Status:
Resolved
Health alert:
140010
Date Issued:
06 Oct 2014
Issued by:
Dr Michael Ackland, Acting Chief Health Officer, Victoria
Issued to:
Health professionals, including those working in sexual health and drug & alcohol services

Key messages

  • People who inject drugs (PWID) are at increased risk of HIV infection
  • Screen people who inject drugs for HIV opportunistically (and at least annually).
  • Link all new cases into HIV care and support.
  • Ensure that all possible attempts are made to contact injecting drug use and sexual contacts of all HIV cases at the time of diagnosis.
  • Educate all PWID about HIV transmission and prevention, safe sex and harm reduction.

What is the issue?

Australia’s prompt and effective response to the HIV epidemic has resulted in a sustained low HIV prevalence among PWID. However, PWID remain at increased risk of HIV infection compared with the general population.

The prevalence of HIV among PWID is approximately 1-2 per cent, compared with 0.1 per cent in the general Australian population. Approximately six per cent of new HIV diagnoses notified nationally between 2003-2013 were in people reporting a history of injecting drug use.

In Victoria there were 307 new HIV diagnoses in 2013. Newly diagnosed individuals who reported injecting drug use as possible exposure for HIV made up seven per cent of cases. Two per cent of cases reported injecting drug use as the only exposure for HIV.

HIV can be transmitted through sharing needles, syringes and other injecting equipment. In addition, drug and alcohol use can increase sexual risk behaviours. Methamphetamine (Ice, crystal meth, meth or shabu), in particular, can enhance sexual arousal and reduce inhibitions thus increasing the likelihood of sexual risk behaviours (e.g. unprotected sex and multiple partners).

Clinicians play a vital role in HIV control and prevention through early diagnosis, management of cases, partner notification and patient education.

What action is required?

Any individual using illicit drugs or synthetic drug products, including synthetic cannabis, is at serious risk of harm. These drugs are untested and unregulated and may therefore include a range of undisclosed chemicals that cause serious health and safety issues.

Screening

  • Screen all PWID opportunistically, and at least annually, for HIV and other blood-borne viruses (hepatitis B, C).

Management of HIV cases

Ensure appropriate management of newly diagnosed HIV cases through:

  • Referral to and retention into HIV care and treatment.
  • Referral to other services where appropriate (i.e. drug & alcohol, mental health, social support).
  • Access to Needle and Syringe Programs and harm reduction information.
  • Coordinated case management, in particular where co-morbidities and social issues are identified • Patient education about HIV transmission, prevention and treatment, safe sex and harm reduction.

Notify all new HIV diagnoses to the Department of Health. HIV notification form can be accessed on the Infectious diseases epidemiology and surveillance website.

Partner notification

  • Ensure that all possible attempts are made to contact injecting drug use and sexual contacts of patients diagnosed with HIV at the time of diagnosis.
  • The partner notification officers (PNOs) from the Department of Health are available to assist with partner notification. The PNOs can contact the sexual and injecting drug use contacts of a person diagnosed with HIV, provide advice and referral to testing. Any identifying information about your patients is kept confidential. The PNOs can be contacted on 9096 3367.

Patient education

Provide education about HIV transmission, prevention and treatment, safe sex and harm reduction to all PWID. Patient resources available online are listed below (under Patient information).