Abstract
This study compared HIV sero-prevalence and risk behaviors between younger and older injecting drug users (IDUs). IDUs aged ≥18 years were interviewed for the 2009 National HIV Behavioral Surveillance System. Using GEE regression, we assessed characteristics of younger (18–29 years) and older (≥30 years) IDUs, and factors associated with past 12-month receptive syringe sharing and unprotected sex (vaginal/anal). Of 10,090 participants, 10 % were younger. HIV sero-prevalence was lower among younger than older IDUs (4 vs. 10 %, p = 0.001). Younger IDUs were more likely (p ≤ 0.002) to be non-black race/ethnicity, report higher household income, homelessness, being arrested and to engage in receptive syringe sharing and unprotected sex. In multivariable models, age remained associated (p < 0.001) with receptive syringe sharing (aPR = 1.14, 95 % CI1.07–1.22) and unprotected sex (aPR = 1.10, 95 % CI1.06–1.14). Although younger IDUs had lower HIV prevalence, their behaviors place them at increased risk of HIV infection and could lead to a rapid spread in this susceptible population.
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References
CDC. Estimated HIV Incidence in the United States, 2007–2010. HIV surveill suppl rep 2012; 17 (4).
CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV HIV surveill suppl rep 2012; 17 (3, part A).
Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300(5):520–9.
Cooper H, Friedman SR, Tempalski B, Friedman R, Keem M. Racial/ethnic disparities in injection drug use in large US metropolitan areas. Ann Epidemiol. 2005;15(5):326–34.
Estrada AL. Health disparities among African-American and hispanic drug injectors—HIV, AIDS, hepatitis B virus and hepatitis C virus: a review. AIDS. 2005;19(Suppl 3):S47–52.
Des Jarlais DC, McCarty D, Vega WA, Bramson H. HIV infection among people who inject drugs: the challenge of racial/ethnic disparities. Am Psychol. 2013;68(4):274–85.
CDC. HIV infection and HIV-associated behaviors among injecting drug users—20 cities, United States, 2009. MMWR. 2012;61(8):133–8.
Fennema JS, Van Ameijden EJ, Van Den Hoek A, Coutinho RA. Young and recent-onset injecting drug users are at higher risk for HIV. Addict. 1997;92(11):1457–65.
Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T- lymphotropic viruses. Am J Public Health. 1996;86(5):655–61.
van Ameijden EJ, van den Hoek JA, Hartgers C, Coutinho RA. Risk factors for the transition from noninjection to injection drug use and accompanying AIDS risk behavior in a cohort of drug users. Am J Epidemiol. 1994;139(12):1153–63.
Nelson KE, Galai N, Safaeian M, Strathdee SA, Celentano DD, Vlahov D. Temporal trends in the incidence of human immunodeficiency virus infection and risk behavior among injection drug users in Baltimore, Maryland, 1988–1998. Am J Epidemiol. 2002;156(7):641–53.
Kral AH, Lorvick J, Edlin BR. Sex- and drug-related risk among populations of younger and older injection drug users in adjacent neighborhoods in San Francisco. J Acquir Immune Defic Syndr. 2000;24(2):162–7.
Hagan H, Des Jarlais DC, Stern R, et al. HCV synthesis project: preliminary analyses of HCV prevalence in relation to age and duration of injection. Int J Drug Policy. 2007;18(5):341–51.
Page K, Morris MD, Hahn JA, Maher L, Prins M. Injection drug use and hepatitis C virus infection in young adult injectors: using evidence to inform comprehensive prevention. Clin Infect Dis. 2013;57(Suppl 2):S32–8.
Doherty MC, Garfein RS, Monterroso E, Brown D, Vlahov D. Correlates of HIV infection among young adult short-term injection drug users. AIDS. 2000;14(6):717–26.
Rondinelli AJ, Ouellet LJ, Strathdee SA, et al. Young adult injection drug users in the United States continue to practice HIV risk behaviors. Drug Alcohol Depend. 2009;104(1–2):167–74.
Binswanger IA, Kral AH, Bluthenthal RN, Rybold DJ, Edlin BR. High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clin Infect Dis. 2000;30(3):579–81.
Broz D, Ouellet LJ. Racial and ethnic changes in heroin injection in the United States: implications for the HIV/AIDS epidemic. Drug Alcohol Depend. 2008;94(1–3):221–33.
Garfein RS, Doherty MC, Monterroso ER, Thomas DL, Nelson K, Vlahov D. Prevalence and incidence of hepatitis C infection among young adult injection drug users. J Acquir Immune Defic Syndr. 1998;18(Suppl 1):S11–9.
