The HIV epidemic among injecting drug users (IDUs) in NYC is the oldest and largest in the world. The proposed research will monitor trends and new developments in the three major components of this epidemic: HIV risk behavior, HIV infection, and HIV immunosuppression. Important recent large- scale changes include: increased safer injection associated with syringe exchanges, increasing intranasal use of heroin and cocaine, a trend towards safer sexual behavior, increased immunosuppression, and new initiatives to provide better health care for IDUs. We will also assess possible causal relationships among trends over time, and generalizability of findings to other sites. This research builds on our current New York and World Health Organization multi-site studies.
Specific aims i nclude: (1) monitoring trends in HIV risk behavior, particularly in association with syringe exchanges; (2) assessing the potential impact of increased intranasal drug use on HIV transmission; (3) monitoring HIV seroprevalence and assessing methods to estimate HIV seroconversion from cross-sectional survey data; (4) monitoring trends in HIV-related immunosuppression and in needs for health care services; (5) continuing our role as the U.S. component for the WHO multi-city study of HIV risk, including comparative analyses with other WHO study cities, especially Bangkok. We will conduct serial cross-sectional surveys with 300 injecting drug users and 200 intranasal drug users per year at the Beth Israel detoxification program. This program serves a geographically and demographically diverse clientele (including a subpopulation of newer injectors) with high frequencies of drug use. These characteristics, along with 10 years of historical data, make it an excellent site for studying trends in the HIV IDU epidemic in NYC, especially among high-frequency injectors, a critical group for the epidemic. The surveys will include HIV risk behaviors, HIV status, CD4 cell counts, factors associated with different routes of drug administration, and receipt of health care. We will assess generalizability of findings from the detoxification subjects through """"""""street surveys,"""""""" a parallel study conducted at a research storefront, and several allied studies. The trends we will study among this population of high-frequency injectors are likely to have substantial impacts on the HIV IDU epidemic nationally. Improved methods of estimating seroincidence from seroprevalence data would also contribute greatly to improved allocation of HIV prevention resources, as proposed under CDC guidelines. Within the proposed research, we will also continue our leadership role in the WHO multi-city study, which provides comparative analyses of risk behavior in developed and developing countries, as well as comparison with our findings from New York.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
2R01DA003574-11A1
Application #
2116766
Study Section
Sociobehavioral Subcommittee (DAAR)
Project Start
1994-09-10
Project End
1999-08-31
Budget Start
1994-09-10
Budget End
1995-08-31
Support Year
11
Fiscal Year
1994
Total Cost
Indirect Cost
Name
Beth Israel Medical Center (New York)
Department
Type
DUNS #
075255364
City
New York
State
NY
Country
United States
Zip Code
10003
Des Jarlais, Don C; McKnight, Courtney; Feelemyer, Jonathan et al. (2018) Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001-2005 and 2011-2015. Drug Alcohol Depend 185:391-397
Campbell, Aimee N C; Wolff, Margaret; Weaver, Laurel et al. (2018) ""It's Never Just About the HIV:"" HIV Primary Care Providers' Perception of Substance Use in the Era of ""Universal"" Antiretroviral Medication Treatment. AIDS Behav 22:1006-1017
Des Jarlais, D C; Cooper, H L F; Arasteh, K et al. (2018) Potential geographic ""hotspots"" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US. PLoS One 13:e0194799
Jõgeda, Ene-Ly; Avi, Radko; Pauskar, Merit et al. (2018) Association of IFN?4 rs12979860 polymorphism with the acquisition of HCV and HIV infections among people who inject drugs. J Med Virol 90:1779-1783
Des Jarlais, Don C; Arasteh, K; Feelemyer, J et al. (2018) Hepatitis C virus prevalence and estimated incidence among new injectors during the opioid epidemic in New York City, 2000-2017: Protective effects of non-injecting drug use. Drug Alcohol Depend 192:74-79
Elliott, Jennifer C; Hasin, Deborah S; Des Jarlais, Don C (2017) Perceived health and alcohol use in individuals with HIV and Hepatitis C who use drugs. Addict Behav 72:21-26
Jõgeda, Ene-Ly; Huik, Kristi; Pauskar, Merit et al. (2017) Prevalence and genotypes of GBV-C and its associations with HIV infection among persons who inject drugs in Eastern Europe. J Med Virol 89:632-638
Des Jarlais, Don C (2017) Harm reduction in the USA: the research perspective and an archive to David Purchase. Harm Reduct J 14:51
Des Jarlais, Don C; Arasteh, Kamyar; Feelemyer, Jonathan et al. (2017) Decline in Herpes Simplex Virus Type 2 Among Non-Injecting Heroin and Cocaine Users in New York City, 2005 to 2014: Prospects for Avoiding a Resurgence of Human Immunodeficiency Virus. Sex Transm Dis 44:85-90
Des Jarlais, Don C; Arasteh, Kamyar; McKnight, Courtney et al. (2017) What happened to the HIV epidemic among non-injecting drug users in New York City? Addiction 112:290-298

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