HIV infection and risk, prevention, and testing behaviors among injecting drug users - National HIV behavioral surveillance system, 20 U.S. Cities, 2009

Dita Broz, Cyprian Wejnert, Huong T. Pham, Elizabeth DiNenno, James D. Heffelfinger, Melissa Cribbin, Nevin Krishna, Eyasu H. Teshale, Gabriela Paz-Bailey, Jennifer Taussig, Shacara Johnson, Jeff Todd, Colin Flynn, Danielle German, Debbie Isenberg, Maura Driscoll, Elizabeth Hurwitz, Nikhil Prachand, Nanette Benbow, Sharon MelvilleRichard Yeager, Jim Dyer, Alicia Novoa, Mark Thrun, Alia Al-Tayyib, Emily Higgins, Eve Mokotoff, Vivian Griffin, Aaron Sayegh, Jan Risser, Hafeez Rehman, Trista Bingham, Ekow Kwa Sey, Lisa Metsch, David Forrest, Dano Beck, Gabriel Cardenas, Chris Nemeth, Lou Smith, Carol Ann Watson, William T. Robinson, DeAnn Gruber, Narquis Barak, Alan Neaigus, Samuel Jenness, Travis Wendel, Camila Gelpi-Acosta, Holly Hagan, Henry Godette, Barbara Bolden, Sally D'Errico, Kathleen A. Brady, Althea Kirkland, Mark Shpaner, Vanessa Miguelino-Keasling, Al Velasco, H. Fisher Raymond, Sandra Miranda de León, Yadira Rolón-Colón, Maria Courogen, Hanne Thiede, Richard Burt, Michael Herbert, Yelena Friedberg, Dale Wrigley, Jacob Fisher, Marie Sansone, Tiffany West-Ojo, Manya Magnus, Irene Kuo

