Has the United Kingdom averted an epidemic of HIV-1 infection among drug injectors?

The United Kingdom has not seen the major spread of HIV-1 infection among drug injectors that was anticipated in the mid-1980s. Although cities in many countries have seen rapid spread of HIV-1 infection to epidemic levels (40% prevalence and above), the United Kingdom is one of several countries that experiences low and stable prevalence rates. Since the mid-1980s there have been major changes in syringe-sharing risk behaviour, and evidence that speci® c preventive interventions have been successful: a plausible case can be made for the success of public health interventions in averting a potential public health disaster. 1 Ten years have passed since the ® rst reported outbreak of HIV-1 infection among drug injec-tors in the United Kingdom. In 1985 it was discovered that at least 50% of injectors tested in Edinburgh were HIV positive, 2,3 and about 40% in Dundee; 4 there were reports of HIV-1 infection among injectors in other areas, and evidence of high-risk syringe-sharing behaviour. 5,6 Heroin use and injecting had spread in the previous decade in many major cities in the United Kingdom , with estimates of about 100 000 injectors throughout the United Kingdom. 7 By 1986 HIV-1 prevalence rates among drug injectors ranged between 44% and 76% in eight European cities, and between 50% and 72% in New York and New Jersey. 4 The situation in 1986± 87 suggested that if the Edinburgh experience were repeated throughout the United Kingdom there might be potentially 50 000 injectors with HIV-1 infection. This has not happened. The cumulative numbers of injecting-related HIV-1 infections known from voluntary testing in the United Kingdom tomates of the untested population) for England and Wales are for about 1800± 2300 living injecting related HIV-1 infected people to the end of 1994. 30 Studies undertaken in various sites, including samples in and out of treatment, show that in England (outside London) the prevalence rate among current injectors is less than 1%. 9 In London, multisite studies of current injectors indicate a stable rate of about 7%. 10 In Glasgow the rate is 1%. 11 Previous high levels in Edin-burgh have now been succeeded by rates of about 20% in subsequently tested samples. 12 Low prevalence of HIV-1 infection has been sustained even though HIV-1 infection has been present in many areas since the early 1980s. By the end of March 1995 there had been a cumulative total of 614 cases of …