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Risk behavior and HIV seroincidence among out-of-treatment injection drug users: a four-year prospective study
W W Wiebel1, A Jimenez, W Johnson
1Division of Epidemiology-Biostatistics, School of Public Health, University of Illinois at Chicago, USA.
Summary
Street-based outreach reduced HIV infections among injection drug users (IDUs). The intervention targeted IDU social networks, decreasing HIV seroconversion and injection risk behaviors significantly.
Area of Science:
- Public Health
- Epidemiology
- Behavioral Science
Background:
- Injection drug users (IDUs) not in treatment are a key population for HIV prevention.
- Street-based outreach interventions can reach hidden IDU populations.
- Understanding trends in HIV risk behaviors and seroconversion is crucial for effective prevention.
Purpose of the Study:
- To monitor trends in HIV risk behaviors and seroconversion among out-of-treatment IDUs.
- To evaluate the impact of a street-based outreach intervention on HIV prevention among IDUs.
- To identify factors associated with HIV seroconversion in this population.
Main Methods:
- Recruitment of 641 HIV-seronegative IDUs using targeted sampling methods from 1988-1992.
- Follow-up for 4 years to monitor HIV seroconversion and risk behaviors.
- Intervention guided by the Indigenous Leader Outreach Model, utilizing ex-addicts to deliver services within IDU social networks.
Main Results:
- Observed incidence of HIV infection decreased from 8.4 to 2.4 per 100 person-years.
- Prevalence of drug risk behaviors decreased from 100% to 14%.
- HIV seroconversion was strongly associated with injection risk behavior (RR = 9.8) but not sex risk behavior.
Conclusions:
- Out-of-treatment IDUs in Chicago reduced new HIV infections through reduced injection risk behaviors.
- The street-based outreach intervention was effective in decreasing HIV incidence and risk behaviors.
- Targeting IDU social networks with prevention services is a viable strategy for HIV control.