Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City

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Abstract
Objective: To compare HIV prevalence among injecting and non-injecting heroin and cocaine users in New York City. As HIV is efficiently transmitted through the sharing of drug-injecting equipment, HIV infection has historically been higher among injecting drug users. Design: Two separate cross-sectional surveys, both with HIV counseling and testing and drug use and HIV risk behavior questionnaires. Methods: Injecting and non-injecting heroin and cocaine users recruited at detoxification and methadone maintenance treatment from 2001–2004 (n = 2121) and recruited through respondent-driven sampling from a research storefront in 2004 (n = 448). Results: In both studies, HIV prevalence was nearly identical among current injectors (injected in the last 6 months) and heroin and cocaine users who had never injected: 13% [95% confidence interval (CI), 12–15%] among current injectors and 12% (95% CI, 9–16%) among never-injectors in the drug treatment program study, and 15% (95% CI, 11–19%) among current injectors and 17% (95% CI, 12–21%) among never injectors in the respondent driven sampling storefront study. The 95% CIs overlapped in all gender and race/ethnicity subgroup comparisons of HIV prevalence in both studies. Conclusions: The very large HIV epidemic among drug users in New York City appears to be entering a new phase, in which sexual transmission is of increasing importance. Additional prevention programs are needed to address this transition.

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