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October 18, 1995

Maintaining Low HIV Seroprevalence in Populations of Injecting Drug Users

Author Affiliations

From the Chemical Dependency Institute, Beth Israel Medical Center (Dr Des Jarlais and Ms Friedmann), and National Development and Research Institutes Inc (Dr Friedman), New York, NY; Tacoma-Pierce County Health Department (Ms Hagan) and Point Defiance AIDS Prevention Project (Mr Purchase), Tacoma, Wash; Communicable Diseases Unit, Ruchill Hospital, Glasgow, Scotland (Drs Goldberg, Frischer, and Green); Departments of Psychiatry and Neurochemistry (Dr Tunving) and Infectious Diseases (Dr Ljungberg), University of Lund (Sweden); Alcohol and Drug Service, St Vincent's Hospital (Dr Wodak), and National Centre in HIV Social Research (Dr Ross), Sydney, New South Wales, Australia; and Departments of Preventive Medicine and Biostatistics (Dr Millson) and Health Administration (Dr Myers), University of Toronto (Ontario). Ms Hagan is now with the Seattle-King County (Wash) Department of Health. Dr Ross is now with the School of Public Health, University of Texas Health Science Center, Houston.

JAMA. 1995;274(15):1226-1231. doi:10.1001/jama.1995.03530150050033

Objectives.  —To describe prevention activities and risk behavior in cities where human immunodeficiency virus (HIV) was introduced into the local population of injecting drug users (IDUs), but where seroprevalence has nevertheless remained low (<5%) during at least 5 years.

Design and Setting.  —A literature search identified five such cities: Glasgow, Scotland; Lund, Sweden; Sydney, New South Wales, Australia; Tacoma, Wash; and Toronto, Ontario. Case histories were prepared for each city, including data on prevention activities and current levels of risk behavior among IDUs.

Participants.  —Injecting drug users recruited from both drug treatment and non-treatment settings in each city.

Interventions.  —A variety of HIV prevention activities for IDUs had been implemented in each of the five cities.

Results.  —There were three common prevention components present in all five cities: (1) implementation of prevention activities when HIV seroprevalence was still low, (2) provision of sterile injection equipment, and (3) community outreach to IDUs. Moderate levels of risk behavior continued with one third or more of the IDUs reporting recent unsafe injections.

Conclusions.  —In low-seroprevalence areas, it appears possible to severely limit transmission of HIV among populations of IDUs, despite continuing risk behavior among a substantial proportion of the population. Pending further studies, the common prevention components (beginning early, community outreach, and access to sterile injection equipment) should be implemented wherever populations of IDUs are at risk for rapid spread of HIV.(JAMA. 1995;274:1226-1231)