Research output: Contribution to journalArticle

Abstract

Problem/Condition: At the end of 2009, an estimated 1,148,200 persons aged ≥13 years were living with human immunodeficiency virus (HIV) infection in the United States. Despite the recent decreases in HIV infection attributed to injection drug use, 8% of new HIV infections in 2010 occurred among injecting drug users (IDUs). Reporting Period: June-December 2009. Description of System: The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, IDUs, and heterosexual adults at increased risk for HIV infection. Data for NHBS are collected in rotating cycles. For the 2009 NHBS cycle, IDUs were recruited in 20 participating MSAs using respondent-driven sampling, a peer-referral sampling method. Participants were eligible if they were aged ≥18 years, lived in a participating MSA, were able to complete a behavioral survey in English or Spanish, and reported that they had injected drugs during the past 12 months. Consenting participants completed an interviewer-administered (face-to-face), anonymous standardized questionnaire about HIV-associated behaviors, and all participants were offered anonymous HIV testing. Analysis of 2009 NHBS data represents the first large assessment of HIV prevalence among IDUs in the United States in >10 years. Results: This report summarizes two separate analyses using unweighted data from 10,200 eligible IDUs in 20 MSAs from the second collection cycle of NHBS in 2009. Both an HIV infection analysis and a behavioral analysis were conducted. Different denominators were used in each analysis because of the order and type of exclusion criteria applied. For the HIV infection analysis, of the 10,200 eligible participants, 10,090 had a valid HIV test result, of whom 906 (9%) tested positive for HIV (range: 2%-19% by MSA). When 509 participants who reported receiving a previous positive HIV test result were excluded from this analysis, 4% (397 of 9,581 participants) tested HIV-positive. For the behavioral analysis, because knowledge of HIV status might influence risk behaviors, 548 participants who reported a previous HIV-positive test result were excluded from the 10,200 eligible participants. All subsequent analyses were conducted for the remaining 9,652 participants. The most commonly injected drugs during the past 12 months among these participants were heroin (90%), speedball (heroin and cocaine combined) (58%), and cocaine or crack (49%). Large percentages of participants reported receptive sharing of syringes (35%); receptive sharing of other injection equipment, such as cookers, cotton, or water (58%); and receptive sharing of syringes to divide drugs (35%). Many participants reported having unprotected sex with oppositesex partners during the past 12 months: 70% of men and 73% of women had unprotected vaginal sex, and 25% of men and 21% of women had unprotected anal sex. A combination of unsafe injection- and sex-related behaviors during the past 12 months was commonly reported; 41% of participants who reported unprotected vaginal sex with one or more opposite-sex partners, and 53% of participants who reported unprotected anal sex with one or more opposite-sex partners also reported receptive sharing of syringes. More women than men reported having sex in exchange for money or drugs (31% and 18%, respectively). Among men, 10% had oral or anal sex with one or more male partners during the past 12 months. Many participants (74%) reported noninjection drug use during the past 12 months, and 41% reported binge drinking during the past 30 days. A large percentage of participants (74%) had ever been tested for hepatitis C, 41% had received a hepatitis C virus infection diagnosis, and 29% had received a vaccination against hepatitis A virus, hepatitis B virus, or both. Most (88%) had been tested for HIV during their lifetime, and 49% had been tested during the past 12 months. Approximately half of participants receivedfree HIV prevention materials during the past 12 months, including condoms (50%) and sterile syringes (44%) and other injection equipment (41%). One third of participants had been in an alcohol or a drug treatment program, and 21% had participated in an individual- or a group-level HIV behavioral intervention. Interpretation: IDUs in the United States continue to engage in sexual and drug-use behaviors that increase their risk for HIV infection. The large percentage of participants in this study who reported engaging in both unprotected sex and receptive sharing of syringes supports the need for HIV prevention programs to address both injection and sex-related risk behaviors among IDUs. Although most participants had been tested for HIV infection previously, less than half had been tested in the past year as recommended by CDC. In addition, many participants had not been vaccinated against hepatitis A and B as recommended by CDC. Although all participants had injected drugs during the past year, only a small percentage had recently participated in an alcohol or a drug treatment program or in a behavioral intervention, suggesting an unmet need for drug treatment and HIV prevention services. Public Health Action: To reduce the number of HIV infections among IDUs, additional efforts are needed to decrease the number of persons who engage in behaviors that increase their risk for HIV infection and to increase their access to HIV testing, alcohol and drug treatment, and other HIV prevention programs. The National HIV/AIDS Strategy for the United States delineates a coordinated response to reduce HIV incidence and HIV-related health disparities among IDUs and other disproportionately affected groups. CDC's high-impact HIV prevention approach provides an essential step toward achieving these goals by using combinations of scientifically proven, cost-effective, and scalable interventions among populations at greatest risk. NHBS data can be used to monitor progress toward the national strategy goals and to guide national and local planning efforts to maximize the impact of HIV prevention programs.

Original languageEnglish (US)
Pages (from-to)1-56
Number of pages56
JournalMMWR Surveillance Summaries
Volume63
Issue number1
StatePublished - 2014

Fingerprint

Virus Diseases
Drug Users
surveillance
HIV
drug
Unsafe Sex
contagious disease
Needle Sharing
Pharmaceutical Preparations
risk behavior
Sexual Behavior
drug use
alcohol
Centers for Disease Control and Prevention (U.S.)
Risk-Taking
Injections
Heroin
Alcohols
local planning
human being

ASJC Scopus subject areas

  • Epidemiology
  • Health, Toxicology and Mutagenesis
  • Health(social science)
  • Health Information Management
  • Medicine(all)

Cite this

Broz, D., Wejnert, C., Pham, H. T., DiNenno, E., Heffelfinger, J. D., Cribbin, M., ... Kuo, I. (2014). HIV infection and risk, prevention, and testing behaviors among injecting drug users - National HIV behavioral surveillance system, 20 U.S. Cities, 2009. MMWR Surveillance Summaries, 63(1), 1-56.

