High seroprevalence epidemics among IDUs pose two critical inter-related questions for public health: how to halt ongoing HIV transmission among IDUs and how to halt the transition from a concentrated IDU epidemic to a generalized heterosexual epidemic. While there are several interventions that have been shown effective in reducing risk behavior among IDUs, no single intervention is effective for all IDUs. Thus, these inter-related problems provide an ideal context for studying combinations of prevention programs. There are five Specific Aims in the proposed research: 1.Conduct systematic reviews of social structural and behavioral interventions to reduce injecting and sexual risk behavior, and biomedical interventions (drug abuse treatment, STI treatment) to reduce risk behavior among injecting drug users, and interventions to build community and policy support for HIV prevention among IDUs. For interventions with previous systeml interventions to reduce injecting and sexual risk behaviors among IDUs and of combinations of interventions at different levels of coverage, including optimization strategies for reducing HIV transmission among IDUs and from IDUs to non-drug using sexual partners 3. Monitor the ongoing high seroprevalence HIV epidemics among IDUs in Tallinn, Estonia to assess current interventions and model an "optimal" set of interventions for that epidemic. HIV prevalence is currently over 50% among IDUs in Tallinn, estimated incidence is over 20/100 person-years at risk and IDUs report high rates of multiple sexual partnerships with inconsistent condom use. 4. Conduct a pilot study of screening and treatment for sexually transmitted infections (STIs) among IDUs in Tallinn to assess feasibility and effectiveness in reducing sexual transmission among IDUs and from IDUs to non-drug injecting sexual partners. The pilot study will include biomedical intervention (screening and treatment) with a state-o transmission from IDUs to non-drug injecting sexual partners are two critical public health problems in many different countries. These inter-related problems are an ideal context for studying the effects of combined HIV prevention programs. Public health significance: Reducing HIV transmission among IDUs and preventing transmission from IDUs to non-drug injecting sexual partners are two critical public health problems in many different countries. These inter-related problems are an ideal context for studying the effects of combined HIV prevention programs.

Public Health Relevance

significance: Reducing HIV transmission among IDUs and preventing transmission from IDUs to non-drug injecting sexual partners are two critical public health problems in many different countries. These inter-related problems are an ideal context for studying the effects of combined HIV prevention programs.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
5R01AI083035-04
Application #
8279278
Study Section
Special Emphasis Panel (ZAI1-GPJ-A (J1))
Program Officer
Sharma, Usha K
Project Start
2009-06-08
Project End
2014-05-31
Budget Start
2012-06-01
Budget End
2014-05-31
Support Year
4
Fiscal Year
2012
Total Cost
$1
Indirect Cost
Name
Beth Israel Medical Center (New York)
Department
Type
DUNS #
075255364
City
New York
State
NY
Country
United States
Zip Code
10003
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Uuskula, Anneli; Rajaleid, Kristiina; Talu, Ave et al. (2013) A decline in the prevalence of injecting drug users in Estonia, 2005-2009. Int J Drug Policy 24:312-8
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Abdul-Quader, Abu S; Feelemyer, Jonathan; Modi, Shilpa et al. (2013) Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav 17:2878-92
Des Jarlais, Don C; Feelemyer, Jonathan P; Modi, Shilpa N et al. (2013) High coverage needle/syringe programs for people who inject drugs in low and middle income countries: a systematic review. BMC Public Health 13:53
Vorobjov, Sigrid; Des Jarlais, Don C; Abel-Ollo, Katri et al. (2013) Socio-demographic factors, health risks and harms associated with early initiation of injection among people who inject drugs in Tallinn, Estonia: evidence from cross-sectional surveys. Int J Drug Policy 24:150-5
Des Jarlais, Don C; Boltaev, Azizbek; Feelemyer, Jonathan et al. (2013) Gender disparities in HIV infection among persons who inject drugs in Central Asia: a systematic review and meta-analysis. Drug Alcohol Depend 132 Suppl 1:S7-12
Des Jarlais, Don C; Feelemyer, Jonathan P; Modi, Shilpa N et al. (2012) Are females who inject drugs at higher risk for HIV infection than males who inject drugs: An international systematic review of high seroprevalence areas. Drug Alcohol Depend 124:95-107
Jarlais, Don C D; Cooper, Hannah L F; Bramson, Heidi et al. (2012) Racial and ethnic disparities and implications for the prevention of HIV among persons who inject drugs. Curr Opin HIV AIDS 7:354-61
Des Jarlais, Don C; Feelemyer, Jonathan P; Modi, Shilpa N et al. (2012) Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: patterns in the international data. PLoS One 7:e31227

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