Risk Factors for Human Immunodeficiency Virus Seroconversion among Out-of-Treatment Drug Injectors in High and Low Seroprevalence Cities

Abstract

From 1988 to 1991, 6,882 drug injectors in 15 US cities were interviewed and had serum samples collected. The interviews and samples were analyzed for determination of significant predictors of human immunodeficiency virus (HIV) seroconversion in the 10 low seroprevalence cities and the five high seroprevalence cities. The unit of analysis was the period of observation between consecutive paired interviews/blood samples. In Cox proportional hazards regression, significant predictors of seroconversion in the low seroprevalence cities were: not being in drug treatment, injecting in outdoor settings or abandoned buildings, using crack cocaine weekly or more frequently, engaging in woman-to-woman sex, being of non-Latino race/ethnicity, and city seroprevalence. Predictors in high seroprevalence cities were: injecting with potentially infected syringes, not being in drug treatment, and having a sex partner who injected drugs. These findings suggest that HIV may be concentrated in sociobehavioral pockets of infection in low seroprevalence cities. For reducing HIV transmission, these results suggest: 1) in low seroprevalence cities, localized monitoring to detect specific emerging sociobehavioral pockets of infection, and quick implementation of appropriate targeted interventions if necessary; 2) in high seroprevalence cities, relatively more emphasis on locality-wide outreach and syringe-exchange projects to reduce risky behavior; and 3) in both types of cities, considerable expansion of drug treatment programs.

Incidence of HIV among injection drug users entering drug treatment programs in four US cities

“…[11][12][13] As in those studies, IDUs in our study frequently reported needle sharing and other indirect sharing behaviors (more than 40%). These self-reported injection-related risk behaviors tended to be more common in Seattle and Los Angeles, where HIV infection was less prevalent.…”

Syringe possession arrests are associated with receptive syringe sharing in two Mexico–US border cities

“…Injecting in public places has been associated with risky injection behaviors and HIV seroconversion in several studies [15,[35][36][37]]-a consequence of hurrying injection to minimize risk of police detection and arrest. This is a particularly common practice among homeless IDUs.…”

“…Overall, 92% were male and 99% considered themselves Hispanic or Latino. Median age was 34 years [interquartile range (IQR): [28][29][30][31][32][33][34][35][36][37][38][39][40] and median time since first injection was 12.5 years (IQR: [8][9][10][11][12][13][14][15][16][17][18][19].…”

Social Networks, Risk-Potential Networks, Health, and Disease

“…Also, the relatively low HIV prevalence in Atlanta (and even lower in Flagstaff) suggests that there might not be enough HIV present in networks (other than those of men who have sex with men) to use it to validate the risk index. Based on the arguments in Friedman et al 12 that HIV seroconversion is best predicted by membership in pockets of infection in cities with low HIV prevalence (whereas behaviors are good predictors where HIV prevalence is 20% or more), we would speculate that the HIV epidemic in Atlanta is still primarily confined to men who have sex with men. This, however, does not explain why this has been the case, how and if there might be an outbreak among IDUs, or how such outbreaks might be prevented.…”