title: Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals?
abstract: OBJECTIVE
  We focus on a little-researched issue-how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals?
  
  
  METHODS
  Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls.
  
  
  RESULTS
  Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes.
  
  
  CONCLUSIONS
  Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.
authors: Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: friedman@ndri.org.
authors: Samuel R
authors: SR
authors: Friedman
authors: Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY.
authors: Brooke S
authors: BS
authors: West
authors: Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY.
authors: Barbara
authors: B
authors: Tempalski
authors: Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY.
authors: Cory M
authors: CM
authors: Morton
authors: College of Nursing, New York University, New York, NY.
authors: Charles M
authors: CM
authors: Cleland
authors: Beth Israel Medical Center, New York, NY.
authors: Don C
authors: DC
authors: Des Jarlais
authors: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
authors: H Irene
authors: HI
authors: Hall
authors: Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA.
authors: Hannah L F
authors: HL
authors: Cooper
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D015528:HIV Seroprevalence / Q000639:trends*; D020010:Heterosexuality; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D015819:Substance Abuse, Intravenous; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult
keywords: Bridging; Epidemics; HIV/AIDS; Heterosexuals; IDU; MSM; Men who have sex with men; Metropolitan areas; People who inject drugs; Urban health