Journal of Urban Health

, 86:132

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


    • National Development and Research Institutes
  • Spencer Lieb
    • Florida Department of HealthBureau of HIV/AIDS
  • Charles M. Cleland
    • National Development and Research Institutes
  • Hannah Cooper
    • Rollins School of Public Health at Emory University
  • Joanne E. Brady
    • National Development and Research Institutes
  • Samuel R. Friedman
    • National Development and Research Institutes
    • Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins University

DOI: 10.1007/s11524-008-9328-1

Cite this article as:
Tempalski, B., Lieb, S., Cleland, C.M. et al. J Urban Health (2009) 86: 132. doi:10.1007/s11524-008-9328-1


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.


Injection drug usersHIV prevalence ratesHIV trends over timePLWAMetropolitan statistical areas

Supplementary material

11524_2008_9328_MOESM1_ESM.pdf (138 kb)
AppendixHIV Research Articles for Estimating HIV Prevalence Rates Among Injection Drug Users 1992-2002 (by MSA and Year) (PDF 141kb)

Copyright information

© The New York Academy of Medicine 2008