HIV infection and risk, prevention, and testing behaviors among injecting drug users - National HIV behavioral surveillance system, 20 U.S. Cities, 2009. / Broz, Dita; Wejnert, Cyprian; Pham, Huong T.; DiNenno, Elizabeth; Heffelfinger, James D.; Cribbin, Melissa; Krishna, Nevin; Teshale, Eyasu H.; Paz-Bailey, Gabriela; Taussig, Jennifer; Johnson, Shacara; Todd, Jeff; Flynn, Colin; German, Danielle; Isenberg, Debbie; Driscoll, Maura; Hurwitz, Elizabeth; Prachand, Nikhil; Benbow, Nanette; Melville, Sharon; Yeager, Richard; Dyer, Jim; Novoa, Alicia; Thrun, Mark; Al-Tayyib, Alia; Higgins, Emily; Mokotoff, Eve; Griffin, Vivian; Sayegh, Aaron; Risser, Jan; Rehman, Hafeez; Bingham, Trista; Sey, Ekow Kwa; Metsch, Lisa; Forrest, David; Beck, Dano; Cardenas, Gabriel; Nemeth, Chris; Smith, Lou; Watson, Carol Ann; Robinson, William T.; Gruber, DeAnn; Barak, Narquis; Neaigus, Alan; Jenness, Samuel; Wendel, Travis; Gelpi-Acosta, Camila; Hagan, Holly; Godette, Henry; Bolden, Barbara; D'Errico, Sally; Brady, Kathleen A.; Kirkland, Althea; Shpaner, Mark; Miguelino-Keasling, Vanessa; Velasco, Al; Raymond, H. Fisher; de León, Sandra Miranda; Rolón-Colón, Yadira; Courogen, Maria; Thiede, Hanne; Burt, Richard; Herbert, Michael; Friedberg, Yelena; Wrigley, Dale; Fisher, Jacob; Sansone, Marie; West-Ojo, Tiffany; Magnus, Manya; Kuo, Irene.

In: MMWR Surveillance Summaries, Vol. 63, No. 1, 2014, p. 1-56.

