HIV incidence among injection drug users in New York City, 1990 to 2002: use of serologic test algorithm to assess expansion of HIV prevention services.
OBJECTIVE
We sought to estimate HIV incidence among injection drug users (IDUs) in New York City from 1990 to 2002 to assess the impact of an expansion of syringe exchange services. Syringe exchange increased greatly during this period, from 250,000 to 3,000,000 syringes exchanged annually.


METHODS
Serum samples were obtained from serial cross-sectional surveys of 3,651 IDUs. HIV-positive samples were tested with the Serologic Test Algorithm for Recent HIV Seroconversion (STARHS) assay to identify recent HIV infections and to estimate HIV incidence. Consistency with other incidence studies was used to assess strengths and limitations of STARHS.


RESULTS
HIV incidence declined from 3.55/100 person-years at risk (PYAR) from 1990-1992, to 2.63/100 PYAR from 1993-1995, to 1.05/100 PYAR from 1996-1998, and to 0.77/100 PYAR from 1999-2002 (P<.001). There was a very strong negative linear relationship (r= -.99, P<.005) between the annual numbers of syringes exchanged and estimated HIV incidence. These results were highly consistent with a large number of shorter incidence studies among IDUs conducted during the time period.


CONCLUSIONS
STARHS testing of samples from large serial cross-sectional surveys can provide important data for the assessment of community-level HIV prevention.
Des Jarlais
Don C
DC
Beth Israel Medical Center, 1st Ave and 16th St, New York, NY 10003, USA. dcdesjarla@aol.com
Perlis
Theresa
T
Arasteh
Kamyar
K
Torian
Lucia V
LV
Beatrice
Sara
S
Milliken
Judith
J
Mildvan
Donna
D
Yancovitz
Stanley
S
Friedman
Samuel R
SR
D015492:AIDS Serodiagnosis; D000328:Adult; D000465:Algorithms; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D018671:Needle-Exchange Programs; D009519:New York City / Q000453:epidemiology; D011314:Preventive Health Services; D040242:Risk Reduction Behavior; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology* / Q000821:virology