HIV among injection drug users declines

By Dr. Ananya Mandal, MDMar 2 2012

According to latest figures the number of needle drug users testing positive for HIV is on the decline.

U.S. health officials say the rate has dropped by half since the 1990s. The decline may be related to a growth in needle exchange programs. For the report more than 10,000 drug users in 20 metropolitan areas were surveyed and tested for HIV in 2009. About 1 in 10 tested positive for the virus. In the '90s, roughly 1 in 5 did. Addicts who inject heroin, cocaine or other drugs have been one of the groups hit hardest by AIDS.

“Despite the fact that we've seen declines in new HIV infections, a substantial number of IDUs (injection drug users) in major US cities are HIV-infected and their risk behavior remains fairly high,” said Dr. Cyprian Wejnert, an epidemiologist at the CDC. “We found 9 percent of IDUs [injection drug users] were HIV-positive and nearly half of those were unaware of their infection,” Wejnert said in a telephone interview.

The study also found that only about half of infected drug users know they carry the AIDS virus. The Centers for Disease Control and Prevention released the study Thursday. HIV rates have been falling in the United States, but pockets of infection continue to persist, especially in high-risk groups such as young people and men who have sex with men.

From the study about one third of injection drug users in the survey said they shared syringes, most said they had unprotected sex in the past year and more than half said they had more than one sexual partner.

The researchers found that rates of HIV testing in this at-risk population are decreasing. “While CDC recommends that individuals are tested for HIV at least annually, only 49 percent, less than half of those interviewed, reported being tested in the last 12 months,” Wejnert said. This represents a significant drop from a survey done in 2005-2006, he said.

Dr. Amy Lansky, deputy director in the Division of HIV/AIDS Prevention at CDC said the findings will be used as CDC focuses on high risk populations. “It’s a really important part of understanding the leading edge of the epidemic.” She said.

“What the data from this report shows is we really do need to continue our efforts to expand HIV testing and improve testing,” she said, adding that the CDC also needs to focus its prevention efforts on reaching more drug users. Such efforts include offering new sterile syringes, condoms, and substance abuse treatment.

The CDC reports that there are 1.2 million Americans with HIV and 1 in 5 U.S. adults with HIV do not know they are infected.

In another related story the Senate approved a proposal that lawmakers say will provide greater access to HIV tests and bring Massachusetts into compliance with federal recommendations aimed at promoting more testing. The measure reduces barriers to testing for the virus that causes AIDS by eliminating the need for doctors to obtain written consent from patients, and instead requires only verbal consent.

“This will increase testing for HIV because it makes it normal, it will be like getting your cholesterol checked when you get your annual physical,” said Senate President Therese Murray.

Only Massachusetts and Nebraska still require specific written consent for HIV testing, according to the National HIV/AIDS Clinicians’ Consultation Center at the University of California, San Francisco.

State law still requires written informed consent from a patient each time information is released from a patient’s file pertaining to HIV. Physicians say that creates barriers to treatment because if, for instance, a patient is being referred to another specialist, the physician must still obtain written consent from the patient before telling the specialist about any HIV-related medications that patient is taking.

The medical society, which sent a letter to lawmakers Wednesday about its remaining concerns, said the current law hampers the growing use of electronic health records, which allow physicians to share patient files more efficiently and accurately.

The AIDS Action Committee released a statement applauding the Senate’s approval of the bill, saying it will expand HIV testing. “There are an estimated 25,000 to 27,000 people living with HIV/AIDS in Massachusetts, but approximately 21% of them are unaware that they are HIV positive,” the statement said. “We cannot end the AIDS epidemic in Massachusetts if those who are HIV positive are unaware of their status.”

But Fenway Health, which specializes in AIDS care, released a statement from its chief executive, Dr. Stephen Boswell, that said the Senate bill has “significant” problems because it still requires written consent before physicians can share information with each other about patients HIV status. “In urgent situations,” Boswell said, “timely communication among clinicians can mean the difference between life and death.”