Journal of Urban Health

, 86:132

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

  • Barbara Tempalski
  • Spencer Lieb
  • Charles M. Cleland
  • Hannah Cooper
  • Joanne E. Brady
  • Samuel R. Friedman
Article

Abstract

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.

Keywords

Injection drug users HIV prevalence rates HIV trends over time PLWA Metropolitan 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)

References

  1. 1.
    Brown BS, Beschner GM. Handbook on Risk of AIDS: Injection Drug Users and Sexual Partners. Westport, CT: Greenwood; 1993.Google Scholar
  2. 2.
    Friedman SR, Jose B, Deren S, Des Jarlais DC, Neaigus A. Risk factors for HIV seroconversion among out-of-treatment drug injectors in high- and low-seroprevalence cities. Am J Epidemiol. 1995;142:864–874.PubMedGoogle Scholar
  3. 3.
    Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programs for prevention of HIV infection. Lancet. 1997;21:1797–800. doi:10.1016/S0140-6736(96)11380-5.CrossRefGoogle Scholar
  4. 4.
    Kral AH, Bluthenthal RN, Booth RE, Watters JK. HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities. Am J Public Health. 1998;88:108–113.PubMedCrossRefGoogle Scholar
  5. 5.
    Malliori M, Zunzunegui MV, Rodriguez-Arenas A, Goldberg D. Drug injecting and HIV-1 infection: major findings from a multi-city study. In: Stimson GV, Des Jarlais DC, Ball A, eds. Drug Injecting and HIV Infection: Global Dimensions and Local Responses. London: Taylor and Francis; 1998.Google Scholar
  6. 6.
    Stimson GV, Des Jarlais DC, Ball A. Drug Injecting and HIV Infection: Global Dimensions and Local Responses. London: UCL; 1998.Google Scholar
  7. 7.
    Bluthenthal RN, Malik MR, Grau LE, Singer M, Marshall P, Heimer R. Sterile syringe access conditions and variations in HIV risk among drug injectors in three cities. Soc Study Addict. 2004;99:1136–1146. doi:10.1111/j.1360-0443.2004.00694.x.CrossRefGoogle Scholar
  8. 8.
    Ciccarone D, Bourgois P. Explaining the geographic variation of HIV among injection drug users in the United States. Subst Use Misuse. 2003;38:2049–63. doi:10.1081/JA-120025125.PubMedCrossRefGoogle Scholar
  9. 9.
    Kral AH, Page-Shafer K, Kellogg T, et al. Persistent HIV incidence among injection drug users in San Francisco during the 1990s: results of five studies. J Acquir Immune Defic Syndr. 2004;37:1667–1669. doi:10.1097/00126334-200412150-00025.PubMedGoogle Scholar
  10. 10.
    MacDonald M, Law M, Kaldor J, Hales J, Dore G. Effectiveness of needle and syringe programmes for preventing HIV transmission. Int J Drug Policy. 2003;14:351–352. doi:10.1016/S0955-3959(03)00133-6.CrossRefGoogle Scholar
  11. 11.
    Friedman SR, Des Jarlais DC. HIV among drug injectors: the epidemic and the response. AIDS Care. 1991;3:239–250. doi:10.1080/09540129108253069.PubMedCrossRefGoogle Scholar
  12. 12.
    Des Jarlais DC, Friedman SR, Novick DM, et al. HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987. JAMA. 1989;126:1008–1012. doi:10.1001/jama.261.7.1008.CrossRefGoogle Scholar
  13. 13.
    Novick DM, Trigg HL, Des Jarlais DC, Friedman SR, Vlahov D, Kreek MJ. Cocaine injection and ethnicity in parenteral drug users during the early years of the human immunodeficiency virus (HIV) epidemic in New York City. J Med Virol. 1989;29:181–185. doi:10.1002/jmv.1890290307.PubMedCrossRefGoogle Scholar
  14. 14.
