A NEW approach to ensure more people injecting drugs are regularly tested for HIV is urgently needed it has been claimed, as new figures show the Glasgow epidemic – now in its fifth year – is ongoing.
Since the start of the HIV outbreak in 2015 there have been 162 diagnoses and though new infection rates had slowed last year, experts claim a “flurry of new cases” since the summer has brought the number up to 22 this year. Of those, about half have been contracted within the last six months, a sign the outbreak has not been contained.
Though substantial work has been done to get people into treatment, with some encouraging results, it is claimed proposals to introduce opt-out – rather than opt-in – testing must be implemented without delay to halt the further spread of HIV.
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The call comes as World Aids day is marked around the globe. Treatment now means that once HIV is diagnosed people are able to live normal lives, with medication reducing the amount of the virus in the blood to undetectable levels, meaning it cannot be transmitted. But those who are unaware they have the virus will still get ill and can infect others through sexual contact or sharing needles.
Dr Andrew McAuley, an academic and blood borne virus expert at Glasgow Caledonian University, who also works for the NHS, said: “Back in April there was cautious optimism because the numbers in 2018 had come down. But there was a flurry of new diagnoses just at the beginning of the summer and there’s been subsequent clusters of diagnoses since – the total number of new diagnoses has comfortably surpassed the whole of last year.
“What that data is showing is that over 50% of new diagnoses this year are recent transmissions so that points towards the outbreak being very much ongoing.” He claimed more work was needed to increase testing levels. While currently only about half of injecting drug users have been tested in the last year, the aim is for all of them to be tested every three months.
“HIV testing levels were pretty low at the time of the outbreak and that has been identified as one of the issues,” he added. “HIV testing is a cornerstone of prevention.
“In the prison service we have opt-out testing because the prison sees a lot of people who are injecting because our drug laws mean crime is part of the picture. The next stage is to introduce opt-out testing in community addiction teams and there is hope that will be the next way forward. More needs to be done to make sure that it is normalised.
“Dry blood spot testing could be carried out in a wide range of health care settings with just a few hours of training,” he said.
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Other problematic issues include the closure of needle exchanges at Central Station and the Simon Community hub. Though a van has replaced these in the last nine months, some have claimed it is less discreet than the previous options, while the increase of cocaine injecting – done more frequently – means there is a greater demand.
Safer injection sites, ruled out by the Home Office, are still being called for. A scheme for giving drug addicts pharmaceutical grade heroin is to open in Glasgow city centre in coming weeks. The pilot scheme aims to treat 20 patients with the most severe addictions in its first year.
Yet McAuley insisted key elements of Glasgow’s response had worked well, including a move towards a more community based service – rather than a clinic-based one. “There is an outreach nurse who works five days a week in the city centre,” he said. NHS teams are supported by outreach workers from Waverley Care.
“The real benefits are that of all the people who have been diagnosed and who are still alive, 100% have [received] treatment and 95% are currently on treatment. Of those on treatment, over 80% of them have had an undetectable viral load in the last month. That data compares brilliantly with other outbreaks.”
Scottish Drugs Forum agreed that more emphasis should be put on ensuring people who are injecting drugs – including heroin and cocaine – are tested for HIV and said that stigma surrounding HIV was often an issue.
The organisation has produced a joint briefing with Waverley Care to mark World Aids Day 2019, with both organisations raising concerns about the ongoing outbreak.
David Liddell, chief executive of the Scottish Drugs Forum, said: “Experience shows that people who inject drugs or have injected drugs are generally willing to be tested if they are asked. However, people are far less likely to demand to be tested – even when they know they have been at risk of infection. Some have never been tested or have not been tested for years. Without sufficient testing we will never contain this outbreak.
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“There is a possibility that people who have not been at risk because they have not injected drugs since their last test will feel stigmatised – the best way to avoid this would be to have opt-out testing where it is expected that you will be tested unless you actively opt out.”
A spokeswoman for NHS Greater Glasgow and Clyde confirmed that the outbreak amongst those who inject drugs was “ongoing” and that new transmissions had increased this year.
She said: “Services have been very successful at engaging those diagnosed as part of the outbreak in treatment. This has been achieved by integrated teamwork between specialist HIV care teams and existing services that work closely with this population.
“Unfortunately, despite the considerable advances in treatment and prognosis, stigma, either real or perceived, continues to be a significant factor for those living with HIV or concerned that they might be at risk. We would like to reassure those that have concerns that they may be infected that they will be supported by a specialist team in a non-judgmental way.
“It is essential that we increase levels of HIV testing to identify those currently undiagnosed. We would advise that individuals with a history of homelessness or injecting drug use in Glasgow city centre have an HIV test every three months.”
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