HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs — 23 Metropolitan Statistical Areas, United States, 2018
Authors: Senad Handanagic, Teresa Finlayson, Janet C. Burnett, Dita Broz, Cyprian Wejnert, Meaghan Abrego, Alia Al-Tayyib, Bridget Anderson, Narquis Barak, Jeremy M. Beckford, Amisha Bhattari, Kathleen A. Brady, Meredith Brantley, Sarah Braunstein, Sidney Carrillo, Onika Chambers, Thomas Clyde, Sandra Miranda De León, Jie Deng, Rose Doherty, Anna Flynn, Colin Flynn, David Forrest, Danielle German, Sara Glick, Vivian Griffin, Emily Higgins, Abdel R. Ibrahim, Tom Jaenicke, Antonio D. Jimenez, Salma Khuwaja, Jennifer Kienzle, Monina Klevens, Jessica Lin, Zaida Lopez, Yingbo Ma, Christopher Mathews, Jack Marr, María Pabón Martínez, Willi McFarland, David Melton, Timothy W. Menza, Desmond Miller, Luis Moraga, Willie Nixon, Chrysanthus Nnumolu, Conall O’Cleirigh, Jenevieve Opoku, E. Roberto Orellana, Paige Padgett, Jonathon Poe, Marisa Ramos, Toyah Reid, Alexis Rivera, William T. Robinson, Yadira Rolón-Colón, Corrine Sanger, Hugo Santacruz, Ekow Kwa Sey, Jennifer Shinefeld, Daniel Shodell, Brandie Smith, Emma Spencer, Ashley Tate, New York, Jeff Todd, Afework Wogayehu, Pascale Wortley, Margaret Vaaler
Journal: MMWR Morbidity and Mortality Weekly Report (2021)

In the United States, 10% of HIV infections diagnosed in 2018 were attributed to unsafe injection drug use or male-to-male sexual contact among persons who inject drugs (PWID) (1). In 2017, among PWID or men who have sex with men and who inject drugs (MSM-ID), 76% of those who received a diagnosis of HIV infection lived in urban areas* (2). To monitor the prevalence of HIV infection and associated behaviors among persons who reported injecting drugs in the past 12 months, including MSM-ID, CDC's National HIV Behavioral Surveillance (NHBS) conducts interviews and HIV testing among populations of persons at high risk for HIV infection (MSM, PWID, and heterosexually active adults at increased risk for HIV infection) in selected metropolitan statistical areas (MSAs) (3). The estimated HIV infection prevalence among PWID in 23 MSAs surveyed in 2018 was 7%. Among HIV-negative PWID, an estimated 26% receptively shared syringes and 68% had condomless vaginal sex during the preceding 12 months. During the same period, 57% had been tested for HIV infection, and 55% received syringes from a syringe services program (SSP). While overall SSP use did not significantly change since 2015, a substantial decrease in SSP use occurred among Black PWID, and HIV prevalence among Black PWID was higher than that among Hispanic and White PWID. These findings underscore the importance of continuing and expanding HIV prevention programs and community-based strategies for PWID, such as those provided by SSPs, especially following service disruptions created by the COVID-19 pandemic (4). Efforts are needed to ensure that PWID have low-barrier access to comprehensive and integrated needs-based SSPs (where legally permissible) that include provision of sterile syringes and safe syringe disposal, HIV and hepatitis C virus (HCV) testing and referrals to HIV and HCV treatment, HIV preexposure prophylaxis, and treatment for substance use and mental health disorders.