Geographic distribution of risk (“Hotspots”) for HIV, HCV, and drug overdose among persons who use drugs in New York City: the importance of local history

Abstract

Aims To identify geographic “hotspots” for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city. Methods A total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses. Results Participants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn. Discussion Heroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.

Pakistan’s Opioid Squeeze: Impacts of Taliban Edicts, Indian Synthetics and Chinese Regulations

“…It is difficult for governments to provide appropriate harm reduction and treatment programmes without a precise accounting of the problem on the ground. Also, increased information on drug use and overdoses allows for an illumination of hotspot locations, which are geographic locations most at risk for drug penetration and HIV/ HCV transmission (Des Jarlais et al, 2019). With real-time and accurate data, officials can pinpoint problem locations for increased medical attention, intervention options, allocation of naloxone and fentanyl test strips, and publicly broadcast drug awareness alerts and related information.…”

Covid myths persist despite evidence to refute them

“…Among those who sought sex outside a normal partnership, there was a reduction in risky behaviour such as use of multiple partners and mouth‐to‐mouth kissing, especially among gay men 38,39 . With longer follow‐up, adaptive sexual behaviour and acceptance of vaccination among high‐risk individuals may have limited the transmission of HIV 40 . This is an interesting finding as vaccination is probably less effective in people living with HIV 41…”

Incentivizing Narcotics Control Through China’s Belt and Road Initiative in South and Southeast Asia

“…Without accurate statistical measures, officials may incorrectly assess the number of harm reduction and rehabilitation services required to address drug-related issues. Moreover, detailed data on drug use and overdoses enable law enforcement to identify geographic hotspots that are most susceptible to drug overdoses (Des Jarlais et al, 2019). This information can help governments provide targeted medical services, drug awareness messaging, overdose reversal antidotes such as naloxone, and other harm reduction and rehabilitation options to minimize public health crises.…”