 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
|
| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Don C. Des Jarlais, PhD1, Theresa Perlis, PhD2, L ucia V. Torian, PhD3, Kaymar Arasteh, PhD2, and Samuel R. Friedman, PhD4. (1) Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 1st Avenue and 16th Street, New York, NY 10003, 212-387-3803, dcdesjarla@aol.com, (2) National Development and Research Institutes, Inc, 71 West 23rd Street, 8th floor, New York, NY 10010, (3) HIV Epidemiology and Surveillance Program, NYC DOHMH, 346 Broadway, Room 706, New York, NY 10013, (4) Center for Drug Use and HIV Research, National Development and Research Institutes, Inc., 71 West 23rd Street, 8th Floor, New York City, NY 10010
Objective: Serologic Test Algorithm for Recent HIV Seroconversion (STARHS, “detuned assay”) was used to measure HIV incidence among injecting drug users in New York City from 1990 to 2000. Syringe exchange programs were legalized and expanded in late 1992.
Methods: Serial cross-sectional surveys were used to obtain serum samples from 4088 IDUs entering Beth Israel Medical Center drug abuse treatment programs (detoxification and methadone maintenance) from 1990 to 2000, and from 1667 IDUs recruited through street outreach from 1990 to 1994. Samples were tested for anti-HIV using replicate EIAs with western blot confirmation. After removal of personal identifiers, HIV+ samples were tested for incident HIV using STARHS.
Results: HIV incidence was 4.8/100 person-years (PY) (95% CI 2.0 to 10.1) in the treatment program sample and 8.9/100 PY (95% CI 5.4 to 15.0) in street sample from 1990-1992, prior to legalization/expansion of syringe exchange programs. Incidence was 2.1/100 PY (95% CI 1.2 to 3.3) from 1993 to 2000 in treatment sample and 3.3/100 PY (95% CI 0.8 to 8.1) from 1993 to 1994 in street sample. Both treatment and street pre-versus post 1992 comparisons were statistically significant (p < .01 by chi-square tests). There was a non-significant decline in incidence among treatment sample from 2.9/100 PY 1993-1995 to 2.1/100 PY in 1996-1998 to 1.8/100 PY in 1999-2000.
Conclusions: Legalization/expansion of syringe exchange in NYC was associated with substantial reduction in HIV incidence. STARHS testing can provide critical data showing potential effects of community-level HIV prevention programs.
Learning Objectives:
Keywords: Injection Drug Users, HIV/AIDS
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.