As the opioid epidemic rages, the U.S. population of people who inject drugs (PWID) is in considerable need of greater efforts to help mitigate their risk of HIV and hepatitis C virus (HCV). A new Centers for Disease Control and Prevention (CDC) report highlights troubling regional and racial disparities in HIV prevalence and risk in this population and stresses the need for greater action to prevent transmission of both HIV and HCV.
Publishing their findings in the Morbidity and Mortality Weekly Report, CDC researchers analyzed data from the agency’s National HIV Behavioral Surveillance survey. Every three years, the NHBS conducts surveys of PWID in 20 major metropolitan areas to analyze their risk of HIV.
Injection drug use is also a major risk factor for HCV, although hep C is not a primary focus of this particular CDC analysis. Compared with HIV, HCV transmits much more readily through the sharing of syringes and other drug paraphernalia and is much more prevalent among PWID.
PWID participants in the NHBS are tested for HIV as a part of the survey and are asked about various behaviors they engaged in during the previous 12 months.
The 2015 survey included sufficient data for the new analysis on 10,348 PWID. A total of 709 of them (6.9 percent) tested positive for HIV, while the remainder tested HIV negative. Consequently, the CDC researchers estimated that 7 percent of the PWID populations in the 20 urban areas are living with the virus.
Eleven percent of the Black participants were HIV positive, compared with 6 percent of whites. The prevalence of the virus was higher among those living in the South (10 percent) than among those in the Midwest (3 percent) and Northeast (5 percent). Among male PWID who reported sex with at least one other man during the previous year, 24 percent were living with HIV.
Among the 9,639 participants who tested negative for HIV, 27 percent reported using drug syringes previously used by another individual (known as receptive syringe sharing), 67 percent reported having condomless vaginal sex, 22 percent reported having condomless anal intercourse with someone of the opposite sex and 45 percent reported having more than one heterosexual sex partner.
Thirty-nine percent of the white HIV-negative respondents reported receptive syringe sharing, compared with 24 percent of Latinos and 17 percent of Blacks in this group. A respective 61 percent, 45 percent and 41 percent of these three racial groups reported sharing other injection equipment. A respective 74 percent and 25 percent of HIV-negative whites reported condomless vaginal and anal sex, compared with a respective 62 percent and 17 percent of Blacks in this category.
During the previous 12 months, 58 percent of the HIV-negative individuals had been tested for HIV, 26 percent had participated in some form of behavioral intervention meant to mitigate their risk for the virus, 52 percent had received syringes from a syringe exchange program and 34 percent received all their syringes from sources providing sterile drug-use materials.
Eighty-two percent of the respondents had ever been tested for HCV.
During the previous 12 months, 51 percent of the white individuals had been tested for HIV, compared with 65 percent of the Blacks and 62 percent of the Latinos in this group.
Thirty-six percent of the HIV-negative individuals in the South obtained syringes from a syringe exchange program, compared with 61 percent in the Northeast, 50 percent in the Midwest and 66 percent in the West. Twenty-six percent of those in the South obtained all their syringes from a sterile source, compared with 28 percent in the West, 44 percent in the Northeast and 43 percent in the Midwest.
Respondents who had health insurance were more likely to have been tested for HIV during the previous 12 months (61 percent of this group did so), compared with those without health insurance (47 percent). The respective proportions of those with and without health insurance who were tested for HCV during the previous 12 months were 85 percent and 70 percent. And the respective proportions of those with and without health insurance who participated in an HIV-risk-reducing behavioral intervention were 28 percent and 15 percent.
“This analysis highlights the ongoing need for risk reduction and HIV prevention services among persons who inject drugs,” the report’s authors write. “Only half of persons who inject drugs used syringe services programs and only a third obtained their syringes exclusively from sterile sources.
“Access to sterile injection and drug preparation equipment is critical for the prevention of HIV infections among persons who inject drugs,” the report continues. “Although access to syringes through syringe services programs has increased in the United States, the available supply is likely insufficient to meet the demand, and multiple areas continue to lack access to these services.
“The recent opioid use epidemic increases the potential for HIV outbreaks among persons who inject drugs, particularly in areas with limited prevention services for persons who inject drugs. Thus, failure to respond appropriately to this prevention gap could reverse earlier successes in reducing HIV infection among persons who inject drugs.”
To read the CDC report, click here.