Research and analysis

Unlinked Anonymous Monitoring (UAM) Survey of HIV and viral hepatitis among people who inject drugs (PWID): 2024 report

Updated 11 December 2024

Applies to England, Northern Ireland and Wales

Data to end of 2023.

Main findings

This section includes the main findings from the Unlinked Anonymous Monitoring (UAM) Survey of HIV and viral hepatitis among people who inject drugs (PWID) in England, Wales, and Northern Ireland (EWNI) for the period 2014 to 2023.

HIV prevalence among UAM Survey participants has remained low and stable over the past decade and was 1% in 2023.

Overall, the proportion of UAM Survey participants with hepatitis C virus (HCV) antibodies (a marker of ever HCV infection) has remained relatively stable over the past decade (from 49% in 2014 to 53% in 2023) and is higher among those aged 35 years and above. This suggests continued exposure to HCV and a treatment effect, with increased uptake of HCV treatment resulting in those recruited to the UAM who are ever-infected living longer.

Chronic hepatitis C (hepatitis C ribonucleic acid (RNA) and antibody positive) prevalence continues to decline from 26% in 2017  to 7.8% in 2023 among all PWID. This decline is noted alongside the scale-up of direct-acting antiviral (DAA) treatment for HCV infection in this population.

The prevalence of HCV antibodies among people who began injecting within the last 3 years (an indication of new infections) has declined in recent years. However, the small (and declining) sample size has resulted in imprecise 95% confidence intervals (CIs) and there is not yet clear evidence of a decline.

In 2023, 27% of UAM Survey participants with chronic HCV infection reported that they were aware of their infection status, a decline in reported awareness from 51% in 2017. This decline in awareness is expected, as the proportion of persons aware of their infection decreases over time as those previously diagnosed and aware of their status are successfully treated and cured. Among those unaware of their infection in 2023, 39% reported receiving an HCV or bloodborne virus (BBV) diagnostic test during the Survey, similar to 38% in 2022. After accounting for participants who either had a test or were awaiting results, 40% were potentially unaware of their chronic infection in 2023. Of this group:

• 63% had injected drugs in the past 4 weeks, among whom 55% reported never being tested or having their last HCV test more than 2 years ago
• 77% had experienced homelessness
• 77% had been in prison

This highlights opportunities for testing and prompt diagnosis among this population.

The proportion of participants who self-reported ever being tested for HIV and HCV remains high. In 2023, 81% of PWID reported ever being tested for HIV, an increase from 77% in 2014, and 88% reported ever being tested for HCV, compared to 84% in 2014. Uptake of HCV and HIV testing in the current or previous year have increased over the last decade at 49% and 39% in 2023, respectively.

The prevalence of antibodies to hepatitis B virus (HBV) core antigen (anti-HBc) a marker of ever infection declined from 14% in 2014 to 7.7% in 2023, indicating fewer people have ever been infected with HBV. However, the prevalence of current HBV infection (HBV surface antigen (HBsAg)) positive among those with antibodies to HBc antigen has remained relatively stable, at 5.8% in 2023 compared to 4.2% in 2014. Among all UAM Survey participants in 2023, the proportion currently living with HBV was 0.44%.

Over the same period, self-reported HBV vaccination uptake has declined, with only 62% of participants in 2023 reporting receipt of at least one dose, compared to 73% in 2014. The decline was observed across all age groups and was particularly low among people aged 25 years and under and in people who started injecting drugs in the past 3 years (33% and 40% respectively in 2023). The decline suggests that PWID remain at risk of HBV infection and is of concern as vaccination is the cornerstone of HBV prevention and control.

Sharing and re-use of injecting equipment reached its highest levels in a decade in 2023. Direct needle and syringe sharing rose to 25%, up from 17% in 2014, while sharing of needles, syringes, and other paraphernalia increased to 44% from 38% in 2014.

Direct sharing remained consistently higher among female participants and notably increased in the aged 25 to 34 years group over the past decade.

In 2023, heroin remained the most injected drug among PWID, with 90% reporting its use in the past month. Crack cocaine was the second most common at 53%, down from a peak of 60% in 2018 but up from 40% in 2014. Other forms of cocaine injection rose to 33% in 2023, compared to 7.6% in 2014. In contrast, amphetamine injection continued to decline, from 24% in 2014 to 7.7% in 2023.

