In November 2011, a strong increase of newly diagnosed HIV infections among IDUs during 2011 was reported to EMCDDA by the Romanian National Focal Point (NFP) on Drugs. This was based on the information provided by routine monitoring and case reporting coordinated by the Centre for Monitoring and Evaluation of HIV/AIDS Infection in Romania. The reported increase was further supported by data from Drug-related Infectious Diseases (DRID) indicator based on routine monitoring performed by Romanian NFP.
A risk assessment performed by the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) in 2011 together with the NFP and representatives of Centre for Monitoring and Evaluation of HIV/AIDS Infection in Romania / Romanian National Institute of Infectious Diseases ‘Prof. Dr. Matei Bals’ (INBI) documented an increased HIV incidence; increased hepatitis C prevalence (indicating increased injecting risk); recent changes in injecting patterns (with more frequent injecting and increased stimulant injecting); and low coverage of effective prevention services (needle and syringe programmes, opiate substitution treatment).
While reporting three to five cases annually from 2007 to 2009, HIV infections among IDUs increased to 12 cases in 2010 to 129 in 2011. Moreover, 102 new cases were registered until the end of June 2012 (2) which is over three times the number of cases reported for the same period in 2011 (30 cases).
Routine monitoring performed at registration for drug treatment services indicated also an increase in HIV-positive cases among IDUs tested (1.1% (2/182) in 2008, 3.3% (11/329) in 2009 and 4.2% (12/288) in 2010) and (11.6%, 25/216) in 2011 (3). The routine monitoring includes testing but also self-reporting.
In fresh unpublished data from the 2012 behavioural surveillance survey (BSS) among IDUs recruited using the RDS sampling procedure (n=417) in Bucharest the HIV prevalence among IDUs reached 52.5%.
No specific HIV testing campaigns had been initiated and most cases were detected when seeking drug treatment or hospital care for other conditions, suggesting that the increases reflected true increases in incidence of HIV infection rather than increased detection of cases.
In a BSS (4) among IDUs published in 2010, there were reports of changes in drug use patterns from 2009, where 97% of respondents reported heroin as the main drug of injection, to 2010, where 67% reported heroin and 31% reported amphetamine-type stimulants, mostly synthetic cathinones, as the main drug of injection. Stimulant use is associated with more frequent injection and there are reports of increased syringe sharing. In 2012 BSS significant changes are seen in drug use patterns. The main drugs of injection were NPS (the new amphetamine type stimulants) for 49.4% of the IDUs.
The HIV outbreak among IDUs in 2011 coincided with a significant reduction of harm reduction service provision due to the ending of the international programmes and funding available from the Global Fund and UNODC.
Following the recommendations of the risk assessment the Romanian National Antidrug Agency initiated efforts to improve the harm reduction service network. It provided about 145 000 extra syringes for the needle exchange programmes active in the field and supported the opening of a new outreach centre coordinated by the Carusel NGO which covers 40 clients per day 2 days a week. It also sustained several advocacy events and measures in order to speed up the adoption of the Anti HIV/AIDS Strategy1 2011-2015 (5) which is now under public debate. The syringes were distributed by 2 outreach centres2 in well-known areas and open scenes of IDUs in the capital city of Bucharest.
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