Update and Overview of Practical Epidemiologic Aspects of HIV/AIDS among Injection Drug Users in the United States

Abstract

In a changing public health landscape in which local, state, and federal agencies must confront threats of bioterrorism, emerging infections, and numerous chronic diseases, transmission of HIV among injection drug users (IDUs) continues to be an important public health issue and one of the driving forces behind the HIV epidemic. Using a computerized MEDLINE search of published articles from January 1981 through October 2005, we conducted a literature review of practical epidemiologic aspects of HIV/AIDS among IDUs in the United States. Although recent trends indicate a decline in the proportion of newly diagnosed HIV infections associated with injection drug use, drug-use behaviors overall still account for 32% of new HIV diagnoses. Factors in addition to syringe sharing contribute to HIV transmission among IDUs: risky sexual behaviors, sharing of drug preparation equipment and drug solutions, and contextual and social factors. Promising approaches for HIV prevention include rapid HIV testing, office-based substance abuse treatment, behavioral interventions, improved communication about syringe exchange programs, and case management. HIV among IDUs continues to be an important public health problem in the 21st century. It is imperative that public health agencies continue to monitor and combat the HIV epidemic among IDUs to ensure that hard-won gains will not be eroded.

Impact of Socio-Medical Factors on the Prevention and Treatment of HIV/AIDS Among Specific Subpopulations

“…While the CDC acknowledged the first cases of HIV among MSMs in 1981, Friedman and colleagues have argued that HIV was present in the IDU New York city population since the mid to late 1970's (2007) (figure 3.1). However infections in this sub-population were ignored due to a hostile legal and sociopolitical environment, influenced by the federal government's "War on Drugs" (Des Jarlais et al, 1989;Des Jarlais et al, 1994;Des Jarlais et al, 2000;Freidman et al, 2007;Santibanez et al, 2006;Stoneburner et al, 1988). This slowed the public health response to the epidemic among IDUs.…”

“…Moreover, IDUs represent a heterogeneous group of people whose behavior varies and often impacts seroprevalence. In addition to injection drug use, an IDU may also; (1) be a MSM; (2) or experience high risk heterosexual contact (Santibanez et al, 2006). However, decades of research has highlighted Freidman et al, 2008) several factors that explain the nexus between IDUs and the transmission of HIV.…”

“…The first of these factors includes the sharing of used syringes and drug equipment (works) (Friedman et al, 1999;Rudolph et al, 2010).Drug equipment such as; (1) used bottle caps, spoons, or other containers ("cookers"); (2) used pieces of filtering cotton or cigarette filters ("cottons"); and (3) water that was already used to dissolve drugs or clean syringes (Friedman et al, 1999) allows for the transfer of infected bloodproduct from one person to the next. Subsets of IDU's who share works and injection shooting galleries (Des Jarlais & Seman, 2008) ,where one syringe is often rented to numerous clients, or those that participate in backloading 3 or frontloading 4 are particularly more likely to become infected (Des Jarlais & Seman, 2008;Friedman, et al, 1999;Santibanez et al, 2006). IDUs often share works due to restricted access to sterile needles and syringes.…”

“…Additionally, law enforcement strategies such as placing police near needle exchange sites and arresting IDUs for drug residue in a used syringe can encourage needle sharing (Des Jarlais & Seman, 2008). However, research indicates that increased access to SEPs exchange has lowered syringe sharing among IDUs, thereby lowering levels of infection among individuals and the larger community, (Riley, et al, 2010;Rotherman-Borus et al, 2010;Rudolph et al, 2010(A); Rudolph et al, 2010(B); Santibanez et al, 2006) and is cost effective and does not lead to increase drug injection or recruit first time injectors (Santibanez et al, 2006). Lack of available substance abuse treatment programs and HAART is yet another factor that explains the impact of injecting drug use on the HIV/AIDS epidemic.…”

HIV Prevention Interventions to Reduce Racial Disparities in the United States: A Systematic Review

“…1 The past three decades of HIV intervention research have attenuated several mechanisms of HIV acquisition. Intravenous drug use has become less relevant in the past decade, [2][3][4] and mother-tochild prevention programs have substantively reduced mother-to-child transmission rates. 5 Since the mid-1990s new HIV cases have steadily declined among whites, however, sexual transmission persists in racial minority groups fueled by sexual mixing patterns.…”