1. 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

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

3. 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

4. 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

5. 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

6. 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

8. 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

9. 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%

10. CURRENT SITUATION
Cohort study estimate of HIV incidence: 0/100 PY (95% CI: 0/ /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

11. 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

12. 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