Top 5 Takeaways

1. Unchanged HIV Prevalence: The estimated HIV prevalence among persons who inject drugs (PWID) in 23 metropolitan statistical areas (MSAs) remained at 7% in 2018, unchanged from 2015.
2. Racial Disparities: HIV prevalence was higher among Black PWID (12%) compared to Hispanic (7%) and White (5%) PWID, despite Black PWID reporting fewer high-risk behaviors.
3. Decrease in SSP Use Among Black PWID: There was a substantial decrease in the use of syringe service programs (SSPs) among Black PWID from 51% in 2015 to 40% in 2018.
4. High-Risk Behaviors: Among HIV-negative PWID, 26% shared syringes receptively, and 68% had condomless vaginal sex in the preceding 12 months.
5. Need for Comprehensive Services: Low-barrier access to integrated needs-based SSPs, including sterile syringes, HIV and HCV testing, and treatment for substance use and mental health disorders, is crucial for HIV prevention among PWID.

Original Article Author and Citation

Corresponding Author

Senad Handanagic, ndv9@cdc.gov

Suggested Citation

Handanagic S, Finlayson T, Burnett JC, Broz D, Wejnert C. HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs — 23 Metropolitan Statistical Areas, United States, 2018. MMWR Morb Mortal Wkly Rep 2021;70:1459–1465. DOI: http://dx.doi.org/10.15585/mmwr.mm7042a1

Summary

In 2018, the estimated HIV prevalence among persons who inject drugs (PWID) in 23 U.S. metropolitan statistical areas (MSAs) was 7%, unchanged from 2015. Despite fewer high-risk behaviors reported by Black PWID, their HIV prevalence was higher compared to Hispanic and White PWID. A notable decrease in the use of syringe service programs (SSPs) was observed among Black PWID. The study highlights the need for low-barrier access to comprehensive and integrated needs-based SSPs to prevent HIV among PWID.

Methods

In 2018, cross-sectional behavioral survey data and HIV testing were collected from PWID in 23 MSAs using respondent-driven sampling. Participants completed a standardized behavioral questionnaire and were offered anonymous HIV testing. Data were analyzed using RDS Analyst version 0.7, producing estimates adjusted for peer-recruitment patterns and reported network size.

Discussion

The findings indicate that HIV prevalence among PWID remained unchanged at 7% from 2015 to 2018. However, Black PWID had higher HIV prevalence despite reporting fewer high-risk behaviors. The decrease in SSP use among Black PWID is concerning and highlights the need to address disparities in access to prevention services. The COVID-19 pandemic further disrupted prevention services, emphasizing the need for continuous monitoring and improved access to HIV prevention services.

Conclusion

Efforts should focus on ensuring low-barrier access to comprehensive and integrated needs-based SSPs, including sterile syringes, HIV and HCV testing, and treatment for substance use and mental health disorders. Addressing racial disparities in SSP use and HIV prevalence is crucial for effective HIV prevention among PWID.

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