    Wodak A, Crofts N, Fisher R. HIV infection among injecting drug users in Asia: an evolving public health crisis. AIDS Care. 1993;5:313–320. doi:10.1080/09540129308258614.PubMedCrossRefGoogle Scholar
  15. 15.
    Strathdee SA, Patrick DM, Currie SL, et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11:F59–65. doi:10.1097/00002030-199708000-00001.PubMedCrossRefGoogle Scholar
  16. 16.
    Tyndall MW, Currie S, Spittal P, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003;17:887–93. doi:10.1097/00002030-200304110-00014.PubMedCrossRefGoogle Scholar
  17. 17.
    Joint Assessment of HIV/AIDS Prevention. Treatment and Care in China. State Council HIV/AIDS Working Committee Office and UN Theme Group on HIV/AIDS in China. 2004.Google Scholar
  18. 18.
    Des Jarlais DC, Johnston P, Friedmann P, et al. Patterns of HIV prevalence among injecting drug users in the cross-border area of Lang Son Province, Vietnam, and Ning Ming County, Guangxi Province, China. BMC Public Health. 2005;5:89. http://www.biomedcentral.com/content/pdf/1471-2458-5-89.pdf. Accessed May 23, 2007. doi:10.1186/1471-2458-5-89.
  19. 19.
    Ohiri K, Claeson M, Razzaghi E, Nassirimanesh B, Afshar P, Power R. HIV/AIDS prevention among injection drug users: Learning from harm reduction in Iran. 2006. http://siteresources.worldbank.org/INTSAREGTOPHIVAIDS/Resources/LancetHarmReductionIran.pdf. Accessed Jan. 15, 2007.
  20. 20.
    Rhodes T, Platt L, Maximova S, et al. Prevalence of HIV, hepatitis C and syphilis among injecting drug users in Russia: a multi-city study. Addiction. 2006;101:252–266. doi:10.1111/j.1360-0443.2006.01317.x.PubMedCrossRefGoogle Scholar
  21. 21.
    Holmberg SD. The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. Am J Public Health. 1996;86:642–654.PubMedCrossRefGoogle Scholar
  22. 22.
    Friedman SR, Lieb S, Tempalski B, et al. HIV among injection drug users in large US metropolitan areas, 1998. J Urban Health. 2005;82:434–445. doi:10.1093/jurban/jti088.PubMedGoogle Scholar
  23. 23.
    Holtgrave DR. Estimation of annual HIV transmission rates in the United States, 1978–2000. J Acquir Immune Defic Syndr. 2004;35:89–92. doi:10.1097/00126334-200401010-00013.PubMedCrossRefGoogle Scholar
  24. 24.
    Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2004. Atlanta: US Department of Health and Human Services. Centers Dis Contr Prev 2005;16:1–46.Google Scholar
  25. 25.
    Centers for Disease Control and Prevention. HIV counseling and testing at CDC-supported sites—United States, 1999–2004. 2006. 1–33. http://www.cdc.gov/hiv/topics/testing/resources/reports/pdf/ctr04.pdf. Accessed July 2, 2008.
  26. 26.
    Centers for Disease Control and Prevention. Trends in HIV/AIDS diagnoses among men who have sex with men—33 states, 2001–2006. Morb Mort Wkly Rep. 2008;57:681–716.Google Scholar
  27. 27.
    Lieb S, Friedman SR, Zeni MB, et al. An HIV prevalence-based model for estimating urban risk-populations of injection drug users and men who have sex with men. J Urban Health. 2004;81:401–415. doi:10.1093/jurban/jth126.PubMedGoogle Scholar
  28. 28.
    Lieb S, Trepka MJ, Thompson DR, et al. Men who have sex with men: estimated population sizes and mortality rates, by race/ethnicity, Miami–Dade County, Florida. J Acquir Immune Defic Syndr. 2007;46:485–490.PubMedGoogle Scholar
  29. 29.