In 2023, nearly a quarter of those who had injected drugs in the past year reported a non-fatal overdose, up from 17% in 2014. Naloxone carriage among participants increased to 66% in 2023 from 54% in 2017. Among those who overdosed, 60% reported naloxone administration, up from 45% in 2014 and similar to 2022.

Introduction

The UAM Survey of PWID aims to monitor the prevalence of HIV, HBV, and HCV infections, as well as associated risk and protective behaviours among PWID. People who have ever injected psychoactive drugs, such as heroin, crack cocaine and amphetamines, are recruited through specialist drug and alcohol agencies across EWNI (see the Methods section for more details).

This report presents an update on the latest UAM Survey, focusing on the description of trend data found in the annual data tables that accompany this report. Within these tables, UAM Survey data for 2014 to 2023 is presented for EWNI combined, as well as separately by country and regions of England.

Methods

The UAM Survey is an annual, cross-sectional, bio-behavioural survey that recruits PWID through specialist agencies within EWNI. These agencies provide a range of services to people who inject psychoactive drugs, from medical treatment to outreach work and needle and syringe programmes. People using these services, who are either currently injecting drugs or have done so previously, are asked to take part in the survey by service staff. Those who consent to take part in the survey provide a dried blood spot (DBS) sample that is tested for HIV, HBV and HCV infection or exposure.

Additionally, a brief anonymous self-completed questionnaire is administered to gather limited demographic and behavioural information. Participants retain the option to decline answering any questions. While the questions asked have varied over time, core questions have remained comparable. The characteristics of people who take part in the survey can vary between years and may be different to the wider population of PWID. Survey participants receive a £10 high street voucher in acknowledgement for their time.

The UAM Survey does not collect personal identifiers. Questionnaire data is linked to a corresponding DBS sample but unlinked from any client identifying information. This ensures that the questionnaire and specimen testing procedures are conducted anonymously. The co-ordination of the UAM Survey is overseen by the UK Health Security Agency (UKHSA), with support from Public Health Wales and the Public Health Agency for Northern Ireland.

Results

Recruitment

In 2023, 124 drug and alcohol services participated in the UAM Survey, compared to 117 services in 2022. The number of participants in the UAM Survey was 3,507, compared to 3,170 in 2022 (Appendix 1, Figure 1).

Figure 1. Map of drug and alcohol services participating in the UAM Survey, 2023

Demographics and environmental risk factors

The proportion of male participants in the 2023 UAM Survey was 74% (95% CI 73% to 76%) (see Data Table 1 in the accompanying spreadsheet).

Over the period 2014 to 2023, the median age of participants increased from aged 37 years in 2014 (age range 15 to 67 years; interquartile range (IQR) aged 32 to 43 years) to 44 years (age range 18 to 75 years; IQR aged 37 to 50 years) in 2023. Median age at first injection has remained stable over the same period (aged 21 years in 2014 and aged 22 years in 2023), which suggests that the increase in median age is a result of an ageing cohort of PWID, as opposed to new PWID who have started injecting at an older age.

The proportion of participants 25 years and under has also decreased over the same period from 5.8% (95% CI 5.0% to 6.6%) in 2014 to 1.4% (95% CI 1.0% to 1.8%) in 2023 (see Data Table 1 in the accompanying spreadsheet).

The proportion of UAM Survey participants who reported injecting drugs in the past year continues to decline from 70% (95% CI 69% to 72%) in 2014 to 57% (95% CI 56% to 59%) in 2023 (see Data Table 1 in the accompanying spreadsheet). This decline aligns with the trend observed in England.

Similarly, the proportion of UAM Survey participants who first injected drugs within the preceding 3 years continues to decline, from 8.2% (244 out of 2,973, 95% CI 7.2% to 9.3%) in 2014 to 5.7% (135 out of 2,385, 95% CI 4.8% to 6.7%) in 2023 (not included in the accompanying data tables).

Compared with the general population, PWID experience severe health inequities across a wide range of health conditions and service access. Homelessness and imprisonment have been associated with increased risk of HCV and bacterial infections, and recent release from prison has been associated with an increased risk of non-fatal overdose.

