Will "Combined Prevention" Eliminate Racial/Ethnic Disparities in HIV Infection among Persons Who Inject Drugs in New York City?

• Authors: Don Des Jarlais, Mt Sinai Beth Israel; Kamyar Arasteh, Mt Sinai Beth Israel; Courtney McKnight, Mt Sinai Beth Israel; Jonathan Feelemyer, Mt Sinai Beth Israel; Holly Hagan, NYU; Hannah Cooper, Emory University; Aimee Campbell, Columbia University; Susan Tross, Columbia University; David Perlman, Mt Sinai Beth Israel
• Journal Title: PLoS ONE
• Volume: Volume 10, Number 5
• Publisher: Public Library of Science | 2015-05-12, Pages e0126180-e0126180
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pone.0126180
• Subjects: Health Sciences, Public Health; Sociology, Public and Social Welfare
• Keywords: Science & Technology; Multidisciplinary Sciences; Science & Technology - Other Topics; SEXUAL TRANSMISSION; USERS; RISK; SEROPREVALENCE; BEHAVIORS; USA

Abstract

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.It has not been determined whether implementation of combined prevention programming for persons who inject drugs reduce racial/ethnic disparities in HIV infection. We examine racial/ethnic disparities in New York City among persons who inject drugs after implementation of the New York City Condom Social Marketing Program in 2007. Quantitative interviews and HIV testing were conducted among persons who inject drugs entering Mount Sinai Beth Israel drug treatment (2007-2014). 703 persons who inject drugs who began injecting after implementation of large-scale syringe exchange were included in the analyses. Factors independently associated with being HIV seropositive were identified and a published model was used to estimate HIV infections due to sexual transmission. Overall HIV prevalence was 4%; Whites 1%, African-Americans 17%, and Hispanics 4%. Adjusted odds ratios were 21.0 (95% CI 5.7, 77.5) for African-Americans to Whites and 4.5 (95% CI 1.3, 16.3) for Hispanics to Whites. There was an overall significant trend towards reduced HIV prevalence over time (adjusted odd ratio = 0.7 per year, 95% confidence interval (0.6-0.8). An estimated 75% or more of the HIV infections were due to sexual transmission. Racial/ethnic disparities among persons who inject drugs were not significantly different from previous disparities. Reducing these persistent disparities may require new interventions (treatment as prevention, pre-exposure prophylaxis) for all racial/ethnic groups.