Research output: Contribution to journalArticle

Broz, D, Wejnert, C, Pham, HT, DiNenno, E, Heffelfinger, JD, Cribbin, M, Krishna, N, Teshale, EH, Paz-Bailey, G, Taussig, J, Johnson, S, Todd, J, Flynn, C, German, D, Isenberg, D, Driscoll, M, Hurwitz, E, Prachand, N, Benbow, N, Melville, S, Yeager, R, Dyer, J, Novoa, A, Thrun, M, Al-Tayyib, A, Higgins, E, Mokotoff, E, Griffin, V, Sayegh, A, Risser, J, Rehman, H, Bingham, T, Sey, EK, Metsch, L, Forrest, D, Beck, D, Cardenas, G, Nemeth, C, Smith, L, Watson, CA, Robinson, WT, Gruber, D, Barak, N, Neaigus, A, Jenness, S, Wendel, T, Gelpi-Acosta, C, Hagan, H, Godette, H, Bolden, B, D'Errico, S, Brady, KA, Kirkland, A, Shpaner, M, Miguelino-Keasling, V, Velasco, A, Raymond, HF, de León, SM, Rolón-Colón, Y, Courogen, M, Thiede, H, Burt, R, Herbert, M, Friedberg, Y, Wrigley, D, Fisher, J, Sansone, M, West-Ojo, T, Magnus, M & Kuo, I 2014, 'HIV infection and risk, prevention, and testing behaviors among injecting drug users - National HIV behavioral surveillance system, 20 U.S. Cities, 2009', MMWR Surveillance Summaries, vol. 63, no. 1, pp. 1-56.
Broz, Dita ; Wejnert, Cyprian ; Pham, Huong T. ; DiNenno, Elizabeth ; Heffelfinger, James D. ; Cribbin, Melissa ; Krishna, Nevin ; Teshale, Eyasu H. ; Paz-Bailey, Gabriela ; Taussig, Jennifer ; Johnson, Shacara ; Todd, Jeff ; Flynn, Colin ; German, Danielle ; Isenberg, Debbie ; Driscoll, Maura ; Hurwitz, Elizabeth ; Prachand, Nikhil ; Benbow, Nanette ; Melville, Sharon ; Yeager, Richard ; Dyer, Jim ; Novoa, Alicia ; Thrun, Mark ; Al-Tayyib, Alia ; Higgins, Emily ; Mokotoff, Eve ; Griffin, Vivian ; Sayegh, Aaron ; Risser, Jan ; Rehman, Hafeez ; Bingham, Trista ; Sey, Ekow Kwa ; Metsch, Lisa ; Forrest, David ; Beck, Dano ; Cardenas, Gabriel ; Nemeth, Chris ; Smith, Lou ; Watson, Carol Ann ; Robinson, William T. ; Gruber, DeAnn ; Barak, Narquis ; Neaigus, Alan ; Jenness, Samuel ; Wendel, Travis ; Gelpi-Acosta, Camila ; Hagan, Holly ; Godette, Henry ; Bolden, Barbara ; D'Errico, Sally ; Brady, Kathleen A. ; Kirkland, Althea ; Shpaner, Mark ; Miguelino-Keasling, Vanessa ; Velasco, Al ; Raymond, H. Fisher ; de León, Sandra Miranda ; Rolón-Colón, Yadira ; Courogen, Maria ; Thiede, Hanne ; Burt, Richard ; Herbert, Michael ; Friedberg, Yelena ; Wrigley, Dale ; Fisher, Jacob ; Sansone, Marie ; West-Ojo, Tiffany ; Magnus, Manya ; Kuo, Irene. / HIV infection and risk, prevention, and testing behaviors among injecting drug users - National HIV behavioral surveillance system, 20 U.S. Cities, 2009. In: MMWR Surveillance Summaries. 2014 ; Vol. 63, No. 1. pp. 1-56.
@article{04851e1d08bf4aaf81c237217c138f54,
title = "HIV infection and risk, prevention, and testing behaviors among injecting drug users - National HIV behavioral surveillance system, 20 U.S. Cities, 2009",
abstract = "Problem/Condition: At the end of 2009, an estimated 1,148,200 persons aged ≥13 years were living with human immunodeficiency virus (HIV) infection in the United States. Despite the recent decreases in HIV infection attributed to injection drug use, 8{\%} of new HIV infections in 2010 occurred among injecting drug users (IDUs). Reporting Period: June-December 2009. Description of System: The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, IDUs, and heterosexual adults at increased risk for HIV infection. Data for NHBS are collected in rotating cycles. For the 2009 NHBS cycle, IDUs were recruited in 20 participating MSAs using respondent-driven sampling, a peer-referral sampling method. Participants were eligible if they were aged ≥18 years, lived in a participating MSA, were able to complete a behavioral survey in English or Spanish, and reported that they had injected drugs during the past 12 months. Consenting participants completed an interviewer-administered (face-to-face), anonymous standardized questionnaire about HIV-associated behaviors, and all participants were offered anonymous HIV testing. Analysis of 2009 NHBS data represents the first large assessment of HIV prevalence among IDUs in the United States in >10 years. Results: This report summarizes two separate analyses using unweighted data from 10,200 eligible IDUs in 20 MSAs from the second collection cycle of NHBS in 2009. Both an HIV infection analysis and a behavioral analysis were conducted. Different denominators were used in each analysis because of the order and type of exclusion criteria applied. For the HIV infection analysis, of the 10,200 eligible participants, 10,090 had a valid HIV test result, of whom 906 (9{\%}) tested positive for HIV (range: 2{\%}-19{\%} by MSA). When 509 participants who reported receiving a previous positive HIV test result were excluded from this analysis, 4{\%} (397 of 9,581 participants) tested HIV-positive. For the behavioral analysis, because knowledge of HIV status might influence risk behaviors, 548 participants who reported a previous HIV-positive test result were excluded from the 10,200 eligible participants. All subsequent analyses were conducted for the remaining 9,652 participants. The most commonly injected drugs during the past 12 months among these participants were heroin (90{\%}), speedball (heroin and cocaine combined) (58{\%}), and cocaine or crack (49{\%}). Large percentages of participants reported receptive sharing