Reports on HIV/AIDS: 1990

APRIL 27, 1990, MMWR, Vol. 39, No. 16, pp. 273-276
Reported by: WW Weddington, MD, R Nemeth-Coslett, PhD, Community Research Br, Div of
Applied Res, National Institute on Drug Abuse, Alcohol, Drug Abuse, and Mental Health
Administration. M Anderson, PhD, R Baxter, MEd, S Baxter, P Biernacki, PhD, BS Brown, PhD,
L DeNeal, PhD, S Deren, PhD, H Feldman, PhD, D Fleming, MD, S Friedman, PhD, S Gates,
P Glider, T Hammett, PhD, D Hunt, L Kotransky, PhD, W McAuliffe, PhD, C McCoy, PhD,
S Margolis, J Mondanaro, MD, H Musikoff, PhD, R Needle, PhD, F Rhodes, PhD, R Robles, PhD,
R Ross, B Rounsaville, MD, R Rucker, PhD, J Schensul, PhD, H Siegal, PhD, M Singer, PhD,
F Snyder, PhD, K South, R Stephens, PhD, S Stevens, PhD, K Vogtsberger, MD, D Watson, MA,
W Wiebel, PhD, M Williams, PhD, R Wood, MD, The National AIDS Research Consortium. Office
of the Director, Center for Prevention Svcs, CDC.
Editorial Note: In 1989, IVDU-associated AIDS cases represented 33% of all reported
AIDS cases (3). Sharing of drug-using paraphernalia among IVDUs is a recognized
mode of transmitting HIV (4-7). Sexual and perinatal transmission also occurs
among this population (8).
Most (about 80%) of IVDUs are not in drug treatment (National Association of State
Alcohol and Drug Abuse Directors, unpublished data). This study describes a
relatively large population at high risk for transmission of HIV. The findings may not
be representative of all IVDUs not in drug treatment in the United States because the
study is limited to volunteer participants in selected cities.
The reduction or elimination of HIV transmission among IVDUs and their sex
partners will require substantial changes in their drug use and sexual behaviors.
Street and community outreach educational programs for IVDUs not in drug treatment can recruit IVDUs for both HIV prevention activities and drug-treatment
programs. In this study, 83% of IVDUs had been incarcerated at some time; thus, HIV
prevention programs for IVDUs who are incarcerated could reach a substantial
proportion of IVDUs who otherwise are not in drug treatment. HIV prevention efforts
targeting IVDUs (including those in drug-treatment centers) should be coordinated at
the community level (9).
To reduce drug use and associated high-risk behavior (e.g., sharing of injection
equipment) drug treatment should be 1) made accessible to those who have never
entered drug treatment (e.g., by increasing public funding); 2) made more accessible
within the criminal justice system (including prisons, jails, and probation and/or
parole systems); and/or 3) used as an alternative to incarceration (10). Additionally,
because HIV seroprevalence can be as high as 14% among non-IVDUs who are sex
partners of IVDUs (CDC, unpublished data), this group should be targeted for
educational and risk-reduction programs.
References
1. CDC. Human immunodeficiency virus infection in the United States: a review of current
knowledge. MMWR 1987;36(no. S-6).
2. Hahn RA, Onorato IM, Jones TS, Dougherty J. Prevalence of HIV infection among intravenouS drug users in the United States. JAMA 1989;261:2677-84.
3. CDC. HIV/AIDS surveillance report. Atlanta: US Department of Health and Human Services,
Public Health Service, January 1990:9.
4. Friedland GH, Harris C, Buktus-Small C, et al. Intravenous drug abusers and the acquired
immunodeficiency syndrome (AIDS): demographics, drug use, and needle sharing patterns.
Arch Intern Med 1985;145:1413-7.
5. Marmor M, des Jarlais DC, Cohen H, et al. Risk factors for infection with human immunodeficiency virus among intravenous drug users in New York City. J AIDS 1987;1:39-44.
6. Chaisson RE, Moss AR, Onishi R, Osmond D, Carlson JR. Human immunodeficiency virus
infection in heterosexual drug users in San Francisco. Am J Public Health 1987;77:169-72.
7. Schoenbaum EE, Hartel D, Selwyn PA, et al. Risk factors for human immunodeficiency virus
infection in intravenous drug users. N EngI J Med 1989;321:874-9.
8. CDC. Update: acquired immunodeficiency syndrome associated with intravenous drug
use-United States, 1988. MMWR 1989;38:165-70.
9. CDC. Coordinated community programs for HIV prevention among intravenous-drug
users-California, Massachusetts. MMWR 1989;38:369-74.
10. Public Health Service. Report of the second Public Health Service AIDS Prevention and
Control Conference. Public Health Rep 1988;103(suppl 1):66-71.

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