Coyle SL, Needle RH, Normand J. Outreach-based HIV prevention for injecting drug users: a review of published outcome data. Public Health Rep. 1998;113(Suppl 1):19–30.
Choi KH, Coates TJ. Prevention of HIV infection. AIDS. 1994;8(10):1371–89.
Des Jarlais DC, Semaan S. HIV prevention research: cumulative knowledge or accumulating studies? an introduction to the HIV/AIDS prevention research synthesis project supplement. J Acquir Immune Defic Syndr. 2002;30(Suppl 1):S1–7.
Stimson G, Alldritt L, Dolan K, Donoghoe M. Preventing the spread of HIV in injecting drug users–the experience of syringe-exchange schemes in England and Scotland. NIDA Res Monogr. 1988;90:302–10.
Chitwood DD, Mccoy CB, Comerford M, Kitner K. The prevalence and incidence of HIV among injection drug users: a five year panel study. popul res Policy Rev. 1999;18:39–53.
Des Jarlais DC, Perlis T, Arasteh K, et al. HIV Incidence among injection drug users in New York City, 1990 to 2002: use of Serologic Test Algorithm to assess expansion of HIV prevention services. Am J Public Health. 2005;95(8):1439–44.
Ouellet LJ, Thorpe LE, Huo D, et al. Prevalence and incidence of HIV among out-of-treatment injecting drug users, Chicago 1994-1996. J Acquir Immune Defic Syndr. 2000;25(5):443–50.
Hahn JA, Evans JL, Davidson PJ, Lum PJ, Page K. Hepatitis C virus risk behaviors within the partnerships of young injecting drug users. Addiction. 2010;105(7):1254–64.
Page K, Hahn JA, Evans J, et al. Acute hepatitis C virus infection in young adult injection drug users: a prospective study of incident infection, resolution, and reinfection. J Infect Dis. 2009;200(8):1216–26.
CDC. Use of enhanced surveillance for hepatitis C virus infection to detect a cluster among young injection-drug users—new York, November 2004-April 2007. MMWR. 2008;57(19):517–21.
CDC. Notes from the field : hepatitis C virus infections among young adults—rural Wisconsin, 2010. MMWR. 2012;61(19):358.
CDC. Hepatitis C virus infection among adolescents and young adults-Massachusetts, 2002-2009. MMWR. 2011; 60(17).
Tempalski B, Pouget ER, Cleland CM, et al. Trends in the population prevalence of people who inject drugs in US metropolitan areas 1992-2007. PLoS ONE. 2013;8(6):e64789.
Gallagher KM, Sullivan PS, Lansky A, Onorato IM. Behavioral surveillance among people at risk for HIV infection in the U.S.: the National HIV Behavioral Surveillance System. Public Health Rep. 2007;122(Suppl 1):32–8.
Lansky A, Abdul-Quader AS, Cribbin M, et al. Developing an HIV behavioral surveillance system for injecting drug users: the National HIV Behavioral Surveillance System. Public Health Rep. 2007;122(Suppl 1):48–55.
CDC. HIV Surveillance Report, 2010; vol 22. 2012. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Accessed May 2, 2012.
Allen DR, Finlayson T, Abdul-Quader A, Lansky A. The role of formative research in the National HIV Behavioral Surveillance System. Public Health Rep. 2009;124(1):26–33.
Heckathorn D. Respondent-driven sampling: a new approach to the study of hidden population. Soc Probl. 1997;44(2):174–99.
Le Marchand C, Evans J, Page K, Davidson PJ, Hahn JA. Hazardous alcohol consumption among young adult IDU and its association with high risk behaviors. Drug Alcohol Depend. 2013;127(1–3):143–9.
HHS. The 2009 HHS Federal Poverty Guidelines. U.S. Department of Health and Human Service (HHS), Federal Register, Vol. 74, No. 14, 2009, 4199–4201. http://aspe.hhs.gov/poverty/09poverty.shtml. Accessed June 26, 2012.
U.S. Census Bureau, Geographic Division. Geographic Terms and Concepts - Census Divisions and Census Regions. http://www.census.gov/geo/reference/gtc/gtc_census_divreg.html. Accessed February 26, 2013.
Heckathorn DD. Extensions of Respondent-Driven Sampling: analyzing continuous variables and controlling for differential recruitment. Sociol Method. 2007;34:193–239.
Gile KJ. Improved inference for respondent-driven sampling data with application to HIV prevalence estimation. J Am Stat Assoc. 2011;106(493):135–46.
Gile KJ, Handcock MS. Network model-assisted inference from respondent-driven sampling data. arXiv:1108.0298. 2011.
Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42(1):121–30.