of syringes (35{\%}); receptive sharing of other injection equipment, such as cookers, cotton, or water (58{\%}); and receptive sharing of syringes to divide drugs (35{\%}). Many participants reported having unprotected sex with oppositesex partners during the past 12 months: 70{\%} of men and 73{\%} of women had unprotected vaginal sex, and 25{\%} of men and 21{\%} of women had unprotected anal sex. A combination of unsafe injection- and sex-related behaviors during the past 12 months was commonly reported; 41{\%} of participants who reported unprotected vaginal sex with one or more opposite-sex partners, and 53{\%} of participants who reported unprotected anal sex with one or more opposite-sex partners also reported receptive sharing of syringes. More women than men reported having sex in exchange for money or drugs (31{\%} and 18{\%}, respectively). Among men, 10{\%} had oral or anal sex with one or more male partners during the past 12 months. Many participants (74{\%}) reported noninjection drug use during the past 12 months, and 41{\%} reported binge drinking during the past 30 days. A large percentage of participants (74{\%}) had ever been tested for hepatitis C, 41{\%} had received a hepatitis C virus infection diagnosis, and 29{\%} had received a vaccination against hepatitis A virus, hepatitis B virus, or both. Most (88{\%}) had been tested for HIV during their lifetime, and 49{\%} had been tested during the past 12 months. Approximately half of participants receivedfree HIV prevention materials during the past 12 months, including condoms (50{\%}) and sterile syringes (44{\%}) and other injection equipment (41{\%}). One third of participants had been in an alcohol or a drug treatment program, and 21{\%} had participated in an individual- or a group-level HIV behavioral intervention. Interpretation: IDUs in the United States continue to engage in sexual and drug-use behaviors that increase their risk for HIV infection. The large percentage of participants in this study who reported engaging in both unprotected sex and receptive sharing of syringes supports the need for HIV prevention programs to address both injection and sex-related risk behaviors among IDUs. Although most participants had been tested for HIV infection previously, less than half had been tested in the past year as recommended by CDC. In addition, many participants had not been vaccinated against hepatitis A and B as recommended by CDC. Although all participants had injected drugs during the past year, only a small percentage had recently participated in an alcohol or a drug treatment program or in a behavioral intervention, suggesting an unmet need for drug treatment and HIV prevention services. Public Health Action: To reduce the number of HIV infections among IDUs, additional efforts are needed to decrease the number of persons who engage in behaviors that increase their risk for HIV infection and to increase their access to HIV testing, alcohol and drug treatment, and other HIV prevention programs. The National HIV/AIDS Strategy for the United States delineates a coordinated response to reduce HIV incidence and HIV-related health disparities among IDUs and other disproportionately affected groups. CDC's high-impact HIV prevention approach provides an essential step toward achieving these goals by using combinations of scientifically proven, cost-effective, and scalable interventions among populations at greatest risk. NHBS data can be used to monitor progress toward the national strategy goals and to guide national and local planning efforts to maximize the impact of HIV prevention programs.",
author = "Dita Broz and Cyprian Wejnert and Pham, {Huong T.} and Elizabeth DiNenno and Heffelfinger, {James D.} and Melissa Cribbin and Nevin Krishna and Teshale, {Eyasu H.} and Gabriela Paz-Bailey and Jennifer Taussig and Shacara Johnson and Jeff Todd and Colin Flynn and Danielle German and Debbie Isenberg and Maura Driscoll and Elizabeth Hurwitz and Nikhil Prachand and Nanette Benbow and Sharon Melville and Richard Yeager and Jim Dyer and Alicia Novoa and Mark Thrun and Alia Al-Tayyib and Emily Higgins and Eve Mokotoff and Vivian Griffin and Aaron Sayegh and Jan Risser and Hafeez Rehman and Trista Bingham and Sey, {Ekow Kwa} and Lisa Metsch and David Forrest and Dano Beck and Gabriel Cardenas and Chris Nemeth and Lou Smith and Watson, {Carol Ann} and Robinson, {William T.} and DeAnn Gruber and Narquis Barak and Alan Neaigus and Samuel Jenness and Travis Wendel and Camila Gelpi-Acosta and Holly Hagan and Henry Godette and Barbara Bolden and Sally D'Errico and Brady, {Kathleen A.} and Althea Kirkland and Mark Shpaner and Vanessa Miguelino-Keasling and Al Velasco and Raymond, {H. Fisher} and {de Le{\'o}n}, {Sandra Miranda} and Yadira Rol{\'o}n-Col{\'o}n and Maria Courogen and Hanne Thiede and Richard Burt and Michael Herbert and Yelena Friedberg and Dale Wrigley and Jacob Fisher and Marie Sansone and Tiffany West-Ojo and Manya Magnus and Irene Kuo",
year = "2014",
language = "English (US)",
volume = "63",
pages = "1--56",
journal = "MMWR. Surveillance summaries : Morbidity and mortality weekly report. Surveillance summaries / CDC",
issn = "1546-0738",
publisher = "Epidemiology Program Office",
number = "1",

