People who inject drugs in the USA – a slow decline in new HIV infections amid worrying emerging trends
Injecting drug use accounted for 9% of all new HIV infections in the USA in 2014 – but new demographic trends among people who inject drugs present new challenges for the HIV response.
New HIV infections among people who inject drugs in the United States of America (USA) decreased by 48% between 2008 and 2014 according to a new report from the Centers for Disease Control (CDC). In 2014, 9% of all new HIV infections resulted from injecting drug use.
However, around a third (31%) of those who visited a needle and syringe exchange programme (NSP) in the last year reported sharing injecting equipment. And while the number of new infections have decreased, the changing demographics of injectors could present a challenge for ensuring vital HIV and hepatitis B and C prevention interventions are delivered successfully in future.
The USA is currently experiencing an exploding epidemic of opioid addiction, with heroin use growing in particular among white men and women in most age groups and across all income levels – rising by 63% between 2002 and 2013 alone. This trend coincides with an increase in hepatitis C infections and new outbreaks of HIV associated with injecting drug use. In the decade from 2002, deaths from heroin overdose also quadrupled.
According to the CDC, whites now account for over half (54%) of all people who inject drugs in the country – up from 38% in 2005. The proportion of black/African American injectors fell from 38% to 19%, while the proportion of Hispanics/Latinos reporting injecting remained stable.
Across all racial and geographic locations, new HIV infections dropped, although some more so than others. Worryingly, this trend is now slowing.
New HIV infections among Black/African Americans and Hispanic/Latino populations who inject drugs each fell by about 50% from 2008 to 2014, with a slower decline from 2012.
HIV infections among whites who inject drugs in urban areas fell by just 28% in the same time period, with little change from 2012. Whites living in non-urban areas also saw a 28% decrease in new HIV infections, but with no change from 2010.
Eugene McCray, MD - Director, CDC’s Division of HIV/AIDS Prevention said: "It is encouraging to see prevention efforts paying off in African-American and Latino communities […] We must now take concrete steps that build upon and accelerate that progress. HIV risk remains too high for all people who inject drugs."
While HIV prevalence among people who inject drugs was highest among black/African Americans, at 9%, in 2014 for the first time more whites were diagnosed with HIV than any other racial group. Age disparities across racial lines are also apparent, with whites tending to start injecting at younger ages (18-28).
Syringe sharing was most commonly reported among white Americans – with 46% saying they had shared in 2015, compared to just 32% for Hispanics and 28% for black/African Americans. They were also least likely to test for HIV – 57% of whites had tested in the last year, compared to 65% for black/African Americans.
Ensuring access to clean needles and syringes and other harm reduction services, including opioid substitution therapy and broader health and prevention services, is an effective way to reduce incidence of blood-borne infections and other drug-related harms for people who inject drugs.
"Until now, the nation has made substantial progress in preventing HIV among people who inject drugs, but this success is threatened,” said Jonathan Mermin, MD, MPH, Director, CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, “Syringe services programs work, and their expansion is pivotal for progress in the coming decades."