Can HIV be eliminated among injecting drug users? among White non-MSM IDUs? New results from New York City

Objective: We examined long-term outcomes of large-scale implementation of syringe exchange in terms of the goal of eliminating HIV infection among IDUs in New York City. Prior to large-scale implementation of syringe exchange in the mid-1990s, HIV prevalence was 57% among Black, 53% among Latino/a, and 27% among White IDUs.

Methods: Subjects were recruited from IDUs entering the Beth Israel drug detoxification program in New York City from 1995 to 2008. This analysis examines HIV prevalence among IDUs who began injecting in 1995 or later, who would have good access to sterile needles and syringes throughout their injecting careers.

Results: Among 1109 subjects who began injecting in 1995 or later, overall HIV prevalence was 6%, and did not increase with years injecting. There was significant variation in by race/ethnicity and gender/MSM behavior: among Blacks: MSM males 40% (95%CI-30.4-60.7), females 16.7% (7.0-31.4) and non-MSM males 8.8% (3.6-17.2). Among Latino/as, MSM males 10% (2.1-26.5), females 8.8% (4.5-15.2) and non-MSM males 4.3% (2.7-6.6); and among Whites, MSM males 10% (0.3-44.5), females 6.8% (2.8-13.5) and non-MSM males 0.5% (0.01-2.5). (All comparisons among racial/ethnic groups and between non-MSM males versus females and MSM males are significant at p>.0001).

Conclusions: If “near elimination” of HIV infection is defined as stable prevalence under 3%, then near elimination has been achieved for White non-MSM IDUs who began injecting after large-scale implementation of syringe exchange in New York. The association of HIV prevalence with vulnerability to sexual acqusition of HIV suggests a need for interventions to reduce sexual transmission.