Approximately two-thirds (64%, 95% CI 62% to 65%) of UAM Survey participants in 2023 reported having ever being in prison, which is a decrease from 70% (95% CI, 68% to 71%) in 2014 (see Data Table 1 in the accompanying spreadsheet).

The proportion of participants reporting homelessness in the past year or current homelessness in 2023 was 41% (95% CI 39% to 43%). This is an increase from 34% (95% CI 32% to 36%) in 2014, but a decrease from previous peaks in 2018 (47%, 95% CI 45% to 49%) and 2020 (49%, 95% CI 47% to 52%) (see Data Table 1 in the accompanying spreadsheet).

Bloodborne viruses (BBVs)

HIV prevalence

Overall, the prevalence of HIV among participants in the UAM Survey has remained low over the past decade and was 1.0% in 2023 (95% CI 0.7% to 1.4%), compared to 1.0% (95% CI 0.7% to 1.4%) in 2014 (Figure 2; see Data Table 2 in the accompanying spreadsheet).

Figure 2. Prevalence of HIV, hepatitis B, and hepatitis C among participants in the UAM Survey of PWID, EWNI, 2014 to 2023

Shaded areas show 95% CI.

Source: UAM Survey of PWID.

Note 1. Denotes the proportion of participants who tested positive for the presence of HCV antibodies, expressed as a percentage.

Note 2. Denotes the proportion of participants who tested positive for antibodies to HBV core antigen, expressed as a percentage.

Note 3. Denotes the proportion of participants who tested positive for antibodies to HIV, expressed as a percentage.

Hepatitis B prevalence

The prevalence of anti-HBc, a marker of ever being infected with HBV, has declined to 7.7% (95% CI 6.8% to 8.6%) in 2023 from 14% (95% CI 13% to 16%) in 2014. This figure has remained stable since 2022, where anti-HBc prevalence was 7.8% (95% CI 6.9% to 8.8%) (Figure 2; see Data Table 3 in the accompanying spreadsheet).

DBS samples are also tested for HBsAg, a marker of current HBV infection. In 2023, the proportion of people who were HBsAg positive among those with antibodies to HBc antigen was 5.8% (95% CI 3.3% to 9.4%), compared to 4.2% (95% CI 2.5% to 6.5%) in 2014 (see Data Table 3 in the accompanying spreadsheet). Of all PWID surveyed in 2023, the proportion who were currently living with hepatitis B was 0.44% (15/3,398, 95% CI, 0.25% to 0.73%) (not included in the accompanying data tables).

Hepatitis C prevalence

The most important risk factor for HCV infection in the UK continues to be injecting drug use.

The proportion of UAM Survey participants in EWNI with evidence of ever being infected with HCV (antibodies to HCV) has remained relatively stable over the past decade. In 2023, this prevalence was 53% (95% CI 51% to 55%), comparable with the 49% (95% CI 47% to 51%) reported in 2014 (Figure 2; see Data Table 4 in the accompanying spreadsheet). This relatively stable prevalence is reflective of ongoing new infections, which are associated with long-term injecting use, and an ageing population, with people who have HCV antibodies living longer as they are treated for chronic HCV. HCV antibody prevalence consistently remains higher among older participants compared to younger ones (see Data Table 4 in the accompanying spreadsheet).

As most new HCV infections are acquired via injecting drug use, the detection of HCV antibodies in a person who has recently started injecting drugs (within the last 3 years) is indicative of a new HCV infection associated with that behaviour. Over the past 5 survey years, the proportion of recent injectors with HCV antibodies has steadily decreased, from 33% (95% CI 26% to 39%) in 2018 to 22% (95% CI 15% to 30%) in 2023 (Figure 3; see Data Table 13 in the accompanying spreadsheet). This downward trend in prevalence of people who recently started injecting could suggest a decline in incidence of HCV in this sub-group of PWID. However, it should be noted that the small sample size has resulted in imprecise 95% CIs and there is not yet clear evidence of a decline.

Figure 3. Prevalence of antibodies to HCV among people who recently started injecting [note 4], EWNI, 2014 to 2023

Vertical lines show 95% CI.