    Office of Management and Budget. Standards for defining metropolitan and micropolitan statistical areas. Fed Regist. 2000;65:8228–82238.Google Scholar
  30. 30.
    Brady JE, Friedman SR, Cooper HL, Flom PL, Tempalski B, Gostnell K. Estimating the prevalence of injection drug users in the US and in large US metropolitan areas from 1992 to 2002. J Urban Health. 2008;85:323–351. doi:10.1007/s11524-007-9248-5.PubMedCrossRefGoogle Scholar
  31. 31.
    Centers for Disease Control and Prevention. HIV/AIDS Surveillance Supplemental Report: AHIV/AIDS in Urban and Nonurban Area of the United States. Atlanta: US Department of Health and Human Services. Centers Dis Contr Prev 2000;6:1–15.Google Scholar
  32. 32.
    Cronk CE, Sarvela PD. Alcohol, tobacco, and other drug use among rural/small town and urban youth: A secondary analysis of the monitoring the future data set. Am J Public Health. 1997;80:760–764.CrossRefGoogle Scholar
  33. 33.
    Havens JR, Walker R, Leukefeld CG. Prevalence of opioid analgesic injection among rural nonmedical opioid analgesic users. Drug Alcohol Depend. 2007;87:98–102. doi:10.1016/j.drugalcdep.2006.07.008.PubMedCrossRefGoogle Scholar
  34. 34.
    Hutchison L, Blakely C. Substance Abuse Trends in Rural Areas. Rural Healthy People 2010: A companion document to Healthy People 2010. Volume 1. College Station, TX: The Texas AM University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center; 2003.Google Scholar
  35. 35.
    Kline A, Mammo A, Culleton R, et al. Trends in injection drug use among persons entering addiction treatment—New Jersey, 1992–1999. Morb Mort Wkly Rep. 2001;50:378–381.Google Scholar
  36. 36.
    Substance Abuse and Mental Health Services Administration, Office of Applied Studies. The NSDUH Report: Demographic and Geographic Variations in Injection Drug Use. Rockville, MD; 2007.Google Scholar
  37. 37.
    Steel E, Fleming PL, Needle R. The HIV rates of injection drug users in less-populated areas. Am J Public Health. 1993;83:286–287.PubMedCrossRefGoogle Scholar
  38. 38.
    Cleveland WS, Grosse E, Shyu WM. Local regression models. Chapter 8 of Statistical Models in Social Sciences. Chambers JM, Hastie TJ, eds. Brooks/Cole; 1992.Google Scholar
  39. 39.
    Friedman SR, Perlis T, Des Jarlais DC. Laws prohibiting over-the-counter syringe sales to injection drug users: relations to population density, HIV prevalence, and HIV incidence. Am J Public Health. 2001;91:791–793.PubMedCrossRefGoogle Scholar
  40. 40.
    Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing reliability. Psychol Bull. 1979;86:420–428. doi:10.1037/0033-2909.86.2.420.PubMedCrossRefGoogle Scholar
  41. 41.
    Friedman SR, Cooper HL, Tempalski B, et al. Relationships of deterrence and law enforcement to drug-related harms among drug injectors in US metropolitan areas. AIDS. 2006;20:93–99.PubMedGoogle Scholar
  42. 42.
    Bluthenthal RN, Kral AH, Erringer EA, Edlin BR. Drug paraphernalia laws and injection-related infectious disease risk among drug injectors. Drug Issues. 1999a;22:1–16.Google Scholar
  43. 43.
    Friedman SR, Perlis T, Lynch J, Des Jarlais DC. Economic inequality, poverty, and laws against syringe access as predictors of metropolitan area rates of drug injection and HIV infection. Proceedings of the Global Research Network Meeting, Durban, South Africa. July 2000.Google Scholar
  44. 44.
    Aitken C, Moore D, Higgs D, Kelsall J, Kerger M. The impact of a police crackdown on a street drug scene: evidence from the street. Int J Drug Policy. 2002;13:189–198. doi:10.1016/S0955-3959(02)00075-0.CrossRefGoogle Scholar
  45. 45.
    Bluthenthal RN, Lorvick J, Kral AH, Erringer EA, Kahn JG. Collateral damage in the war on drugs: HIV risk behaviors among injection drug users. Int J Drug Policy. 1999;10:25–38. doi:10.1016/S0955-3959(98)00076–0.CrossRefGoogle Scholar
  46. 46.
    Cooper H, Moore L, Gruskin S, Krieger N. The impact of a police drug crackdown on drug injectors’ ability to practice harm reduction: a qualitative study. Soc Sci Med. 2005;61:673–68. doi:10.1016/j.socscimed.2004.12.030.PubMedCrossRefGoogle Scholar
  47. 47.
    Maher L, Dixon D. Policing and public health: law enforcement and harm minimization in a street-level drug market. Br J Criminol. 1999;39:488–512. doi:10.1093/bjc/39.4.488.CrossRefGoogle Scholar
  48. 48.
    Rhodes T, Kimber J, Small W, et al. Public injecting and the need for ‘safer environment interventions’ in the reduction of drug-related harm. Addition. 2006;101:1384–1393. doi:10.1111/j.1360-0443.2006.01556.x.CrossRefGoogle Scholar
  49. 49.
    Federal Bureau of Investigation. US Uniform Crime Reporting Program Data: County-Level Detailed Arrest and Offense Data. 1992–2002.Google Scholar
  50. 50.
    United States Census Bureau. United States Census Annual Surveys of Government Finances. 1992.Google Scholar
  51. 51.
    United States Census Bureau. United States Census Annual Surveys of Government Finances. 1997.Google Scholar
  52. 52.
    United States Census Bureau. United States Census Annual Surveys of Government Finances. 2002.Google Scholar
  53. 53.
    Lynch JW, Smith GD, Harper S, et al. Income inequality a determinant of population health? Part 1. A systemic review. Milbank Q. 2004;82:5–99. doi:10.1111/j.0887-378X.2004.00302.x.PubMedCrossRefGoogle Scholar
  54. 54.
    Kaplan GA, Pamuk ER, Lynch JW, Cohen RD, Balfour JL. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996;312:999–1003.PubMedGoogle Scholar
  55. 55.
    Diez-Roux AV, Nieto FJ, Muntaner C, et al. Neighborhood environments and coronary heart disease: a multilevel analysis. Am J Epidemiol. 1997;146:48–63.PubMedGoogle Scholar
  56. 56.
    Diez-Roux AV, Nieto FJ, Caulfield L, Tyroler HA, Watson RL, Szklo M. Neighborhood differences in diet: the Atherosclerosis in Communities (ARIC) Study. J Epidemiol Community Health. 1999;53:55–63.PubMedCrossRefGoogle Scholar
  57. 57.
    Sanmartin C, Ross NA, Tremblay S, Wolfson M, Dunn JR, Lynch J. Labour market income inequality and mortality in North American metropolitan areas. J Epidemiol Community Health. 2003;57:792–797. doi:10.1136/jech.57.10.792.PubMedCrossRefGoogle Scholar
  58. 58.
    United States Census Bureau. Housing and Household Economic Statistics Division. Poverty Index; 2000.Google Scholar
  59. 59.
    Des Jarlais DC, Hagan H, Friedman SR, Ward TP. HIV among injecting drug users: epidemiology and emerging public health perspectives. In: Merigan TC Jr, Bartlett JG, Bolognesi D, eds. Textbook of AIDS Medicine, 2nd edn. Baltimore: Williams Wilkins; 1999.Google Scholar
  60. 60.
    Burris S, Vernick J, Ditzler A, Strathdee S. The legality of selling or giving syringes to injection drug users. In: Jones TS, Coffin PO, eds. Preventing blood-borne infections through pharmacy syringe sales and safe community syringe disposal. J Am Pharm Assoc 2002;42(Suppl. 2):S13–S17.Google Scholar
