11. Some countries report increases in injecting risk behaviour or low coverage of prevention services among IDUs. These factors combined may indicate a risk for increased HIV transmission and future outbreaks. These countries would benefit from critically reviewing their national prevention and control programmes.

However, about half of the countries in the EU/EEA report a low incidence of HIV cases among IDUs, and the overall incidence in the EU/EEA has been declining steadily since the early 2000s. These outbreaks show that there is a continuous need to keep public health and sufficient preventive services on the agenda in challenging economic times.

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