WASHINGTON—Despite declines in HIV incidence among injection drug users (IDU), the practice of HIV risk behaviors remains high among this population, according to a study published in the April 9 issue of Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The incidence of HIV cases dropped by about 80 percent among IDUs since the late 1980s, but there are still many HIV infections occurring among this group. In 2006, about 6,600 new HIV infections occurred among IDUs, which is about 12 percent of the total new infections in the U.S.

The study, which surveyed 10,301 IDU whose HIV status was negative or unknown, found that during the study period about one third of participants reported sharing syringes and about two thirds reported having had unprotected vaginal sex (62.6 percent) or multiple partners (47.2 percent). “Clearly, while we have seen some declines in the numbers of infections, risk behaviors in this group are still ongoing and therefore prevention efforts are still needed,” according to Amy Lansky, Ph.D., acting deputy director for surveillance, epidemiology and laboratory science in CDC’s Division of HIV/AIDS Prevention, who is a coauthor of the study.

People who have sex with an IDU are at risk for infection through the sexual transmission of HIV. Children born to mothers who contracted HIV through sharing needles or having sex with an IDU may become infected as well.

Testing for HIV

A bright spot in the study was that nearly three-quarters of the IDUs surveyed had been tested for HIV in the past year. “It is very encouraging and its great that that many people are being tested, but it also means that with the level of risk behaviors that we saw in this study that more testing is still needed,” Dr. Lansky said.

Dr. Lansky said providers should follow CDC HIV testing recommendations that call for routine HIV testing in the medical setting. “One thing that is important is to do HIV testing and our recommendations are that people coming in for healthcare should be screened, and particularly groups that have risk behaviors, such as people who inject drugs, should be tested at least annually for HIV,” she said. “It is important to also talk about risk reduction practices, both injection practices like having access and using new sterile needles for injection, but also other sexual behavior changes are important as well.”

The study stated that because IDUs are at high risk for numerous blood-borne and sexually transmitted infections, they are prime candidates for integrated health services “that provide disease prevention counseling and relevant screening (or vaccination) for hepatitis, sexually transmitted diseases, tuberculosis, or HIV, whenever they seek healthcare.”

Dr. Lansky explained that healthcare providers should “think about the whole package of risk” for an IDU patient and their need for screening and vaccination for hepatitis, STDs, tuberculosis and drug treatment referrals when necessary.

The researchers noted that the study findings “underscore the need to continue current public health strategies (e.g., ready IDU access to HIV testing, sterile syringes and condoms) and expand the reach of effective behavioral interventions that focus on the HIV risks of sharing syringes and other injection equipment and engaging in high-risk sexual behavior.”

As part of the study, researchers analyzed data on risk behaviors, HIVtesting and the use of prevention services. Interviews were conducted with IDUs in 23 metropolitan areas. Participants were asked whether, during the preceding 12 months they 1) shared syringes; 2) shared injection equipment; 3) had vaginal sex; 4) had unprotected vaginal sex; 5) had more than one opposite-sex partner; 6) were tested for HIV infection; and 7) participated in an individual or group HIV behavioral intervention. Participants also were asked whether they had ever been tested for hepatitis C infection.

The data was collected through the National HIV Behavioral Surveillance System from May 2005 through February 2006.