HIV incidence among injecting drug users in New York City syringe-exchange programmes

Don Des Jarlais, Michael Marmor, Denise Paone, Stephen Titus, Qiuhu Shi, Theresa Perlis, Benny Jose, Samuel R. Friedman

Research output: Contribution to journalArticle

Abstract

Background. There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants. Methods. We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n = 280), in which multiple interviews and saliva samples were collected from participants at exchange sites; the Vaccine Preparedness Initiative cohort (n = 133 continuing exchangers and 188 non-exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n = 1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe exchanges. Findings. HIV incidence among continuing exchange-users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95% CI 0.54, 4.65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1.38 per 100 person-years at risk (0.23, 4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (2.41, 11.49), and in the NADR cities, 6.23 per 100 person-years at risk (4.4, 8.6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3.35 (95% CI 1.29, 8.65) for incident HIV infection compared with using the exchanges. Interpretation. We observed an individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.

Original languageEnglish (US)
Pages (from-to)987-991
Number of pages5
JournalLancet
Volume348
Issue number9033
DOIs
StatePublished - Oct 12 1996

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Needle-Exchange Programs
Drug Users
HIV
HIV Infections
Syringes
Incidence
Acquired Immunodeficiency Syndrome
Vaccines
Research
Equipment and Supplies
Injections
Seroepidemiologic Studies
Street Drugs
Saliva
Interviews
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Des Jarlais, D., Marmor, M., Paone, D., Titus, S., Shi, Q., Perlis, T., ... Friedman, S. R. (1996). HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet, 348(9033), 987-991. https://doi.org/10.1016/S0140-6736(96)02536-6

HIV incidence among injecting drug users in New York City syringe-exchange programmes. / Des Jarlais, Don; Marmor, Michael; Paone, Denise; Titus, Stephen; Shi, Qiuhu; Perlis, Theresa; Jose, Benny; Friedman, Samuel R.

In: Lancet, Vol. 348, No. 9033, 12.10.1996, p. 987-991.

Research output: Contribution to journalArticle

Des Jarlais, D, Marmor, M, Paone, D, Titus, S, Shi, Q, Perlis, T, Jose, B & Friedman, SR 1996, 'HIV incidence among injecting drug users in New York City syringe-exchange programmes', Lancet, vol. 348, no. 9033, pp. 987-991. https://doi.org/10.1016/S0140-6736(96)02536-6
Des Jarlais, Don ; Marmor, Michael ; Paone, Denise ; Titus, Stephen ; Shi, Qiuhu ; Perlis, Theresa ; Jose, Benny ; Friedman, Samuel R. / HIV incidence among injecting drug users in New York City syringe-exchange programmes. In: Lancet. 1996 ; Vol. 348, No. 9033. pp. 987-991.
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abstract = "Background. There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants. Methods. We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n = 280), in which multiple interviews and saliva samples were collected from participants at exchange sites; the Vaccine Preparedness Initiative cohort (n = 133 continuing exchangers and 188 non-exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n = 1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe exchanges. Findings. HIV incidence among continuing exchange-users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95{\%} CI 0.54, 4.65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1.38 per 100 person-years at risk (0.23, 4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (2.41, 11.49), and in the NADR cities, 6.23 per 100 person-years at risk (4.4, 8.6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3.35 (95{\%} CI 1.29, 8.65) for incident HIV infection compared with using the exchanges. Interpretation. We observed an individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.",
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