The future of the HIV pandemic will be hugely influenced by the populous countries of China, India and Russia. Can we predict what will happen to the HIV epidemics in these countries? By what means does HIV infection most commonly occur in these countries and what can be done to prevent it? Researchers from Imperial College, London and the UK Public Health Laboratory Service examined these questions by analysing behavioural and biological survey data with mathematical models of disease transmission.

Needle sharing by injecting drug users (IDU) plays a central role in the spread of HIV in Eastern Europe and Asia. The rapid spread seen among IDU has led to predictions of a catastrophic 'next-wave' of infections in India, China and Russia by the US National Intelligence Council. The researchers looked at current knowledge about HIV transmission in these countries, the role of IDU and whether predictions about the future can be made. They report:

• The current HIV epidemic varies in the three countries explored. Russia is reporting a faster growth in infections than anywhere else in the world due to a series of epidemics among IDU in different parts of the country. In China IDU also account for the majority of new infections (60 to 70 per cent of reported infections). In India 85 per cent of new infections are due to heterosexual transmission, but IDU are a significant source of new infections in the northeast of the country.
• The future of the HIV epidemics in these countries is uncertain because we don’t know enough about sexual behaviour in the general population. However, even in the absence of widespread transmission, sexual transmission will become of increasing importance even among IDU.
• Higher levels of sexual mixing between risk and non-risk sexual groups leads to higher prevalence of HIV in the general population. In the three countries studied, there are different but significant levels of sexual mixing between sex workers and their clients and between IDU and others. Significant overlap also exists between sex work and drug use. In parts of Russia 40 per cent of female IUD report being actively engaged in commercial sex.

The researchers recommend that:

• The increasing importance of infection through sexual transmission highlights the need to include safe sex messages and condom distribution in needle exchange and harm reduction programmes that target drug users.
• Quantitative surveys of the sexual behaviour of adults in these countries are needed if the potential for HIV spread is to be assessed. These surveys need to include comparable indicators across countries and cultures that can be used to inform the policy response.

Source(s):
'Modelling emerging HIV epidemics: the role of injecting drug use and sexual transmission in the Russian Federation, China and India', International Journal of Drug Policy 14: 25-343, by N.C. Grassly et al, 200

id21 Research Highlight: 17 November 2003

Further Information:
Nicholas C. Grassly
Department of Infectious Disease Epidemiology
Faculty of Medicine
Imperial College London
St. Mary’s Hospital
Norfolk Place
London W2 1PG
UK

Contact the contributor: n.grassly@imperial.ac.uk

Imperial College, London, UK

Public Health Laboratory Service, UK

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