HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002
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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.
KeywordsInjection drug users HIV prevalence rates HIV trends over time PLWA Metropolitan statistical areas
This project was supported by the National Institute of Drug Abuse (R01 DA13336; Community Vulnerability and Response to IDU-Related HIV).
We would like to thank Dr. Peter L. Flom, Daniel R. Thompson and Enrique Pouget for their statistical advice and Dr. David Holtgrave for his insight regarding the PLWHA data. We further thank the Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, specifically Michael Fanning, David Hurst and Renee R. Stein for providing the HIV Counseling & Testing data and Andrew Mitsch from the CDC’s HIV Incidence and Case Surveillance Branch for providing PLWA data for which these analyses are based. We also thank Ms. Makini Booth for assembling the research on HIV prevalence studies and related literature reviews for which the research estimates are based.
We would further like to thank the following State and Local Health Departments and researchers for their assistance:
Alabama: Anthony Merriweather
Florida: Melinda Waters, Marlene LaLota, Lorene Maddox
Hawaii: Don C. Des Jarlais, Roy Ohye, Peter, M. Whiticar
Kansas: Jennifer VandeVelde, Karl V. Milhon
Massachusetts: Drew Hanchett, Deborah Isenberg, Teresa Anderson
New Mexico: Andrew Gans, Kathleen Rooney, Lily N. Foster, Bruce G. Trigg
New York: Mara San Antonio-Gaddy, Punkin Stevens, Daniel O’Connell, Thomas Chesnut
Pennsylvania: Kenneth McGarvey, Benjamin Muthambi, Brenda Doucette
Puerto Rico: José Toro-Alfonso, Rafaela R. Robles, Sherry Deren
Virginia: Chris Delcher, Jeff Stover, Jennifer Bissette, Theresa Henry
Washington: Frank Chaffee, Hanne Thiede, Leslie Pringle, Keith Okita, Michael Hanrahan, Mark Doescher
- 1.Brown BS, Beschner GM. Handbook on Risk of AIDS: Injection Drug Users and Sexual Partners. Westport, CT: Greenwood; 1993.Google Scholar
- 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.Stimson GV, Des Jarlais DC, Ball A. Drug Injecting and HIV Infection: Global Dimensions and Local Responses. London: UCL; 1998.Google Scholar
- 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
- 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.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.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.
- 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.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.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
- 29.Office of Management and Budget. Standards for defining metropolitan and micropolitan statistical areas. Fed Regist. 2000;65:8228–82238.Google Scholar
- 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
- 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.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.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
- 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
- 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.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
- 49.Federal Bureau of Investigation. US Uniform Crime Reporting Program Data: County-Level Detailed Arrest and Offense Data. 1992–2002.Google Scholar
- 50.United States Census Bureau. United States Census Annual Surveys of Government Finances. 1992.Google Scholar
- 51.United States Census Bureau. United States Census Annual Surveys of Government Finances. 1997.Google Scholar
- 52.United States Census Bureau. United States Census Annual Surveys of Government Finances. 2002.Google Scholar
- 58.United States Census Bureau. Housing and Household Economic Statistics Division. Poverty Index; 2000.Google Scholar
- 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.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.SAS Institute. SAS/STAT® 9.1 User’s Guide. Cary, NC: SAS Institute; 2004.Google Scholar
- 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.
- 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