  61. 61.
    SAS Institute. SAS/STAT® 9.1 User’s Guide. Cary, NC: SAS Institute; 2004.Google Scholar
  62. 62.
    R Development Core Team. (2008). R: A language and environment for statistical computing. Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, URL http://www.R-project.org.
  63. 63.
    Des Jarlais D, Marmor M, Paone D, Titus S, Shi Q, Perlis T, et al. HIV incidence among syringe exchange participants in New York City. Lancet. 1996;348:987–991. doi:10.1016/S0140-6736(96)02536-6.PubMedCrossRefGoogle Scholar
  64. 64.
    Pouget ER, Deren S, Fuller C, et al. Receptive syringe sharing among injection drug users in Harlem and the Bronx during the New York State expanded syringe access program. J Acquir Immune Defic Syndr. 2005;39:471–477. doi:10.1097/01.qai.0000152395.82885.c0.PubMedCrossRefGoogle Scholar
  65. 65.
    Wood E, Hogg RS, Lima D, et al. Highly active antiretroviral therapy and survival in HIV-infected injection drug users. JAMA. 2008;300:550–554. doi:10.1001/jama.300.5.550.PubMedCrossRefGoogle Scholar
  66. 66.
    Morris JD, Golub ET, Mehta SH, Jacobson L, Gange SJ. Injection drug use and patterns of highly active antiretroviral therapy use: an analysis of ALIVE, WIHS, and MACS cohorts. AIDS Res Ther. 2007;4:1–8. doi:10.1186/1742-6405-4-12.CrossRefGoogle Scholar
  67. 67.
    Des Jarlais DC, Perlis TE, 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;88:1801–1806.PubMedCrossRefGoogle Scholar
  68. 68.
    Des Jarlais DC, Marmor M, Friedmann P, et al. HIV incidence among injection drug users in New York City, 1992–1997: evidence for a declining epidemic. Am J Public Health. 2000;90:352–359.PubMedCrossRefGoogle Scholar
  69. 69.
    Friedman SR, Curtis R, Neaigus A, Jose B, Des Jarlais DC. Social networks, drug injectors’ lives, and HIV/AIDS. New York: Kluwer/Plenum; 1999.Google Scholar
  70. 70.
    Morris M. Sexual networks and HIV. AIDS. 1997;11(Suppl A):S209–S216. doi:10.1097/00002030-199705000-00012.PubMedGoogle Scholar
  71. 71.
    Friedman SR, Tempalski B, Brady J, et al. Predictors of the degree of drug treatment coverage for injection drug users in 94 metropolitan areas in the United States. Int J Drug Policy. 2007;18:475–485. doi:10.1016/j.drugpo.2006.10.004.PubMedCrossRefGoogle Scholar
  72. 72.
    Tempalski B, Flom PL, Friedman SR, et al. Social and political factors predicting the presence of syringe exchange programs in 96 Metropolitan areas in the United States. Am J Public Health. 2007;97:437–447. doi:10.2105/AJPH.2005.065961.PubMedCrossRefGoogle Scholar
  73. 73.
    Tempalski B, Cooper H, Friedman SR, Des Jarlais DC, Brady J. Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug. Int J Drug Policy. 2008;19S:S47–S58. doi:10.1016/j.drugpo.2007.11.011.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2008

Authors and Affiliations

  • Barbara Tempalski
    • 1
  • Spencer Lieb
    • 2
  • Charles M. Cleland
    • 1
  • Hannah Cooper
    • 3
  • Joanne E. Brady
    • 1
  • Samuel R. Friedman
    • 1
    • 4
  1. 1.National Development and Research InstitutesNew YorkUSA
  2. 2.Florida Department of HealthBureau of HIV/AIDSTallahasseeUSA
  3. 3.Rollins School of Public Health at Emory UniversityAtlantaUSA
  4. 4.Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA

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