Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001-2005 and 2011-2015

• Type of Material: Article
• Authors: Don C. Des Jarlais, Icahn School of Medicine at Mount Sinai; Courtney McKnight, Icahn School of Medicine at Mount Sinai; Jonathan Feelemyer, Icahn School of Medicine at Mount Sinai; Kamyar Arasteh, Icahn School of Medicine at Mount Sinai; Susan Tross, Columbia University; Aimee N. C. Campbell, Columbia University; Hannah Cooper, Emory University; David C. Perlman, Icahn School of Medicine at Mount Sinai
• Language: English
• Date: 2018-04-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.drugalcdep.2017.12.039
• Title of Journal or Parent Work: Drug and Alcohol Dependence
• ISSN: 0376-8716
• Volume: 185
• Start Page: 391
• End Page: 397
• Grant/Funding Information: This work was supported through grants R01DA003574, and R01DA035707 from the US National Institute on Drug Abuse.
• Keywords: FUTURE-DIRECTIONS; New York city; WOMEN; RISK BEHAVIORS; PREVENTION; GLOBAL PERSPECTIVE; Substance Abuse; INTERVENTIONS; SEROPREVALENCE; TRANSMISSION; Life Sciences & Biomedicine; Psychiatry; SIMPLEX-VIRUS TYPE-2; USERS; Science & Technology; HIV; Sex/Gender disparities; Injection drug use
• Research Categories: Health Sciences, Public Health; Health Sciences, Mental Health

Abstract

Background: We examined whether sex disparities (heterosexual male:female) in HIV infection continue to persist at the “end of the HIV epidemic” among persons who inject drugs (PWID) in New York City (NYC). An “end of the epidemic” was operationally defined as 1) prevalence of untreated HIV infection <5%, and 2) estimated HIV incidence <0.5/100 person-years. Methods: PWID were recruited from persons entering substance use treatment programs at Mount Sinai Beth Israel in 2001–2005 and 2011–2015. A structured interview was administered, and HIV and HSV-2 testing was conducted. Incidence was estimated using newly diagnosed cases of HIV. Disparity analyses compared prevalence of HIV, of untreated HIV, HIV risk behaviors, and estimated HIV incidence. Results: By 2011–2015, both heterosexual male and female PWID met the two criteria for an “end of the epidemic,” and there were no significant differences in the prevalence of untreated HIV infection. A large sex difference remained in estimated HIV incidence. In 2013–2015, estimated HIV incidence was 2.8/10,000 PY for males and 7.1/10,000 PY for females. Females had greater risk for HIV on several factors. Conclusion: While NYC has reached an “end of the epidemic” for both heterosexual male and female PWID, sex disparities persist, particularly differences in HIV incidence. Eliminating the sex disparities may require a greater focus on factors associated with sexual transmission.