HIV Among Injection Drug Users in Large US Metropolitan Areas, 1998

Friedman, Samuel R.; Lieb, Spencer; Tempalski, Barbara; Cooper, Hannah L.F.; Keem, Marie; Friedman, Risa; Flom, Peter L.

doi:10.1093/jurban/jti088

Cited by 55 publications

(51 citation statements)

References 26 publications

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“…Friedman et al 22 estimated 1998 HIV prevalence rates among IDUs within the same 96 large MSAs as Holmberg. These estimates were based on (1) adjusting Centers for Disease Control (CDC) Counseling and Testing data by regression imputation techniques with research study data, and (2) estimates of the ratio of the number of IDUs living with HIV to the number of IDUs living in an MSA.…”

Section: Historical Data On Differences In Hiv Prevalence Among Idus mentioning

confidence: 99%

“…Dissimilarity in methods and problems of regression to (and from) the mean, limited our ability to study change in these estimates and makes interurban comparisons between Holmberg's 1992 21 estimates and Friedman's 1998 22 HIV prevalence estimates problematic. Developing our HIV prevalence rates among IDUs over time will enhance our capacity to study the determinants of changes in HIV epidemics.…”

Section: Historical Data On Differences In Hiv Prevalence Among Idus mentioning

confidence: 99%

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HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002

et al. 2008

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This research presents estimates of HIV prevalence rates among injection drug users (IDUs) in large US metropolitan statistical areas (MSAs) during 1992-2002. Trend data on HIV prevalence rates in geographic areas over time are important for research on determinants of changes in HIV among IDUs. Such data also provide a foundation for the design and implementation of structural interventions for preventing the spread of HIV among IDUs. Our estimates of HIV prevalence rates among IDUs in 96 US MSAs during 1992-2002 are derived from four independent sets of data: (1) research-based HIV prevalence rate estimates; (2) Centers for Disease Control and Prevention Voluntary HIV Counseling and Testing data (CDC CTS); (3) data on the number of people living with AIDS compiled by the CDC (PLWAs); and (4) estimates of HIV prevalence in the US. From these, we calculated two independent sets of estimates: (1) calculating CTS-based Method (CBM) using regression adjustments to CDC CTS; and (2) calculating the PLWA-based Method (PBM) by taking the ratio of the number of injectors living with HIV to the numbers of injectors living in the MSA. We take the mean of CBM and PBM to calculate over all HIV prevalence rates for 1992-2002. We evaluated trends in IDU HIV prevalence rates by calculating estimated annual percentage changes (EAPCs) for each MSA. During 1992-2002, HIV prevalence rates declined in 85 (88.5%) of the 96 MSAs, with EAPCs ranging from -12.9% to -2.1% (mean EAPC=-6.5%; p<0.01). Across the 96 MSAs, collectively, the annual mean HIV prevalence rate declined from 11.2% in 1992 to 6.2 in 2002 (EAPC, -6.4%; p<0.01). Similarly, the median HIV prevalence rate declined from 8.1% to 4.4% (EAPC, -6.5%; p<0.01). The maximum HIV prevalence rate across the 11 years declined from 43.5% to 22.8% (EAPC, -6.7%; p<0.01). Declining HIV prevalence rates may reflect high continuing mortality among infected IDUs, as well as primary HIV prevention for non-infected IDUs and self-protection efforts by them. These results warrant further research into the population dynamics of disease progression, access to health services, and the effects of HIV prevention interventions for IDUs.

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Section: Historical Data On Differences In Hiv Prevalence Among Idus mentioning

confidence: 99%

Section: Historical Data On Differences In Hiv Prevalence Among Idus mentioning

confidence: 99%

HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002

et al. 2008

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“…5,6 Studies that have attempted to examine more precise associations between community characteristics and HIV infection among IDUs have found that income inequality at the standard metropolitan statistical area-level is associated with higher HIV prevalence among IDUs. [7][8][9] In a different study, residing in census tracts with high male unemployment was found to be associated with prevalent HIV among IDUs (income equality was not considered in this study). 10 In terms of HIV risk behaviors, a few studies have examined the association between community characteristics and injection-related HIV risk among IDUs.…”

Section: Introductionmentioning

confidence: 99%

Community Characteristics Associated with HIV Risk among Injection Drug Users in the San Francisco Bay Area: A Multilevel Analysis

