HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002

National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY 10010, USA.
Journal of Urban Health (Impact Factor: 1.9). 11/2008; 86(1):132-54. DOI: 10.1007/s11524-008-9328-1
Source: PubMed


This research presents estimates of HIV prevalence rates among injection drug users (IDUs) in large US metropolitan statistical areas (MSAs) during 1992-2002. Trend data on HIV prevalence rates in geographic areas over time are important for research on determinants of changes in HIV among IDUs. Such data also provide a foundation for the design and implementation of structural interventions for preventing the spread of HIV among IDUs. Our estimates of HIV prevalence rates among IDUs in 96 US MSAs during 1992-2002 are derived from four independent sets of data: (1) research-based HIV prevalence rate estimates; (2) Centers for Disease Control and Prevention Voluntary HIV Counseling and Testing data (CDC CTS); (3) data on the number of people living with AIDS compiled by the CDC (PLWAs); and (4) estimates of HIV prevalence in the US. From these, we calculated two independent sets of estimates: (1) calculating CTS-based Method (CBM) using regression adjustments to CDC CTS; and (2) calculating the PLWA-based Method (PBM) by taking the ratio of the number of injectors living with HIV to the numbers of injectors living in the MSA. We take the mean of CBM and PBM to calculate over all HIV prevalence rates for 1992-2002. We evaluated trends in IDU HIV prevalence rates by calculating estimated annual percentage changes (EAPCs) for each MSA. During 1992-2002, HIV prevalence rates declined in 85 (88.5%) of the 96 MSAs, with EAPCs ranging from -12.9% to -2.1% (mean EAPC=-6.5%; p<0.01). Across the 96 MSAs, collectively, the annual mean HIV prevalence rate declined from 11.2% in 1992 to 6.2 in 2002 (EAPC, -6.4%; p<0.01). Similarly, the median HIV prevalence rate declined from 8.1% to 4.4% (EAPC, -6.5%; p<0.01). The maximum HIV prevalence rate across the 11 years declined from 43.5% to 22.8% (EAPC, -6.7%; p<0.01). Declining HIV prevalence rates may reflect high continuing mortality among infected IDUs, as well as primary HIV prevention for non-infected IDUs and self-protection efforts by them. These results warrant further research into the population dynamics of disease progression, access to health services, and the effects of HIV prevention interventions for IDUs.

Download full-text


Available from: Charles M Cleland
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Injection drug use (IDU) continues to be a significant public health issue in the U.S. and internationally, and there is evidence to suggest that the burden of injection drug use and associated morbidity and mortality falls disproportionately on minority communities. IDU is responsible for a significant portion of new and existing HIV/AIDS cases in many parts of the world. In the U.S., the prevalence of HIV and hepatitis C virus is higher among populations of African-American and Latino injection drug users (IDUs) than among white IDUs. Methadone maintenance therapy (MMT) has been demonstrated to effectively reduce opiate use, HIV risk behaviors and transmission, general mortality and criminal behavior, but opiate-dependent minorities are less likely to access MMT than whites. A better understanding of the obstacles minority IDUs face accessing treatment is needed to engage racial and ethnic disparities in IDU as well as drug-related morbidity and mortality. In this study, we explore knowledge, attitudes and beliefs about methadone among 53 out-of-treatment Latino and African-American IDUs in Providence, RI. Our findings suggest that negative perceptions of methadone persist among racial and ethnic minority IDUs in Providence, including beliefs that methadone is detrimental to health and that people should attempt to discontinue methadone treatment. Additional potential obstacles to entering methadone therapy include cost and the difficulty of regularly attending a methadone clinic as well as the belief that an individual on MMT is not abstinent from drugs. Substance use researchers and treatment professionals should engage minority communities, particularly Latino communities, in order to better understand the treatment needs of a diverse population, develop culturally appropriate MMT programs, and raise awareness of the benefits of MMT.
    Full-text · Article · Mar 2009 · International Journal of Environmental Research and Public Health
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Population-based HIV incidence, prevalence, and mortality rates among men who have sex with men (MSM) have been unavailable, limiting assessment of racial/ethnic disparities and epidemic dynamics. Using estimated numbers of MSM aged >or=18 years by race/ethnicity as denominators, from models in our prior work, we estimated MSM HIV prevalence and mortality rates for 2006-2007 and HIV incidence rates for 2006 in Florida. Overall, the estimated MSM HIV prevalence rates per 100,000 MSM were 7354.8 (2006), and 7758.3 (2007). With white MSM as the referent, MSM HIV prevalence rate ratios (RRs) equaled 3.7 for blacks in 2006 and 3.6 in 2007 and 1.7 for Hispanics in both years (all P < 0.001). Among all MSM with HIV, the mortality rates were 199.8 (2006) and 188.4 (2007), with RRs of 5.4 for blacks in 2006 and 4.9 in 2007, and 1.6 for Hispanics in 2006 and 1.4 in 2007 (all P < 0.001). In 2006, the estimated HIV incidence rate among all MSM was 656.1 per 100,000 MSM, with RRs of 5.5 (blacks) and 2.0 (Hispanics) (both P < 0.001). A sensitivity analysis indicated that error due to misclassification of minority MSM as males who are not MSM lowered rates and RRs for all the 3 indicators but racial/ethnic disparities persisted (all P < 0.001). The impact of HIV by each measure was greater on black and Hispanic MSM than on white MSM. Quantifying estimates of HIV incidence, HIV prevalence, and mortality rates among MSM with HIV informs HIV surveillance, prevention, treatment, resource allocation, and community mobilization.
    Full-text · Article · Feb 2010 · JAIDS Journal of Acquired Immune Deficiency Syndromes
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Increased natural killer (NK) activation has been associated with resistance to HIV-1 infection in several cohorts of HIV-1 exposed, uninfected individuals. Inheritance of protective NK receptor alleles (KIR3DS1 and KIR3DL1) has also been observed in a subset of HIV-1 exposed, uninfected individuals. However, the exact mechanism contributing to NK activation in HIV-1 exposed, uninfected intravenous drug users (EU-IDU) remains to be elucidated. We investigated the role of both host genotype and pathogen-induced dendritic cell modulation of NK activation during high-risk activity in a cohort of 15 EU-IDU individuals and 15 control, uninfected donors from Philadelphia. We assessed the activation status of NK cells and dendritic cells by flow cytometry and utilized functional assays of NK-DC cross-talk to characterize the innate immune compartment in EU-IDU individuals. As previously reported, NK cell activation (CD69) and/or degranulation (CD107a) was significantly increased in EU-IDU individuals compared with control uninfected donors (P = 0.0056, n = 13). Genotypic analysis indicated that the frequency of protective KIR (KIR3DS1) and HLA-Bw4*80I ligands was not enriched in our cohort of EU-IDU individuals. Rather, plasmacytoid dendritic cells (PDC) from EU-IDU exhibited heightened maturation (CD83) compared with control uninfected donors (P = 0.0011, n = 12). When stimulated in vitro, both PDCs and NK cells from EU-IDU individuals maintained strong effector cell function and did not exhibit signs of exhaustion. Increased maturation of PDCs is associated with heightened NK activation in EU-IDU individuals suggesting that both members of the innate compartment may contribute to resistance from HIV-1 infection in EU-IDU.
    Full-text · Article · Sep 2010 · AIDS (London, England)
Show more