Wagner KD, Pollini RA, Patterson TL, et al. Cross-border drug injection relationships among injection drug users in Tijuana, Mexico. Drug Alcohol Depend. 2011;113(2–3):236–41.
Frost SD, Brouwer KC, Firestone Cruz MA, et al. Respondent-driven sampling of injection drug users in two U.S.-Mexico border cities: recruitment dynamics and impact on estimates of HIV and syphilis prevalence. J Urban Health. 2006;83(6 Suppl):i83–97.
Szwarcwald CL, De Souza Junior PR, Damacena GN, Junior AB, Kendall C. Analysis of data collected by RDS among sex workers in 10 Brazilian cities, 2009: estimation of the prevalence of HIV, variance, and design effect. J Acquir Immune Defic Syndr. 2011;57(Suppl 3):S129–35.
Skov T, Deddens J, Petersen MR, Endahl L. Prevalence proportion ratios: estimation and hypothesis testing. Int J Epidemiol. 1998;27(1):91–5.
Strathdee SA, Galai N, Safaiean M, et al. Sex differences in risk factors for HIV seroconversion among injection drug users: a 10-year perspective. Arch Intern Med. 2001;161(10):1281–8.
Becker Buxton M, Vlahov D, Strathdee SA, et al. Association between injection practices and duration of injection among recently initiated injection drug users. Drug and alcohol dependence. 2004;75(2):177–83.
Cassin S, Geoghegan T, Cox G. Young injectors: a comparative analysis of risk behaviour. Ir J Med Sci. 1998;167(4):234–7.
Miller CL, Johnston C, Spittal PM, et al. Opportunities for prevention: hepatitis C prevalence and incidence in a cohort of young injection drug users. Hepatology. 2002;36(3):737–42.
Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001;357(9266):1397–401.
Des Jarlais DC, Arasteh K, McKnight C, Hagan H, Perlman DC, Semaan S. Associations between herpes simplex virus type 2 and HCV With HIV among injecting drug users in New York City: the current importance of sexual transmission of HIV. Am J Public Health. 2011;101(7):1277–83.
Dolan KA, Niven H. A review of HIV prevention among young injecting drug users: a guide for researchers. Harm reduct j. 2005;2(1):5.
Novelli LA, Sherman SG, Havens JR, Strathdee SA, Sapun M. Circumstances surrounding the first injection experience and their association with future syringe sharing behaviors in young urban injection drug users. Drug Alcohol Depend. 2005;77(3):303–9.
Nelson KE, Vlahov D, Solomon L, Cohn S, Muñoz A. Temporal trends of incident human immunodeficiency virus infection in a cohort of injecting drug users in Baltimore, MD. Arch Intern Med. 1995;155:1305–11.
Des Jarlais DC, Perlis T, Friedman SR, et al. Declining seroprevalence in a very large HIV epidemic: injecting drug users in New York City, 1991 to 1996. Am J Public Health. 1998;88(12):1801–6.
Carneiro M, Fuller C, Doherty MC, Vlahov D. HIV prevalence and risk behaviors among new initiates into injection drug use over the age of 40 years old. Drug Alcohol Depend. 1999;54(1):83–6.
Kleinman PH, Goldsmith DS, Friedman SR, Hopkins W. Des Jarlais DC. Knowledge about and behaviors affecting the spread of AIDS: a street survey of intravenous drug users and their associates in New York City. Int J Addict. 1990;25(4):345–61.
O’Sullivan LF, Udell W, Patel VL. Young urban adults’ heterosexual risk encounters and perceived risk and safety: a structured diary study. J Sex Res. 2006;43(4):343–51.
Bailey SL, Ouellet LJ, Mackesy-Amiti ME, et al. Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young adult injection drug users in five U.S. cities. Drug Alcohol Depend. 2007;91(Suppl 1):S18–29.
Galea S, Vlahov D. Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration. Public Health Rep. 2002;117(Suppl 1):S135–45.
Coady MH, Latka MH, Thiede H, et al. Housing status and associated differences in HIV risk behaviors among young injection drug users (IDUs). AIDS Beh. 2007;11(6):854–63.
Wood E, Li K, Small W, Montaner JS, Schechter MT, Kerr T. Recent incarceration independently associated with syringe sharing by injection drug users. Public Health Rep. 2005;120(2):150–6.
Koblin BA, Chesney MA, Husnik MJ, et al. High-risk behaviors among men who have sex with men in 6 US cities: baseline data from the EXPLORE study. Am J Public Health. 2003;93(6):926–32.
Williams LA, Klausner JD, Whittington WL, Handsfield HH, Celum C, Holmes KK. Elimination and reintroduction of primary and secondary syphilis. Am J Public Health. 1999;89(7):1093–7.
