Metropolitan Social Environments and Pre-HAART/HAART Era Changes in Mortality Rates (per 10,000 Adult Residents) among Injection Drug Users Living with AIDS

Friedman, Samuel R.; West, Brooke S.; Pouget, Enrique R.; Hall, H. Irene; Cantrell, Jennifer; Tempalski, Barbara; Chatterjee, Sudip; Hu, Xiaohong; Cooper, Hannah L. F.; Galea, Sandro; Des Jarlais, Don C.
February 2013
PLoS ONE;Feb2013, Vol. 8 Issue 2, p1
Academic Journal
Background: Among the largest US metropolitan areas, trends in mortality rates for injection drug users (IDUs) with AIDS vary substantially. Ecosocial, risk environment and dialectical theories suggest many metropolitan areas characteristics that might drive this variation. We assess metropolitan area characteristics associated with decline in mortality rates among IDUs living with AIDS (per 10,000 adult MSA residents) after highly active antiretroviral therapy (HAART) was developed. Methods: This is an ecological cohort study of 86 large US metropolitan areas from 1993–2006. The proportional rate of decline in mortality among IDUs diagnosed with AIDS (as a proportion of adult residents) from 1993–1995 to 2004–2006 was the outcome of interest. This rate of decline was modeled as a function of MSA-level variables suggested by ecosocial, risk environment and dialectical theories. In multiple regression analyses, we used 1993–1995 mortality rates to (partially) control for pre-HAART epidemic history and study how other independent variables affected the outcomes. Results: In multivariable models, pre-HAART to HAART era increases in ‘hard drug’ arrest rates and higher pre-HAART income inequality were associated with lower relative declines in mortality rates. Pre-HAART per capita health expenditure and drug abuse treatment rates, and pre- to HAART-era increases in HIV counseling and testing rates, were weakly associated with greater decline in AIDS mortality. Conclusions: Mortality among IDUs living with AIDS might be decreased by reducing metropolitan income inequality, increasing public health expenditures, and perhaps increasing drug abuse treatment and HIV testing services. Given prior evidence that drug-related arrest rates are associated with higher HIV prevalence rates among IDUs and do not seem to decrease IDU population prevalence, changes in laws and policing practices to reduce such arrests while still protecting public order should be considered.


Related Articles

  • HIGH HIV SEROPREVALENCE EPIDEMICS AMONG INJECTING DRUG USERS; NEW YORK CITY AND BANGKOK. Des Jarlais, Don C.; Choopanya, Kachit; Vanichseni, Suphak; Friedmann, Patricia; Raktham, Suwanee; Friedman, Samuel R. // Journal of Drug Issues;Winter97, Vol. 27 Issue 1, p87 

    New York City, U.S.A., and Bangkok, Thailand, experienced two of the most important HIV epidemics among injecting drug users (IDUs) in the world. The epidemic in New York was the first, and by far the largest, HIV epidemic among IDUs. The Bangkok epidemic was notable both for the rapidity of HIV...

  • Paranoid Psychosis as the First Presentation of a Fulminating Lethal Case of AIDS. Thomas, Christopher S.; Szabadi, E. // British Journal of Psychiatry;Nov87, Vol. 151, p693 

    A 34-year-old heterosexual intravenous drug abuser presented with a paranoid psychosis and was subsequently found to have the Acquired Immune Deficiency Syndrome (AIDS). The patient died 14 days later of generalised septicaemia. The case is reported and the aetiology and pathogenesis of the...

  • Economic Recession and Emergence of an HIV-1 Outbreak among Drug Injectors in Athens Metropolitan Area: A Longitudinal Study. Paraskevis, Dimitrios; Nikolopoulos, Georgios; Fotiou, Anastasios; Tsiara, Chrissa; Paraskeva, Dimitra; Sypsa, Vana; Lazanas, Marios; Gargalianos, Panagiotis; Psichogiou, Mina; Skoutelis, Athanasios; Wiessing, Lucas; Friedman, Samuel R.; Jarlais, Don C. d. e. s.; Terzidou, Manina; Kremastinou, Jenny; Malliori, Meni; Hatzakis, Angelos // PLoS ONE;Nov2013, Vol. 8 Issue 11, p1 

    Background: During 2011, a dramatic increase (1600%) of reported HIV-1 infections among injecting drug users (IDUs) was noted in Athens, Greece. We herein assess the potential causal pathways associated with this outbreak. Methods: Our study employed high resolution HIV-1 phylogenetic and...

  • The Changing Face of the HIV Epidemic in Taiwan: A New Challenge for Public Health Policy Strategies. Kow-Tong Chen; Hsiao-Ling Chang; Chu-Tzu Chen; Ying-An Chen // AIDS Patient Care & STDs;Mar2009, Vol. 23 Issue 3, p195 

    The goals of this study were to examine trends, risk factors, and survival rates of people diagnosed with HIV/AIDS. We used national surveillance data reported to the Taiwan Center for Disease Control (Taiwan CDC). The subjects of this study were all confirmed HIV and AIDS cases in Taiwan. From...

  • Reviews of professional periodicals. Stearns, Charles L. // Federal Probation;Dec92, Vol. 56 Issue 4, p74 

    Reviews the article `Intravenous Drugs and the AIDS Epidemic: Findings From a 20 City Sample Arrestees,' by Scott Decker and Richard Rosenfeld in the October 1992 issue of `Crime and Delinquency periodical.'

  • Epidemic of AIDS related virus (HTLV-III/LAV) infection among intravenous drug abusers. Robertson, J.R.; Bucknall, A.B.V.; Welsby, P.D.; Roberts, J.J.K.; Inglis, J.M.; Peutherer, J.F.; Brettle, R.P. // British Medical Journal (Clinical Research Edition);2/22/1986, Vol. 292 Issue 6519, p527 

    Examines the prevalence of AIDS related virus infection among intravenous drug abusers. Correlation of sharing needles and syringes with seropositivity; Necessity of rapid and aggressive intervention to control the spread of infection; Percentage of population infected.

  • HIV, AIDS , AND DRUG ABUSE IN THE INTERNATIONAL SECTOR. Inciardi, James A.; Harrison, Lana D. // Journal of Drug Issues;Winter97, Vol. 27 Issue 1, p1 

    The article discusses the prevalence of HIV and AIDS among intravenous drug users. The spread of HIV/AIDS has been considered as both an epidemic (occurring in a specific geographical area) and a pandemic (an epidemic occurring in many parts of the world at the same time). The same goes with the...

  • Intravenous Drug Abuse and the HIV Epidemic in two Midwestern Cities: A Preliminary Report. Siegal, Harvey A. // Journal of Drug Issues;Spring90, Vol. 20 Issue 2, p281 

    This paper reports on data being collected on Intravenous drug abusers (IVDAs), their sexual partners and the spread of HIV among them in the cities of Dayton and Columbus, Ohio. Findings are reported on some 253 subjects in Dayton and 164 subjects in Columbus. The sample in each city was...

  • Stages in the Response of the Drug Abuse Treatment System to the AIDS Epidemic in New York City. Des Jarlais, Don C. // Journal of Drug Issues;Spring90, Vol. 20 Issue 2, p335 

    The acquired immunodeficiency syndrome (AIDS) has profoundly changed the nature of intravenous drug use and of treatment for intravenous drug abuse. Program staff are finding themselves confronted by the need to provide drug abuse treatment to persons who are likely to die, and challenged by the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics