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Morbidity and Mortality Weekly Report

HIV Infection and HIV-Associated Behaviors Among Injecting Drug Users — 20 Cities, United States, 2009


Despite a recent reduction in the number of human immunodeficiency virus (HIV) infections attributed to injecting drug use in the United States (1), 9% of new U.S. HIV infections in 2009 occurred among injecting drug users (IDUs) (2). To monitor HIV-associated behaviors and HIV prevalence among IDUs, CDC's National HIV Behavioral Surveillance System (NHBS) conducts interviews and HIV testing in selected metropolitan statistical areas (MSAs). This report summarizes data from 10,073 IDUs interviewed and tested in 20 MSAs in 2009. Of IDUs tested, 9% had a positive HIV test result, and 45% of those testing positive were unaware of their infection. Among the 9,565 IDUs with HIV negative or unknown HIV status before the survey, 69% reported having unprotected vaginal sex, 34% reported sharing syringes, and 23% reported having unprotected heterosexual anal sex during the 12 previous months. Although these risk behavior prevalences appear to warrant increased access to HIV testing and prevention services, for the previous 12-month period, only 49% of the IDUs at risk for acquiring HIV infection reported having been tested for HIV, and 19% reported participating in a behavioral intervention. Increased HIV prevention and testing efforts are needed to further reduce HIV infections among IDUs.

NHBS monitors HIV-associated behaviors and HIV prevalence among populations at high risk for acquiring HIV. In 2009, NHBS staff members in 20 MSAs with high prevalence of acquired immunodeficiency syndrome (AIDS)* collected cross-sectional behavioral risk data and conducted HIV testing among IDUs using respondent-driven sampling, a peer-referral sampling method (3,4). Recruitment chains in each city began with one to 15 initial participants recruited by NHBS staff members during formative assessment and planning. Initial participants who completed the interview were asked to recruit up to five other IDUs through use of a coded coupon system designed to track referrals. Recruitment continued for multiple waves; all participation was voluntary. Persons were eligible to participate if they had injected drugs during the previous 12 months, resided in the MSA, and could complete the interview in English or Spanish. After participants gave oral informed consent, in-person interviews were conducted by trained interviewers who administered a standardized, anonymous questionnaire about HIV-associated behaviors. All respondents were offered anonymous HIV testing, which was performed by collecting blood or oral specimens for either rapid testing in the field or laboratory-based testing. A nonreactive rapid test result was considered HIV negative; a reactive rapid test result was considered HIV positive if confirmed by Western blot or indirect immunofluorescence assay. Incentives were offered for participating in the interview, completing an HIV test, and for recruiting IDUs to participate.

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Information in this article was accurate in March 2, 2012. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.