CDC. Increases in unsafe sex and rectal gonorrhea among men who have sex with men, San Francisco, 1994-1997. MMWR. 1999; 48(3).
Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS ONE. 2011;6(8):e17502.
Johnson BD, Golub A. Generational trends in heroin use and injection in New York City. In: Musto DF, editor. One hundred years of heroin. Westport: Auburn House of Greenwood; 2002. p. 92–128.
Johnson BD, Williams T, Kojo AD, Sanabria H. Drug abuse in the inner city: impact on hard-drug users and the community. In: Tonry M, Wilson JQ, editors. Drug and crime (crime and justice: a review of research, 13). Chicago: University of chicago press; 1990. p. 9–67.
Hunt LB, Chambers CD. The Heroin Epidemics. A study of Heroin Use in the United States, 1965-1975. New York: NY: Spectrum; 1976.
CDC. HIV infection among injection-drug users—34 States, 2004–2007. MMWR. 2009;58(46):1291–5.
Johnson BD, Thomas G, Golub A. Trends in heroin use among Manhattan arrestees from the heroin and crack eras. In: Inciardi JA, Harrison LD, editors. Heroin in the Age of Crack Cocaine. Thousand Oaks: Sage; 1998. p. 109–30.
Boyle JM, Brunswick AF. What happened in Harlem? analysis of a decline in heroin use among a generation unit of urban black youth. J Drug Issues. 1980;10(1):109–30.
Des Jarlais DC, Friedman SR, Perlis T, et al. Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City. J Acquir Immune Defic Syndr Hum Retrovirol. 1999;20(1):67–72.
Fuller CM, Vlahov D, Ompad DC, Shah N, Arria A, Strathdee SA. High-risk behaviors associated with transition from illicit non-injection to injection drug use among adolescent and young adult drug users: a case-control study. Drug Alcohol Depend. 2002;66(2):189–98.
Garfein RS, Golub ET, Greenberg AE, et al. A peer-education intervention to reduce injection risk behaviors for HIV and hepatitis C virus infection in young injection drug users. AIDS. 2007;21(14):1923–32.
Neaigus A, Friedman SR, Jose B, et al. High-risk personal networks and syringe sharing as risk factors for HIV infection among new drug users. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;11:499–509.
Des Jarlais DC, Perlis T, Arasteh K, et al. Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990–2001. AIDS. 2005;19(Supplement 3):S20–5.
Pouget ER, Deren S, Fuller CM, et al. Receptive syringe sharing among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program. JAIDS. 2005;39(4):471–7.
Huo D, Ouellet LJ. Needle exchange and sexual risk behaviors among a cohort of injection drug users in Chicago, Illinois. Sex Transm Dis. 2009;36(1):35–40.
Huo D, Ouellet LJ. Needle exchange and injection-related risk behaviors in Chicago: a longitudinal study. J Acquir Immune Defic Syndr. 2007;45(1):108–14.
Donoghoe MC, Verster A, Pervilhac C, Williams P. Setting targets for universal access to HIV prevention, treatment and care for injecting drug users (IDUs): towards consensus and improved guidance. Int J Drug Policy. 2008;19(Suppl 1):S5–14.
Degenhardt L, Mathers B, Vickerman P, Rhodes T, Latkin C, Hickman M. Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. Lancet. 2010;376(9737):285–301.
CDC. Public health and injection drug use. MMWR. 2001;50(19):377–99.
Thorpe LE, Bailey SL, Huo D, Monterroso ER, Ouellet LJ. Injection-related risk behaviors in young urban and suburban injection drug users in Chicago (1997–1999). J Acquir Immune Defic Syndr. 2001;27(1):71–8.
CDC. Innovative CDC Effort Expands HIV Testing into Pharmacies. Press release: June 26, 2012. http://www.cdc.gov/nchhstp/newsroom/NHTDPressRelease2012.html. Accessed February 20, 2013.
Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. 2006;55(RR-14):1–17.
Dowling-Guyer S, Johnson ME, Fisher DG, et al. Reliability of drug users’ self-reported HIV risk behaviors and validity of self-reported recent drug use. Assessment. 1994;1(4):383–92.
Rhodes T, Stimson GV, Crofts N, Ball A, Dehne K, Khodakevich L. Drug injecting, rapid HIV spread, and the ‘risk environment’: implications for assessment and response. AIDS. 1999;13(Suppl A):S259–69.
Crawford ND, Vlahov D. Progress in HIV reduction and prevention among injection and noninjection drug users. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S84–7.
