Risk Factors for AIDS among persons who inject drugs: HIV transmission during and after the pandemic

New York University, New York NY

Investigators

Linked publications & trials

Abstract

It is difficult to underestimate the potential public health significance of the pandemic for generating new outbreaks of HIV among PWID. While public health scale implementation of “combined prevention and care for HIV” among PWID has led to dramatic reductions in HIV transmission in many high-income countries, multiple outbreaks of HIV have also occurred, e.g., in the US, Western and Eastern Europe, and Israel. While there were distinct features of each outbreak, a number of common features were noted across the outbreaks, including: 1) community economic dislocations, 2) inadequate or interrupted HIV prevention services, 3) local introduction of new injectable drugs, and 4) homeless PWID as a very high-risk group. The pandemic and its associated lockdown/control measures appear to be re-creating the very conditions that generated HIV outbreaks among PWID in the pre-pandemic era. Additionally, the pandemic has been associated with a large increase in the use of fentanyl, which increases the potential for HIV risk behavior and the risk of drug overdose. We propose to examine HIV risk behaviors among PWID during and after the pandemic to understand the potential effect of pandemic-related disruptions in NYC, a location that has experienced the world’s largest local HIV epidemic among PWID, through three specific aims: Assess short term (within 3 years) impact of the pandemic on HIV risk among PWID in NYC, including potential increases in critical bio-behavioral risks (composite risk for HIV transmission and composite multi-person risk for HIV acquisition).20,21 Compare trends in fatal and non-fatal overdoses in New York City to identify possible factors related to recent trends in fatal overdoses. Identify organizational and individual behavioral factors, focusing on fentanyl use, that may be associated with low HIV incidence and overdose prevention among PWID in New York City. Multiple methods will be used to achieve these aims, including continuous RDS surveys, with follow-up of PWID of particular interest, and in-depth qualitative interviews. We will contribute data to local, national and international studies of the effects of the pandemic on HIV risk, HIV outbreaks among PWID, and drug overdose.