Monitoring the spread of HIV and AIDS in Scotland 1983-1994

This review examines the nature and extent of the spread of HIV and AIDS in Scotland from the early to mid 1980s up to 1994. By December 1994, 2,209 HIV-infected cases, of whom 604 had progressed to AIDS, had been reported to the Scottish Centre for Infection and Environmental Health. Scotland's comprehensive surveillance system sheds light on the dynamics of HIV spread in high and low risk population groups. For injecting drug users, most were infected between 1983 and 1986, and since then the number of new infections has declined dramatically; this trend likely reflects the impact of prevention initiatives, particularly needle syringe exchange and methadone maintenance. Infection probably entered homosexual/bisexual male populations around 1980 to 1981, with numbers peaking about 1985 and then declining in the mid to late 1980s; however, the incidence of infection appears to have remained relatively constant during the 1990s. For heterosexual men and women a gradual increase in the number of new infections occurred throughout the mid to late 1980s, although there is evidence that the rate of new infections has stabilised in recent years; the majority of infections have been confined to the non-injecting sexual partners of injectors and to persons who have had sexual exposure abroad, usually in Africa. Prevention initiatives to reduce the sexual transmission of HIV must be further developed and those aimed at injectors should be maintained.