Source: UAM Survey of PWID.

Note 4. People who recently started injecting are defined as PWID who commenced injecting drugs within the 3 years prior to their participation in the UAM Survey.

Note 5. During 2020 and 2021, recruitment to the UAM Survey was impacted by the COVID-19 pandemic. As a result, there were changes in the geographic and demographic profile of people taking part. This should be considered when interpreting data for these years. Due to small numbers, data for 2020 and 2021 are combined.

Chronic HCV prevalence

Chronic HCV infection is indicated by a positive test for HCV RNA in addition to HCV antibodies. Some samples were of insufficient quality for RNA testing (2.7% of HCV antibody positive samples in 2023). Therefore, to estimate the proportion of cleared and chronic infections across all antibody positive samples, adjusted estimates have been produced. This has been calculated by applying the ratio of chronic to cleared infections to the HCV antibody positive samples with missing RNA status by year and geographical region (Figure 4).

Over the last decade, the prevalence of chronic HCV infection among PWID has substantially declined, particularly since 2017. The proportion of participants with evidence of chronic HCV infection dropped from 26% in 2017 (95% CI 24% to 28%) to 12% in 2022 (95% CI 11% to 13%) and further to 7.8% in 2023 (95% CI 6.9% to 8.7%) (see Data Table 4 in the accompanying spreadsheet). The decline in chronic HCV infection from 2017 onwards corresponds with the scale-up of DAA treatment for HCV among PWID. Alongside this, the proportion of participants with evidence of cleared infection has increased, rising from 27% in 2017 (95% CI 25% to 29%) to 45% in 2023 (95% CI 43% to 47%) (Figure 4). The combined reduction in chronic HCV prevalence and rise in cleared infections underscore the impact of DAA treatment.

Figure 4. Trend in HCV prevalence among people injecting psychoactive drugs in the UAM Survey of PWID, EWNI, 2014 to 2023 [note 6]

Vertical lines show 95% CI.

Source: UAM Survey of PWID.

Note 6. Retrospective analysis of HCV RNA (to 2016) was performed as part of the EPIToPE study, funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (Grant Reference Number RP-PG-0616-20008). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. 

Uptake of interventions and services

Hepatitis B vaccination

PWID face a heightened risk of acquiring HBV, making vaccination advisable for those who currently inject drugs, those who are likely to start injecting and their close contacts. The UAM Survey collects information on self-reported uptake of HBV vaccine (Figure 5; see Data Table 7 in the accompanying spreadsheet). Self-reported uptake of at least one dose of the HBV vaccine among survey participants has declined over the last decade from 73% in 2014 (95% CI 71% to 74%) to 62% (95% CI 60% to 64%) in 2023. The decline was observed across all age groups, but self-reported HBV vaccine uptake was particularly low in people aged 25 years and under (see Data Table 7 in the accompanying spreadsheet) and people who first injected within the preceding 3 years (see Data Table 13 in the accompanying spreadsheet). However, the number of people aged 25 years and under as well as people who recently started injecting participating in the UAM Survey are small (and declining) and should be interpreted cautiously.

Figure 5. Uptake of hepatitis B vaccination, and of hepatitis C and HIV testing in the current or previous year, among participants in the UAM Survey of PWID, EWNI, 2014 to 2023

Source: UAM Survey of PWID.

HIV testing

The proportion of respondents who self-reported HIV testing has increased over the past decade. In 2023, 81% (95% CI 80% to 83%) of PWID reported ever being tested for HIV, and 39% (95% CI 38% to 41%) reported being tested in the current or previous year. In 2014, the figures were 77% (95% CI 76% to 79%) and 32% (95% CI 30% to 33%), respectively (Figure 5, see Data Table 8 in the accompanying spreadsheet).

The proportion of participants with antibodies to HIV who were aware they were living with HIV was 84% (95% CI 67% to 95%) in 2023, a decrease from 100% in 2019 (see Data Table 8 in the accompanying spreadsheet). However, the numbers are very small and should be interpreted with caution. After accounting for those who had a diagnostic HIV or BBV test at the time of completing the survey, or participants who said they were awaiting their test result, 88% (28 out of 32, 95% CI 71% to 96%) were potentially aware of their infection (not included in data table).

