AEGiS-15IAC: Structural factors to guide structural P INTERVENTION: Predictors of IDU population size, HIV prevalence among IDUs, and prevention program coverage for IDUs.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Structural factors to guide structural

INTERVENTION: Predictors of IDU population size, HIV prevalence among IDUs, and prevention program coverage for IDUs.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrC1109)

Friedman SR, Tempalski B, Cooper H, Keem M, Friedman R, Flom PL
National Development and Research Institutes, New York, NY, United States

BACKGROUND: Little research has been done on structural predictors of IDU population prevalence, HIV prevalence among IDUs, or prevention program coverage.

METHODS: Using methods similar to Holmberg's (1996), we estimated IDUs per 10,000 population and HIV prevalence rates in IDUs for 96 large USA metropolitan areas in 1998. Prevention data are from government databases. Results report independent significant (p<.05) predictors in logistic regression.

RESULTS: The number of IDUs per 10,000 population is positively associated with unemployment rate (1990) and per capita arrests (1994-97) for cocaine or heroin possession. HIV prevalence is positively associated with laws against over-the-counter syringe sales (1990), police per capita (1993), Black/White residential segregation (1990), and IDUs per 10,000 population (1993). HIV counseling and testing coverage for IDUs was associated with more IDUs per 10,000 population (1993). The proportion of IDUs who were in drug abuse treatment was positively associated with the proportion of IDUs diagnosed with AIDS (1993) and negatively associated with being in a state with "right to work" laws that restrict labor unions and with police per capita (1993).

CONCLUSIONS: These data on the relationships of earlier predictors to later epidemiologic characteristics and prevention coverage in 96 metropolitan areas have important implications for policy and interventions. (Nonetheless, more extensive longitudinal research is needed to understand underlying causal pathways.) Restrictions on syringe availability are associated with more HIV. Indicators of need for treatment and testing (prior AIDS incidence, population prevalence of IDUs) are related to more programming for IDUs. Socioeconomic ills like racial inequality and unemployment, and restrictions on unions, are associated with less prevention and more IDUs/10,000. Policies emphasizing arrests and police are associated with more IDUs, more HIV, and less treatment.

Keywords: AEGIS, Prevalence, Acquired Immunodeficiency Syndrome, HIV, HIV Seropositivity, HIV Infections, Incidence, Syringes, Population Density, Commerce, Anti-HIV Agents, HIV Antibodies, HIV-1, epidemiology, immunology, methods

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