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FAINT LIGHT ON THE HORIZON? TRENDS IN HIV PREVALENCE, INCIDENCE AND NEEDLE BORROWING AMONG INJECTION DRUG USERS PARTICIPATING IN THE survUDI STUDY
Michel Alary1,2, Catherine Hankins1,3,4, Raymond Parent1, Lina Noël1 and the SurvUDI Working Group
1: Institut national de santé publique, Québec; 2: Groupe de recherche en épidémiologie, Hôpital du Saint-Sacrement du CHA, Québec; 3: Direction de la santé publique de Montréal-Centre, Montréal; 4: Department of Epidemiology and Stastistics, McGill University, Montréal
Objectives: To study temporal trends in HIV prevalence, incidence and needle practices among IDUs participating in the SurvIDU study between 1995 and 2000.
Methods: In 8 health districts of the Province of Quebec and in Ottawa/Carlton, IDUs who had injected drugs during the previous 6 months provided a saliva sample. They answered a questionnaire in a face-to-face interview and were assigned a unique identifier allowing the detection of multiple visits by a same IDU (repeater). Temporal trends comparing data collected from 1995 to 2000 for first time participants and for repeaters were assessed.
Results: From 1995 to 2000, 9724 questionnaires were administered to 6387 individuals. 123 seroconversions were observed among 1386 initially HIV-negative repeaters. Overall HIV prevalence and incidence were 14.5% (95% CI: 13.6-15.4) and 4.8 per 100 person-years (PY) (95% CI: 3.9-5.6). Overall prevalence and incidence ranged respectively from 20.1% and 7.2/100 PY in Ottawa and 16.7% and 6.0/100 PY in Montreal to 4.7% and 3.8/100 PY in semiurban sites. In the previous 6 months, 38.4% of participants had borrowed needles which had been used by others. Among first-time participants in Montreal, downward trends in needle borrowing (45.1% vs 34.9%; p=0.0001) were accompanied by a decline in HIV prevalence (13.7% to 12.5%; p=0.04). Among repeaters, declines in needle borrowing were seen in Quebec City (43.4% vs 34.8%; p=0.005) accompanied by a decline in incidence (5.1 vs 1.1 per 100 PY, p=0.04).
Conclusion: Positive secular trends in needle practices and HIV prevalence may be occurring in Montreal while encouraging declines in needle borrowing and HIV incidence may be occurring among repeat participants in the SurvUDI study in Quebec City. Further study to understand these tendencies will assist in the design of prevention programmes among IDU.