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Glasgow's major HIV outbreak amongst people who inject drugs shows no sign of slowing

Chris Hicks

In 2015, an HIV outbreak was detected amongst people who inject drugs (PWIDs) in Glasgow. Three years on the outbreak has still not been controlled, and over 100 PWIDs in Scotland have been diagnosed with HIV. Those diagnosed have complex needs and experience severe social exclusion, with 40% having a history of incarceration and 45% reported ever being homeless.

Work is underway to support those diagnosed and to prevent further infections but there are a number of policy issues that are impacting upon efforts to control the outbreak. This includes the closure of one of the main needle exchange services in Glasgow and the UK Government currently preventing the opening of a Drug Consumption Room (DCR) in the city. 

In 2016, a needle exchange service in Glasgow Rail Station was set up for the explicit purpose of supporting efforts to control the HIV outbreak. The service has provided more than 40,000 sets of clean injecting equipment since opening. But late last year Network Rail closed the service due to a number of incidents. The closure of the service is short-sighted and will only mean that efforts to reduce the outbreak are negatively affected.

Furthermore, stakeholders in Glasgow have been advocating for a Drug Consumption Room (DCR) to be opened. There is evidence to suggest their effectiveness in significantly reducing sharing of injecting equipment (and therefore HIV transmissions) and drug related deaths. For the opening of a DCR to be lawful a change is required to the Misuse of Drugs Act 1971. Yet despite the crisis in Glasgow the UK Government has refused to change the law and is blocking the opening of any DCR.

Prevalence of HIV amongst PWIDs in the UK currently stands at around 0.85%. Key to this success has been a history of political investment in harm reduction as an approach to drug policy. In the 80s harm reduction services were scaled up dramatically in response to the HIV epidemic. Needle and syringe programmes were introduced, opioid substitution therapy (OST) was expanded, and education schemes regarding safer injecting techniques were run. This led to low levels of HIV amongst PWIDs which has remained a constant success to today. But this outbreak shows us that we cannot be complacent and that an HIV outbreak could occur elsewhere in the UK if steps are not taken to increase investment in and coverage of drug services.

There has however been a significant shift in England’s drug policy since 2010 with a move to a more abstinence-orientated approach, for example moving from maintenance on OST and taking people off OST too soon. This has coincided with severe cuts to the public health budget. Drug misuse treatment faced more reductions in funding than any other public health area in 2016/17 with a 14% reduction in funding, and there are further cuts planned up to 2020/21. This all means that access to drug treatment will be reduced, the very services that are needed to prevent outbreaks in the first place.

For further information on the HIV outbreak please see our briefing here.

NAT Topic

Jul 6, 2018 By charlie.alderwick