HIV infection and AIDS among drug injectors at Rio de Janeiro: perspectives and unanswered questions

Abstract

Data from various countries show considerable variation in the rate of spread of the human immunodeficiency virus (HIV) among drug injectors. Although further research is needed to predict the rate of increase of seroprevalence at Rio de Janeiro, preliminary data confirm the presence of the virus, with a seroprevalence of about 33 per cent in 1990. Issues arising from research into the probable determinants of viral spread among the thousands of drug injectors in the city are outlined in the present paper. Even before the research is completed, however, it is clear that interventions are needed to reduce further viral transmission both among drug injectors and from them to their sexual partners and offspring. Efforts should be made to prevent the population at risk from initiating the practice of drug injection, and to promote a major expansion in drug abuse treatment facilities. Drug injectors should also be encouraged to reduce the risk of their becoming infected or passing on the virus to others, through educational outreach, through the distribution of supplies that facilitate risk reduction (bleach, syringes, condoms), and through innovative approaches to behaviour change.

PIP: Data from various countries show considerable variation in the rate and extent of HIV spread among IV drug users (IVDU). More than 11,000 people have been diagnosed as having AIDS in Brazil, of whom 1700 were in Rio de Janeiro. 82 of these 1700 people were heterosexual IVDUs and 16 were homosexual or bisexual IVDUs. Although additional research is needed to predict the level and rate of increase of HIV seroprevalence in Rio de Janeiro, preliminary data suggest that as many as 33% of IVDUs in 1990 may have been HIV-seropositive. Such data clearly warrant interventions to reduce HIV transmission within this population and from them to their sex partners and offspring. This paper outlines issues arising from research into the probable determinants of viral spread among the thousands of drug injectors in the city. Efforts need to be made to prevent the population at risk from beginning to use injecting drugs and to promote a major expansion in drug abuse treatment facilities. Drug injectors should also be encouraged to reduce the risk of their becoming infected or passing the virus to others. Approaches could include educational outreach; the distribution of supplies which facilitate risk reduction such as bleach, syringes, and condoms; and innovative approaches to behavior change.