Do metropolitan HIV epidemic histories and programs for people who inject drugs and Men who have sex with men predict AIDS incidence and mortality among heterosexuals?

• Authors: Samuel R. Friedman, National Development and Research Institutes; Brooke S. West, National Development and Research Institutes; Barbara Tempalski, National Development and Research Institutes; Cory M. Morton, National Development and Research Institutes; Charles M. Cleland, New York University; Don C. Des Jarlais, Beth Israel Deaconess Medical Center; H. Irene Hall, Centers for Disease Control and Prevention; Hannah Cooper, Emory University
• Journal Title: Annals of Epidemiology
• Volume: Volume 24, Number 4
• Publisher: Elsevier: 12 months | 2014-04-01, Pages 304-311
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.annepidem.2014.01.008
• Subjects: Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Urban health; Metropolitan areas; HIV/AIDS; Bridging; Heterosexuals; People who inject drugs; IDU; Men who have sex with men; MSM; Epidemics; RACIAL RESIDENTIAL SEGREGATION; SYRINGE EXCHANGE PROGRAMS; METHAMPHETAMINE USE; UNITED-STATES; TREATMENT COVERAGE; NEEDLE-EXCHANGE; GAY MEN; US; USERS; RISK

Abstract

Purpose: We focus on a little-researched issue-how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? Methods: Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls. Results: Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. Conclusions: Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.