Drug injectors in Glasgow: a community at risk? A report from a multidisciplinary group. The Possilpark Group.

In 1987 it became apparent that the number of drug injectors with HIV infection living in a district in the north of Glasgow was increasing. As this area was well served by a wide variety of clinical, epidemiological and laboratory facilities, a multidisciplinary group was convened to examine the extent and spread of infection, and its relationship to behavioural and environmental factors. By 1989 a World Health Organisation working group had developed a standardised methodology, consisting of an interview schedule and voluntary anonymous HIV testing procedures. The study has been implemented annually in Glasgow since 1990, with a collateral project evaluating prevalence of injecting drug use in the general population. The Glasgow HIV Behavioural and Prevalence Study was designed to yield as representative as possible a sample of the city's injectors, respondents being drawn from a variety of in-treatment and out-of-treatment sites. Of the estimated 8,500 injectors in Glasgow (1.35% of the population aged 15-55), 503 and 535 injectors were recruited to the study in 1990 and 1991 respectively. Over 90% of respondents injected daily and reported injecting, on average, four different types of drugs in the six months prior to interview, the three most commonly injected drugs being buprenorphine, heroin and temazepam. There is evidence of HIV risk reduction for sharing of injecting equipment and for using condoms with casual sexual partners. Salivary testing has proved to be successful, less than 5% of respondents refusing to be tested; the prevalence rate was 1.8% in 1990 and 1.1% in 1991. While HIV prevalence remains low, all-cause mortality among injectors in Glasgow is high; drug injecting is probably responsible for more deaths among people aged under 40 than any other factor. At the present time, the drug injecting epidemic in Glasgow poses a considerable challenge to the city's public health services.