Hepatitis C virus (HCV) infection is the most commonly reported bloodborne infection in the United States, causing substantial morbidity and mortality and costing billions of dollars annually. To update the estimated HCV prevalence among all adults aged ≥18 years in the United States, we analyzed 2013‐2016 data from the National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of HCV in the noninstitutionalized civilian population and used a combination of literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for four additional populations: incarcerated people, unsheltered homeless people, active‐duty military personnel, and nursing home residents. We estimated that during 2013‐2016 1.7% (95% confidence interval [CI], 1.4‐2.0%) of all adults in the United States, approximately 4.1 (3.4‐4.9) million persons, were HCV antibody‐positive (indicating past or current infection) and that 1.0% (95% CI, 0.8‐1.1%) of all adults, approximately 2.4 (2.0‐2.8) million persons, were HCV RNA–positive (indicating current infection). This includes 3.7 million noninstitutionalized civilian adults in the United States with HCV antibodies and 2.1 million with HCV RNA and an estimated 0.38 million HCV antibody‐positive persons and 0.25 million HCV RNA–positive persons not part of the 2013‐2016 NHANES sampling frame. Conclusion: Over 2 million people in the United States had current HCV infection during 2013‐2016; compared to past estimates based on similar methodology, HCV antibody prevalence may have increased, while RNA prevalence may have decreased, likely reflecting the combination of the opioid crisis, curative treatment for HCV infection, and mortality among the HCV‐infected population; efforts on multiple fronts are needed to combat the evolving HCV epidemic, including increasing capacity for and access to HCV testing, linkage to care, and cure.

In poor, inner-city communities young smokers of crack cocaine, particularly women who have sex in exchange for money or drugs, are at high risk for HIV infection. Crack use promotes the heterosexual transmission of HIV.

OBJECTIVES: This study examines the relationship between sex trading and psychological distress and the implications of that relationship for prevention of human immunodeficiency virus among a sample of young women recruited from the streets of Harlem. METHODS: Interviews were conducted with 346 predominantly drug-using women, aged 18 to 29 years, of whom 176 had exchanged sex for money or drugs in the previous 30 days and were categorized as "sex traders." Psychological distress was measured by using the Brief Symptom Inventory. RESULTS: Sex traders scored significantly higher than non-sex traders on the General Severity Index and on eight of the nine subscales of the Brief Symptom Inventory. Multivariate analysis indicated that after adjustments were made for age; ethnicity; pregnancy; recent rape; perceived risk for acquired immunodeficiency syndrome; current, regular crack use; and current, regular alcohol use, sex traders scored 0.240 units higher on the General Severity Index than non-sex traders. CONCLUSIONS: Poor mental health and drug dependence may under-mine the motivation and ability of these sex traders to adopt safer sex behavior. Therefore, interventions need to be integrated with mental health services and drug treatment to reduce risk behavior in this population.

Tuberculosis (TB) is the most common opportunistic infection and the leading cause of death in persons infected with human immunodeficiency virus (HIV) worldwide. Because HIV is spreading in regions with the highest rates of Mycobacterium tuberculosis infection, HIV is responsible for an increasing proportion of the world's cases of TB. However, advances in molecular biology, clinical practice, and public health policy during the past 5 years offer reasons for hope. Molecular methods have provided insights into the epidemiology of M. tuberculosis transmission and the mechanisms of drug resistance. Rapid diagnostic tests have been developed to facilitate the diagnosis of TB. Retrospective and prospective studies have shown that TB in the HIV-infected person is highly treatable and often preventable. Moreover, directly observed therapy can decrease rates of treatment failure, relapse, drug resistance, and secondary spread. For two consecutive years, the incidence of TB in the United States has declined. Additional resources are needed, however, to achieve similar gains in the developing world.

Drug paraphernalia laws in 47 U.S. states make it illegal for injection drug users (IDUs) to possess syringes. It has been suggested that these laws lead to syringe sharing by deterring IDUs from carrying their own syringes. We examined the relationship between concern about arrest while carrying drug paraphernalia and injection-related risk behaviors among street-recruited IDUs in Northern California. In 1996, 424 10Us were interviewed, of whom 76 percent were African American, 36 percent were female, and 15 percent were HIV positive. Thirty-five percent (150) reported concern about being arrested while carrying drug paraphernalia. In multivariate analyses that controlled for potential confounders, IDUs concerned about being arrested were significantly more likely than other IDUs to share syringes (adjusted odds ratio [AOR] =2.28; 95 percent confidence interval [CI]=1.19, 4.34) and injection supplies (AOR= 3.23; 95 percent CI=2.03, 5.13). These data suggest that decriminalizing syringes and needles would likely result in reductions in the behaviors that expose IDUs to blood borne viruses.