Aids taking heavy toll of city's drug users: Edinburgh feels impact of HIV

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TEN YEARS after HIV was first transmitted by intravenous injection, more drug users in Edinburgh are dying from Aids than from overdoses, according to a study published tomorrow.

Deaths due to drug overdoses predominated throughout the early 1980s in injecting drug users, but the impact of HIV infection, contracted largely through sharing needles and some heterosexual sex, is now being felt.

A crackdown by Scottish police on drug users in the early days of the Aids epidemic forced addicts to share needles, and accelerated the spread of the virus. Edinburgh became known as the Aids capital of Europe.

According to a study of 203 injecting users, more than half of whom were HIV positive, there were 16 Aids-related deaths between 1983 and 1992, 10 of them in 1991. In contrast, there were 15 overdose deaths, mostly in the mid to late 1980s.

Although patterns of drug use changed in Edinburgh because of the risks of HIV, the researchers say that a shortage of heroin and a new approach by legal, social and medical services had a significant effect.

From 1984 onwards, stiffer sentences for people convicted of dealing in heroin or possessing the drug 'disrupted an active drug-using community dramatically', according to a report in tomorrow's British Medical Journal.

Over the study period, less than a fifth of users stopped injecting, and just over a fifth (21 per cent) stopped and restarted. The remainder continued to use drugs regularly.

In a second study in the BMJ, the Public Health Laboratory Service reports that the incidence of HIV in pregnant women in London rose from 1 in 560 to 1 in 380 between January 1990 and June 1993. The researchers say that the rise is due to an influx of women from sub-Saharan Africa or to an increase in transmission of the virus within the UK. 'Both mechanisms are probably operating,' the report says.

Although the incidence of Aids in some European countries is between three and four times higher than in England and Wales, HIV among pregnant women here is comparable with that of the worst affected cities such as Paris and Rome. Incidence appears to have peaked in these cities, however, while in London it is still rising.

More than 400,000 blood samples were tested from women attending antenatal clinics in London and other parts of England. As expected, the prevalence of HIV was higher in the capital than Manchester, Leeds and Bradford and other non-metropolitan areas. The highest incidence in centres outside London was lower than the lowest prevalence in the capital. Wide variation was seen between different centres in London, ranging from 0.04 per cent to 0.51 per cent.