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HIV Infection and Drug Use in the Netherlands: The Course of the Epidemic

The introduction of human immunodeficiency virus (HIV) among injecting drug users (IDUs) in the Netherlands has been traced back to 1982, whereas the first case of the acquired immunodeficiency syndrome (AIDS) in an IDU was diagnosed in 1985. By the end of December 1995, 438 AIDS cases among IDUs had been reported to the surveillance system, 53% of whom were Amsterdam residents, making the capital the epicenter of the national HIV epidemic. After a rapid spread of HIV during the first half of the 1980s, HIV prevalence stabilized at about 30% during the second half of that decade in Amsterdam. Since 1984, a variety of preventive measures have been implemented, including needle and syringe exchange programs. These measures have contributed to large reductions in HIV risk behavior. However, an important residual of HIV risk behavior remains and new infections of HIV continue to occur. In recent years, new HIV infections have been outnumbered by the increasing number of deaths occurring among HIV-infected IDUs. A large fraction of these deaths have occurred without an AIDS diagnosis. By 1994, an estimated 1,400 HIV-infected IDUs remained in the country who were still alive and AIDS-free and this number is expected to decrease further in the near future.