What happened to the HIV epidemic among non-injecting drug users in New York City?
HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs.



Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years.



Mount Sinai Beth Israel drug treatment programs in New York City, USA.



We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non-injecting drug practice.



Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ2and multivariable logistic regression were used to compare 2005-10 versus 2011-14.



HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005-10 to 8% in 2011-14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% confidence interval = 0.03/1000-7/1000).



HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Don C
DC
Des Jarlais
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Kamyar
K
Arasteh
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Courtney
C
McKnight
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Jonathan
J
Feelemyer
New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
Aimee N C
AN
Campbell
New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
Susan
S
Tross
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Hannah L F
HL
Cooper
College of Nursing, New York University, New York, NY, USA.
Holly
H
Hagan
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
David C
DC
Perlman
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D019970:Cocaine-Related Disorders / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000706:statistics & numerical data*; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006556:Heroin Dependence / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence
D044966:Anti-Retroviral Agents
Crack-cocaine; HIV; New York City; non-injection drug use; prevalence/incidence; substance use/abuse