HIV seropositivity in community-recruited and drug treatment samples of injecting drug users

Abstract
To assess the representativeness of drug use treatment samples for measuring HIV seroprevalence among injecting drug users (IDU) in community settings. Seroprevalence was determined in two cross-sectional, convenience samples including an unlinked survey of IDU entrants to all publicly-funded drug-treatment programs and a survey of community-recruited IDU. Unconditional logistic regression [odds ratio (OR)] was used to calculate unadjusted and adjusted OR to measure the association between HIV seropositivity and site of recruitment. Between 1988 and 1989, 25% of 870 community-recruited IDU were seropositive, compared with 13% of 671 entrants to drug-treatment programs. This twofold risk of HIV seropositivity among community-recruited IDU remained after adjustment for sample differences in gender, race-ethnicity, and age group (adjusted OR, 2.09; 95% confidence interval, 1.58-2.78). These results suggest the importance of extending HIV surveillance outside of drug-treatment facilities. Active serologic surveillance may be feasible by coupling recent saliva and fingerstick sampling techniques with existing community outreach education efforts.