In recent years, an increase in newly diagnosed HIV cases within Glasgow has brought warnings of a new HIV pandemic. One of the groups mainly affected were Glasgow’s homeless who were injecting cocaine.
Cocaine is a stimulant drug made from the coca plant. It is known for its energising, motivating, sociability, confidence building and inhibition-lowering properties. It affects the pathways of the body’s feel good chemicals: Serotonin, Dopamine and Norepinephrine. It has been connected with the clubbing scene and Chemsex practices (using the drug immediately before or during sex to enhance the experience).
The popularity of cocaine has increased over recent years, with the UN estimating that 18.1 million people globally used it in 20171. There are various factors contributing to this increase:
- The decline in purity of other illicit drugs including heroin and new psychoactive substances (NSP’s).
- Increased production of cocaine which has increased by 25% each year since 2015.
- Purity of cocaine has increased with the UN estimating 1,976 tons of 100% pure cocaine was produced in 2017. 2
Even COVID-19 and lockdown has not stopped supplies. A drug charity working in Glasgow (Crew 2000) reported 50% of their regular cocaine users receiving treatment have increased their use during COVID-19.3
How is Cocaine connected to HIV?
HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system and destroys cells; it first came to the UK scene in 1980s. It is a transferable disease through vaginal and anal fluids, semen, blood and breast milk from an infected person. However, it is classed as a fragile virus, meaning it does not survive outside the body for long.
People who use cocaine often use paraphernalia which can lead to blood contamination. This includes bank notes used in snorting, which can cause abrasion to nasal tissue, using crack pipes with the risk of causing abrasions or burns, using needles and syringes to inject, etc. If sharing of these items with a person who carries HIV but is non-suppressive, the virus could be transmitted to others. Within Glasgow homeless communities they were often found to be injecting in non-sterile areas such as alleyways. New cases of HIV diagnosis saw 1,872 people’s transmission route was through injecting drug use. 4
As previously mentioned, cocaine is linked to sexual activity and risk taking as it lowers inhibitions and provides users with confidence. People using cocaine may not feel in control of decision making when it comes to engaging in sexual behaviour. This may lead to unsafe sex. Within homeless communities there are often strong links to engagement in prostitution to fund their drug habit. This behaviour can increase risks of STI’s including HIV. In 2019, 71,216 cases of HIV reported transmission was sexually based.5
Research suggests that cocaine can accelerate the progression of HIV infection. It can impair immune cell functions and promote the replication of the virus. It can also accelerate the development of the neurological conditions of memory loss, movement difficulties and visual impairment, collectively known as NeuroAIDS. 6
There are around 105,200 people within the UK living with HIV, with 1 in 16 of those infected unaware they have the condition. With advancements in treatment many receiving help are able to be in a state of virally suppressed, meaning they cannot pass on the disease. In 2019, 98,552 people in the UK with HIV received care, including 285 under 15 year olds (HIV can be transmitted from mother in the womb, during the birth or through breast milk).5 World Aids Day 2020 focused on Ending the Stigma Around HIV, and helped people get to know the facts. In the 1980’s it was wrongly labelled the disease of the gay community and heroin users, creating a lot of stigma around the illness, with many thinking it was a disease that only affected these groups, which was one of the misconceptions of the virus and the resulting condition known as AIDS. HIV does not discriminate and can affect anyone who puts themselves at risk.
Harm reduction services such as health campaigns, needle and syringe exchange programmes, counselling around HIV testing and diagnosis, practicing safer sex, free condom services, regular STI and HIV testing if sexually active all move to prevention, but more is needed. It has been suggested that other drug paraphernalia exchange programmes should be provided in drug treatment in the UK. Such programmes include testing the purity and strength of drugs on the street and providing drug consumption rooms as a safe place to consume drugs, with the intention of reducing the harm caused by drug taking.
Drug Consumption Rooms: These have been working well in other countries but have been declined in the UK. However, in Glasgow there is a drug consumption bus being provided, especially to those living on the streets, providing users with a clean, sterile facility where users can take drugs under supervision.
Drug Testing: Purities of drugs are changing, and many have not realised that the purity of cocaine has increased until they witness the side effects. Currently The Loop provide this service in limited areas.
Collaboration Work: For some of these services to be provided on a larger scale in the UK, collaboration between harm reduction services and drug legislation governing bodies needs to begin. Often UK drug law becomes a barrier to effective harm reduction measures.
To find out more about drug testing and drug consumption rooms, read our blog post: Should The UK Follow The Swiss Approach to Tackling Drugs?
References:
- pdf (unodc.org) p11
- pdf (unodc.org)p10
- Crew 2000, Taking Drugs Seriously: Cocaine webinar
- UK HIV Statistics | National AIDS Trust
- UK HIV Statistics | National AIDS Trust
- Why are cocaine users at risk for contracting HIV/AIDS and hepatitis? | National Institute on Drug Abuse (NIDA)