Drug Abuse & HIV
CDC Report Highlights Link Between Drug Abuse and Spread of HIV
By Neil Swan, NIDA NOTES Staff Writer
An extensive review of existing research data confirms that behavior
associated with drug abuse is the single largest factor in the spread of
HIV/AIDS in this country. Half of all new infections with HIV, the virus that
causes AIDS, now occur among injecting drug users (IDUs), according to the data
review, which was conducted at the Centers for Disease Control and Prevention (CDC)
in Atlanta.
The study focused on three groups recognized as being at highest risk for
transmission of HIV: IDUs, men who have sex with men, and heterosexual men and
women who are at risk because they have sex with IDUs and/or bisexual or gay
men. The review used data gathered from America's 96 largest cities, where HIV
infection rates are the highest in the Nation. The trends in HIV infection rates
found in these cities also apply to the Nation's population in general, says the
CDC reviewer Dr. Scott D. Holmberg.
Most newly HIV-infected IDUs live in northeastern cities from Boston to
Washington, D.C., as well as in Miami and San Juan, Puerto Rico, reports the CDC
reviewer. In these cities, where injection drug use rates are also the highest
among the 96 cities surveyed, an average of 27 percent of all IDUs are
HIV-infected.
"These data confirm and underscore the connection between injection drug use and
the continuing spread of HIV and AIDS," says NIDA Director Dr. Alan I. Leshner.
"Drug abuse and HIV are truly interlinked epidemics."
"The information further demonstrates that NIDA has a critical role indeed in
addressing the drug abuse-HIV connection and in focusing scientific research to
understand and deal with the further spread of this devastating disease," he
says.
The data confirm earlier figures from periodic CDC reports on the number of
newly diagnosed cases of AIDS and HIV infection, which suggested that the
proportion of new HIV cases linked to drug abuse was close to one-half. (See "NIDA
Plays Key Role in Studying Links Between AIDS and Drug Abuse," NIDA NOTES,
May/June 1995)
Dr. Holmberg set out to estimate the size and direction of the HIV epidemic in
major U.S. cities with populations greater than 500,000. He compiled a large
computer model for tracking disease trends by reviewing more than 350 documents,
several large research data sets, and information from 220 public health
authorities. Some of the reports date back 10 or more years.
The 96 metropolitan areas Dr. Holmberg looked at have an estimated 1.5 million
IDUs, 1.7 million gay and bisexual men, and 2.1 million at-risk heterosexuals.
Among these three risk groups there are currently an estimated 565,000 HIV
infections, with 38,000 new infections occurring each year. Using these data to
make nationwide projections, the review concludes that there are about 700,000
current HIV infections, with 41,000 new HIV infections occurring each year in
the U.S. population.
An estimated 19,000 IDUs are infected each year in these 96 metropolitan areas,
indicating an HIV incidence rate of about 1.5 infections per 100 IDUs per year,
Dr. Holmberg reports. Infection rates are lower for the other two high-risk
groups. Although gay and bisexual men still represent the group with the
greatest number of current HIV infections, the rate of infection-except in young
and ethnic/minority gay men-is much lower now than it was a decade ago, Dr.
Holmberg reports. For gay and bisexual men, the HIV infection rate per 100
persons per year is 0.7; for at-risk heterosexuals-those who have sex with IDUs
or gay and bisexual men-the rate is 0.5 infections per 100 persons per year.
At-risk heterosexual women outnumber at-risk heterosexual men about 4 to 1.
In the research review, HIV incidence rates for metropolitan areas were broken
down by estimated numbers of HIV-infected people in each of the three at-risk
groups. An estimated HIV infection rate for each group in each city was also
provided. "This is highly valuable epidemiological information for better
targeting prevention strategies," says Dr. Leshner.
"The HIV epidemic is now clearly driven by infections occurring among injecting
drug users, their sex partners, and their offspring," concludes Dr. Holmberg in
his review. However, NIDA-funded efforts to educate IDUs to modify their risky
drug use behaviors have proven effective, he says. Evidence shows that HIV
infection rates in injecting drug users have declined over the past several
years in the largest drug-using communities, he reports.
In cities in New York and northern New Jersey, the epicenter of the AIDS
epidemic among injecting drug users, many IDUs are switching to practices that
may lessen their risk of contracting HIV, such as using sterile, never-used
needles and syringes; cleaning needles and paraphernalia; sniffing rather than
injecting heroin and cocaine; or abstaining from drug use altogether. This shows
that drug abuse and AIDS prevention programs targeting IDUs are working, Dr.
Holmberg says.
His review further illuminates the link between the AIDS epidemic and drug abuse
as primarily a public health issue. Within this public health perspective, the
CDC scientist's review also provides important insights for policymakers,
clinicians, and administrators who are planning and implementing drug abuse and
HIV prevention and treatment programs. Targeting HIV treatment and prevention
programs to IDUs also holds potential for reducing the spread of other
blood-borne infections, including hepatitis B and C viruses.
Source:
Holmberg, S.D. The estimated prevalence and incidence of HIV in 96 large U.S.
metropolitan areas. American Journal of Public Health 86(5):642-654, 1996.
From NIDA NOTES, March/April 1997
HIV and drug addiction.
Venkataraman R.
Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. WePeC6038.
Non-governmental organisation, New Delhi, India
Issue: The constant struggle for survival in the conflict situation of North
East India is leading more and more people to find solace in drugs. Today, over
80 per cent of them are now into injections and Spasmo Proxyvon, a pain-killing
drug. This drug has captured the minds and hearts of youths aged 15 to 30 years.
Many have fallen victim to it. There is now an emergence of HIV/AIDS cases among
females that shows it is no longer confined to intravenous drug users who
comprises of mostly men. There is increasing evidence that women and children
are now prone to the epidemic. The entire system is collapsing and needs to be
overhauled. Description: Within the context of political, economic and social
dimensions of armed conflict and violence, Oxfam-India and its partners are
undertaking intervention efforts to mitigate impact of HIV/AIDS on drug users.
Oxfam is working with the youth, women, children and men to: raise awareness;
improve quality of life, change attitudes and to build capacity. Lessons learnt:
There has been a marked decrease in needle sharing among intravenous drug users
as a result of new needles and syringes being provided through Oxfam partner
organisations. Injecting drug users are receiving rehabilitation support and
more HIV+ women and men are accessing psychosocial support - this is especially
significant given the culture of denial, stigma and discrimination, especially
against HIV+ women. However, relapse rates of drug users are still very high.
Very few women are involved in decision-making process or even in programme
designing. Therefore, the focus on HIV and related problems are not addressed
properly. Recommendations: Women need to be involved in the decision making
process, HIV to be mainstreamed in development programmes, more government
lobbying required.
Medical information: Cure HIV, Inc. does not intend to provide specific medical advice or treatment. Cure HIV, Inc. intends to provide the website visitors with documents and information to better understand HIV / AIDS and its prevention and treatment.