The role of injection drug use in the emergence of Human Immunodeficiency Virus infection in Estonia.
OBJECTIVE
This article reviews the marked increase in human immunodeficiency virus (HIV) among injection drug users (IDU) in Estonia, a former Soviet Union republic bordering the Baltic Sea. HIV infection associated with injecting drug use has been reported worldwide. In Eastern Europe large-scale HIV epidemics have been observed from 1995 onward, after injection drug use (IDU) communities became infected.


METHODS
In Estonia, surveillance of HIV infection is based on the mandatory universal notification of newly identified cases, with the same reporting principles in use throughout the last decades. By legal regulations every sample sent for HIV testing has to be coded (on the testing form) to identify the transmission category it belongs to. HIV testing was introduced in Estonia in 1987; by now over 2 million HIV tests have been performed.


RESULTS
To date since 1987, 1305 cases of HIV have reported in Estonia. The incidence of HIV infections remained very low until recently, even when a considerable rise occurred in the incidence of sexually transmitted diseases, especially syphilis. Through 1999, only 96 cases of HIV had been reported nationally. Since then however, a dramatic increase has occurred. The cumulative data, including the information recorded on HIV testing forms and clinical records suggest that IDU was a factor in nearly 90% of the new HIV cases reported in year 2000.


CONCLUSIONS
HIV infection appeared in Estonia much later than in many other parts of the world, so the experience from other countries that have confronted with the challenges of HIV could be of great help and importance for Estonia. The IDU related HIV infection epidemic in Estonia emphasizes an urgent need for preventive measures for IDUs as the target group.
Uusküla
Anneli
A
Clinic of Dermatovenerology, University of Tartu, Estonia. annskla@ut.ee
Kalikova
Aneli
A
Zilmer
Kai
K
Tammai
Lea
L
DeHovitz
Jack
J
D021821:Communicable Diseases, Emerging / Q000453:epidemiology*; D018563:Disease Notification / Q000331:legislation & jurisprudence; D004196:Disease Outbreaks; D004957:Estonia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology