08/11/09

Drug Warriors: blind or just innumerate?

As promised, a note on the UK’s latest data on HIV among drug injectors. Some of the US’s battalions of Drug Warriors have been crowing that the new figures show a rise in infection rates among junkies in the UK: clear evidence that the nation’s policy of making sterile needles and injecting equipment available to people who need them doesn’t work.

Unlike the United States, the UK has bothered to track HIV infection among large, representative samples of drug injectors (both current injectors and those in methadone and other treatment programmes) since close to the start of the epidemic. Part of this effort involved testing anonymous samples of left over blood for HIV — the samples were usually taken from treatment or diagnostic purposes and are stripped of all but the most basic demographic and risk information (age, sex, length of time injecting, recent needle sharing) before being tested with HIV. The results, shown separately for London and the rest of England and Wales are shown below.

uk_idu

(Click to enlarge)

Yes, prevalence for the whole of England and Wales (including London — Scotland has its own system and reports separately) has risen by over 77% in the last decade. But still, fewer than one injector in 60 is infected with HIV. If you draw the graph using a normal percentage scale, you’ll see something close to the true level of infection — still too high, of course, but not exactly an overwhelming prevention failure when compared with data from any city or country that doesn’t have needle exchanges. The graph compares what happened in the UK with what happened in Jakarta, just because I happened to have the Indonesian data handy. But it would look just the same with data from Bangkok or Moscow or even New York in the years before the city (with no help from the federal government) began to hand out needles.

uk_jakarta_idu

(Click to enlarge)

Since I’m just a numbers nerd and obviously don’t have a great visual imagination, perhaps someone could help me out here: how can you conclude from these pictures that safe injecting programmes fail to prevent HIV?

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This post was published on 08/11/09 in Science, War on drugs.

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  1. Comment by Roger, 08/11/09, 11:20:

    Now you could try to explain why the % of HIV-infected in Jakarta remains stable over the years…

  2. Comment by carolyn V Brown MD MPH, 09/11/09, 03:44:

    Elizabeth,

    When I was in Kenya (2004-2006), it was obvious that folks were falling like flies from HIV/AIDS, tuberculosis, malaria, malnutrition etc etc etc. When I got back to America, I entered the journal reading stream again and came across the hype for Vitamin D and its miracles. All things in perspective… However, when I began to learn that Africans cannot make Vitamin D. When I read that Vitamin D is valuable for building an immune response. When I realized that the people I had dealt with had ___?? Vitamin D levels. When I read more about the effect of Vitamin D on management of tuberculosis. I began to ask if Vitamin D had anything to do with assistance or detriment in building an immuune rsponse in tuberculosis, HIV/AIDS, and other such stuff.

    I asked our regional search library to look and I have not found very much. I communicated with a fellow from the Netherlands and one from Berkeley but that was about it. My sense was that they thought it was interesting but didn’t know a lot.

    Of course I’d love to do a study of Vitamin D levels at the equator, the prevalence of HIV/AIDS, the managements, and whether anybody is alive at the end of any management with Vitamin D.

    I would be very interested in your take on this. Bill Gates keeps challenging folks to present some “novel” ideas. I don’t want to be stupid, but I do wonder.

    I just can’t seem to find much data. I realize that may not be your favorite area, but I do keep looking.

    Your thoughts on this welcomed.

  3. Comment by Muscleguy, 09/11/09, 02:28:

    Roger, the Jakarta graph clearly shows the rate of infection has achieved saturation in the population being measured. The 50% uninfected will include those with clean needle supply (well off junkies) as well as those who will be infected and who will replace those infected injectors who die (I suspect their life expectancy is not too long). IOW the seemingly static line hides the dynamic nature of the situation.

    Lines that curve over like that in the right situation are diagnostic of a saturation effect whether in Chemistry, Biochemstry or many other situations.

  4. Comment by Muscleguy, 09/11/09, 03:18:

    @CarolynBrown

    It is not that Africans cannot make VitD, in tropical latitudes with high levels of sunlight exposure dark skin provides perfectly adequate amounts of VitD. It is only when Africans move to higher or lower latitudes that the levels of UV light exposure, especially in the winter, are insufficient. Europeans have no such problem, their light skins enabling them to make enough VitD at those latitudes, if they expose enough of it.

    Not being able to find much data on a problem can be indicative of there not being a problem to provide data for. This should always be considered before embarking on a research project. IOW for good reasons VitD plays no significant role in HIV infection.

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