HCV testing

The proportion of UAM Survey participants reporting ever being tested for HCV has increased over the last decade with 88% (95% CI 87% to 89%) reporting ever being tested for HCV in 2023, compared to 84% (95% CI 83% to 85%) in 2014 (Figure 5, see Data Table 9 in the accompanying spreadsheet). This data may not capture where people have been tested but were not aware of this happening, for example opt-out testing in emergency departments, hence this proportion may be underestimated.

The proportion of participants who reported being tested for HCV in the current or previous year increased from 36% in 2014 (95% CI 34% to 38%) to 47% in 2018 (95% CI 45% to 48%). Since then, it has remained relatively stable, reaching 49% in 2023 (95% CI 48% to 51%) (see Data Table 9 in the accompanying spreadsheet).

Awareness of HCV infection

Awareness of HCV infection is an important indicator of unmet testing and treatment needs. As treatment with DAAs is more widely available, people aware of their status are more likely to have been treated, while those who remain un- or under-tested are less likely to be aware of their status and as a result have unmet testing and treatment needs.

In 2023, 27% (95% CI 21% to 34%) of UAM Survey participants with chronic HCV infection reported that they were aware of their infection status, a decline in reported awareness since 2017 (51%, 95% CI 47% to 56%) (see Data Table 9 in the accompanying spreadsheet). This decline in awareness is expected, as the proportion of persons aware of their infection decreases over time as those previously diagnosed and aware of their status are successfully treated and cured.

Diagnostic BBV testing is frequently offered by participating drug and alcohol services alongside the UAM Survey, with respondents likely to receive their results shortly after completion of the survey. Therefore, the proportion aware of their chronic infection is likely an underestimate.

Among UAM Survey participants with chronic HCV who were unaware of their infection in 2023, 39% reported receiving an HCV or BBV diagnostic test at the time of completing the survey (59 out of 150, 95% CI 31% to 48%), compared to 38% in 2022 (68 out of 178, 95% CI 31% to 46%) (not included in the accompanying data tables).

After accounting for participants who either had a diagnostic HCV or BBV test at the time of completing the survey, or participants who said they were awaiting their test result, 60% were aware or potentially aware of their chronic infection in 2023 (131 out of 217, 95% CI 54% to 67%), compared to 66% in 2022 (181 out of 275, 95% CI 60% to 71%) (not included in the accompanying data tables). Among those who remained unaware of their chronic infection, 63% (51 out of 81, 95% CI, 52% to 73%) reported injecting in the last 4 weeks and of these 55% (28 out of 51, 95% CI, 40% to 69%) reported that they had never been tested or that their last HCV test was more than 2 years ago (not included in the accompanying data tables). Of those who were unaware of their chronic infection, 77% (64 out of 83, 95% CI, 67% to 86%) had experienced homelessness and 77% (63 out of 82, 95% CI, 66% to 85%) had been in prison (not included in the accompanying data tables).

HCV care and treatment

Among UAM Survey participants in 2023 who tested positive for HCV antibodies and were aware of their infection, 71% (476 out of 667, 95% CI 68% to 75%) reported that they had seen a specialist nurse or doctor (hepatologist) for their HCV and had been offered and accepted treatment (not included in the accompanying data tables). This is an increase from 30% (152 out of 508, 95% CI 26% to 34%) in 2017 (not included in the accompanying data tables). Among this group, 6.9% (32 out of 467, 95% CI 4.7% to 9.5%) had a chronic HCV infection (not included in the accompanying data tables). This increase in HCV treatment uptake seen from 2017 onwards corresponds with the scale-up of DAA treatment for HCV among PWID.

In 2023, among participants who had ever had an HCV infection, were aware of their status and had ever seen a hepatitis nurse or doctor, 16% (95 out of 591, 95% CI 13% to 19%) reported having been infected with HCV more than once. The majority of those who reported having been infected with HCV more than once also reported that they had injected drugs in the past year (81%, 76 out of 94, 95% CI 71% to 88%), had ever experienced homelessness (92%, 87 out of 95, 95% CI 84% to 96%) and had ever been in prison (80%, 75 out of 94, 95% CI 70% to 87%) (not included in the accompanying data tables).

