ENDING HIV TRANSMISSION ALONG PEOPLE WHO INJECT DRUGS – THE TALE OF TWO CITIES, NEW YORK CITY (USA) AND HAI PHONG (VIETNAM) Risk Factors Study Team: Don.

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Presentation transcript:

ENDING HIV TRANSMISSION ALONG PEOPLE WHO INJECT DRUGS – THE TALE OF TWO CITIES, NEW YORK CITY (USA) AND HAI PHONG (VIETNAM) Risk Factors Study Team: Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, Jonathan Feelemyer, Aimee N. C. Campbell, Susan Tross, Hannah LF Cooper, Holly Hagan, David C. Perlman NIDA: R01 DA041978 DRIVE Study Team: Don C Des Jarlais, Huong Duong Thi, Oanh Khuat Thi Hai, Khuê Pham Minh, Giang Hoang Thi, Thanh Nham Thi Tuyet, Kamyar Arasteh, Jonathan Feelemyer, Theodore Hammett, Marianne Peries, Laurent Michel, Vinh Vu Hai, Marie Jauffret Roustide, Jean-Pierre Moles, Didier Laureillard, and Nicolas Nagot NIDA: R01 DA003574

“No conflicts of interest to declare” Conflict of Interest “No conflicts of interest to declare”

AREAS THAT EXPERIENCED RAPID TRANSMISSION AND HIGH HIV PREVALENCE AMONG PWID Argentina Brazil China Estonia France Indonesia Italy New York City (USA) Russia Spain Thailand Vancouver, Canada Ukraine Viet Nam

AREAS THAT PREVENTED HIV EPIDEMICS United Kingdom (Scotland, Ireland) Australia CONDITIONS FOR PREVENTED EPIDEMICS PWID informed about HIV risk Very good access to sterile injection equipment “Community viral load” prevalence of untreated HIV infection is 5% or less

AREAS WHERE HIV EPIDEMIC HAS ENDED Amsterdam (Netherlands) Baltimore (USA) France New York City (USA) Taiwan Vancouver (Canada) Using combined prevention and treatment to create the conditions of “prevented epidemics” Needle/syringe exchange Condom distribution Antiretroviral therapy (ART) for HIV positive PWID

RISK FACTORS STUDY: METHODS Patients recruited from treatment programs at Mount Sinai Beth Israel hospital in New York City Only drug users who have injected were included in sample Participation rate was very high (~95%) Risk behavior questionnaire administered to patients along with HIV testing

KEY EVENTS: RISK FACTORS STUDY Dissemination of information about AIDS risk behavior: early 1980s Implementation of needle/syringe exchange programs: mid 1990’s Implementation of “Treatment as Prevention”: early 2000s

CURRENT SITUATION Percentage of PWID population who are HIV seronegative and engaging in receptive sharing: 15% Percentage of PWID population who are HIV seropositive PWID and engaging in distributive sharing and are not on antiretroviral therapy (ART): 0.2%

CURRENT SITUATION Cohort study estimate of HIV incidence: 0/100 PY (95% CI: 0/100 - 0.1/100 PY) Newly diagnosed cases of HIV among PWID estimate of HIV incidence: .04/100 PY Department of Health goal: eliminate injecting- related HIV transmission

CURRENT SITUATION Opioid Epidemic—persons transitioning from opioid analgesic use to heroin/fentanyl injection Need to reduce very high numbers of overdoses Need to avoid resurgence of HIV transmission

CONCLUSIONS Possible to greatly reduce—perhaps eliminate— injecting related HIV transmission Reduce transmission potential HIV seropositives Good community access to sterile syringes, medication-assisted treatment, behavior change by seropositives, ART for treatment as prevention MONITOR POSSIBLE CHANGES IN DRUG USE