Glasgow HIV outbreak: Cocaine and homelessness create 'perfect storm'

Researchers say these factors helped create the “perfect storm” in Glasgow, where an outbreak of HIV was detected among people who inject drugs.

The findings come after it emerged that cocaine prices are at their lowest in 25 years.

The UN’s 2018 World Drug Report revealed the UK street price of a gram of the class A drug was £41 in 2016, the latest year for which figures were available. This sum was the lowest since 1990, when the series began.

Experts from Glasgow Caledonian University (GCU) and Health Protection Scotland (HPS) worked with NHS Greater Glasgow and Clyde and the University of the West of Scotland (UWS) to uncover the scale and drivers of the region’s HIV crisis for the first time.

They found a “significant rise” in cocaine injecting, as well as homelessness, helped create the public health problem.

Blood-borne virus expert Dr Andrew McAuley, of GCU and HPS, said the findings – published in The Lancet – provide “further justification for interventions such as the proposed drug consumption room” in Glasgow. That plan, which garnered cross-party political support, was refused by the Home Office.

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More than one million needles and syringes are distributed in the Greater Glasgow area every year in a bid to prevent the sharing of blood-borne conditions.

However, more than 100 new HIV cases were diagnosed among injecting drug users in the area from 2015 to 2017, prompting calls for action.

The annual rate of new HIV diagnoses among drug injectors for the whole of Scotland stood at around 15 until 2015, when it jumped to 52, and all but five of this total were recorded in the Greater Glasgow and Clyde health board area.

Researchers analysed surveys on the health and behaviours of almost 4000 injecting drug users. From 2011 to 2014, 50% of HIV-positive injecting drug users said they had injected cocaine within the past six months. By 2017-18, that figure had increased to 83%.

Among HIV-negative injecting drug users, the figure for 2011-12 was 16%, rising to 48% by 2017-18.

Co-author Dr Norah Palmateer, GCU senior research fellow, said: “The sharp rise in cocaine injecting identified is the single largest risk factor for acquiring HIV in Glasgow, possibly because it is likely to cause individuals to inject more often which, in turn, makes them more vulnerable to infection.

“Our research identifies key determinants of HIV infection among a vulnerable population of individuals to inform public health interventions that can be targeted to prevent further new infections and to help test and treat those already exposed.”

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McAuley commented: “The prevalence of HIV has been low and stable in this population since major outbreaks of HIV in the 1980s in Edinburgh and Dundee. However, the prevalence of HIV in Glasgow has increased 10-fold among people who inject drugs in the past seven years, from just 1% to over 10% in the city centre.

“The key drivers of infection are an increase in cocaine injecting, and homelessness. We also have a large population of people who inject in public places in Glasgow at a time when HIV has re-emerged. A combination of these factors has created a perfect storm for rapid transmission of HIV among people who inject drugs in Glasgow.

“Although the outbreak has affected more than 100 individuals, until now we weren’t sure of the impact of the outbreak on the overall population of people who inject drugs in Glasgow.”

and the rapid increase in cases led to plans for the UK’s first legal drug injection facility, based on successful public health interventions in countries including Canada, France and Denmark.

The Home Office, however, says it has “no plans” to allow the introduction of such a centre.