In 2023, 89% of participants who were offered and received treatment reported that they completed their most recent round of HCV treatment (392 out of 440, 95% CI 86% to 92%). Of these, 86% (320 out of 371, 95% CI 82% to 90%) reported a successful outcome (that treatment cleared HCV) (not included in the accompanying data tables). Among those who reported that they cleared their HCV, 3.5% (11 out of 314, 95% CI 1.8% to 6.2%) showed evidence of chronic HCV (not included in the accompanying data tables). This could be due to re-infections or infections not being successfully cleared.

Needle exchange use

The majority of PWID who took part in the UAM Survey in 2023 had ever accessed a needle exchange (84%, 95% CI 83% to 85%), compared to 82% (95% CI 81% to 83%) in 2022, a decline from 90% (95% CI 89% to 91%) in 2019 (see Data Table 1 in the accompanying spreadsheet). Among participants who reported injecting within the last 4 weeks, 95% had ever accessed a needle exchange (1,149 out of 1,210, 95% CI 94% to 96%), compared to 97% in 2019 (1,408 out of 1,451, 95% CI 96% to 98%) (not included in data tables).

Drug treatment

Engagement with drug treatment services was high, with over three quarters of survey participants reporting current engagement with treatment for their drug use (prescription of a detox or maintenance medicine) in 2023 (75%, 95% CI 73% to 76%), a proportion that is higher than seen in 2014 (72%, 95% CI 70% to 73%) (see Data Table 1 in the accompanying spreadsheet) and is a similar trend to other data sources in England.

Injecting risk behaviour

Injecting equipment sharing

Sharing and re-use of injecting equipment has increased in 2023. The level of needle and syringe (direct) sharing reported by survey participants who had injected during the preceding month (4 weeks) was 25% in 2023 (95% CI 23% to 28%), an increase from 17% in 2014 (95% CI 15% to 19%) (see Data Table 5 in the accompanying spreadsheet). Sharing of needle, syringe and other injecting paraphernalia like filters and spoons (direct and indirect sharing) also increased to 44% among individuals who had injected in the past month in 2023 (95% CI 41% to 47%), compared to 38% in 2014 (95% CI 36% to 41%) and 39% in 2022 (95% CI 36% to 42%) (see Data Table 6 the accompanying spreadsheet). These are the highest proportions for both direct and indirect sharing over the last 10 years.

Between 2014 and 2023, direct sharing was consistently higher among female participants compared to male participants (see Data Table 5 in the accompanying spreadsheet). There has also been a notable increase in direct sharing within the aged 25 to 34 years age group (Figure 6; see Data Table 5 in the accompanying spreadsheet).

Figure 6. Levels of needle and syringe sharing by age group among participants in the UAM Survey of PWID who had injected during the preceding 4 weeks, EWNI, 2014 to 2023

Source: UAM Survey of PWID.

Note 7. During 2020 and 2021, recruitment to the UAM Survey was impacted by the COVID-19 pandemic. As a result, there were changes in the geographic and demographic profile of people taking part. This should be considered when interpreting data for these years. Due to small numbers, data for 2020 and 2021 are combined.

Drug trends

Heroin remained the most commonly injected drug, reported by 90% of those who had injected in the preceding month in 2023 (95% CI 88% to 91%), with crack cocaine following at 53% (95% CI 50% to 56%) (see Data Table 1 in the accompanying spreadsheet). This is much higher than the proportion reporting crack cocaine injection in 2014 (40%, 95% CI 37% to 42%) but a decline since the peak in 2018 at 60%, (95% CI 57% to 62%) (see Data Table 1 in the accompanying spreadsheet; Figure 7). Crack cocaine injection is associated with behaviours known to increase the risk of BBVs as well as skin and soft tissue infections, including the sharing of injecting equipment, groin injection and higher injection frequency.

There was also an increase in the injection of other forms of cocaine among those who had injected in the preceding month; 33% in 2023 (95% CI 30% to 36%) versus 7.6% in 2014 (95% CI 6.3% to 9.0%) (see Data Table 1 in the accompanying spreadsheet; Figure 7). Cocaine injection has continued to increase in Northern Ireland, with 91% reporting powder cocaine injection in the last month (49 out of 54, 95% CI 80% to 97%), which may be reflective of the ongoing outbreak of HCV and HIV in the country (not included in the accompanying data tables).

