Abstract
BackgroundPeople who inject drugs (PWID) have increased risk of morbidity and mortality. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992–2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term health trends among PWID populations.MethodologyWe calculated the number of PWID in the US annually from 1992–2007 and apportioned estimates to MSAs using multiplier methods. We used four types of data indicating drug injection to allocate national annual totals to MSAs, creating four distinct series of component estimates of PWID in each MSA and year. The four component estimates are averaged to create the best estimate of PWID for each MSA and year. We estimated PWID prevalence rates for three subpopulations defined by gender, age, and race/ethnicity. We evaluated trends using multi-level polynomial models.ResultsPWID per 10,000 persons aged 15–64 years varied across MSAs from 31 to 345 in 1992 (median 104.4) to 34 to 324 in 2007 (median 91.5). Trend analysis indicates that this rate declined during the early period and then was relatively stable in 2002–2007. Overall prevalence rates for non-Hispanic black PWID increased in 2005 as compared to other racial/ethnic groups. Hispanic prevalence, in contrast, declined across time. Importantly, results show a worrisome trend in young PWID prevalence since HAART was initiated – the mean prevalence was 90 to 100 per 10,000 youth in 1992–1996, but increased to >120 PWID per 10,000 youth in 2006–2007.ConclusionsOverall, PWID rates remained constant since 2002, but increased for two subpopulations: non-Hispanic black PWID and young PWID. Estimates of PWID are important for planning and evaluating public health programs to reduce harm among PWID and for understanding related trends in social and health outcomes.
Highlights
Injection drug use continues to account for a substantial proportion of new Human immunodeficiency virus (HIV) diagnoses in the United States, and is the third most frequently reported risk factor for HIV infection, after male-to-male sexual contact and high-risk heterosexual contact [1,2]
Results show a worrisome trend in young People who inject drugs (PWID) prevalence since Highly Active Antiretroviral Treatment (HAART) was initiated – the mean prevalence was 90 to 100 per 10,000 youth in 1992–1996, but increased to
As expected CTS and Treatment Entry Data System (TEDS) component series correlate more strongly with each other than with AIDS component series, since counseling and testing, and drug treatment represent services that can help to prevent HIV infection or delay progression to AIDS for those who are infected. These was an overall declining correlation between the drug treatment counseling and testing and AIDS-based component estimates, and to some extent, between the counseling and testing and AIDS-based component estimates which may suggest that the performance of the AIDS adjustment formula that relates HIV prevalence to AIDS cases deteriorates over time, or that our estimates are affected by service bias to a greater extent over time
Summary
Injection drug use continues to account for a substantial proportion of new Human immunodeficiency virus (HIV) diagnoses in the United States, and is the third most frequently reported risk factor for HIV infection, after male-to-male sexual contact and high-risk heterosexual contact [1,2]. People who inject drugs (PWID) represented 9% of new HIV infections in 2009 and 17% of those living with HIV in 2008 [2,3]. More than 50% of PWID living with a diagnosis of HIV infection at the end of 2009 were non-Hispanic black, 27% were Hispanic, and 21% were non-Hispanic white [1,2,10]. Non-Hispanic blacks who inject drugs are ten times as likely to be diagnosed with HIV as non-Hispanic white injectors [8,9]. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992–2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term health trends among PWID populations
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