AIDS and drug abuse

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While illicit drug abuse in any form can be associated with harmful consequences, drug injection is commonly regarded as the most dangerous method of administration. One of the most serious consequences is the possibility of contracting the Acquired Immune Deficiency Syndrome (AIDS).

There are 30 million people in the world affected with AIDS, approximately 90 per cent of which live in developing countries. An estimated of 2.6 million are children, most of whom have been infected by their mothers. It is believed that 22 per cent of those affected by AIDS acquired the virus through infected needles while using illegal drugs.

AIDS is an acronym for acquired immunodeficiency syndrome, so-called to reflect the acquired impairment to the immune system as distinct from inherited immunodeficiencies. The disease thus opens the door to other infections. The contagious agent called human immunodeficiency virus (HIV) directly attacks a group of blood cells that play a critical role in the functioning of the immune system. As the disease progresses, the defense mechanisms in the cells are reduced until they become extinct.

An individual testing positive for HIV or having an HIV-related illness, means that has been exposed to the virus-that one has been infected by HIV, that may experience a long period (10 years or more) of asymptomatic, chronic infection that will gradually weaken the immune system to the point where full-blown AIDS is reached. An intravenous drug user diagnosed with AIDS usually dies within one or two years.

For a long time AIDS was mistakenly interpreted as a the "gay disease", but by the end of the 1980s the world had learned that the disease also spreads by heterosexual contact, unprotected sexual intercourse with an HIV-positive partner and through the sharing of needles by intravenous drug users. While HIV infection in the United States is more frequent among homosexuals, in Europe it occurs more often among intravenous drug users.

Infected addicts, of course, can transmit the infection to others through sexual relations. In developed countries, an estimated 80 per cent of infected heterosexuals have contracted the virus through sexual relations with IDUs.

WHAT IS AN IDU?

A comparative study prepared by the World Health Organization between 1989 and 1992 profiled the typical IDU (injecting drug user) by recruiting 6390 drug-injecting addicts who were not receiving medical treatment. The results of studies conducted in, 12 cities (Athens, Bangkok, Berlin, Glasgow, London, Madrid, New York, Rome, Rio de Janeiro, Santos, Sidney, and Toronto) revealed that IDUs are generally single, widowers, separated, or divorced males between 20-34 years of age, with one child, or in some instances childless. Most have under 10 years of schooling and are unemployed. Over 50 per cent have been arrested and spent at least one night in jail. In New York, Toronto, Athens and Glasgow, more than 30 per cent have been jailed more than five times.

THE AIDS/IDU LINK

As research progressed, the single common denominator between the different transmission routes proved to be the blood chain. The virus passes from the body of an infected person into the bloodstream of another through bodily excreta semen, vaginal secretions or from contact with through micro-injuries or lesions, or directly injected into the veins. Once absorbed into the recipient's bloodstream, the virus finds its target cells for replications and invades the organism. Thus, injecting drug use with contaminated needles is a primary HIV transmission route. Also, sharing infected needles increases the risk of HIV infection regardless of whether injection is into the vein, into a muscle, or under the skin.

The use of contaminated needles, which introduces the HIV virus into the blood stream, increases the risk of transmission through unsafe sexual relations. Today, sexual contact with an infected addict is a sure route to infection. The micro-transfusions that occur when two or more people use the same needles are a particularly efficient vehicle for the transmission of HIV.

Once injecting drug use became 'fashionable' the first HIV-infected IDUs started to appear. Infection then quickly spread. In big cities like New York, Rio de Janeiro, and Bangkok, HIV has been introduced into the local population of injecting drug users through 'bridge groups' of homosexuals who also inject drugs.

Drug tourism in another source of infection-drug users travel across borders seeking cheaper drugs. If they took their "hypodermic needle kit," they would arouse suspicion among the police, so they opt to share needles locally. They go to a "shooting gallery" or go to a professional injector who may use the same needles on several dozen or clients. Whatever form the sharing takes, it effectively multiplies the risk of becoming infected and of transmitting the virus.

SOME FACTS

In many countries faced with a serious trafficking or local production problems, the pattern of HIV transmission among injecting drug users (IDUs) is stark testimony to the so-called 'spill over effect' which happens when portions. of illicitly produced or trafficked drugs end up being consumed in the local market. In Thailand, for instance, opiate consumers made a gradual transition from opium smoking to heroine smoking and finally to heroin injection between 1950 and 1970. The levels of HIV infection among addicts increased from one per cent at the beginning of 1988 to 32-43 per cent in September of that year. The level stabilized at 40-50 per cent in 1994, and then reached an estimated 80 per cent in 1996. The number of AIDS cases registered among IDUs jumped from 7 in 1990 to 691 in 1994. While other elements have also contributed to the spread of AIDS in Thailand, the illegal use of heroine through injection has contributed significantly to the higher rate.

HIV infection appears among IDUs in more than 60 countries in the world, in Africa, Asia, Europe, America and Oceania. However, levels of infection vary considerably. In Italy, 69 per cent of those infected are IDUs, in Myanmar and Spain 66 per cent, in Poland 41 per cent, in Switzerland 40 per cent, in Brazil 39 per cent, in the United States 30 per cent, and in France and Indian 25 per cent. Infection levels are lower in other countries of Central America and Europe.

A survey in 1992, representing 61 per cent of the world's population, revealed between 3.1 and 3.6 million IDUs. It is difficult to understand the epidemic proportion of drug abuse without taking into account geographic, cultural, social, and other factors. But the phenomenon is worldwide. Asia appeared on the international AIDS-epidemic trend line in the 1980s, and now ranks second in terms of HIV transmission through drug injection.

Whatever policies or strategies countries may adopt to address the problem, these must necessarily include provisions and complementary activities to stem the injection of illicit drugs as well as the spread of the illness.

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