Needle and syringe sharing among people who inject drugs has climbed to its highest level in ten years. That is the headline finding from new figures published by the UK Health Security Agency (UKHSA).

The data comes from the 2024 Unlinked Anonymous Monitoring (UAM) Survey of HIV and viral hepatitis among people who inject drugs. UKHSA updated the report on 12 August 2026, with figures covering the period up to the end of 2023. Public Health Wales and the Public Health Agency for Northern Ireland supported the work. The annual survey recruits participants through more than a hundred specialist drug and alcohol services across England, Wales and Northern Ireland.

The Scale of Needle and Syringe Sharing

In 2023, 3,507 people took part in the survey. Direct sharing of injecting equipment, meaning needles and syringes passed between users, rose to 25 percent. That is up from 17 percent in 2014. Count other paraphernalia such as filters and spoons too, and sharing of injecting equipment reached 44 percent, compared with 38 percent a decade earlier. Both figures are the highest recorded in the survey’s ten year history.

The rise was not spread evenly. Women have consistently reported higher rates of needle and syringe sharing than men throughout the past decade. The survey also flagged a marked increase among those aged 25 to 34. Every shared needle carries a real risk of passing on hepatitis C, hepatitis B or HIV. That is precisely why the upward trend has drawn concern from public health officials.

Hepatitis C Cases Are Falling, but Awareness Is Slipping

There is genuine progress buried in the numbers. Chronic hepatitis C infection, meaning an active infection rather than one the body has cleared, dropped sharply from 26 percent of participants in 2017 to just 7.8 percent in 2023. That decline tracks closely with the wider rollout of direct acting antiviral treatment, a medicine that can cure most people within weeks.

Yet awareness told a different story. Only 27 percent of those with a chronic infection in 2023 knew they had it. That figure stood at 51 percent back in 2017. UKHSA points to a simple explanation. As more people are cured, those still carrying the infection make up a growing share of the undiagnosed group. Even so, the human picture behind that statistic is stark. Among those unaware of their infection, 77 percent had experienced homelessness and 77 percent had been in prison. Bloodborne virus risk, it seems, is tightly bound up with social instability, not drug use alone.

Hepatitis C antibodies, a marker of past infection, showed up in 53 percent of participants overall. That is little changed from 49 percent in 2014. The figure stays stubbornly high because new infections keep occurring even as older cases get cured, a pattern the report links directly to ongoing needle and syringe sharing.

Vaccination Uptake Is Going the Wrong Direction

Hepatitis B tells a more worrying story about prevention. Just 62 percent of participants in 2023 reported having had at least one dose of the hepatitis B vaccine. That is down from 73 percent in 2014. The decline was sharpest among the youngest injectors. Only 33 percent of those aged 25 and under said they had been vaccinated. Among people who had started injecting within the past three years, uptake stood at just 40 percent.

Vaccination remains the single most effective tool against hepatitis B, a virus still detected as a marker of past infection in 7.7 percent of participants. This falling uptake among the youngest and newest injectors is one of the clearest warning signs in the whole report. It points to a widening gap in early intervention at exactly the moment people are most vulnerable to settling into long term injecting habits.

HIV Remains Rare, but Testing Gaps Persist

HIV prevalence has stayed low and stable. It sat at 1 percent in 2023, unchanged from 2014. Testing uptake has improved over the decade. In 2023, 81 percent of participants said they had ever been tested for HIV, and 88 percent for hepatitis C. Both figures are up on 2014. Still, the survey found real gaps. Services keep missing chances for testing and prompt diagnosis, particularly among people cycling through homelessness and prison.

An Ageing Population, Still at Risk

The survey paints a picture of an ageing cohort. Median age among participants rose from 37 in 2014 to 44 in 2023. Meanwhile, the share of participants aged 25 and under fell from 5.8 percent to just 1.4 percent. Heroin remained the most commonly injected drug, used by 90 percent of recent injectors. Injection of crack cocaine and other forms of cocaine has risen substantially since 2014. Amphetamine injection, by contrast, has continued to decline.

Non fatal overdose has also climbed. Twenty six percent of people who had injected in the past year reported a non fatal overdose, up from 17 percent in 2014. Naloxone carriage has climbed too, reported by 66 percent of past year injectors in 2023, up from 54 percent in 2017, though this has not stopped overdose rates from growing.

Why Prevention Still Matters Most

Three quarters of survey participants reported current engagement with drug treatment. Needle exchange access remains widespread too. Yet the rise in needle and syringe sharing shows that service access alone has not reversed risky injecting behaviour.

The figures point to a simple truth that bears repeating. Stopping injecting drug use from starting in the first place remains the surest way to prevent hepatitis C, hepatitis B and HIV transmission. This matters most for young people and anyone newly exposed to injecting.

Hepatitis B vaccination is falling fastest among the youngest and most recently initiated injectors. Sharing of injecting equipment is at its highest point in a decade. Together, these trends make a strong case for renewed investment in early intervention, education and treatment pathways that tackle the root causes of drug use, rather than only managing its consequences.

Source: dbrecoveryresources