HIV Risk Among Urban and Suburban People Who Inject Drugs: Elevated Risk Among Fentanyl and Cocaine Injectors in Maryland

Abstract

Drug overdose remains a leading cause of death in the US, with growing rates attributable to illicit fentanyl use. Recent HIV outbreaks among people who inject drugs (PWID) and service disruptions from COVID-19 have renewed concerns on HIV resurgence. We examined the relationship between fentanyl use and three injection-related HIV risk behaviors among PWID in Baltimore City (BC) and Anne Arundel Country (AAC), Maryland. PWID (N = 283) were recruited to the study through targeted sampling at street-based locations in BC and AAC from July 2018 to March 2020. Receptive syringe sharing (RSS) [adjusted odds ratio (AOR): 2.8, 95% confidence interval (CI): 1.2-6.3] and daily injecting (AOR: 1.9, 95% CI: 1.0-3.6) were associated with injecting fentanyl and cocaine together. Fentanyl availability and COVID-19 bring new HIV prevention challenges, particularly among those who inject fentanyl with cocaine, highlighting the importance to expand and sustain harm reduction, prevention, and treatment services for PWID to reduce HIV and overdose burden.

Global and Regional Estimate of HIV-Associated Stroke Burden: A Meta-Analysis and Population Attributable Modeling Study

“…40,41 Additionally, proper secondary prevention measures and adequate acute treatment and rehabilitation are crucial for improving stroke outcomes among PLWH, bridging the gap in HIV-related stroke care between developed and developing nations. 4 Middle-developed and developed countries should focus on improving primary prevention, particularly focusing on intravenous drug users, 42 men who have sex with men, 43 transgender people, 44 sex workers, 45 and refugees and migrants. 36 Traditional risk scores may perform poorly because they generally underestimate the risk in HIV-infected populations.…”

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

“…Yet, in a 2018 report, people living with HIV, including people with a history of injection drug use, reported missed HIV testing opportunities with healthcare providers before their diagnosis (Wejnert et al, 2018). The COVID-19 pandemic has further hampered the process of linking people with substance use disorder to treatment and harm reduction tools, further increasing overdose rates, injection-related bacterial infections, and HIV (DiGennaro et al, 2021;Park et al, 2022;Vasylyeva et al, 2020).…”