HIV infection during limited versus combined HIV prevention programs for IDUs in New York City

The importance of transmission behaviors

Don Des Jarlais, Kamyar Arasteh, Courtney Mcknight, Holly Hagan, David C. Perlman, Lucia V. Torian, Sara Beatice, Salaam Semaan, Samuel R. Friedman

Research output: Contribution to journalArticle

Abstract

Objectives: As no single HIV prevention program has eliminated HIV transmission, there is growing interest in the effectiveness of " combined" prevention programming. To compare HIV infection among persons injecting in the initial programs environment (IPE) in New York City (self-initiated risk reduction, methadone, education/outreach, and HIV testing) to HIV infection among persons injecting in a combined programs environment (CPE) (above programs plus large-scale syringe exchange). To identify potential behavioral mechanisms through which combined programs are effective. Methods: Subjects were recruited from the Beth Israel drug detoxification program. A risk behavior questionnaire was administered and HIV testing conducted. Subjects who injected only between 1984 and 1994 (IPE) were compared to subjects who injected only between 1995 and 2008 (CPE). Results: 261 IPE subjects and 1153 CPE subjects were recruited. HIV infection was significantly lower among the CPE subjects compared to IPE subjects: prevalence 6% versus 21%, estimated incidence 0.3/100 person-years versus 4/100 person-years (both p<0.001). The percentage of subjects at risk of acquiring HIV through receptive syringe sharing was similar across CPE and IPE subjects (30% versus 33%). The percentage of subjects at risk of transmitting HIV through injection-related behaviors (who were both HIV seropositive and reported passing on used needles/syringes), was much lower among the CPE subjects than among the IPE subjects (1% versus 10%, p<0.001). Conclusions: Combined prevention programs can greatly reduce HIV transmission. Reducing distributive sharing by HIV seropositive injecting drug users (IDUs) may be a critical component in reducing HIV transmission in high seroprevalence settings.

Original languageEnglish (US)
Pages (from-to)154-160
Number of pages7
JournalDrug and Alcohol Dependence
Volume109
Issue number1-3
DOIs
StatePublished - Jun 2010

Fingerprint

Drug Users
Syringes
HIV Infections
HIV
Pharmaceutical Preparations
Detoxification
Methadone
Testing
Needles
Education
Needle Sharing
Seroepidemiologic Studies
Israel
Risk Reduction Behavior
Risk-Taking

Keywords

  • HIV prevention programs
  • IDUs
  • New York City
  • Prevention for positives
  • Syringe exchange

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Toxicology
  • Pharmacology
  • Pharmacology (medical)

Cite this

HIV infection during limited versus combined HIV prevention programs for IDUs in New York City : The importance of transmission behaviors. / Des Jarlais, Don; Arasteh, Kamyar; Mcknight, Courtney; Hagan, Holly; Perlman, David C.; Torian, Lucia V.; Beatice, Sara; Semaan, Salaam; Friedman, Samuel R.

In: Drug and Alcohol Dependence, Vol. 109, No. 1-3, 06.2010, p. 154-160.

Research output: Contribution to journalArticle

@article{5b80d87910af45159178cc76f8a5168a,
title = "HIV infection during limited versus combined HIV prevention programs for IDUs in New York City: The importance of transmission behaviors",
abstract = "Objectives: As no single HIV prevention program has eliminated HIV transmission, there is growing interest in the effectiveness of {"} combined{"} prevention programming. To compare HIV infection among persons injecting in the initial programs environment (IPE) in New York City (self-initiated risk reduction, methadone, education/outreach, and HIV testing) to HIV infection among persons injecting in a combined programs environment (CPE) (above programs plus large-scale syringe exchange). To identify potential behavioral mechanisms through which combined programs are effective. Methods: Subjects were recruited from the Beth Israel drug detoxification program. A risk behavior questionnaire was administered and HIV testing conducted. Subjects who injected only between 1984 and 1994 (IPE) were compared to subjects who injected only between 1995 and 2008 (CPE). Results: 261 IPE subjects and 1153 CPE subjects were recruited. HIV infection was significantly lower among the CPE subjects compared to IPE subjects: prevalence 6{\%} versus 21{\%}, estimated incidence 0.3/100 person-years versus 4/100 person-years (both p<0.001). The percentage of subjects at risk of acquiring HIV through receptive syringe sharing was similar across CPE and IPE subjects (30{\%} versus 33{\%}). The percentage of subjects at risk of transmitting HIV through injection-related behaviors (who were both HIV seropositive and reported passing on used needles/syringes), was much lower among the CPE subjects than among the IPE subjects (1{\%} versus 10{\%}, p<0.001). Conclusions: Combined prevention programs can greatly reduce HIV transmission. Reducing distributive sharing by HIV seropositive injecting drug users (IDUs) may be a critical component in reducing HIV transmission in high seroprevalence settings.",
keywords = "HIV prevention programs, IDUs, New York City, Prevention for positives, Syringe exchange",
author = "{Des Jarlais}, Don and Kamyar Arasteh and Courtney Mcknight and Holly Hagan and Perlman, {David C.} and Torian, {Lucia V.} and Sara Beatice and Salaam Semaan and Friedman, {Samuel R.}",
year = "2010",
month = "6",
doi = "10.1016/j.drugalcdep.2009.12.028",
language = "English (US)",
volume = "109",
pages = "154--160",
journal = "Drug and Alcohol Dependence",
issn = "0376-8716",
publisher = "Elsevier Ireland Ltd",
number = "1-3",