Academy of educational development. A comprehensive approach: preventing blood-borne infections among injection drug users. 2000. http://www.cdc.gov/idu/pubs/ca/comprehensive-approach.pdf. Accessed April 9, 2013.
CDC. Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary of guidance from CDC and the U.S. department of health and human services. MMWR. 2012;61(5):1–43.
Sacks-Davis R, Horyniak D, Grebely J, Hellard M. Behavioural interventions for preventing hepatitis C infection in people who inject drugs: a global systematic review. Int J Drug Policy. 2012;23(3):176–84.
Latkin CA, Sherman S, Knowlton A. HIV prevention among drug users: outcome of a network-oriented peer outreach intervention. Health Psychol. 2003;22(4):332–9.
Latka MH, Hagan H, Kapadia F, et al. A randomized intervention trial to reduce the lending of used injection equipment among injection drug users infected with hepatitis C. Am J Public Health. 2008;98(5):853–61.
Mackesy-Amiti ME, Finnegan L, Ouellet LJ, et al. Peer-education intervention to reduce injection risk behaviors benefits high-risk young injection drug users: a latent transition analysis of the CIDUS 3/DUIT Study. AIDS Beh. 2012;17(6):2075–83.
Vlahov D, Fuller CM, Ompad DC, Galea S, Des Jarlais DC. Updating the infection risk reduction hierarchy: preventing transition into injection. J Urban Health. 2004;81(1):14–9.
Chatterjee S, Tempalski B, Pouget ER, Cooper HL, Cleland CM, Friedman SR. Changes in the prevalence of injection drug use among adolescents and young adults in large U.S. metropolitan areas. AIDS Beh. 2011;15(7):1570–8.
Young AM, Havens JR. Transition from first illicit drug use to first injection drug use among rural Appalachian drug users: a cross-sectional comparison and retrospective survival analysis. Addiction. 2012;107(3):587–96.
Grau LE, Dasgupta N, Harvey AP, et al. Illicit use of opioids: is OxyContin a “gateway drug”? The American journal on addictions/American Academy of Psychiatrists in Alcoholism and Addictions. 2007;16(3):166–73.
Acknowledgments
This work was supported by the Division of HIV/AIDS Prevention at the CDC. The authors would like to thank Joseph Prejean and all reviewers for helpful comments on the manuscript. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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This study was conducted for the NHBS study group
The members of this NHBS study group are listed in appendix
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The NHBS Study Group includes to following members: Atlanta, GA: Jennifer Taussig, Shacara Johnson, Jeff Todd; Baltimore, MD: Colin Flynn, Danielle German; Boston, MA: Debbie Isenberg, Maura Driscoll, Elizabeth Hurwitz; Chicago, IL: Nikhil Prachand, Nanette Benbow; Dallas, TX: Sharon Melville, Richard Yeager, Jim Dyer, Alicia Novoa; Denver, CO: Mark Thrun, Alia Al-Tayyib; Detroit, MI: Emily Higgins, Eve Mokotoff, Vivian Griffin; Houston, TX: Aaron Sayegh, Jan Risser, Hafeez Rehman; Los Angeles, CA: Trista Bingham, Ekow Kwa Sey; Miami, FL: Lisa Metsch, David Forrest, Dano Beck, Gabriel Cardenas; Nassau-Suffolk, NY: Chris Nemeth, Lou Smith, Carol-Ann Watson; New Orleans, LA: William T. Robinson, DeAnn Gruber, Narquis Barak; New York City, NY: Alan Neaigus, Samuel Jenness, Travis Wendel, Camila Gelpi-Acosta, Holly Hagan; Newark, NJ: Henry Godette, Barbara Bolden, Sally D’Errico; Philadelphia, PA: Kathleen A. Brady, Althea Kirkland, Mark Shpaner; San Diego, CA: Vanessa Miguelino-Keasling, Al Velasco; San Francisco, CA: H. Fisher Raymond; San Juan, PR: Sandra Miranda De León, Yadira Rolón-Colón; Seattle, WA: Maria Courogen, Hanne Thiede, Richard Burt; St Louis, MO: Michael Herbert, Yelena Friedberg, Dale Wrigley, Jacob Fisher; Washington, DC: Marie Sansone, Tiffany West-Ojo, Manya Magnus, Irene Kuo; Behavioral Surveillance Team
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Broz, D., Pham, H., Spiller, M. et al. Prevalence of HIV Infection and Risk Behaviors Among Younger and Older Injecting Drug Users in the United States, 2009. AIDS Behav 18 (Suppl 3), 284–296 (2014). https://doi.org/10.1007/s10461-013-0660-4
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DOI: https://doi.org/10.1007/s10461-013-0660-4