}

TY - JOUR

T1 - HIV infection and risk, prevention, and testing behaviors among injecting drug users - National HIV behavioral surveillance system, 20 U.S. Cities, 2009

AU - Broz, Dita

AU - Wejnert, Cyprian

AU - Pham, Huong T.

AU - DiNenno, Elizabeth

AU - Heffelfinger, James D.

AU - Cribbin, Melissa

AU - Krishna, Nevin

AU - Teshale, Eyasu H.

AU - Paz-Bailey, Gabriela

AU - Taussig, Jennifer

AU - Johnson, Shacara

AU - Todd, Jeff

AU - Flynn, Colin

AU - German, Danielle

AU - Isenberg, Debbie

AU - Driscoll, Maura

AU - Hurwitz, Elizabeth

AU - Prachand, Nikhil

AU - Benbow, Nanette

AU - Melville, Sharon

AU - Yeager, Richard

AU - Dyer, Jim

AU - Novoa, Alicia

AU - Thrun, Mark

AU - Al-Tayyib, Alia

AU - Higgins, Emily

AU - Mokotoff, Eve

AU - Griffin, Vivian

AU - Sayegh, Aaron

AU - Risser, Jan

AU - Rehman, Hafeez

AU - Bingham, Trista

AU - Sey, Ekow Kwa

AU - Metsch, Lisa

AU - Forrest, David

AU - Beck, Dano

AU - Cardenas, Gabriel

AU - Nemeth, Chris

AU - Smith, Lou

AU - Watson, Carol Ann

AU - Robinson, William T.

AU - Gruber, DeAnn

AU - Barak, Narquis

AU - Neaigus, Alan

AU - Jenness, Samuel

AU - Wendel, Travis

AU - Gelpi-Acosta, Camila

AU - Hagan, Holly

AU - Godette, Henry

AU - Bolden, Barbara

AU - D'Errico, Sally

AU - Brady, Kathleen A.

