In Scotland, free IEP saw over 4.4 million needles and syringes distributed in 2016/2017. Before 2014, there were between 15 and 20 PWID diagnosed with HIV each year in Scotland, approximately 10 per year in the NHS Greater Glasgow and Clyde Health Board Area (hereafter “Glasgow”). Although there have been HIV outbreaks among PWID in Scotland in the 1980s, the most recent was in 1993, with 14 cases identified. Response to these outbreaks has been focused on improving harm reduction services, such as engagement in opioid agonist therapy (OAT), enhanced IEP, and increasing HIV awareness alongside antiretroviral therapy (ART) for those diagnosed. These outbreaks have been associated with homelessness, economic recession, stimulant injecting, suboptimal drug treatment coverage, and injecting equipment provision (IEP). Large-scale outbreaks of human immunodeficiency virus (HIV) among people who inject drugs (PWID) have been reported in Europe and the United States in recent years. Antiretroviral therapy, ART, HIV, outbreak, PWID
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