224637 Patterns in Transitions from IDU-Concentrated to Heterosexual HIV Epidemics

Wednesday, November 10, 2010 : 1:35 PM - 1:50 PM

Jonathan Feelemyer, MS , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Don C. Des Jarlais, PhD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Shilpa Modi, BA , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Kamyar Arasteh, PhD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Louisa Dengenhardt, PhD , National Drug and Alcohol Research Center, University of NSW, Randwick, Australia
Bradley Mathers, MBChB , National Drug and Alcohol Research Center, University of NSW, Randwick, Australia
Holly Hagan, PhD , College of Nursing, New York University, New York, NY
     
Background: High prevalence HIV infections among injection drug users (IDUs) may transition to self-sustaining heterosexual epidemics. Despite evidence of such epidemic transitions, little international comparative research exists on this topic.

Methods: An international systematic review was conducted on transitions from IDU-concentrated to self-sustaining heterosexual epidemics. The 2009 UN Reference Group report identified 14 countries that currently have high prevalence (20% or greater) HIV epidemics among IDUs; four additional countries and one US city that previously experienced high HIV epidemics among IDUs were included. Electronic databases and national health agency reports were used to obtain annual incidence data for IDU and heterosexual HIV/AIDS cases. “Transition to a self-sustaining heterosexual epidemic” was defined as the year heterosexual HIV/AIDS cases surpassed IDU HIV/AIDS cases.

Results: Transitions occurred in Argentina, Brazil, France, Indonesia, Italy, Netherlands, Scotland, Ukraine, New York City, and appear imminent in Estonia and Russia. Two types of transitions occurred: A) rapid, high incidence—with transition occurring within 2 years of IDU peak incidence for most countries, and within 20% of the incidence peak among IDUs (Argentina, Brazil, France, Indonesia, Netherlands, Ukraine) and B) long-term, low incidence—8 to 10 years after peak IDU incidence and at levels 50% or less than peak incidence for IDU cases (Italy, Scotland, New York City).

Conclusions: This study documented transitions from IDU to heterosexual epidemics. The finding of two transition types provides a framework for future research including epidemic modeling. It is concerning that transitions in low/middle income countries occurred at high incidence levels.

Learning Areas:
Epidemiology
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
1.Describe the transitions from IDU concentrated to self sustaining heterosexually driven epidemics in countries with documented high HIV incidence among injection drug users. 2.Differentiate between countries that experienced rapid, high incidence transitions and countries that experienced slow, low incidence transitions. 3.Analyze country dependent factors and their influence on the type of transition that occurred.

Keywords: HIV Risk Behavior, Injection Drug Users

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee programs related to substance abuse prevention, treatment programs, and harm reduction for HIV-infected individuals.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5155.0: HIV/AIDS and sexually transmitted infection epidemiology