AU - Kirkland, Althea

AU - Shpaner, Mark

AU - Miguelino-Keasling, Vanessa

AU - Velasco, Al

AU - Raymond, H. Fisher

AU - de León, Sandra Miranda

AU - Rolón-Colón, Yadira

AU - Courogen, Maria

AU - Thiede, Hanne

AU - Burt, Richard

AU - Herbert, Michael

AU - Friedberg, Yelena

AU - Wrigley, Dale

AU - Fisher, Jacob

AU - Sansone, Marie

AU - West-Ojo, Tiffany

AU - Magnus, Manya

AU - Kuo, Irene

PY - 2014

Y1 - 2014

N2 - Problem/Condition: At the end of 2009, an estimated 1,148,200 persons aged ≥13 years were living with human immunodeficiency virus (HIV) infection in the United States. Despite the recent decreases in HIV infection attributed to injection drug use, 8% of new HIV infections in 2010 occurred among injecting drug users (IDUs). Reporting Period: June-December 2009. Description of System: The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, IDUs, and heterosexual adults at increased risk for HIV infection. Data for NHBS are collected in rotating cycles. For the 2009 NHBS cycle, IDUs were recruited in 20 participating MSAs using respondent-driven sampling, a peer-referral sampling method. Participants were eligible if they were aged ≥18 years, lived in a participating MSA, were able to complete a behavioral survey in English or Spanish, and reported that they had injected drugs during the past 12 months. Consenting participants completed an interviewer-administered (face-to-face), anonymous standardized questionnaire about HIV-associated behaviors, and all participants were offered anonymous HIV testing. Analysis of 2009 NHBS data represents the first large assessment of HIV prevalence among IDUs in the United States in >10 years. Results: This report summarizes two separate analyses using unweighted data from 10,200 eligible IDUs in 20 MSAs from the second collection cycle of NHBS in 2009. Both an HIV infection analysis and a behavioral analysis were conducted. Different denominators were used in each analysis because of the order and type of exclusion criteria applied. For the HIV infection analysis, of the 10,200 eligible participants, 10,090 had a valid HIV test result, of whom 906 (9%) tested positive for HIV (range: 2%-19% by MSA). When 509 participants who reported receiving a previous positive HIV test result were excluded from this analysis, 4% (397 of 9,581 participants) tested HIV-positive. For the behavioral analysis, because knowledge of HIV status might influence risk behaviors, 548 participants who reported a previous HIV-positive test result were excluded from the 10,200 eligible participants. All subsequent analyses were conducted for the remaining 9,652 participants. The most commonly injected drugs during the past 12 months among these participants were heroin (90%), speedball (heroin and cocaine combined) (58%), and cocaine or crack (49%). Large percentages of participants reported receptive sharing of syringes (35%); receptive sharing of other injection equipment, such as cookers, cotton, or water (58%); and receptive sharing of syringes to divide drugs (35%). Many participants reported having unprotected sex with oppositesex partners during the past 12 months: 70% of men and 73% of women had unprotected vaginal sex, and 25% of men and 21% of women had unprotected anal sex. A combination of unsafe injection- and sex-related behaviors during the past 12 months was commonly reported; 41% of participants who reported unprotected vaginal sex with one or more opposite-sex partners, and 53% of participants who reported unprotected anal sex with one or more opposite-sex partners also reported receptive sharing of syringes. More women than men reported having sex in exchange for money or drugs (31% and 18%, respectively). Among men, 10% had oral or anal sex with one or more male partners during the past 12 months. Many participants (74%) reported noninjection drug use during the past 12 months, and 41% reported binge drinking during the past 30 days. A large percentage of participants (74%) had ever been tested for hepatitis C, 41% had received a hepatitis C virus infection diagnosis, and 29% had received a vaccination against hepatitis A virus, hepatitis B virus, or both. Most (88%) had been tested for HIV during their lifetime, and 49% had been tested during the past 12 months. Approximately half of participants receivedfree HIV prevention materials during the past 12 months, including condoms (50%) and sterile syringes (44%) and other injection equipment (41%). One third of participants had been in an alcohol or a drug treatment program, and 21% had participated in an individual- or a group-level HIV behavioral intervention. Interpretation: IDUs in the United States continue to engage in sexual and drug-use behaviors that increase their risk for HIV infection. The large percentage of participants in this study who reported engaging in both unprotected sex and receptive sharing of syringes supports the need for HIV prevention programs to address both injection and sex-related risk behaviors among IDUs. Although most participants had been tested for HIV infection previously, less than half had been tested in the past year as recommended by CDC. In addition, many participants had not been vaccinated against hepatitis A and B as recommended by CDC. Although all participants had injected drugs during the past year, only a small percentage had recently participated in an alcohol or a drug treatment program or in a behavioral intervention, suggesting an unmet need for drug treatment and HIV prevention services. Public Health Action: To reduce the number of HIV infections among IDUs, additional efforts are needed to decrease the number of persons who engage in behaviors that increase their risk for HIV infection and to increase their access to HIV testing, alcohol and drug treatment, and other HIV prevention programs. The National HIV/AIDS Strategy for the United States delineates a coordinated response to reduce HIV incidence and HIV-related health disparities among IDUs and other disproportionately affected groups. CDC's high-impact HIV prevention approach provides an essential step toward achieving these goals by using combinations of scientifically proven, cost-effective, and scalable interventions among populations at greatest risk. NHBS data can be used to monitor progress toward the national strategy goals and to guide national and local planning efforts to maximize the impact of HIV prevention programs.

