Declining seroprevalence in a very large HIV epidemic: injecting drug users in New York City, 1991 to 1996.

Abstract

OBJECTIVES: This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City. METHODS: We analyzed temporal trends in HIV seroprevalence from 1991 through 1996 in 5 studies of injecting drug users recruited from a detoxification program, a methadone maintenance program, research storefronts in the Lower East Side and Harlem areas, and a citywide network of sexually transmitted disease clinics. A total of 11,334 serum samples were tested. RESULTS: From 1991 through 1996, HIV seroprevalence declined substantially among subjects in all 5 studies: from 53% to 36% in the detoxification program, from 45% to 29% in the methadone program, from 44% to 22% at the Lower East Side storefront, from 48% to 21% at the Harlem storefront, and from 30% to 21% in the sexually transmitted disease clinics (all P < .002 by chi 2 tests for trend). CONCLUSIONS: The reductions in HIV seroprevalence seen among injecting drug users in New York City from 1991 through 1996 indicate a new phase in this large HIV epidemic. Potential explanatory factors include the loss of HIV-seropositive individuals through disability and death and lower rates of risk behavior leading to low HIV incidence.

Trends in the AIDS Epidemic Among New York City's Injection Drug Users: Localized or Citywide?

“…Future policy changes at the state and federal levels may have a major impact on the AIDS epidemic among IDUs throughout New York City. First, over-the-counter syringe sale in pharmacies was recently legalized in New York State 26 and became effective January 1,2001. Pharmacy sales may provide many legal sterile syringe distribution locations where none have existed before.…”

“…1 The New York City AIDS cases among IDUs have accounted for almost one quarter of the total number of IDU AIDS cases and one tenth of all AIDS cases in the United States. 1 The estimated size of the city's HIV-seropositive IDU population (approximately 70,000) is five times greater than the two next largest metropolitan statistical areas combined. 2 A majority of heterosexually transmitted AIDS cases among females involve sexual contact with a male IDU.…”

“…9 Further reductions in risk behavior were documented, and considerable evidence for a first actual decline in a very large HIV epidemic among IDUs was presented. 1 A question remains, however, as to whether this decline occurred throughout the city. With an area of 321.8 square miles, New York City's five boroughs (the Bronx, Brooklyn, Queens, Staten Island, and Manhattan) are also individual counties.…”

Risks for HIV infection among users and sellers of crack, powder cocaine and heroin in central Harlem: Implications for interventions

“…Current data (through 2002) indicate several changes since 1999, as only 35.7% of adult cases with a reported transmission category were IDUs, 35.1% MSM, and 24.4% heterosexual (NYCDOH, 2004). Research and prevention efforts may have been responsible for the reduction in seroprevalence and transmission behaviours among IDUs in the last decade (Maslow, et al, 2002;Des Jarlais et al, 1998.…”

What Do Pharmacists Think About New York State's New Nonprescription Syringe Sale Program? Results of a Survey

“…[1][2][3][4] In May 2000, New York State legislation was enacted to expand access to and availability of hypodermic needles and syringes without prescription as a human immunodeficiency virus (HIV) prevention measure on a demonstration basis, effective January 1, 2001, through March 31, 2003. [6][7][8][9][10] Under the new program, named the Expanded Syringe Access Demonstration Program (ESAP), New York State pharmacies may register with the New York State Department of Health (NYSDOH) to sell or furnish 10 or fewer hypodermic needles and syringes to individuals 18 years of age or older without a doctor's prescription.…”