Abstract
AimsTo identify geographic “hotspots” for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city.MethodsA total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses.ResultsParticipants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn.DiscussionHeroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.
Highlights
The non-medical use of heroin and cocaine often leads to multiple adverse health consequences
Potential hotspots for injecting-related HIV and hepatitis C virus (HCV) and drug overdose among persons who inject drugs (PWID) A total of 988 PWID were recruited into the study from 2011 to 2018
While these PWID resided in many different ZIP codes, there was evidence of concentration: 61% reported residing in the 32 ZIP codes that had 10+ participants
Summary
The non-medical use of heroin and cocaine often leads to multiple adverse health consequences. In addition to the primary adverse health consequences of substance use disorders, the use of these drugs can lead to blood-borne infections—HIV and hepatitis C virus (HCV)—and drug overdoses and can lead to risky sexual behaviors that can increase transmission of sexually transmitted infections [1]. These adverse consequences are important for public health in that there are many harm reduction interventions that can reduce these consequences even if the underlying substance use disorder is not eliminated [2]. A better understanding of the persistence of drug use problem hotspots in New York City and other cities throughout the world may provide for more sophisticated delivery of harm reduction services
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