Human immunodeficiency virus (HIV), hepatitis C (HCV) and hepatitis B (HBV)

Of particular concern in the EU is the drug-related spread of HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV), usually through behaviours associated with drug injection. Available data suggest that the prevalence of HIV infection among drug injectors (IDUs) varies greatly between, as well as within, European countries, from about 1 % in the United Kingdom to over 30 % in Spain. In some countries and regions, HIV prevalence among IDUs has remained very high (over 25 %) since the mid-1990s. Although these data may reflect well-established epidemics, in these areas special prevention efforts remain important to prevent further infections.

It may be misleading to rely completely on national data sets, which in general have suggested a fairly stable situation across the EU, as trends may differ widely within regions and cities. Increases in HIV prevalence among subgroups of IDUs have recently been reported from regions or cities in Spain, Ireland, Italy, the Netherlands, Austria, Portugal, Finland and the United Kingdom. This picture remains diverse, as in some of these countries decreases were also recorded in other subgroups, and in other countries prevalence has remained stable or decreased.

Data on HIV infection in young and in new IDUs may be a better indicator of recent infections and again indicate that new infections are continuing to occur in some regions. AIDS incidence has fallen across the EU since the introduction of more effective treatments.

Hepatitis C infection can cause severe chronic health problems, and the treatment of conditions related to HCV infections is likely to become a major cost to European healthcare systems. The prevalence of hepatitis C is extremely high among drug injectors in all countries, with infection rates varying between 40 % and 90 %. Among notification data where a risk category is known, 90 % of cases of hepatitis C and 40–80 % of cases of hepatitis B are related to injecting drug use. Trends over time show a mixed picture, with increases and decreases being observed in different regions. The prevalence of HCV infection among young IDUs and new IDUs is high in general (40 % or more), confirming a high incidence of new infections, with injectors continuing to acquire the disease after relatively short periods of injecting. Throughout the EU, approximately 20–60 % of IDUs have antibodies against hepatitis B, suggesting a large potential for vaccination programmes directed at this disease in IDUs.