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HIV and Hepatitis C Risk Factors and Prevention Among People Who Inject Drugs

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More than half of young injection drug users in the U.S. shared syringes previously used by others and a large majority reported unprotected sex, according to the latest data on people who inject drugs from the National HIV Behavioral Surveillance System, published in the July 4 edition of Morbidity and Mortality Weekly Report Surveillance Summaries. The survey found that 9% had HIV and 41% had hepatitis C.

As summarized in the July 3 edition of the CDC's e-HAP bulletin, the surveillance results show that injection drug users in the U.S. "engage in sexual and drug-use behaviors that increase their risk for HIV infection which highlights the critical need for strengthened prevention efforts to help to decrease risk behaviors, and increase access to HIV testing, substance abuse treatment, as well as other prevention services for [injection drug users]."

The CDC estimates that 8% of new HIV infections in 2010 occurred among injection drug users. The latest results come from the second cycle of National HIV Behavioral Surveillance drug injector surveys, conducted in 2009. Injection drug users in 20 metropolitan areas were offered HIV tests and asked about their risk behaviors, prior HIV testing, and use of prevention services. Participants included 10,200 adults (age 18 or older) who reported injecting drugs at least once during the past 12 months.

Among 10,090 participants with valid HIV test results, 906 (9%) tested positive. Among the approximately 400 people who had not previously tested positive, the new diagnosis rate was 4%. The CDC recommends that people who inject drugs should be tested for HIV each year. Although most survey participants had been tested at least once before, only 49% had been tested during the past year.

Looking at viral hepatitis, 41% had received a positive hepatitis C virus (HCV) diagnosis. HCV is more easily transmitted by injection equipment than HIV, and HCV infection rates among people who inject drugs are typically higher. Nearly one-third (29%) said they had been vaccinated against hepatitis A, hepatitis B, or both.

In a behavioral analysis restricted to the 9652 participants who had not previously tested HIV positive, the most commonly injected drugs were heroin (90%), speedball or heroin plus cocaine (58%), and cocaine or crack (49%). Nearly three-quarters reported also using non-injected drugs and 41% reported binge drinking during the past year.

According to the report, about one-third of participants reported receptive syringe sharing, or using a needle after someone else. Young injection drug users aged 18-29 were most likely -- at 52% -- to reported receptive sharing. Overall, more than half (58%) shared other injection equipment such as cookers, cotton, or water. During the past year 44% said they had received sterile syringes and 41% had received other injection equipment through needle exchanges or other harm reduction efforts.

A majority of participants -- 70% of men and 73% of women overall -- reported unprotected vaginal sex during the past 12 months, while 25% and 21%, respectively, reported unprotected anal sex. Again, risk behavior was most common among young injectors, with 80% of men and 89% of women in the 18-29 age group reporting unprotected sex. Among men, 10% reported oral or anal sex with a male partner. Further, 31% of women and 18% of men said they had exchanged sex for money or drugs.

"[Injection drug users]in the United States continue to engage in sexual and drug-use behaviors that increase their risk for HIV infection," the study authors summarized. "The large percentage of participants in this study who reported engaging in both unprotected sex and receptive sharing of syringes supports the need for HIV prevention programs to address both injection and sex-related risk behaviors among [injection drug users]."

"To reduce the number of HIV infections among [injection drug users], additional efforts are needed to decrease the number of persons who engage in behaviors that increase their risk for HIV infection and to increase their access to HIV testing, alcohol and drug treatment, and other HIV prevention programs," the authors concluded.

"A high-impact approach for expanded HIV prevention for [injection drug users] is suggested, which includes a combination of cost-effective evidence-based biomedical, behavioral, and structural approaches that are able to increase access to and use of HIV testing, care, and treatment and to prevention services to achieve the greatest possible reductions in HIV incidence and HIV-related disparities," they recommended. "A combination prevention approach for [injection drug users] also includes prevention and treatment of other infectious diseases, including [sexually transmitted diseases] and [hepatitis B and C virus] infections, thus integration of multiple service programs for [injection drug users] might increase the effectiveness of HIV prevention efforts."

7/16/14

Sources

D Broz, C Wejnert, HTPham, et al.HIV Infection and Risk, Prevention, and Testing Behaviors Among Injecting Drug Users -- National HIV Behavioral Surveillance System, 20 U.S. Cities, 2009. Morbidity and Mortality Weekly Report Surveillance Summaries 63(ss06):1-51. July 4, 2014.

CDC. New CDC Report: HIV Infection & Risk, Prevention and Testing Behaviors among Injecting Drug Users. e-HAP. July 3, 2014.