Tempalski Barbara, Lieb Spencer, Cleland Charles M, Cooper Hannah, Brady Joanne E, Friedman Samuel R
National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY 10010, USA.
J Urban Health. 2009 Jan;86(1):132-54. doi: 10.1007/s11524-008-9328-1. Epub 2008 Nov 18.
This research presents estimates of HIV prevalence rates among injection drug users (IDUs) in large US metropolitan statistical areas (MSAs) during 1992-2002. Trend data on HIV prevalence rates in geographic areas over time are important for research on determinants of changes in HIV among IDUs. Such data also provide a foundation for the design and implementation of structural interventions for preventing the spread of HIV among IDUs. Our estimates of HIV prevalence rates among IDUs in 96 US MSAs during 1992-2002 are derived from four independent sets of data: (1) research-based HIV prevalence rate estimates; (2) Centers for Disease Control and Prevention Voluntary HIV Counseling and Testing data (CDC CTS); (3) data on the number of people living with AIDS compiled by the CDC (PLWAs); and (4) estimates of HIV prevalence in the US. From these, we calculated two independent sets of estimates: (1) calculating CTS-based Method (CBM) using regression adjustments to CDC CTS; and (2) calculating the PLWA-based Method (PBM) by taking the ratio of the number of injectors living with HIV to the numbers of injectors living in the MSA. We take the mean of CBM and PBM to calculate over all HIV prevalence rates for 1992-2002. We evaluated trends in IDU HIV prevalence rates by calculating estimated annual percentage changes (EAPCs) for each MSA. During 1992-2002, HIV prevalence rates declined in 85 (88.5%) of the 96 MSAs, with EAPCs ranging from -12.9% to -2.1% (mean EAPC=-6.5%; p<0.01). Across the 96 MSAs, collectively, the annual mean HIV prevalence rate declined from 11.2% in 1992 to 6.2 in 2002 (EAPC, -6.4%; p<0.01). Similarly, the median HIV prevalence rate declined from 8.1% to 4.4% (EAPC, -6.5%; p<0.01). The maximum HIV prevalence rate across the 11 years declined from 43.5% to 22.8% (EAPC, -6.7%; p<0.01). Declining HIV prevalence rates may reflect high continuing mortality among infected IDUs, as well as primary HIV prevention for non-infected IDUs and self-protection efforts by them. These results warrant further research into the population dynamics of disease progression, access to health services, and the effects of HIV prevention interventions for IDUs.
本研究呈现了1992 - 2002年期间美国大型都市统计区（MSA）注射吸毒者（IDU）中艾滋病毒流行率的估计值。随着时间推移，地理区域内艾滋病毒流行率的趋势数据对于研究注射吸毒者中艾滋病毒变化的决定因素至关重要。此类数据还为设计和实施预防艾滋病毒在注射吸毒者中传播的结构性干预措施提供了基础。我们对1992 - 2002年期间美国96个都市统计区注射吸毒者中艾滋病毒流行率的估计值来自四组独立数据：（1）基于研究的艾滋病毒流行率估计值；（2）疾病控制与预防中心自愿艾滋病毒咨询与检测数据（CDC CTS）；（3）疾病控制与预防中心汇编的艾滋病患者人数数据（PLWA）；以及（4）美国艾滋病毒流行率的估计值。据此，我们计算了两组独立的估计值：（1）使用对疾病控制与预防中心CTS的回归调整来计算基于CTS的方法（CBM）；（2）通过计算感染艾滋病毒的注射吸毒者人数与都市统计区注射吸毒者人数的比率来计算基于PLWA的方法（PBM）。我们取CBM和PBM的平均值来计算1992 - 2002年期间所有的艾滋病毒流行率。我们通过计算每个都市统计区的估计年度百分比变化（EAPC）来评估注射吸毒者艾滋病毒流行率的趋势。在1992 - 2002年期间，96个都市统计区中有85个（88.5%）的艾滋病毒流行率下降，EAPC范围为 - 12.9%至 - 2.1%（平均EAPC = - 6.5%；p < 0.01）。在这96个都市统计区总体上，年度平均艾滋病毒流行率从1992年的11.2%下降至2002年的6.2%（EAPC， - 6.4%；p < 0.01）。同样，艾滋病毒流行率中位数从8.1%下降至4.4%（EAPC， - 6.5%；p < 0.01）。11年期间的最高艾滋病毒流行率从43.5%下降至22.8%（EAPC， - 6.7%；p < 0.01）。艾滋病毒流行率下降可能反映了受感染注射吸毒者持续的高死亡率，以及对未感染注射吸毒者的原发性艾滋病毒预防和他们的自我保护努力。这些结果值得进一步研究疾病进展的人群动态、获得卫生服务的情况以及针对注射吸毒者的艾滋病毒预防干预措施的效果。