The injection of amphetamine and amphetamine-type drugs among those who had injected drugs in the last month continued to decline from a high of 24% in 2014 (95% CI 22% to 26%) to 7.7% in 2023 (95% CI 6.3% to 9.3%), similar to the 2022 figure of 8.6% (95% CI 7.1% to 10%) (see Data Table 1 in the accompanying spreadsheet; Figure 7).

Figure 7. Levels of crack, amphetamines and cocaine injection among the participants in the UAM Survey of PWID who had injected during the preceding 4 weeks, EWNI, 2014 to 2023

Source: UAM Survey of PWID.

Non-fatal overdose and naloxone use

Among 2023 UAM Survey participants who reported injecting during the preceding year, 26% reported having overdosed to the point of losing consciousness in the preceding year (95% CI 24% to 28%), an increase from 17% in 2014 (95% CI 16% to 19%) and similar to 2022 (24%, 95% CI 22% to 26%) (see Data Table 12 in the accompanying spreadsheet).

Naloxone is an opioid antagonist which can temporarily reverse the effects of an opioid overdose and is distributed to individuals who use drugs and their friends, family members, as well as various healthcare and other professionals who may encounter overdose situations. The proportion of participants who had injected in the last year and who reported carrying naloxone has increased from 54% in 2017 (95% CI 52% to 56%) to 66% in 2023 (95% CI 64% to 68%) (see Data Table 12 in the accompanying spreadsheet). 60% of those who reported overdosing in the preceding year reported having had naloxone administered (95% CI 55% to 65%), an increase from 45% (95% CI 40% to 51%) in 2014. This is similar to 2022 (58%, 95% CI 53% to 63%) (see Data Table 12 in the accompanying spreadsheet).

Appendix 1. Participating centres in 2023

North East England

• Change Grow Live, Gateshead Needle Exchange
• Change Grow Live, Newcastle
• County Durham Drug and Alcohol Recovery Service, Durham and North, Old Elvet
• County Durham Drug and Alcohol Recovery Service, Horde and Peterlee
• HepC Trust, Priestfields
• South Tyneside Adult Recovery Service, South Tyneside
• We Are With You, Redcar

North West England

• Achieve, Salford Recovery Service, Salford
• Achieve, Trafford
• Achieve, Bury
• Calico, Blackburn
• Change Grow Live, Bootle
• Change Grow Live, East Lancashire
• Change Grow Live, Halton, Widnes and Runcorn
• Change Grow Live, Inspire, Pendle
• Change Grow Live, Inspire, Preston
• Change Grow Live, Lancaster and Morecambe
• Change Grow Live, Manchester, Bradnor Point
• Change Grow Live, Outreach Team
• Change Grow Live, Southport
• Change Grow Live, St. Helens
• Change Grow Live, Tameside
• HepC Trust, Cumbria
• Inspire (CGL), Fleetwood
• Inspire (CGL), St. Annes

Yorkshire and Humber

• Barnsley Recovery Steps, Barnsley
• Calderdale Recovery Steps, Calderdale
• Change Grow Live, CHART Kirklees, Dewsbury
• Change Grow Live, CHART Kirklees, Huddersfield
• Change Grow Live, Rotherham
• East Riding Partnership, Bridlington
• East Riding Partnership, Goole
• East Riding Partnership, Hull
• Forward, Leeds
• HepC Trust, Yorkshire
• We Are With You, Grimsby

London

• Addiction Recovery Community Hillingdon, ARCH
• Better Lives, Islington
• Change Grow Live, Camden
• Change Grow Live, New Direction, Lewisham
• Kingston Wellbeing Service, Kingston upon Thames
• South London and Maudsley NHS Trust
• The Grove Treatment Service, Haringey
• Turning Point, Harrow Road
• Turning Point, Kensington and Chelsea
• Turning Point, Wardour Street
• Via, Greenwich
• Westminster Drug Project, Redbridge

