Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City: a new stage in a very large HIV epidemic

Cornell University, Итак, New York, United States
AIDS (Impact Factor: 5.55). 02/2007; 21(2):231-5. DOI: 10.1097/QAD.0b013e3280114a15
Source: PubMed


To compare HIV prevalence among injecting and non-injecting heroin and cocaine users in New York City. As HIV is efficiently transmitted through the sharing of drug-injecting equipment, HIV infection has historically been higher among injecting drug users.
Two separate cross-sectional surveys, both with HIV counseling and testing and drug use and HIV risk behavior questionnaires.
Injecting and non-injecting heroin and cocaine users recruited at detoxification and methadone maintenance treatment from 2001-2004 (n = 2121) and recruited through respondent-driven sampling from a research storefront in 2004 (n = 448).
In both studies, HIV prevalence was nearly identical among current injectors (injected in the last 6 months) and heroin and cocaine users who had never injected: 13% [95% confidence interval (CI), 12-15%] among current injectors and 12% (95% CI, 9-16%) among never-injectors in the drug treatment program study, and 15% (95% CI, 11-19%) among current injectors and 17% (95% CI, 12-21%) among never injectors in the respondent driven sampling storefront study. The 95% CIs overlapped in all gender and race/ethnicity subgroup comparisons of HIV prevalence in both studies.
The very large HIV epidemic among drug users in New York City appears to be entering a new phase, in which sexual transmission is of increasing importance. Additional prevention programs are needed to address this transition.

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    • "Available global estimates on the numbers of ATS and cocaine users show high burden (Degenhardt & Hall, 2012) and ATS use appears to be rising in many countries including some in South America, East and South East Asia (Dargan & Wood, 2012). HIV prevalence is also high among persons who use non-injection drugs (Strathdee & Stockman, 2010) and studies in New York City have shown that HIV prevalence among injecting and non-injecting heroin and cocaine users were similar (Des Jarlais et al., 2007). The principal risk for HIV transmission among non-injection substance users is from high risk sexual behaviours and both cocaine and ATS can increase sexual arousal and promote risky sex (El-Bassel, Shaw, Dasgupta, & Strathdee, 2014a; Shoptaw et al., 2013; Strathdee & Stockman, 2010). "
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    ABSTRACT: Background: Women who use drugs, irrespective of whether these are injected or not, are faced with multiple issues which enhance their vulnerability to HIV. Methods: In this commentary, we explore the HIV risks and vulnerabilities of women who use drugs as well as the interventions that have been shown to reduce their susceptibility to HIV infection. Results: Women who inject drugs are among the most vulnerable to HIV through both unsafe injections and unprotected sex. They are also among the most hidden affected populations, as they are more stigmatized than their male counterparts. Many sell sex to finance their own and their partner's drug habit and often their partner exerts a significant amount of control over their sex work, condom use and injection practices. Women who use drugs all over the world face many different barriers to HIV service access including police harassment, judgmental health personnel and a fear of losing their children. Conclusion: In order to enable these women to access life-saving services including needle-syringe and condom programs, opioid substitution therapy and HIV testing and treatment, it is essential to create a conducive environment and provide tailor-made services that are adapted to their specific needs.
    International Journal of Drug Policy 09/2014; 26. DOI:10.1016/j.drugpo.2014.09.003 · 2.40 Impact Factor
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    • "(H.L. Mills). et al., 2002, 1998; Des Jarlais et al., 2007; Johnston et al., 2008; Malekinejad et al., 2008; Robinson et al., 2006). RDS works as follows: a number of individuals (seeds) are recruited at random from the population. "
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    ABSTRACT: Background Respondent Driven Sampling (RDS) is a network or chain sampling method designed to access individuals from hard-to-reach populations such as people who inject drugs (PWID). RDS surveys are used to monitor behaviour and infection occurence over time; these estimations require adjusting to account for over-sampling of individuals with many contacts. Adjustment is done based on individuals’ reported total number of contacts, assuming these are correct. Methods Data on the number of contacts (degrees) of individuals sampled in two RDS surveys in Bristol, UK, show larger numbers of individuals reporting numbers of contacts in multiples of 5 and 10 than would be expected at random. To mimic these patterns we generate contact networks and explore different methods of mis-reporting degrees. We simulate RDS surveys and explore the sensitivity of adjusted estimates to these different methods. Results We find that inaccurate reporting of degrees can cause large and variable bias in estimates of prevalence or incidence. Our simulations imply that paired RDS surveys could over- or under-estimate any change in prevalence by as much as 25%. These are particularly sensitive to inaccuracies in the degree estimates of individuals with who have low degree. Conclusions There is a substantial risk of bias in estimates from RDS if degrees are not correctly reported. This is particularly important when analysing consecutive RDS samples to assess trends in population prevalence and behaviour. RDS questionnaires should be refined to obtain high resolution degree information, particularly from low-degree individuals. Additionally, larger sample sizes can reduce uncertainty in estimates.
    Drug and Alcohol Dependence 06/2014; 142(100). DOI:10.1016/j.drugalcdep.2014.06.015 · 3.42 Impact Factor
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    • "(E.J. Edelman). can occur either through the sharing of drug-injecting equipment or sexual risk behaviors (Des Jarlais et al., 2007; Strathdee and Stockman, 2010). Established interventions for HIV prevention for these populations and their partners include needle and syringe exchange programs; condoms; and expanded combination antiretroviral therapy for HIV-infected individuals (Marshall and Wood, 2010). "
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    ABSTRACT: Background Opioid dependence is a major risk factor for HIV infection, however, the impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected opioid-dependent patients is unknown. Methods We conducted a longitudinal analysis of 303 HIV-infected opioid-dependent patients initiating buprenorphine/naloxone treatment. Outcomes included self-reported past 90-day needle-sharing and non-condom use. We assessed trends over the 12 months using the Cochran-Armitage trend test. Using Generalized Estimating Equations, after multiple imputation, we determined factors independently associated with needle-sharing and non-condom use, including time-updated variables. We then conducted a mediation analysis to determine whether substance use explained the relationship between time since treatment initiation and needle-sharing. Results Needle-sharing decreased from baseline to the fourth quarter following initiation of buprenorphine/naloxone (9% vs. 3%, p < 0.001), while non-condom use did not (23% vs. 21%, p = 0.10). HIV risk behaviors did not vary based on the presence of a detectable HIV-1 RNA viral load. Patients who were homeless and used heroin, cocaine/amphetamines or marijuana were more likely to report needle-sharing. Heroin use fully mediated the relationship between time since treatment initiation and needle-sharing. Women, patients who identified as being gay/lesbian/bisexual, those married or living with a partner and who reported heroin or alcohol use were more likely to report non-condom use. Older patients were less likely to report non-condom use. Conclusions While buprenorphine/naloxone is associated with decreased needle-sharing among HIV-infected opioid-dependent patients, sexual risk behaviors persist regardless of viral load. Targeted interventions to address HIV risk behaviors among HIV-infected opioid-dependent populations receiving buprenorphine/naloxone are needed.
    Drug and alcohol dependence 06/2014; 139. DOI:10.1016/j.drugalcdep.2014.03.006 · 3.42 Impact Factor
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