HIV infection among persons who inject illicit drugs: problems and prospects

Intravenous drug use continues as the second most common risk behavior associated with acquired immune deficiency syndrome (AIDS) in the United States and Europe. Recently there has been increased public and research attention to this problem. Five areas of public health concern for AIDS among i.v. drug users are identified and discussed: (a) the potential spread of human immunodeficiency virus (HIV) to drug users in developing countries; (b) the emergence of cocaine use associated with HIV infection; (c) ethnic differences in seroprevalence rates among i.v. drug users, with ethnic minorities tending to have higher rates; (d) difficulties in changing the sexual behavior of i.v. drug users; and (e) an increased frequency of fatal infections among HIV seropositive drug users that are not counted with the current surveillance definition of AIDS. There have been numerous studies of AIDS risk reduction among i.v. drug users, but the ultimate effect of the behavior change on spread of the virus is not yet clear. Preliminary studies from New York City, San Francisco, and Stockholm indicate a relative stabilization of seroprevalence in those cities, suggesting that the behavior changes reported in those cities may be significantly slowing the rate of viral spread.