A comparison of the prevalence of HIV infection and injecting risk behaviour in urban and rural samples in Scotland

Aims. To compare the prevalence of HIV infection and injecting risk behaviour among injecting drug users from urban and rural areas. Designs. Two samples of injecting drug users were recruited using a multi-site sampling strategy. Respondents were first interviewed by trained interviewers than specimens of saliva were collected for anonymous testing for antibodies to HIV. Setting. Respondents were recruited from drug treatment services and street sites. Participants. Respondents were eligible for inclusion in the study if they had 'ever' injected a drug and were currently using drugs. Measurements. Measurements taken included self-reported patterns of drug use and injecting risk behaviour. Specimens of saliva were tested for the presence of HIV infection using GACELISA with reactive populations which are geographically discrete but broadly similar in profile and current injecting risk behaviour. The prevalence of HIV infection among IDUs from Dundee city was found to be 26.8% (95% CI, 20.2%-33.0%) compared with 3.7% (95% CI, 0.13%-15.8%) for IDUs from rural Tayside. This marked difference in prevalence of HIV infection we attribute to a high level of injecting risk among urban IDUs between 1980 and 1984, limited migration from the urban epicentre of infection and a reluctance among rural IDUs to share with IDUs outside their immediate social and kinship networks. Conclusions. Although current levels of injecting risk behaviour are similar in our urban and rural samples, rural IDUs may be less likely to contract HIV from their fellow injectors because of the lower prevalence of HIV infection and more closed sharing networks within the rural population. The implications of this for the development and expansion of drug services are considered.