HIV transmission as a result of drug market violence: a case report

Human immunodeficiency virus (HIV) transmission among injection drug users (IDU) represents a significant factor driving the global HIV epidemic [1], and HIV incidence remains elevated among this population in numerous settings globally [2]. While the use of contaminated injection equipment and unprotected sexual intercourse account for the majority of infections worldwide, other routes of HIV transmission have received less attention. For instance, few studies have examined less common routes of HIV infection [3], and we know of none that have considered the potential of direct blood-to-blood contact via violent altercations among IDU. Although HIV infection through violent interaction is likely rare, the potential of antiretroviral post-exposure prophylaxis to reduce the risk of HIV transmission under these circumstances makes it important to examine this potential route of transmission among drug user populations [4,5]. This may be particularly important given the high rates of drug market violence among IDU [6].We present the circumstances surrounding the HIV infection of a 39 year old white male who is a participant within a prospective epidemiological cohort study of IDU in Vancouver, Canada. In addition to completing a quantitative survey which assesses HIV risk behavior, study participants also provide a blood sample for HIV testing at semi-annual visits. As well, the cohort has a concurrent qualitative component designed to examine HIV seroconversions among participants. Qualitative interviews are conducted with cohort participants who recently received a positive HIV test result, to collect additional data regarding sexual, and injection behavior in the time prior to seroconversion, as well as details regarding potential sources of infection. Data from qualitative interviews generate a detailed description of circumstances surrounding each individual's HIV infection and are triangulated with cohort data and nursing records from pre-test counselling.The pre