What happened to the HIV epidemic among non-injecting drug users in New York City?

Don Des Jarlais, Kamyar Arasteh, Courtney Mcknight, Jonathan Feelemyer, Aimee N C Campbell, Susan Tross, Hannah L F Cooper, Holly Hagan, David C. Perlman

Research output: Contribution to journalArticle

Abstract

Background and aims: HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs. Design: Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years. Setting: Mount Sinai Beth Israel drug treatment programs in New York City, USA. Participants: We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non-injecting drug practice. Measures: Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ2 and multivariable logistic regression were used to compare 2005–10 versus 2011–14. Findings: HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005–10 to 8% in 2011–14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% confidence interval = 0.03/1000–7/1000). Conclusions: HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.

Original languageEnglish (US)
Pages (from-to)290-298
Number of pages9
JournalAddiction
Volume112
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Drug Users
HIV
Pharmaceutical Preparations
Sexual Partners
Heroin
Cocaine
Smoking
Crack Cocaine
Therapeutics
Incidence
Israel
Hispanic Americans
Sexual Behavior
African Americans
Cross-Sectional Studies
Logistic Models
Demography
Confidence Intervals

Keywords

  • Crack-cocaine
  • HIV
  • New York City
  • non-injection drug use
  • prevalence/incidence
  • substance use/abuse

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

What happened to the HIV epidemic among non-injecting drug users in New York City? / Des Jarlais, Don; Arasteh, Kamyar; Mcknight, Courtney; Feelemyer, Jonathan; Campbell, Aimee N C; Tross, Susan; Cooper, Hannah L F; Hagan, Holly; Perlman, David C.

In: Addiction, Vol. 112, No. 2, 01.02.2017, p. 290-298.

Research output: Contribution to journalArticle

Des Jarlais, Don ; Arasteh, Kamyar ; Mcknight, Courtney ; Feelemyer, Jonathan ; Campbell, Aimee N C ; Tross, Susan ; Cooper, Hannah L F ; Hagan, Holly ; Perlman, David C. / What happened to the HIV epidemic among non-injecting drug users in New York City?. In: Addiction. 2017 ; Vol. 112, No. 2. pp. 290-298.
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abstract = "Background and aims: HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs. Design: Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years. Setting: Mount Sinai Beth Israel drug treatment programs in New York City, USA. Participants: We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7{\%} male, 6.1{\%} white, 25.7{\%} Hispanic and 65.8{\%} African American. Smoking crack cocaine was the most common non-injecting drug practice. Measures: Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ2 and multivariable logistic regression were used to compare 2005–10 versus 2011–14. Findings: HIV prevalence declined approximately 1{\%} per year (P < 0.001), with a decline from 16{\%} in 2005–10 to 8{\%} in 2011–14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95{\%} confidence interval = 0.03/1000–7/1000). Conclusions: HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.",
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