et al. 2007

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Community characteristics have been associated with racial and ethnic health disparities for a wide range of ailments and conditions. Previous research has found that rates of AIDS cases among injection drug users (IDUs) vary by community characteristics. However, few studies have examined whether community characteristics are associated with HIV risk behaviors among IDUs. To address this gap in the literature, we examined the associations between census-tract-level community characteristics and injection-related and sex-related HIV risk behaviors among IDUs in the San Francisco Bay Area. Individual HIV risk behaviors were collected from 4,956 IDUs between 1998 and 2002. Using 2000 US census data, we constructed four census-level community measures: percent African American, percent male unemployment, percent of households that receive public assistance, and median household income. All community variables were measured continuously. Multilevel modeling was used to determine if community characteristics were associated with recent (in the last 6 months) receptive and distributive syringe sharing, multiple sex partners, and unprotected sex risk while controlling for potential individual-level confounders. In bivariate analysis, most of the census-tract-level community characteristics were significantly associated with injection-related HIV risk, while no community characteristics were associated with sex-related risk. However, results from multivariate multilevel models indicate that only percent African American in a census tract was associated with receptive [adjusted odds ratio (AOR) = 0.93; 95% confidence interval (CI) = 0.89, 0.99] and distributive syringe sharing (AOR = 0.94; 95% CI = 0.92, 0.99), net of individual-level characteristics. Accounting for individual-level factors in the multivariate model in the sex-related risk models revealed a significant inverse relationship between percent African American and propensity to engage in unprotected sex (AOR = 0.95; 95% CI = 0.92, 0.99); community-level characteristics remained unassociated with multiple sex partners. In this exploratory analysis, percent African American in a census tract was inversely associated with injection-related risk. The census-tract-level community characteristics we examined seem to exert little influence on individual risk among long-term chronic IDUs. More research is needed examining the influence of other community characteristics that were unmeasured in this paper but might be related to sex and drug risk among IDUs such as shooting galleries, crack houses, drug markets, and availability of preventive HIV services.

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“…CTS-based estimates may be affected by the extent to which the history of the local HIV epidemic varies across racial/ethnic groups of injectors. 85,86 For instance, in an MSA where HIV entered the local communities of Black injectors before it entered communities of White injectors, CTS-based estimates of Black IDU prevalence may be artificially low, given that HIV-positive individuals are unlikely to be retested. This bias, however, might be countered by frequent retests among HIVnegative Black injectors, who might be particularly concerned about HIV transmission.…”

Section: Limitations and Validationmentioning

confidence: 99%

“…1, 2, 3 and 4. Moreover, our capacity to adjust APIDSbased estimates for local HIV seroprevalence was limited given (1) our use of CTS data to calculate HIV seroprevalence, 70,85 and (2) spatial, temporal, and racial/ethnic variations in the time between HIV diagnosis and AIDS diagnosis, [62][63][64][65] variations that we could not adjust for. In addition, CDC reporting guidelines for APIDS and for CTS define injectors as anyone who has injected since 1978.…”

Section: Estimating Injection Drug Use Among Black and White Adultsmentioning

confidence: 99%

Estimating the Prevalence of Injection Drug Use among Black and White Adults in Large U.S. Metropolitan Areas over Time (1992–2002): Estimation Methods and Prevalence Trends

et al. 2008

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No adequate data exist on patterns of injection drug use (IDU) prevalence over time within racial/ethnic groups in U.S. geographic areas. The absence of such prevalence data limits our understanding of the causes and consequences of IDU and hampers planning efforts for IDU-related interventions. Here, we (1) describe a method of estimating IDU prevalence among non-Hispanic Black and non-Hispanic White adult residents of 95 large U.S. metropolitan statistical areas (MSAs) annually over an 11-year period (1992--2002); (2) validate the resulting prevalence estimates; and (3) document temporal trends in these prevalence estimates. IDU prevalence estimates for Black adults were calculated in several steps: we (1) created estimates of the proportion of injectors who were Black in each MSA and year by analyzing databases documenting injectors' encounters with the healthcare system; (2) multiplied the resulting proportions by previously calculated estimates of the total number of injectors in each MSA and year (Brady et al., 2008); (3) divided the result by the number of Black adults living in each MSA each year; and (4) validated the resulting estimates by correlating them cross-sectionally with theoretically related constructs (Black- and White-specific prevalences of drug-related mortality and of mortality from hepatitis C). We used parallel methods to estimate and validate White IDU prevalence. We analyzed trends in the resulting racial/ethnic-specific IDU prevalence estimates using measures of central tendency and hierarchical linear models (HLM). Black IDU prevalence declined from a median of 279 injectors per 10,000 adults in 1992 to 156 injectors per 10,000 adults in 2002. IDU prevalence for White adults remained relatively flat over time (median values ranged between 86 and 97 injectors per 10,000 adults). HLM analyses described similar trends and suggest that declines in Black IDU prevalence decelerated over time. Both sets of IDU estimates correlated cross-sectionally adequately with validators, suggesting that they have acceptable convergent validity (range for Black IDU prevalence validation: 0.27 < r < 0.61; range for White IDU prevalence: 0.38 < r < 0.80). These data give insight, for the first time, into IDU prevalence trends among Black adults and White adults in large U.S. MSAs. The decline seen here for Black adults may partially explain recent reductions in newly reported cases of IDU-related HIV evident in surveillance data on this population. Declining Black IDU prevalence may have been produced by (1) high AIDS-related mortality rates among Black injectors in the 1990s, rates lowered by the advent of HAART; (2) reduced IDU incidence among Black drug users; and/or (3) MSA-level social processes (e.g., diminishing residential segregation). The stability of IDU prevalence among White adults between 1992 and 2002 may be a function of lower AIDS-related mortality rates in this population; relative stability (and perhaps increases in some MSAs) in initiating IDU among White drug users; and social process...

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HIV Among Injection Drug Users in Large US Metropolitan Areas, 1998

Cited by 55 publications

References 26 publications

HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002

HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002

Community Characteristics Associated with HIV Risk among Injection Drug Users in the San Francisco Bay Area: A Multilevel Analysis

Estimating the Prevalence of Injection Drug Use among Black and White Adults in Large U.S. Metropolitan Areas over Time (1992–2002): Estimation Methods and Prevalence Trends

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