National HIV Prevention Conference Atlanta, Georgia, USA — July 27 - 30, 2003

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-B1002
Des Jarlais DC, Perlis T, Torian LV, Arasteh K, Friedman SR
Beth Israel Medical Center, New York, NY Development and Research Institutes, New York, NY; 3 New York City Department of Health and Mental Hygiene, New York, NY

BACKGROUND/OBJECTIVES:: Serologic Test Algorithm for Recent HIV Seroconversion (STARHS, "detuned assay") was used to measure HIV incidence among injecting drug users in New York City from 1990 to 2000. Syringe exchange programs were legalized and expanded in late 1992.

METHODS: Serial cross-sectional surveys were used to obtain serum samples from 4088 IDUs entering Beth Israel Medical Center drug abuse treatment programs (detoxification and methadone maintenance) from 1990 to 2000, and from 1667 IDUs recruited through street outreach from 1990 to 1994. Samples were tested for anti-HIV using replicate EIAs with western blot confirmation. After removal of personal identifiers, HIV+ samples were tested for incident HIV using STARHS.

RESULTS: HIV incidence was 4.8/100 person-years (PY) (95% CI 2.0 to 10.1) in the treatment program sample and 8.9/100 PY (95% CI 5.4 to 15.0) in street sample from 1990-1992, prior to legalization/expansion of syringe exchange programs. Incidence was 2.1/100 PY (95% CI 1.2 to 3.3) from 1993 to 2000 in treatment sample and 3.3/100 PY (95% CI 0.8 to 8.1) from 1993 to 1994 in street sample. Both treatment and street pre-versus post 1992 comparisons were statistically significant (p < .01 by chi-square tests). There was a non-significant decline in incidence among treatment sample from 2.9/100 PY 1993-1995 to 2.1/100 PY in 1996-1998 to 1.8/100 PY in 1999-2000.

CONCLUSIONS: Legalization/expansion of syringe exchange in NYC was associated with substantial reduction in HIV incidence. STARHS testing can provide critical data showing potential effects of community-level HIV prevention programs.

030727
M1-B1002

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