Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992

Abstract

<h3>Objectives.</h3> —To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. <h3>Design and Setting.</h3> —Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. <h3>Participants.</h3> —Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. <h3>Interventions.</h3> —Community-based AIDS prevention programs, including underground syringe exchanges. <h3>Main Outcome Measures.</h3> —Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. <h3>Results.</h3> —The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4⁺cell counts declined from 0.716×10⁹/L (716/μL) to 0.575×10⁹/L (<i>P</i>&lt;.009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (<i>P</i>&lt;.001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. <h3>Conclusions.</h3> —The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission. (<i>JAMA</i>. 1994;271:121-127)