Study links Glasgow HIV outbreak to surge in homelessness and addicts injecting cocaine

More than 100 new cases of HIV were diagnosed among injecting drug users in the region during the seven-year period, compared to an average of 15 annually in the whole of Scotland in previous years. The last major outbreaks were in Edinburgh and Dundee in the 1980s.

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Researchers from Glasgow Caledonian University, whose study is published in the Lancet today, said the majority of cases tested positive for the rare HIV subtype C, and that further analysis revealed the strain involved is unique to Scotland.

The spike in HIV coincided with a significant increase in the proportion of addicts injecting cocaine, from 16% to 50% across the region, and from 37% to 77% in Glasgow city centre.

Cocaine injection is a known risk factor for HIV because its stimulant effects are short-lived, encouraging addicts to inject more frequently and thereby increase their risk of exposure to blood-borne viruses because they are less likely to be using clean equipment.

The researchers add that it is "unclear why there has been such a huge recent shift towards powder cocaine injecting" in a locality traditionally dominated by heroin, but suggest that a reported decline in heroin purity in the UK at a time when the purity of cocaine circulating in Europe is higher "might have increased its attractiveness".

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The addicts affected were also more likely to have been homeless in the six months prior to HIV diagnosis, and to have a history of prison time.

Dr Andrew McAuley, a senior epidemiologist and lead author on the study, said: “The key drivers of infection are an increase in cocaine injecting, and homelessness.

"We also have a large population of people who inject in public places in Glasgow at a time when HIV has re-emerged.

"A combination of these factors has created a perfect storm for rapid transmission of HIV among people who inject drugs in Glasgow.”

Dr McAuley added that the research has been “vital in informing, not just the response to the outbreak itself, but planning to mitigate similar outbreaks occurring in the future”.

Andrew Horne, director of Addaction Scotland, said: "We are seeing increased reporting of cocaine use in the services we provide - in both community settings and online in our webchat.

"We are very concerned about the 10-fold increase in HIV infection rates across Glasgow; and the rise in street homelessness is there for all to see."

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The researchers say that their findings highlight the need for review the addictions response to cocaine among injecting drug users, but add that the provision of sterile syringes and other equipment to drug users was "set back by the closure of the city's largest needle and syringe programme".

Glasgow City Cuncil's plans for a drug consumption room - approved by the Scottish Government to reduce drug abuse in public - are roadblocked by the need for legislative change at UK level, although a so-called heroin 'shooting gallery' is due to open in the city.

Addiction and homelessness often go hand-in-hand, but there are hopes that Glasgow's new 'Housing First' model could help break the cycle by providing extra support to those whose lifestyles have been chaotic.

A spokeswoman for Glasgow’s Health and Social Care Partnership said: "This multi-agency, rapid rehousing model was successfully pioneered in Europe and the US and was introduced in Glasgow last year.

“People are being found flats and provided with intensive wrap-around support to handle daily essentials like ensuring you’re in receipt of benefits, paying your rent, liaising with utility companies as well as attending medical appointments to combat your addiction.

"It is helping people with addictions keep a roof over their heads and rebuild their lives."