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

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.

Field-based performance of three pre-market rapid hepatitis C virus antibody assays in STAHR (Study to Assess Hepatitis C Risk) among young adults who inject drugs in San Diego, CA

“…25 HIV-HCV co-infection was low (ranging from 30.7% to 33.3% among persons with HIV across reference methods) in this sample as compared with other PWID studies (80-89%). 7,21,22 Some of this may be attributable to age as anti-HCV is less prevalent among younger populations, resulting in lower co-infection rates.…”

Prevention And Treatment Produced Large Decreases In HIV Incidence In A Model Of People Who Inject Drugs

“…In brief, we calibrated model outputs to historic HIV surveillance data from the New York City Department of Health & Mental Hygiene, 35,36 and to previously validated estimates of key epidemiologic outcomes for PWID, computed for the New York MSA between 1992 and 2002. 18,37,38 We also used historical HIV incidence estimates (1992-2002) for New York PWID to calibrate the primary outcome of interest (see Exhibit 2). 3 Calibrated outputs for other variables of interest (e.g., drug user prevalence, AIDS incidence) are shown Appendix exhibits A7-A9.…”

A quasi-markov model for transmission and disease elimination: Hepatitis C among people who inject drugs

“…And, P11=P44, P12=P42, P13=P43, P17=P27=P37=P47= P57=P67=μ and for k=1,…, (27, Some research has found that following spontaneous clearance of an acute infection a proportion of individuals may have protective immunity to re-infection; however, findings regarding a conferring of a protective immunity are equivocal [40][41][42][43]. In order to capture the possibility of some level of a protective immunity, a corresponding state (z) was included in the natural history model with a low transition probability (0.25) [19].…”