Prevention of HIV infection in street-recruited injection drug users

Edgar R. Monterroso, Merle E. Hamburger, David Vlahov, Don Des Jarlais, Lawrence J. Ouellet, Frederick L. Altice, Robert H. Byers, Peter R. Kerndt, John K. Watters, Benjamin P. Bowser, M. Daniel Fernando, Scott D. Holmberg

Research output: Contribution to journalArticle

Abstract

Background: Injection drug users (IDUs) and their sex partners account for an increasing proportion of new AIDS and HIV cases in the United States, but public debate and policy regarding the effectiveness of various HIV prevention programs for them must cite data from other countries, from non-street-recruited IDUs already in treatment, or other programs, and from infection rates for pathogens other than HIV. Methods: Participants were recruited from the street at six sites (Baltimore [Maryland], New York [two sites], Chicago [Illinois], San Jose [California], Los Angeles [California], and at a state women's correctional facility [Connecticut]), interviewed with a standard questionnaire, and located and reinterviewed at one or more follow-up visits (mean, 7.8 months later). HIV serostatus and participation in various programs and behaviors that could reduce HIV infection risk were determined at each visit. Results: In all, 3773 participants were recruited from the street, and 2306 (61%) were located and interviewed subsequently. Of 3562 initial serum specimens, 520 (14.6%) were HIV-seropositive; at subsequent assessment, 19 people, all from the East Coast and Chicago, had acquired HIV. Not using previously used needles was substantially protective against HIV acquisition (relative risk [RR], 0.29; 95% confidence interval [CI], 0.11-0.80) and, in a multivariate model, was significantly associated with use of needle and syringe exchange programs (adjusted odds ratio [OR(adj)], 2.08; 95% CI, 1.15-3.85). Similarly, reduction of injection frequency was very protective against seroconversion (RR, 0.33; 95% CI, 0.14-0.80), and this behavior was strongly associated with participation in drug treatment programs (OR(adj), 3.54; 95% CI, 2.50-5.00). In a separate analysis, only 37.5% of study-participants had sufficient new needles to meet their monthly demand. Conclusions: In this large multicity study of IDUs in the United States, several HIV prevention strategies appeared to be individually and partially effective; these results indicate the continued need for, and substantial gaps in, effective approaches to preventing HIV infection in drug users.

Original languageEnglish (US)
Pages (from-to)63-70
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume25
Issue number1
DOIs
StatePublished - Sep 1 2000

Fingerprint

Drug Users
HIV Infections
HIV
Injections
Needle-Exchange Programs
Confidence Intervals
Needles
Baltimore
Los Angeles
Public Policy
Acquired Immunodeficiency Syndrome
Odds Ratio
Therapeutics
Infection
Serum
Pharmaceutical Preparations

Keywords

  • Drug treatment
  • HIV
  • HIV prevention
  • Injection drug use
  • Needle and syringe exchange programs

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Monterroso, E. R., Hamburger, M. E., Vlahov, D., Des Jarlais, D., Ouellet, L. J., Altice, F. L., ... Holmberg, S. D. (2000). Prevention of HIV infection in street-recruited injection drug users. Journal of Acquired Immune Deficiency Syndromes, 25(1), 63-70. https://doi.org/10.1097/00126334-200009010-00009

Prevention of HIV infection in street-recruited injection drug users. / Monterroso, Edgar R.; Hamburger, Merle E.; Vlahov, David; Des Jarlais, Don; Ouellet, Lawrence J.; Altice, Frederick L.; Byers, Robert H.; Kerndt, Peter R.; Watters, John K.; Bowser, Benjamin P.; Fernando, M. Daniel; Holmberg, Scott D.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 25, No. 1, 01.09.2000, p. 63-70.

Research output: Contribution to journalArticle

Monterroso, ER, Hamburger, ME, Vlahov, D, Des Jarlais, D, Ouellet, LJ, Altice, FL, Byers, RH, Kerndt, PR, Watters, JK, Bowser, BP, Fernando, MD & Holmberg, SD 2000, 'Prevention of HIV infection in street-recruited injection drug users', Journal of Acquired Immune Deficiency Syndromes, vol. 25, no. 1, pp. 63-70. https://doi.org/10.1097/00126334-200009010-00009
Monterroso, Edgar R. ; Hamburger, Merle E. ; Vlahov, David ; Des Jarlais, Don ; Ouellet, Lawrence J. ; Altice, Frederick L. ; Byers, Robert H. ; Kerndt, Peter R. ; Watters, John K. ; Bowser, Benjamin P. ; Fernando, M. Daniel ; Holmberg, Scott D. / Prevention of HIV infection in street-recruited injection drug users. In: Journal of Acquired Immune Deficiency Syndromes. 2000 ; Vol. 25, No. 1. pp. 63-70.
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AU - Hamburger, Merle E.

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AU - Ouellet, Lawrence J.

AU - Altice, Frederick L.

AU - Byers, Robert H.

AU - Kerndt, Peter R.

AU - Watters, John K.

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AU - Holmberg, Scott D.

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N2 - Background: Injection drug users (IDUs) and their sex partners account for an increasing proportion of new AIDS and HIV cases in the United States, but public debate and policy regarding the effectiveness of various HIV prevention programs for them must cite data from other countries, from non-street-recruited IDUs already in treatment, or other programs, and from infection rates for pathogens other than HIV. Methods: Participants were recruited from the street at six sites (Baltimore [Maryland], New York [two sites], Chicago [Illinois], San Jose [California], Los Angeles [California], and at a state women's correctional facility [Connecticut]), interviewed with a standard questionnaire, and located and reinterviewed at one or more follow-up visits (mean, 7.8 months later). HIV serostatus and participation in various programs and behaviors that could reduce HIV infection risk were determined at each visit. Results: In all, 3773 participants were recruited from the street, and 2306 (61%) were located and interviewed subsequently. Of 3562 initial serum specimens, 520 (14.6%) were HIV-seropositive; at subsequent assessment, 19 people, all from the East Coast and Chicago, had acquired HIV. Not using previously used needles was substantially protective against HIV acquisition (relative risk [RR], 0.29; 95% confidence interval [CI], 0.11-0.80) and, in a multivariate model, was significantly associated with use of needle and syringe exchange programs (adjusted odds ratio [OR(adj)], 2.08; 95% CI, 1.15-3.85). Similarly, reduction of injection frequency was very protective against seroconversion (RR, 0.33; 95% CI, 0.14-0.80), and this behavior was strongly associated with participation in drug treatment programs (OR(adj), 3.54; 95% CI, 2.50-5.00). In a separate analysis, only 37.5% of study-participants had sufficient new needles to meet their monthly demand. Conclusions: In this large multicity study of IDUs in the United States, several HIV prevention strategies appeared to be individually and partially effective; these results indicate the continued need for, and substantial gaps in, effective approaches to preventing HIV infection in drug users.

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