HIV incidence among injecting drug users in New York City syringe-exchange programmes

Don C. Des Jarlais, Michael Marmor, Denise Paone, Stephen Titus, Qiuhu Shi, Theresa Perlis, Benny Jose, Samuel R. Friedman

Research output: Contribution to journalArticle

Abstract

Background. There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants. Methods. We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n = 280), in which multiple interviews and saliva samples were collected from participants at exchange sites; the Vaccine Preparedness Initiative cohort (n = 133 continuing exchangers and 188 non-exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n = 1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe exchanges. Findings. HIV incidence among continuing exchange-users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95% CI 0.54, 4.65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1.38 per 100 person-years at risk (0.23, 4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (2.41, 11.49), and in the NADR cities, 6.23 per 100 person-years at risk (4.4, 8.6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3.35 (95% CI 1.29, 8.65) for incident HIV infection compared with using the exchanges. Interpretation. We observed an individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.

Original languageEnglish (US)
Pages (from-to)987-991
Number of pages5
JournalLancet
Volume348
Issue number9033
DOIs
StatePublished - Oct 12 1996

ASJC Scopus subject areas

  • Medicine(all)

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    Des Jarlais, D. C., Marmor, M., Paone, D., Titus, S., Shi, Q., Perlis, T., Jose, B., & Friedman, S. R. (1996). HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet, 348(9033), 987-991. https://doi.org/10.1016/S0140-6736(96)02536-6