Low HIV infections in drug-users point to needle exchange success

Sustained, extremely low levels of HIV transmission among people who inject drugs, including gay and bisexual men, reflect the success of needle-exchange programmes and other harm reduction measures, researchers say.

The new study shows in the years from 1996 to 2018, Aotearoa New Zealand averaged just one HIV diagnosis per year among both heterosexual people who inject drugs, and the most at-risk group in the study: gay and bisexual men who inject drugs.

In the 23-year period covered, 1653 people were diagnosed with HIV (excluding cases contracted overseas). The most common mode of transmission was sex between men (77.4 percent), followed by sex between men and women (14.2 percent). Only 2.9 percent of the cases were in people who injected drugs.

The lead author is Dr Peter Saxton from the University of Auckland’s Centre for Addiction Research. “Our study shows that HIV has been effectively controlled among most people who inject drugs in New Zealand, and this record has been sustained over multiple decades,” he says.  

“The fact that HIV diagnoses have remained so low for so long in New Zealand suggests that effective interventions have reached the majority of people who inject drugs. These include needle exchange programmes, condoms, HIV testing and treatments. It’s critical that these services continue, and engage better with those who continue to find themselves at risk of contracting HIV.”

Established in the late 1980s, the New Zealand Needle Exchange Programme is a network of 20 regional outlets and 180 pharmacies and alternative outlets who supply free, sterile needles and empathetic advice and information to injecting drug-users. It’s an example of the harm reduction approach to drug use, which seeks to work alongside people to improve their health and wellbeing without coercion, judgement or discrimination.

Co-author Dr Geoff Noller is a researcher with the programme. “There is no question that the inception 30 years ago of a national needle exchange programme, a world first, has allowed New Zealand to maintain one of the lowest rates globally of HIV infection among people who inject drugs: consistently below one percent,” he says.

“But we have to remain on our toes. HIV is transmitted very easily by sharing injecting equipment, and the potential for clusters of infection to occur quickly is always there. Ongoing resourcing of harm reduction strategies such as needle exchange, safe sex options and HIV surveillance in at-risk populations is vital.”

Co-author Dr Sue McAllister, leader of the AIDS Epidemiology Group at University of Otago, says: “Our data suggests New Zealand has one of the smallest epidemics among people who inject drugs internationally. However, our findings that 20 percent of gay and bisexual men who inject drugs had HIV, and that in 2018, six gay and bisexual men who inject drugs were diagnosed with HIV, show there is no room for complacency.”

Read the article:

Drug and Alcohol Review: Injecting drug use among gay and bisexual men in New Zealand:
Findings from national human immunodeficiency virus epidemiological and behavioural surveillance