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Declining seroprevalence in a very large HIV epidemic: injecting drug users in New York City, 1991 to 1996.

D C Des Jarlais, T Perlis, S R Friedman, S Deren, T Chapman, J L Sotheran, S Tortu, M Beardsley, D Paone, L V Torian, S T Beatrice, E DeBernardo, E Monterroso and M Marmor

Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA. dcdesjarla@aol.com

OBJECTIVES: This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City. METHODS: We analyzed temporal trends in HIV seroprevalence from 1991 through 1996 in 5 studies of injecting drug users recruited from a detoxification program, a methadone maintenance program, research storefronts in the Lower East Side and Harlem areas, and a citywide network of sexually transmitted disease clinics. A total of 11,334 serum samples were tested. RESULTS: From 1991 through 1996, HIV seroprevalence declined substantially among subjects in all 5 studies: from 53% to 36% in the detoxification program, from 45% to 29% in the methadone program, from 44% to 22% at the Lower East Side storefront, from 48% to 21% at the Harlem storefront, and from 30% to 21% in the sexually transmitted disease clinics (all P < .002 by chi 2 tests for trend). CONCLUSIONS: The reductions in HIV seroprevalence seen among injecting drug users in New York City from 1991 through 1996 indicate a new phase in this large HIV epidemic. Potential explanatory factors include the loss of HIV-seropositive individuals through disability and death and lower rates of risk behavior leading to low HIV incidence.

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