}

TY - JOUR

T1 - HIV infection during limited versus combined HIV prevention programs for IDUs in New York City

T2 - The importance of transmission behaviors

AU - Des Jarlais, Don

AU - Arasteh, Kamyar

AU - Mcknight, Courtney

AU - Hagan, Holly

AU - Perlman, David C.

AU - Torian, Lucia V.

AU - Beatice, Sara

AU - Semaan, Salaam

AU - Friedman, Samuel R.

PY - 2010/6

Y1 - 2010/6

N2 - Objectives: As no single HIV prevention program has eliminated HIV transmission, there is growing interest in the effectiveness of " combined" prevention programming. To compare HIV infection among persons injecting in the initial programs environment (IPE) in New York City (self-initiated risk reduction, methadone, education/outreach, and HIV testing) to HIV infection among persons injecting in a combined programs environment (CPE) (above programs plus large-scale syringe exchange). To identify potential behavioral mechanisms through which combined programs are effective. Methods: Subjects were recruited from the Beth Israel drug detoxification program. A risk behavior questionnaire was administered and HIV testing conducted. Subjects who injected only between 1984 and 1994 (IPE) were compared to subjects who injected only between 1995 and 2008 (CPE). Results: 261 IPE subjects and 1153 CPE subjects were recruited. HIV infection was significantly lower among the CPE subjects compared to IPE subjects: prevalence 6% versus 21%, estimated incidence 0.3/100 person-years versus 4/100 person-years (both p<0.001). The percentage of subjects at risk of acquiring HIV through receptive syringe sharing was similar across CPE and IPE subjects (30% versus 33%). The percentage of subjects at risk of transmitting HIV through injection-related behaviors (who were both HIV seropositive and reported passing on used needles/syringes), was much lower among the CPE subjects than among the IPE subjects (1% versus 10%, p<0.001). Conclusions: Combined prevention programs can greatly reduce HIV transmission. Reducing distributive sharing by HIV seropositive injecting drug users (IDUs) may be a critical component in reducing HIV transmission in high seroprevalence settings.

AB - Objectives: As no single HIV prevention program has eliminated HIV transmission, there is growing interest in the effectiveness of " combined" prevention programming. To compare HIV infection among persons injecting in the initial programs environment (IPE) in New York City (self-initiated risk reduction, methadone, education/outreach, and HIV testing) to HIV infection among persons injecting in a combined programs environment (CPE) (above programs plus large-scale syringe exchange). To identify potential behavioral mechanisms through which combined programs are effective. Methods: Subjects were recruited from the Beth Israel drug detoxification program. A risk behavior questionnaire was administered and HIV testing conducted. Subjects who injected only between 1984 and 1994 (IPE) were compared to subjects who injected only between 1995 and 2008 (CPE). Results: 261 IPE subjects and 1153 CPE subjects were recruited. HIV infection was significantly lower among the CPE subjects compared to IPE subjects: prevalence 6% versus 21%, estimated incidence 0.3/100 person-years versus 4/100 person-years (both p<0.001). The percentage of subjects at risk of acquiring HIV through receptive syringe sharing was similar across CPE and IPE subjects (30% versus 33%). The percentage of subjects at risk of transmitting HIV through injection-related behaviors (who were both HIV seropositive and reported passing on used needles/syringes), was much lower among the CPE subjects than among the IPE subjects (1% versus 10%, p<0.001). Conclusions: Combined prevention programs can greatly reduce HIV transmission. Reducing distributive sharing by HIV seropositive injecting drug users (IDUs) may be a critical component in reducing HIV transmission in high seroprevalence settings.

KW - HIV prevention programs

KW - IDUs

KW - New York City

KW - Prevention for positives

KW - Syringe exchange

UR - http://www.scopus.com/inward/record.url?scp=77949485911&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77949485911&partnerID=8YFLogxK

U2 - 10.1016/j.drugalcdep.2009.12.028

DO - 10.1016/j.drugalcdep.2009.12.028

M3 - Article

VL - 109

SP - 154

EP - 160

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

SN - 0376-8716

IS - 1-3

ER -