CDC Releases Two Reports on HIV Prevalence and Behavioral Data Related to HIV Transmission and Prevention Among People Who Inject Drugs
This week, the Centers for Disease Control and Prevention (CDC) published two reports presenting the HIV prevalence and risk behaviors data related to HIV transmission and prevention among people who inject drugs (PWID). The data are from the 2012 cycle of the National HIV Behavioral Surveillance (NHBS) system. In total, 10,117 PWID were interviewed, of those, 10,002 were tested. The report published in the Morbidity and Mortality Weekly Report (MMWR) presents weighted data on HIV prevalence and key behaviors that are intended to generalize the findings to the entire PWID population in the 20 cities that participate in NHBS. The DHAP Surveillance Report provides descriptive, unweighted data and is the first CDC report that presents HIV risk behaviors by three HIV infection categories –HIV-negative, HIV-positive-aware (PWID who are HIV positive and aware of infection), and HIV-positive-unaware (PWID who are HIV positive and are unaware of infection). Presenting data by HIV infection categories is important because risk behaviors are often associated with HIV infection category. For example, HIV-positive-aware individuals may modify their behaviors to prevent transmission to others.
The Morbidity and Mortality Weekly Report states that among people who inject drugs in the 20 NHBS cities, 11% were estimated to be living with HIV; 63% were estimated to be aware of their infection. The percentage of PWID living with HIV was higher among non-Hispanic blacks (16%) compared to non-Hispanic whites (5%). Among the 9,425 PWID included in the behavioral analysis, 30% reported using a syringe that had been used by someone else, with the highest percentage of receptive sharing among 18-39 year olds. Seventy percent of PWID reported having vaginal sex without a condom, 25% reported heterosexual anal sex without a condom and, 5% of males reported male-to-male anal sex without a condom. Among PWID reporting a negative or unknown HIV infection status, 51% reported that they had an HIV test in the past 12 months and 75% had not participated in an HIV behavioral intervention in the previous 12 months. In addition, PWID with health insurance were more likely to have been tested for HIV in the previous 12 months than were PWID without health insurance.
The DHAP Surveillance Report notes that 34% of HIV-negative PWID, 39% of HIV-positive—unaware PWID, and 23% of HIV-positive—aware PWID reported receptively sharing syringes. Both heterosexual HIV-positive—aware males and females who inject drugs reported less sex without a condom than HIV-negative PWID. Among HIV-positive—aware PWID, 93% reported having ever visited a health care provider for HIV care, 61% reported that they did so within 3 months after diagnosis, and 82% reported visiting a health care provider for HIV care in the 6 months before the interview.
The 2012 NHBS data show no significant changes in HIV prevalence and the percentage of PWID who are aware of their infection compared to 2009. Nonetheless, many PWID are still at risk for acquiring HIV due to drug use practices and sexual behaviors. The findings emphasize the importance of and the continued need for targeted HIV prevention strategies for PWID. Comprehensive strategies should include access to sterile injection and drug preparation equipment; treatment for substance use and mental disorders; opioid substitution therapy; counseling, testing, and treatment for HIV infection; education on drug- and sex-related risks and risk-reduction for PWID and their sex partners; and preexposure prophylaxis (PrEP) for adult PWID at substantial risk for HIV acquisition. The findings suggest that an integration of multiple service programs for PWID might increase the effectiveness of HIV prevention efforts.