title: HIV infection during limited versus combined HIV prevention programs for IDUs in New York City: the importance of transmission behaviors.
abstract: OBJECTIVE
  As no single HIV prevention program has eliminated HIV transmission, there is growing interest in the effectiveness of "combined" prevention programming. To compare HIV infection among persons injecting in the initial programs environment (IPE) in New York City (self-initiated risk reduction, methadone, education/outreach, and HIV testing) to HIV infection among persons injecting in a combined programs environment (CPE) (above programs plus large-scale syringe exchange). To identify potential behavioral mechanisms through which combined programs are effective.
  
  
  METHODS
  Subjects were recruited from the Beth Israel drug detoxification program. A risk behavior questionnaire was administered and HIV testing conducted. Subjects who injected only between 1984 and 1994 (IPE) were compared to subjects who injected only between 1995 and 2008 (CPE).
  
  
  RESULTS
  261 IPE subjects and 1153 CPE subjects were recruited. HIV infection was significantly lower among the CPE subjects compared to IPE subjects: prevalence 6% versus 21%, estimated incidence 0.3/100 person-years versus 4/100 person-years (both p<0.001). The percentage of subjects at risk of acquiring HIV through receptive syringe sharing was similar across CPE and IPE subjects (30% versus 33%). The percentage of subjects at risk of transmitting HIV through injection-related behaviors (who were both HIV seropositive and reported passing on used needles/syringes), was much lower among the CPE subjects than among the IPE subjects (1% versus 10%, p<0.001).
  
  
  CONCLUSIONS
  Combined prevention programs can greatly reduce HIV transmission. Reducing distributive sharing by HIV seropositive injecting drug users (IDUs) may be a critical component in reducing HIV transmission in high seroprevalence settings.
authors.affiliation: Beth Israel Medical Center, 160 Water Street - 24th Floor, New York, NY 10038 USA. dcdesjarla@aol.com
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
authors.forename: Kamyar
authors.initials: K
authors.lastname: Arasteh
authors.forename: Courtney
authors.initials: C
authors.lastname: McKnight
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
authors.forename: David C
authors.initials: DC
authors.lastname: Perlman
authors.forename: Lucia V
authors.initials: LV
authors.lastname: Torian
authors.forename: Sara
authors.initials: S
authors.lastname: Beatice
authors.forename: Salaam
authors.initials: S
authors.lastname: Semaan
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Friedman
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D003625:Data Collection; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D006266:Health Education; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs; D009339:Needles; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D012309:Risk-Taking; D012725:Sexual Behavior; D012931:Social Environment; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult