Female and male differences in AIDS diagnosis rates among people who inject drugs in large U.S. metro areas from 1993 to 2007.
OBJECTIVE
We estimated female and male incident AIDS diagnosis rates (IARs) among people who inject drugs (PWID) in U.S. metropolitan statistical areas (MSAs) over time to assess whether declines in IARs varied by sex after combination antiretroviral therapy (cART) dissemination.


METHODS
We compared IARs and 95% confidence intervals for female and male PWID in 95 of the most populous MSAs. To stabilize estimates, we aggregated data across three-year periods, selecting a period immediately preceding cART (1993-1995) and the most recent after the introduction of cART for which data were available (2005-2007). We assessed disparities by comparing IAR 95% confidence intervals for overlap, female-to-male risk ratios, and disparity change scores.


RESULTS
IARs declined an average of 58% for female PWID and 67% for male PWID between the pre-cART and cART periods. Among female PWID, IARs were significantly lower in the later period relative to the pre-cART period in 48% of MSAs. Among male PWID, IARs were significantly lower over time in 86% of MSAs.


CONCLUSIONS
IARs among female PWID in large U.S. MSAs have declined more slowly than among male PWID. This suggests a need for increased targeting of prevention and treatment programs and for research on MSA level conditions that may drive differences in declining AIDS rates among female and male PWID.
Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA. Electronic address: bswest@ucsd.edu.
Brooke S
BS
West
National Development and Research Institutes, Inc., New York, NY.
Enrique R
ER
Pouget
National Development and Research Institutes, Inc., New York, NY.
Barbara
B
Tempalski
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
Hannah L F
HL
Cooper
Centers for Disease Control and Prevention, Atlanta, GA.
H Irene
HI
Hall
Centers for Disease Control and Prevention, Atlanta, GA.
Xiaohong
X
Hu
National Development and Research Institutes, Inc., New York, NY.
Samuel R
SR
Friedman
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000821:virology; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
D019380:Anti-HIV Agents
AIDS; Gender; Health status disparities; Injection drug use