AB - Problem/Condition: At the end of 2009, an estimated 1,148,200 persons aged ≥13 years were living with human immunodeficiency virus (HIV) infection in the United States. Despite the recent decreases in HIV infection attributed to injection drug use, 8% of new HIV infections in 2010 occurred among injecting drug users (IDUs). Reporting Period: June-December 2009. Description of System: The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, IDUs, and heterosexual adults at increased risk for HIV infection. Data for NHBS are collected in rotating cycles. For the 2009 NHBS cycle, IDUs were recruited in 20 participating MSAs using respondent-driven sampling, a peer-referral sampling method. Participants were eligible if they were aged ≥18 years, lived in a participating MSA, were able to complete a behavioral survey in English or Spanish, and reported that they had injected drugs during the past 12 months. Consenting participants completed an interviewer-administered (face-to-face), anonymous standardized questionnaire about HIV-associated behaviors, and all participants were offered anonymous HIV testing. Analysis of 2009 NHBS data represents the first large assessment of HIV prevalence among IDUs in the United States in >10 years. Results: This report summarizes two separate analyses using unweighted data from 10,200 eligible IDUs in 20 MSAs from the second collection cycle of NHBS in 2009. Both an HIV infection analysis and a behavioral analysis were conducted. Different denominators were used in each analysis because of the order and type of exclusion criteria applied. For the HIV infection analysis, of the 10,200 eligible participants, 10,090 had a valid HIV test result, of whom 906 (9%) tested positive for HIV (range: 2%-19% by MSA). When 509 participants who reported receiving a previous positive HIV test result were excluded from this analysis, 4% (397 of 9,581 participants) tested HIV-positive. For the behavioral analysis, because knowledge of HIV status might influence risk behaviors, 548 participants who reported a previous HIV-positive test result were excluded from the 10,200 eligible participants. All subsequent analyses were conducted for the remaining 9,652 participants. The most commonly injected drugs during the past 12 months among these participants were heroin (90%), speedball (heroin and cocaine combined) (58%), and cocaine or crack (49%). Large percentages of participants reported receptive sharing of syringes (35%); receptive sharing of other injection equipment, such as cookers, cotton, or water (58%); and receptive sharing of syringes to divide drugs (35%). Many participants reported having unprotected sex with oppositesex partners during the past 12 months: 70% of men and 73% of women had unprotected vaginal sex, and 25% of men and 21% of women had unprotected anal sex. A combination of unsafe injection- and sex-related behaviors during the past 12 months was commonly reported; 41% of participants who reported unprotected vaginal sex with one or more opposite-sex partners, and 53% of participants who reported unprotected anal sex with one or more opposite-sex partners also reported receptive sharing of syringes. More women than men reported having sex in exchange for money or drugs (31% and 18%, respectively). Among men, 10% had oral or anal sex with one or more male partners during the past 12 months. Many participants (74%) reported noninjection drug use during the past 12 months, and 41% reported binge drinking during the past 30 days. A large percentage of participants (74%) had ever been tested for hepatitis C, 41% had received a hepatitis C virus infection diagnosis, and 29% had received a vaccination against hepatitis A virus, hepatitis B virus, or both. Most (88%) had been tested for HIV during their lifetime, and 49% had been tested during the past 12 months. Approximately half of participants receivedfree HIV prevention materials during the past 12 months, including condoms (50%) and sterile syringes (44%) and other injection equipment (41%). One third of participants had been in an alcohol or a drug treatment program, and 21% had participated in an individual- or a group-level HIV behavioral intervention. Interpretation: IDUs in the United States continue to engage in sexual and drug-use behaviors that increase their risk for HIV infection. The large percentage of participants in this study who reported engaging in both unprotected sex and receptive sharing of syringes supports the need for HIV prevention programs to address both injection and sex-related risk behaviors among IDUs. Although most participants had been tested for HIV infection previously, less than half had been tested in the past year as recommended by CDC. In addition, many participants had not been vaccinated against hepatitis A and B as recommended by CDC. Although all participants had injected drugs during the past year, only a small percentage had recently participated in an alcohol or a drug treatment program or in a behavioral intervention, suggesting an unmet need for drug treatment and HIV prevention services. Public Health Action: To reduce the number of HIV infections among IDUs, additional efforts are needed to decrease the number of persons who engage in behaviors that increase their risk for HIV infection and to increase their access to HIV testing, alcohol and drug treatment, and other HIV prevention programs. The National HIV/AIDS Strategy for the United States delineates a coordinated response to reduce HIV incidence and HIV-related health disparities among IDUs and other disproportionately affected groups. CDC's high-impact HIV prevention approach provides an essential step toward achieving these goals by using combinations of scientifically proven, cost-effective, and scalable interventions among populations at greatest risk. NHBS data can be used to monitor progress toward the national strategy goals and to guide national and local planning efforts to maximize the impact of HIV prevention programs.

UR - http://www.scopus.com/inward/record.url?scp=84904066158&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904066158&partnerID=8YFLogxK

M3 - Article

C2 - 24990587

AN - SCOPUS:84904066158

VL - 63

SP - 1

EP - 56

JO - MMWR. Surveillance summaries : Morbidity and mortality weekly report. Surveillance summaries / CDC

JF - MMWR. Surveillance summaries : Morbidity and mortality weekly report. Surveillance summaries / CDC

SN - 1546-0738

IS - 1

ER -