Experts fear an HIV outbreak in Glasgow is out of control, with ten new cases already this year, and many of the drug users affected unable or unwilling to comply with treatment.

Prior to the outbreak in 2015, new cases of HIV were stable at 10 or fewer a year, but the same number have been infected in the first three months of 2017, bringing the total number diagnosed in a little over two years to 88 people.

The outbreak centres on a group of chaotic intravenous drug users who congregate in the city centre and tend to inject in public places - secretly, hurriedly and often sharing needles or other equipment.

The problem is believed to have been exacerbated by the use of the legal high Ethylphenidate - now banned - which has a shorter-lived effect than heroin, causing users to inject it twice as often. Public health experts in the city believe the outbreak adds urgency to plans for a pilot safer-injecting facility where addicts can take drugs safely under supervision and receive treatment.

Dr Emelia Crighton, vice chair of Glasgow Alcohol and Drugs Partnership, said: “Usually people who get HIV comply with treatment, no problem. But this group are not doing. We may manage to get some stable and get their viral load down for a spell but the next thing is they do not come any more.”

Attempts to educate and treat those diagnosed fall down because this population have chaotic lifestyles, characterised by poverty, homelessness and spells in and out of jail, she said. “We have tried lots of things to adapt treatments to their lifestyle, but the addiction is the main stumbling block.”

Initiatives include wider access to needle exchanges, changing the design of needles to discourage sharing, encouraging people to smoke rather than inject drugs, and dispensing HIV treatment in the community rather than expecting people to attend clinics. The limited success of these has led directly to the push for a ‘shooting gallery’ where chaotic city centre users can inject more safely.

Dr Crighton added: “There is always a concern about the outbreak spreading. So far luckily we have not seen it anywhere outwith this group.” However the outbreak is believed to be spreading via sexual transmission as well as through IV drug use, she said.

Prospects are bleak for those who cannot engage with treatment while the cost to the NHS will be around £32m for those currently diagnosed - who are expected to need treatment costing an average £360,800 each, over their lifetime. “Sooner or later this will progress to Aids. But there is nowadays no reason to end up that way. Addiction is simply ruining these people’s lives - nothing comes between them and the hit,” Dr Crighton said.

David Liddell, director of Scottish Drugs Forum said anecdotal evidence suggested cocaine use by members of the affected group may have contributed to the HIV outbreak, with users needing to inject more frequently than when they took heroin because the effects of cocaine are shorter-lived.  “We can’t be sure with any confidence that the outbreak is at an end," he said. "Given the transient nature of the population we are talking about, a further spread has to be a concern.”