East Midlands

• Change Grow Live, Nottinghamshire, County South (Hucknall)
• Change Grow Live, Nottinghamshire, Mansfield
• Change Grow Live, Nottinghamshire, Newark on Trent
• Change Grow Live, Nottinghamshire, Worksop
• Derbyshire NHS, Chesterfield
• Derbyshire NHS, Ilkeston
• Derbyshire NHS, Ripley
• Derbyshire NHS, Swadlincote
• Health Shop, Nottingham
• We Are With You, Boston
• We Are With You, Grantham
• We Are With You, Lincoln

West Midlands

• Alcohol and Drug Services, Stoke-on-Trent
• Change Grow Live, Birmingham, Blucher Street
• Change Grow Live, Birmingham, Church Lane
• Change Grow Live, Birmingham, Griffins Brook Lane
• Change Grow Live, Birmingham, Hospital Street
• Change Grow Live, Birmingham, Shady Lane
• Change Grow Live, Coventry
• Change Grow Live, Nuneaton
• Change Grow Live, Rugby
• Change Grow Live, Warwickshire
• HepC Trust, Leicester
• Recovery Near You, Wolverhampton
• Telford Stars
• Turning Point, Herefordshire Recovery Service

East of England

• Change Grow Live, Great Yarmouth
• Change Grow Live, Norwich
• Change Grow Live, Spectrum, Hatfield
• Change Grow Live, Spectrum, Hertford
• Change Grow Live, Spectrum, Stevenage
• Change Grow Live, Watford
• Essex Specialist Treatment and Recovery Service, Basildon
• Essex Specialist Treatment And Recovery Service, Chelmsford
• Essex Specialist Treatment And Recovery Service, Colchester
• Essex Specialist Treatment And Recovery Service, Harlow
• The Forward Trust, Thurrock

South East England

• Change Grow Live, Reading
• Change Grow Live, Southampton
• HepC Trust, East Kent
• HepC Trust, West Kent
• Inclusion, Aldershot
• Inclusion, Aylesbury
• Inclusion, Hampshire
• Inclusion, Isle of Wight
• Inclusion, Wycombe
• Thames Valley ODN outreach
• Turning Point, Banbury
• Turning Point, Didcot
• Turning Point, Roads to Recovery, Oxford

South West England

• Avon Drug Problem Team, Bristol
• Bath and North East Somerset Drug and Alcohol Treatment Service, Midsummer Norton
• Bath and North East Somerset Drug and Alcohol Treatment Service, Bath City Centre
• Bath and North East Somerset Drug and Alcohol Treatment Service, Bath Homeless Service (Manvers Street Hostel)
• EDP Drug and Alcohol Services, Exeter Humankind
• Reach, Dorset, Gillingham
• Reach, Dorset, Weymouth and Dorchester
• Reach - Dorset, Wimborne
• Together Drug and Alcohol Service, North Devon and Torridge
• Together Drug and Alcohol Service, South and West Devon
• Torbay District Addictions Service, Shrublands
• Turning Point Impact, Salisbury
• Turning Point Somerset, Taunton
• Turning Point Somerset, Yeovil
• We Are With You, Bournemouth Engagement and Assessment Team, Bournemouth
• We Are With You, Poole
• We are with you, Truro
• Wiltshire Substance Misuse Service, Trowbridge

Northern Ireland

• Inclusion, Belfast
• Lough House Addiction Service, Newtownards
• Railway Community Addiction Service, Ballymena
• South Eastern Outreach Team, Simon Community
• Substitute Prescribing Team, Belfast

Wales

• Barod, Swansea
• Betsi Cadwaladr University Health Board, North Wales
• Cardiff On Site Dispensing Service, DaTT, Cardiff

Acknowledgements

We would like to thank all the staff of collaborating drug services, Hepatitis C Trust Peer teams, and participants in the UAM Survey of PWID.

Prepared by: Bennet Dugbazah, Eleanor Clarke, Helen Dwyer, Iman Amanour, Ugochi Inweregbu, Niamh Canning, Samreen Ijaz, Justin Shute, Ross Harris, Holly Mitchell, Monica Desai.

Suggested citation

UKHSA. UAM Survey of HIV and viral hepatitis among PWID, data to end of 2023. London: UKHSA. December 2024.