United Press International - Monday, July 8, 2002
Ed Susman, UPI Science News

Troubling increases of HIV infection among drug users have been reported in Ho Chi Minh City -- formerly Saigon -- in Vietnam, in Togliatti City, Russia, and across China. In addition, researchers have found rapidly rising increases of infection among drug users in Western Europe, and they expressed concern that the war against terror in Afghanistan could trigger a new outbreak of HIV/AIDS in neighboring Pakistan due to disruption of drug use patterns.

"These outbreaks are happening in dozens of cities around the world," said Dr. Alex Wodak, director of the alcohol and drug treatment service at St. Vincent's Hospital in Sydney, Australia.

In a series of presentations, the researchers showed:

-- In Togliatti City, along the Volga River with a population of more than 750,000, the percentage of injecting drug users infected with the human immunodeficiency virus has reached 56 percent, said Ali Judd, a researcher at the Imperial College Faculty of Medicine in London. Of those, Judd said, 43 percent of the women surveyed among the injecting drug user population admitted to being sex workers, meaning they could infect their clients with HIV and provide an avenue for the virus to infect the general population.

Judd said fear of police persecution meant injecting drug users did not carry their own drug paraphernalia, which appears to have contributed to increasing instances of needle-sharing -- one of the common forms of HIV transmission.

-- In Ho Chi Minh City, with a population of 7 million in the former South Vietnam, about 20 percent of injecting drug users were infected with HIV through the early 1990s. That figure rocketed to 81 percent from 1998 to 2001, said Dr. Le Thuy Lan Thao, program manager for the city's AIDS Committee. She also said HIV infection among pregnant women has risen from near zero in 1995 to one-half of 1 percent in 2001, and there has been an abrupt and rapid increase in infections among new military recruits, from near zero in 1998 to 2.9 percent in 2001.

-- In Pakistan, epidemiologists surveying usage patterns of injecting drug users warned that the war on terror has disrupted heroin supplies from Afghanistan. In a survey in the city of Lahore, drug users -- due to changes in availability of heroin -- have begun to increase injecting drug use, said Steffanie Strathdee, associate professor of epidemiology at Johns Hopkins University in Baltimore, Md. She said injecting drug use prior to the bombing campaign in Afghanistan among those surveyed was about 57.8 percent. In the months after the bombing, however, injecting drug use was 76.9 percent.

Instead of inhaling heroin, more drug users were injecting liquid narcotics obtained from pharmacies, Strathdee said. "These are disturbing situations." Although there is no evidence HIV exists among closed rings of injecting drug users in Lahore, she suggested as individuals move in and out of these groups, HIV infection will emerge and spread rapidly through the region's estimated 3-million-plus injecting drug users.

"We need to scale up prevention measures to keep this from happening," she said, "but the impact of a post-Sept. 11 world has been a scaling down of drug prevention programs in Pakistan."

Wodak said attempts to control injecting drug use through law enforcement procedures has resulted in users avoiding syringe exchange programs and engaging in risky drug use behaviors.

"These are not good findings in Pakistan," he said. "These changing risk patterns will eventually kill far more people than died in the World Trade Center attacks." About 3,000 died in the terror attacks in New York.

-- In Western Europe, researchers have found pockets of rapidly increasing infections among injecting drug users in Portugal and Italy.

"We were used to thinking that the epidemic in Western Europe was stable," said Lucas Wiessing, a researcher with the European Monitoring Centre for Drugs and Drug Addiction in Lisbon, Portugal. "But we have found that despite prevention measures, HIV transmission continues at high rates among subgroups of injecting drug users in some countries."

Wiessing noted rapidly rising rates of HIV infection in Sardegna, Italy, and in Lisbon and Porto, Portugal.

-- In China, researchers from the Centers for Disease Control and Prevention in Atlanta, Ga., documented a 58 percent increase in the number of HIV/AIDS cases confirmed by testing and a 30 percent increase in the number of people infected with HIV from 2000 to 2001.

A survey of residents found a general lack of knowledge about transmission of the disease, said CDC researcher Deborah Holtzman. She said 72 percent of people in seven counties in China did not know proper use of condoms could prevent transmission. Eighty-one percent were unaware sharing needles would transmit the virus and 85 percent did not realize the disease could be transmitted from mother-to-child.

-- In India, where as many as 4 million people already are infected with HIV, doctors said local governments still tend to ignore the growing epidemic despite an astounding increase in cases. Since 1990 the number of cases in India has risen from 400,000 to 4 million. "I don't think it will continue to increase at that rate of 10 times in a decade," said Salim Habayeb of the World Bank, "but it could increase by as much as six-fold in the next decade. I don't think it is going to stop overnight."

By 2012, about 24 million people in India could be infected with the disease, Habayeb said.
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