New Zealand needle exchange programmes keeps HIV rates low

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Sustained, extremely low levels of HIV transmission among people who inject drugs, including gay and bisexual men, reflect the success of needle-exchange programmes and other harm reduction measures, researchers say.

The study shows in the years from 1996 to 2018, Aotearoa New Zealand averaged just one HIV diagnosis per year among both heterosexual people who inject drugs, and the most at-risk group in the study: gay and bisexual men who inject drugs.

In the 23-year period covered, 1,653 people were diagnosed with HIV (excluding cases contracted overseas). The most common mode of transmission was sex between men (77.4%), followed by sex between men and women (14.2%). Only 2.9% of the cases were in people who injected drugs.

The lead author is Dr Peter Saxton from the University of Auckland’s Centre for Addiction Research. “Our study shows that HIV has been effectively controlled among most people who inject drugs in New Zealand, and this record has been sustained over multiple decades,” he says.

Established in the late 1980s, the New Zealand Needle Exchange Programme is a network of 20 regional outlets and 180 pharmacies and alternative outlets who supply free, sterile needles and empathetic advice and information to injecting drug-users. It’s an example of the harm reduction approach to drug use, which seeks to work alongside people to improve their health and wellbeing without coercion, judgement or discrimination.

Co-author Dr Sue McAllister, leader of the AIDS Epidemiology Group at University of Otago, says: “Our data suggests New Zealand has one of the smallest epidemics among people who inject drugs internationally. However, our findings that 20% of gay and bisexual men who inject drugs had HIV, and that in 2018, six gay and bisexual men who inject drugs were diagnosed with HIV, show there is no room for complacency.”

Abstract
Introduction and Aims: Gay and bisexual men (GBM) who inject drugs are disproportionately affected by human immunodeficiency virus (HIV) because of dual transmission risks. New Zealand has a progressive history of harm reduction and was the first country to publicly fund needle exchange programs in 1988 for people who inject drugs (PWID). We combine national HIV epidemiological and bio‐behavioural surveillance data to understand HIV risk among this subpopulation.
Design and Methods: We examine trends in new HIV diagnoses 1996–2018 by mode of transmission, and compare HIV cases attributed to sex between men (MSM‐only), MSM/injecting drug use (IDU) and IDU‐only. IDU among GBM in a national HIV behavioural surveillance survey was also examined. We compare GBM by IDU status (never, ‘recent’, previous) and identified predictors of recent IDU.
Results: Of 1653 locally‐acquired HIV diagnoses 1996–2018, 77.4% were MSM‐only, 1.5% MSM/IDU, 1.4% IDU‐only and 14.2% heterosexual mode of transmission. On average, just one HIV diagnosis attributed to MSM/IDU and IDU, respectively, occurred per annum. MSM/IDU cases were more likely than MSM‐only cases to be indigenous Māori ethnicity. Of 3163 GBM survey participants, 5.4% reported lifetime IDU and 1.2% were recent IDU. Among GBM, HIV positivity was 20% among recent IDU and 5.3% among never injectors. Predictors of recent IDU were: age under 30; more than 20 male partners; female partner; condomless intercourse; HIV positivity.
Discussion and Conclusion; New Zealand has averted high endemic HIV rates seen among GBM and PWID in other countries and results have been sustained over 30 years.

Authors
Peter JW Saxton, Susan M MCAllister, Geoffrey E Noller, David AL Newcombe, Kathryn A Leafe

The University of Auckland material

Drug and Alcohol Review abstract

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