Table 3:
Outbreak case details
| Year outbreak first observed | Pre-outbreak HIV prevention services* | Reduction in prevention services (eg, OST, NSP etc.)? | Pre-outbreak number of HIV cases per year (PWID)* † | Peak outbreak HIV rate (PWID)* † | Previous economic problems | Highly susceptible subgroups | Changes in drug injection patterns | Current HIV case count | Percentage of cases among all cases attributable to PWID during outbreak period | |
|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||
| Study location | ||||||||||
| Athens, Greece | 2011 | Low | No | 10 to 20 | 525 cases over a one-year period (2012) | Economic recession | People who are homeless | No | ~106 cases per year (2018) | 50.4% |
| Bucharest, Romania | 2011 | Medium | Yes | 5 to 12 | 308 cases per year | Poverty | MSM, PWID, and CSW | Increase in synthetic drug use (ie, legal highs such as bath salts) | ~80 cases per year (2018) | 20 to 25% |
| Dublin, Ireland | 2014 | High | No | 10 to 20 | 57 cases over two-year period (2014 to 2015) | Economic recession | People who are homeless | Increase in daily “snow blow” (a psychoactive drug) injections | ~10 cases per year (2018) | 7.4% to 10.1% |
| Tel Aviv, Israel | 2012 | High | Yes | ~40 | 73 cases over one-year period (2012) | No | People who are homeless involved in sharing new synthetic cathinones without single paraphernalia and reusing paraphernalia | Increase in synthetic cathinone | ~25 cases per year (2016) | 14.2% to 15.3% |
| Luxembourg | 2013 | Medium | No | <4 | 68 cases over four-year period (2013 to 2017) | Precarious economic situation of PWID | People who are homeless | Increase in cocaine supply, decrease in heroin supply | 4 cases (2018) | 10.7% to 22.3% |
| Scott County, Indiana, USA | 2014 | None | No | <1 | 227 cases over three-year period (2015 to 2017) | Low employment rates | Multi-generational family use | Prescription oxymorphone injection | 10 cases (2018) | >95% |
| Glasgow, Scotland, UK | 2015 | High | No | ~10 | 48 cases over a one-year period (2015) | Austerity | People who are homeless, involved in criminal justice system | Heroin with cocaine injection (so-called "snowballing") | 26 cases (2019) | 25% |
| Southeastern Saskatchewan, Canada | 2016 | Medium | No | <1 | 16 cases over two-year period (2016 to 2017) | High prevalence of poverty in Indigenous First Nations communities | People who are homeless, First Nations Indigenous populations, and rural residents | Unknown Hydromorphone, cocaine, and morphine were commonly reported | 2 cases (2018) | 73% |
| Summary of studies | Range: 2011 to 16 | 1 none; 1 low; 3 medium; 3 high | 2 out of 8 | Range: <1 to 20 | Range: 16 to 547 HIV cases (during outbreak period) | 7 out of 8 | People who are homeless: 6 out of 8 | 5 out of 8 | Range: 2 to 93 cases | 7.4% to >95% |
CSW=commercial sex workers. MSM=men who have sex with men. NSP=needle and syringe programmes. OST=opioid substitution treatment. PWID=people who inject drugs.
*
Coverage according to UNAIDS Technical Guidelines (for OST: low, 0–20%; medium, 20–40%; high ≥40%).
†
PWID cases only; coverage according to UNAIDS Technical Guidelines (for NSP: low, 0–100 syringes per PWID; medium, 100–200 syringes per PWID; high, ≥200 syringes per PWID).