Abstract
Background and AimsTo examine whether drug users (DU) in the Amsterdam Cohort Study (ACS) are still at risk for HIV, we studied trends in HIV incidence and injecting and sexual risk behaviour from 1986 to 2011.MethodsThe ACS is an open, prospective cohort study on HIV. Calendar time trends in HIV incidence were modelled using Poisson regression. Trends in risk behaviour were modelled via generalized estimating equations. In 2010, a screening for STI (chlamydia, gonorrhoea and syphilis) was performed. Determinants of unprotected sex were studied using logistic regression analysis.ResultsThe HIV incidence among 1298 participants of the ACS with a total follow-up of 12,921 person-years (PY) declined from 6.0/100 PY (95% confidence interval [CI] 3.2–11.1) in 1986 to less than 1/100 PY from 1997 onwards. Both injection and sexual risk behaviour declined significantly over time. Out of 197 participants screened for STI in 2010–2011, median age 49 years (IQR 43–59), only 5 (2.5%) were diagnosed with an STI. In multivariable analysis, having a steady partner (aOR 4.1, 95% CI 1.6–10.5) was associated with unprotected sex. HIV-infected participants were less likely to report unprotected sex (aOR 0.07, 95% CI 0.02–0.37).ConclusionsHIV incidence and injection risk behaviour declined from 1986 onwards. STI prevalence is low; unprotected sex is associated with steady partners and is less common among HIV-infected participants. These findings indicate a low transmission risk of HIV and STI, which suggests that DU do not play a significant role in the current spread of HIV in Amsterdam.
Highlights
Drug users (DU) are at risk for HIV through both injection risk behaviour and sexual risk behaviour, with injection risk behaviour being the predominant mode of HIV transmission [1]
Of all the drug users (DU), 1158 (69%) participants reported at baseline that they had ever injected drugs and 59 participants started injecting drugs during follow-up
Prevalence of unprotected sex is substantial, it is associated with having sex with a steady partner and, of interest, such prevalence is less in HIV-infected participants
Summary
Drug users (DU) are at risk for HIV through both injection risk behaviour and sexual risk behaviour, with injection risk behaviour being the predominant mode of HIV transmission [1]. In addition to the separate patterns of transmission, there is a degree of overlap between (injecting) drug use and sexual risk behaviour. Use of stimulants (e.g., cocaine) is associated with an increased risk of unprotected sex [1,8,9]. Another overlap was seen in DU who worked as commercial sex workers (CSW) [10,11]. To examine whether drug users (DU) in the Amsterdam Cohort Study (ACS) are still at risk for HIV, we studied trends in HIV incidence and injecting and sexual risk behaviour from 1986 to 2011
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