In 2014-2015, we saw 2 large outbreaks of HIV infection related to the unsafe use
of injection equipment. In Cambodia, 242 persons in one rural commune (population:
approximately 8,000) received a diagnosis of HIV infection over the course of 3 months.
These infections were attributed to the reuse of injection equipment by an unlicensed
health care provider in the informal health care sector.
1
In the U.S. State of Indiana, 181 persons in a rural southeastern town (population:
approximately 4,200) received a diagnosis of HIV infection over the course of 6 months.
These infections were attributed to the unsafe injection of prescription opioids
2
by people who inject drugs (PWID) for recreational uses. In Cambodia and Indiana,
a large percentage of the infections were determined to have occurred recently (ie,
within 6-9 months of diagnosis) (Table 1).
3
,
4
Table 1Common characteristics: Cambodia and Indiana HIV outbreaks, 2014-2015
| Outbreak element | Cambodia | Indiana |
|---|---|---|
| Setting | Rural | Rural |
| Mode of HIV transmission | Unsafe injection (medical) | Unsafe injection (nonmedical) |
| Timing of HIV spread | Rapid (mo) | Rapid (mo) |
| Preoutbreak community HIV prevalence | Low (0.6%) | Low (<0.1%) |
| Community access to HIV testing | Minimal | Minimal |
| Outbreak HCV infection prevalence | High (82%) | High (92%) |
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References
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Van Handel M., Van Handel M.. US counties vulnerable to large HIV epidemics among PWID in special session: unsafe injection practices among people who inject drugs in rural communities: a new phase of the HIV epidemic? In: Conference Program 2015 National HIV Prevention Conference (Special Session 13). Atlanta, GA: 2015.
Article info
Publication history
Published online: November 23, 2016
Footnotes
Funding/support: Funding for the outbreak investigation in Indiana was provided by the U.S. Centers for Disease Control and Prevention (CDC). The CDC's work on the Cambodia outbreak was supported by the U.S. President's Emergency Plan for AIDS Relief.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Conflicts of interest: None to report.
Identification
Copyright
Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
