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

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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.

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Notes

  1. e.g., number of IDUS tested in 1992 N = 673; number tested in 1997 N = 88.

  2. Akron, OH; Charleston, SC; Gary, IN; Greenville, SC; Kansas City, KS; Minneapolis–St. Paul, MN-WI; Syracuse, NY; Ventura, CA; Youngstown, PA.

  3. Birmingham, AL; Little Rock, AR; Norfolk, VA; San Juan, PR; Wichita, KS.

  4. Albany-Schenectady, NY; Ann Arbor, MI; Atlanta, GA; Buffalo-Niagara Falls, NY; Nassau–Suffolk, NY; Providence–Fall River–Warwick, RI–MA; Rochester, NY.

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Acknowledgments

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

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Authors and Affiliations

  1. National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA

    Barbara Tempalski, Charles M. Cleland, Joanne E. Brady & Samuel R. Friedman

  2. Florida Department of Health, Bureau of HIV/AIDS, Tallahassee, FL, USA

    Spencer Lieb

  3. Rollins School of Public Health at Emory University, Atlanta, GA, USA

    Hannah Cooper

  4. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Samuel R. Friedman

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  1. Barbara Tempalski
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  2. Spencer Lieb
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  3. Charles M. Cleland
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  4. Hannah Cooper
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  5. Joanne E. Brady
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  6. Samuel R. Friedman
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Correspondence to Barbara Tempalski.

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Appendix

HIV Research Articles for Estimating HIV Prevalence Rates Among Injection Drug Users 1992-2002 (by MSA and Year) (PDF 141kb)

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Tempalski, B., Lieb, S., Cleland, C.M. et al. HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002. J Urban Health 86, 132–154 (2009). https://doi.org/10.1007/s11524-008-9328-1

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