HIV Among Drug Users at Beth Israel Medical Center, New York City, the First 25 Years

Abstract

New York City experienced the first and largest HIV epidemic among injecting drug users (IDUs). Using data collected from IDUs entering the Beth Israel drug detoxification program, we trace the history of this epidemic from the mid-1970s through the early 2000s. The epidemic can best be described in terms of successive stages: (1) introduction and rapid transmission of HIV in the IDU population; (2) stabilization of HIV prevalence at a high level (over 50%); (3) a decline in incidence and prevalence, following large-scale implementation of syringe exchange programs; and (4) a sexual transmission phase, in which HIV prevalence is approximately equal among injecting and noninjecting heroin and cocaine users, and sexual transmission is more important than injecting-related transmission among IDUs. Given the current spread of HIV among IDUs in many places in the world, New York City provides a very strong example for implementation of large-scale comprehensive syringe exchange programs as early as possible in HIV epidemics among IDUs.

Keywords :

• injection drug use
• HIV/AIDS
• New York City, HIV epidemic

THE AUTHORS

Don C. Des Jarlais, Ph.D., is Director of Research for The Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center and Professor of Epidemiology and Social Medicine at the Albert Einstein College of Medicine in New York. He is one of the leading authorities on AIDS and intravenous drug use and has published extensively on these related topics.

Kamyar Arasteh, Ph.D., is a principal investigator and biostatistician at the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center. His expertise includes behavioral pharmacology, addiction, and behavioral epidemiology of HIV/AIDS.

Samuel R. Friedman, Ph.D., sociologist, is a Senior Research Fellow at the National Development and Research Institutes, Inc., and the Director of the Interdisciplinary Theoretical Synthesis Core at the Center for Drug Use and HIV Research. Dr. Friedman is an author of over 350 publications on HIV, sexually transmitted infections, and drug use epidemiology and prevention.