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

BACKGROUND AND AIMS: HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. 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, 3) estimate HIV incidence among NIDUs.

DESIGN: Serial-cross sectional surveys of persons entering drug treatment programs. Persons 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% male, 6% white, 26% Hispanic and 66% 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. Chi square and multivariable logistic regression were used to compare 2005 – 2010 versus 2011 – 2014.

FINDINGS: HIV prevalence declined approximately 1% per year (p < 0.001), with a decline from 16% in 2005 – 2010 to 8% in 2011- 2014 (p < 0.001). The percentages  of participants smoking crack and having multiple sexual partners declined, the percentage of HIV positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% CI 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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Full citation:
Des Jarlais DC, Arasteh K, McKnight C, Feelemyer J, Campbell AN, Tross S, Cooper HL, Hagan H, Perlman DC (2017).
What happened to the HIV epidemic among non-injecting drug users in New York City?
Addiction, 112 (2), 290-298. doi: 10.1111/add.13601. PMCID: PMC5233554.